If you have a musculoskeletal injury or movement dysfunction, your doctor may refer you to physical therapy to help decrease pain and improve mobility. Your symptoms may be mild, or you may have symptoms that severely limit your functional mobility.
Many treatment options exist for patients who are referred to physical therapy. Physical agents and modalities are often used to decrease pain and inflammation. Exercises may be prescribed to help improve endurance, strength, or range of motion. Your physical therapist should be prepared to explain to you the reason for each treatment and what to expect from each treatment.
Exercise is a controlled physical stress applied to the body to help improve strength, range of motion, or flexibility. Exercise can be passive or active. Passive exercise is one that requires you to simply relax while another person, like a physical therapist, applies the stress. One example of this is a hamstring stretch where a person lifts your leg to elongate the hamstring muscle on the back of your thigh.
If you attend physical therapy in a clinic, at home, or while in the hospital, you will likely be engaged in some form of exercises to help improve your mobility. Many times you will be instructed in a home exercise program. The home program is a group of exercises that are prescribed by your physical therapist that you perform on your own. The home exercise program can be very important to help you return to normal function.
Ultrasound is a deep heating treatment used to treat many musculoskeletal conditions like sprains, strains, or tendonitis. Ultrasound is administered by your physical therapist using an ultrasound machine. A wand called a sound head is pressed gently against your skin and moved in small circular sweeps near the site of injury. A small amount of gel is used so the ultrasound waves are absorbed into the skin and muscles.
Electrical stimulation and TENS (transcutaneous electrical neuromuscular stimulation) is occasionally used in physical therapy to help decrease pain around injured tissue. There are two theories about how the stimulation works: the gate theory and the opiate theory.
Other forms of electrical stimulation may be used to contract muscles. This is called neuromuscular electrical stimulation (NMES) and is used to help your injured muscles "relearn" how to function properly.
To use lumbar traction, you must be strapped into a mechanical machine. There is a vest that helps support your ribs, and another device that wraps around your pelvis. The vest and pelvic device are stabilized with straps, and a mechanical force is applied with a machine.
Cervical traction is applied in either the sitting or lying position. If sitting, a harness is attached to the head and a pulley system is used with a small weight attached. The weight provides the traction force while you sit comfortably in a chair. In lying, or supine, traction, a specific device is used. You must lie down on your back and strap your forehead into the device. Then, a pneumatic pump is used to help provide the traction force to your neck.
Theoretically, traction helps to separate the joints and disc spaces in the low back or neck, which in turn helps to decrease pressure on spinal nerves.
5. Joint Mobilization
Joint mobilization occurs when your physical therapist passively moves the joints of your body in specific directions. This can help to decrease pain and improve mobility. While we often think of our joints moving as hinges, there is a gliding motion that also occurs between the joints of the body. This gliding motion is increased during joint mobilizations. The degree to which your therapist moves each joint depends upon the amount of pressure and the direction of force applied to the joint.
While joint mobilization is a passive treatment, your physical therapist can teach you self-mobilization techniques so you can manage your problem independently. This can help you return to normal function quickly and offer you a strategy to prevent future problems.
Massage is using the hands to knead the injured tissues of your body to help decrease pain, improve circulation, and decrease muscle tension. There are many massage techniques, including effleurage, pettrisage, and trigger point massage.
Moist heat, or hot packs, may be applied to your body if you have an injury. The heat helps to increase circulation to the injured tissues, relax the muscles, and provide pain relief.
In a physical therapy clinic, hot packs are kept in a device called a hydrocollator. This is a large tank of hot water. The hot packs are cloth packs filled with a sand, clay and silica mixture. The hot pack absorbs the hot water, and then it is wrapped in terry cloth covers and towels before being applied to your body. The hot pack is usually kept on the injured body part for 15 to 20 minutes.
Caution must be used when using hot packs as the skin may suffer burns if insufficient toweling is used during the application of the heat.
If you have an injury, cold packs or ice may be applied to your body to help decrease pain and control inflammation. Ice is usually used during the acute or initial phase of injury to limit localized swelling around tissues.
Cold packs are usually applied for 15 to 20 minutes. Like hot packs, care must be used to prevent skin damage from getting too cold.
Iontophoresis is a form of electrical stimulation that is used to deliver medication across the skin to inflamed or injured tissues. Most often, a steroid like dexamethasone is used in the treatment of inflammation. This steroid can help decrease pain and swelling of tissues that occurs when they are inflamed.
Iontophoresis can be used in the treatment of other conditions as well, depending upon the medication that is used during treatment.
10. Laser or Light Therapy
Light therapy involves using light at a specific wavelength to help improve the healing process of injured tissues. The treatment is painless and usually lasts for approximately one to three minutes. To apply light therapy, your physical therapist will hold the light emitting wand directly over your injured body part and press a button to activate the light.
Light therapy can be used in the treatment of chronic pain, inflammation, or wound healing.
The theory behind light therapy is that photons of light carry energy, and this energy applied to injured tissues can help improve cellular processes and speed healing or decrease pain.
Whirlpools are a form of hydrotherapy and are used to help improve circulation, maintain clean wounds, or control inflammation. Whirlpools can be hot or cold. The usual temperature for a hot whirlpool is between 98 and 110 degrees Fahrenheit. A cold whirlpool bath is typically 50 to 60 degrees Fahrenheit.Whirlpool baths have a motor or agitator that helps move the water around the body part that is being treated. This motion can have a soothing effect, and can also be used in the treatment of wound debridement.
A typical whirlpool session involves placing your body part to be treated into the water and relaxing while the water swirls around it. Gentle exercises can be performed to help improve motion around the body part while it is in the whirlpool. Care must be taken to ensure that the whirlpool bath is not too cold or hot, as temperature extremes can damage your skin during treatment.
Prentice, W. (1998). Therapeutic modalities for allied health professionals. New York: McGraw-Hill.