Therapeutic Treatment Modalities used in Physical Therapy
Physical therapists employ a number of different therapeutic tools to enable recovery for a very broad array of physical injuries, disorders and long term chronic problems, too numerous to outline completely in this section. We do, however, offer a brief description of many [not all] the tools we use at FYZICAL Therapy & Balance Centers to help manage recovery of soft tissue injuries and disorders, increase your functional range of motion, your muscular strength, improve posture and body mechanics and restore balance, walking capabilities and reduce your risk of initial or recurrent injury from sports, work overuse or falling.
Physical therapists are trained in the therapeutic application of various basic physical agents that we call modalities. These agents are thermal [heat and cold], electrical, sound, light and mechanical, each briefly explained below. They are used to reduce pain and joint swelling, reduce muscle spasm, restore functional joint mobility, increase local blood flow to injured tissues and deliver medications subcutaneously in conjunction with other procedures.
MODALITIES often used: Thermal Modalities (Heat & Cold)
Many different musculoskeletal conditions, such as muscles strains and tendonitis, are treated with ultrasound by a physical therapist. Often used to reduce local inflammation, promote tissue healing by increasing blood supply in relatively superficial tissues, no deeper than 5 or 6 centimeters
- High frequency sound waves that produce a form of deep tissue heating
- For relief of pain and muscle spasm
- Promotes circulation
- Relaxes tight muscles/soft tissue – prepares tissues for stretching
- Use of ultrasound to drive in topical medications through the skin
- Medications are usually a form of cortisone and xylocaine
- For treatment of localized inflammations (e.g., heel spurs, tendonitis)
Moist Heat (Hydrocollator)
- Produces a deeper heat than a dry heating pad; still relatively superficial due to local blood cooling effect; penetrates only 1-2 cm.
- Increases local circulation, reduces swelling, relaxes muscles/soft tissue, prepares tissue for other treatments
- A form of heat using paraffin wax and mineral oil
- Usually applied to hands or feet where other applications of heat are difficult
Short Wave Diathermy
- Deep soft tissue heating; 5-10cm tissue depth;
- Increases muscular blood supply and tissue perfusion;
- Increases healing and extensibility of these tissues;
- Also used to prepare for other treatments.
- Use of “ice packs” or “ice massage” in acute injuries and for pain relief (acute or chronic)
- Reduces swelling, inflammation, muscles spasm.
- Spray and stretch technique is used to facilitate stretching of very sensitive muscles in spasm while applying manual therapeutic techniques.
Used in a variety of conditions to reduce pain and inflammation, promote tissue healing, stimulate or promote nerve and or muscle function, ionic transdermal medication transfer, muscular re education, biofeedback and sensory integrative therapy. Electrotherapeutics are well researched, not painful and are a foundation of some PT interventions.
The most commonly used electrotherapeutic techniques are listed below, in some technical detail.
- IFC; Interferential Current; Analgesia, blood flow; joints
- Pre-modulated Current; Analgesia; intramuscular edema; muscles
- HVGS; High Volt Galvanic Stimulation; Analgesia; intraarticular edema; joints
- DC Current; Manual e-stimulation; Facial Nerve Palsy; Denervated Muscle; muscle re-education
- TENS: Transcutaneous Electr. Nerve Stim; Pain mediation; chronic pain syndromes
- MENS; Microcurrent Electr. Nerve Stim; Soft tissue healing; cellular proliferation
- Combination; E-stim/US; US/E-stimulation; trigger points; myofibrocytic nodules
- Iontophoreses; Low Volt DC current; transcutaneous ion transfer; Tendonitis, bursitis; capsulitis; constrictive tenosynovitis
- NMES; NeuroMuscular Electrical Stim;
- FES: Functional Electrical Stim; Muscle re-training or contractile augmentation
- BiPhasic Stimulation; Muscle re-training or contractile augmentation
- Russian Muscle Stimulation; Medium frequency waveforms; Muscle re-education; CVA, TBI, Parkinson’s (10/50/10)
- LVES; Low Voltage Electrical Stim; Muscle relaxation in cases of low grade myospasm
- This type of treatment is used by physical therapists to help accelerate the healing process at an injured site. Light therapy uses light at a specific wavelength, and involves the therapist holding a light emitting wand over the injured area. This treatment is painless, and only takes a few short minutes to administer.
- Infrared & Near Infrared
- Cold Laser Therapy
- Laser Therapy
Sequential extremity compression; for post traumatic acute and chronic effusion &/or edema [soft tissue swelling].
Therapeutic Procedures and Exercises
In addition to the physical agents and treatment modalities used in PT, there are other types of procedures such as therapeutic exercise prescription, neuromuscular re training, visual and electrical biofeedback, manual therapeutic techniques, soft tissue release and biomechanical analysis and correction of various physical impairments and dysfunctions.
These are briefly outlined below:
- Computerized mechanical traction; neural decompression
- progressive/regressive mode; step variable
- Radiculopathy; HNP; Spondylosis; foraminal stenosis
A longitudinal pull or distraction of spinal segments for the relief of nerve irritation (radicultis) or muscle spasm by use of a machine on the cervical (neck) spine with the use of a neck halter or lumbar (low back) spine with the use of a pelvic belt attached to a patient lying down. Traction is particularly helpful for those who suffer from lower back pain and neck pain, especially after a car accident. This type of physical therapy helps to decrease this pain and increase the spine’s mobility by separating the joints and disc spaces in the lower back and/or neck, alleviating pressure on spinal nerves.
Lumbar traction involves the patient being strapped into a traction machine with a vest to support the ribs and a belt that wraps around the patient’s pelvic region. After the vest and belt are secured and stabilized, force is applied with a machine.
Cervical traction involves a harness being attached to the patient’s head, as well as a pulley system and small weight. As the patient sits or lies comfortably, the weight will provide some traction force, and alleviates pressure on the cervical area of the neck.
Physical therapists are highly trained professions, skilled in the use of manually applied forces to relieve pain or correct acquired joint impairments such as restricted motion or mal-positioning anywhere along the muscle-tendon-joint complexes. These manual procedures are used throughout the extremities [arms and legs] as well as throughout the entire spinal column. There are many different types of these manual procedures, with different names and therapeutic purposes, too numerous to mention here..
Therapeutic Massage, Myofascial and Connective Tissue Release Techniques
- This is quite a broad area and common physical therapy techniques that involve the therapist applying pressure to the affected area to help decrease pain, reduce muscle tension and improve circulation.
- A form of specific soft tissue mobilization using the hands for systematic manipulation and release of the muscles and surrounding connective tissue. These techniques may be used to improve local circulation, reduce swelling, relieve muscle spasm and tightness, stretch acquired adhesions and generally help restore lost or impaired mobility. It can also be used during manual lymphatic drainage techniques to reduce chronic swelling.
Canalith Repositioning Procedures [CRP]
Some disorders of the inner ear result from the displacement of very small granular material from where they normally reside [within the vestibule] to other areas [semicircular canals], causing vertigo and imbalance. These symptoms can be very disabling, brought on by certain commonly performed movements such as turning in bed, looking up or turning one’s head. Physical therapists who have specific training, can employ specialized techniques [Canalith Repositioning Procedures; CRP] to return these tiny granules to their correct resting place, resolving this type of positional vertigo. The treatment is quick, painless and highly effective, after only 1-4 visits.
Analysis of the body’s posture to identify areas of imbalance and inordinate stress, possibly contributing to a person’s chronic pain or functional impairment. We use corrective measures to restore proper alignment of the musculoskeletal system to reduce undue stress and strain.
This is the way we sit, stand, bend, lift, push and generally position our body to perform simple or complex physical tasks, during regular activities of daily living [ADL’s] or within the worksite environment. Physical therapists are trained to understand proper movement techniques and identify incorrect techniques, with the goal of correction to a more efficient and productive movement model. We utilize our education skills, teaching corrective and proper technique, sometimes our manual skills to correct certain body impediments to proper mobility and corrective exercise to strengthen and fortify those body areas necessary for long term effectiveness.
Retraining of movement, balance, coordination, posture and position sense. This is a highly specialized form of therapeutic exercise and movement re-training that often involves computerized pre exercise testing to guide and evaluate treatment and the use of visual biofeedback techniques in order to enhance the effects of training.
Analysis of the different stages of walking to determine any deviations and the training to re-educate the body in the proper movement patterns
Exercises and activities to improve the ability to maintain the body in equilibrium both statically (indifferent positions) and dynamically (in different activities).
Therapeutic Exercise Prescription
Exercise is a very common and non-invasive method of treatment used in a physical therapy setting. Exercise can help to improve a patient’s strength, flexibility and range of motion, and can help a patient regain their functional and mobile independence.
The uses, categories and variations of therapeutic exercise are too numerous to be presented in any detail here.
However, very generally, they can be:
- PASSIVE: Manual procedures [different than those previously described above] carried out by the therapist, without active patient participation.
- ACTIVE: Movements performed by the patient, either independently or with some form of manual or mechanical assistance. This is generally used to increase or restore normal joint mobility and to prepare for more vigorous exercise.
- RESISTIVE: Active movements performed by the patient, in order to produce muscle contraction that will ultimately result in increased muscular strength. This form of exercise can be used at various stages of tissue healing, as guided and directed by the physical therapist. There are many types of resistive exercise, each having its own main benefit and precautions; Using your own body weight, external weights, elastic bands or exercise machines, your physical therapist will determine which exercises are appropriate for you and in which way to start and progress or change them.
Exercise is almost always incorporated into a physical therapy program, and usually involves activities that the patient will be instructed to perform at home on their own, in addition to the clinical setting with a therapist.
Since many injuries or disorders that physical therapist treat are sustained due to overuse, incorrect body mechanics or the unique stresses employed in certain sports, occupations or everyday activiites, physicl therapists are trained to teach patients the underlying causes of these disorders. We routinely discuss, educate and train patients accordingly;
- Postural correction and training;
- Alexander Technique; Frederick Matthias Alexander:
- ADL’s [Activities of Daily Living]
- Body mechanics; lifting, bending, reaching
- Occupational Ergonomics
- Bed/body Mobility; Moshe Feldenkrais; somatic movement
- Gait and ambulation training
- Balance recovery and fall prevention
- Low back pain management; Back school