Physical Therapy & Pain Management - Ten Effective Methods

“Each October, the American Physical Therapy Association (APTA) celebrates the profession of Physical Therapy. This year, no doubt influenced by America’s opioid abuse challenges, the role Physical Therapy plays in pain management is being highlighted. Pain is one of the primary reasons patients seek out care from their physicians, and reducing or eliminating pain is typically one of the primary goals of our physical therapy treatment plan. In keeping with this year’s focus, below we’ve listed brief descriptions of several pain modulating strategies used in our department. Ask your doctor if he or she thinks any of these may be helpful in managing your pain.” - Rick Rossman, PT, MS, Associate Director

Physical Therapy & Pain Management — Ten Effective Methods

Over the past decade, our understanding of how and why pain exists has changed. While pain was once thought to originate at the level of the tissues (i.e., if a knee was injured, pain signals originated at the level of the knee), it is now believed that pain is not perceived until the brain concludes there is a potential threat to those tissues. Today's findings suggest that if a knee is injured, danger signals originate at the level of the knee, these signals are relayed to the brain, and the brain determines if it needs to respond by sending an output of pain. This response is individual—what causes one person's brain to respond, may not cause another's to do so. This response is based on many different variables.

Once diagnosed, your physical therapist will work with you to develop a treatment plan to help address any pain associated with your condition. Because the mechanisms of pain vary, each approach to care will also likely vary. It should also be stated there is now evidence that simply understanding pain may result in reduced symptoms.

Below are ten effective ways PVHMC Physical Therapists help manage painful injuries and conditions in our patients.

• Manual Therapy — Beneficial for any injury —This hands-on approach separates physical therapists from many other health practitioners. Manual therapeutic techniques such as soft tissue and joint mobilization, massage, tactile cues and manual strengthening to reeducate the body into proper postures and movement patterns are effective ways to reduce or eliminate tissue restrictions and help patients move better.
• Ice — Beneficial for recent painful injuries, inflammation and swelling —Ice works by constricting blood vessels, thus minimizing bleeding, swelling and inflammation. Professional and collegiate athletes the same Game Ready units available to our patients. These combine circulating ice water with intermittent vasopneumatic compression.
• Heat — Helpful for lingering injuries causing muscle spasms or joint and soft tissue stiffness —Heat results in vasodilation, which can decrease spasm and increase mobility in soft tissues such as muscles, tendons, and ligaments. Softer, relaxed, and more pliable tissues respond better to stretching. Heating methods include whirlpool, hydrocollator packs, Fluidotherapy or hot paraffin wax (both used primarily for hands).
• Ultrasound — Most often used for connective tissue injuries —Ultrasound uses sound waves (at a million cycles per second … you can’t hear it!) to generate heat at varying tissue depths. This modulates the body’s natural healing response and prepares tissues for stretching and exercise.
• Iontophoresis — Effective for painful, superficial inflammation —Iontophoresis delivers medication, such as anti-inflammatory steroids, through the skin to an inflamed tissue. The medication is applied to a patch and pushed through the skin over several hours by current from a small battery in the patch.
• Spinal Traction — Can help with nerve entrapment —Injury, or arthritic changes, can crowd or pinch nerve and other tissue in our spine. Traction is a form of decompression therapy that reduces spinal pressure. It can be performed manually or mechanically. Since it is non-invasive, it is often an effective option to more invasive treatments.
• Electrical Stimulation — Very effective for relieving pain, relaxing spasm, restoring muscular strength —Electrical stimulation is a common treatment option used for multiple purposes. Depending on current parameters such as frequency, duration and waveform, this modality can relax or contract a muscle or alter the pain response from an injured or irritated tissue. Neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC/H-wave) are common types of electrical stimulation.
• Aquatic Therapy — Best for arthritic conditions, those with chronic pain or poor balance —When land-based exercise is too much, aquatic therapy (or “water exercise”) may be a better choice. This form of exercise, in a warm water environment, combines beneficial movements with the support and safety of the water. The buoyancy of the water reduces the forces on joints and muscles by more than 50 percent, while reducing the fear of falling. With the guidance of an aquatic physical therapist, movements can once again be both helpful and fun!
• Postural & Positioning Education — Effective for any injury or painful condition —Postural awareness and proper positioning is critical in controlling even minor forces that can cause or exacerbate a patient’s symptoms. The goal is to minimize stress across irritated tissues during both routine daily activities or sports and recreational movements.
• Exercise — Best for virtually any injury or illness —Although it may not be obvious, exercise, even simple movements, is now recognized as “the go-to” strategy to treat pain and prevent its reoccurrence. But not just any exercise … these are targeted stretching and/or strengthening movements. Many injuries result from, or are aggravated by, a less active lifestyle. Recently you may have heard the expression … “Sitting is the new Smoking” … which dramatically reflects how bad sedentary positions are for our well being. Indeed, “Movement is the best medicine!”