PT and Pain Management Modalities

By David Sisk, DPT

La Plata Physical Therapy, Inc.

. http://www.laplatapt.com/

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PT and Pain Management Modalities

Physical therapy offers a number of avenues of treatment for rehabilitation while restoring function, building strength, promoting soft tissue extensibility, and increasing general conditioning. While progressing with these goals, it is always a consideration of a therapist to consider pain management as part of a patient’s plan of care.

Transcutaneous electrical nerve stimulation (TENS) is an inexpensive nonpharmacological intervention used in the treatment of acute and chronic pain conditions. These electrically powered devices deliver alternating current via cutaneous electrodes positioned near the painful area in the body. At frequencies and intensities used clinically, TENS activates large diameter afferent fibers, which sends input to the central nervous system to activate descending efferent systems to reduce high levels of pain.

Therapeutic Ultrasound is another pain modality applied using the head of an ultrasound probe that is placed in direct contact with your skin via a transmission coupling gel. Thermal ultrasound therapy uses a more continuous transmission of sound waves. The sound waves cause microscopic vibrations in the deep tissue molecules, increasing heat and friction. The warming effect encourages healing in the soft tissues by increasing the metabolism at the level of the tissue cells. Mechanical, or Non-Thermal ultrasound therapy uses pulses of sound waves to penetrate tissues. While this still has a minor warming effect on the tissues, it also causes expansion and contraction in the tiny gas bubbles of the soft tissues. This helps to decrease the inflammatory response, reducing tissue swelling and thus decreasing pain.

Cryotherapy/cold-therapy works for pain by eliciting the body’s “fight or flight” response, which stimulates the production of endorphins, thus decreasing the body’s perception of symptomatic pain. Cryotherapy can be used alone or in conjunction with other pain management techniques such as massage therapy, manual therapy, dry needling, etc., which can enhance the effectiveness and maximizes the benefits of the treatment.