|Physical therapy has a long history of use in medical practice particularly in pain.
Primitive man, when injured, may have instinctively rubbed (massaged) his injured part
and he may have looked to the suns warmth for pain relief. Perhaps, he rubbed the painful
area with snow or applied a hot stone to relieve his pain. The ancient Egyptian and Greek
physicians, employed electric fish for the treatment of various diseases and pain. Hydrotherapy,
exercise, heat, cold and massage were advocated by both Greek and Roman physicians. In more
recent time many physicians have added to our understanding of many pain mechanisms and given
us greater understanding of the use of physical modalities for treatment.
Physical modalities, if appropriately used, can be effective in reducing acute or sub-acute pain and
can be very beneficial for chronic pain. The use of physical therapy does not ensure the elimination
of pain. This is due to the fact that the perception of pain is different from patient to patient. While
total relief of pain may be ideal, it is very difficult and not always attainable, particularly in chronic
pain. However, even if there is residual pain, it is very frequently less intense and is at a bearable level
and may allow the patient to engage in his or her daily activities and/or function better in work activities.
A list of specific physical therapies includes:
- down through history heat and cold have been used for the relief of pain.
The sedative, antispasmodic, analgesic, and decongestive effects of heat are well known.
Superficial heat includes hot packs, paraffin baths, and heat lamps. Hydrotherapy, (warm
or hot whirlpool bathes). Deep heat includes ultrasound, short wave diathermy, and microwave.
- there is no agreement on the effectiveness of cold over heat in the control of pain,
however, application of cold to local areas produce some
therapeutic effects, including reduction of temperature, reduction of neuromuscular transmission, analgesia, and an anti-inflammatory effect.
Cold packs, (many sizes and shapes are available commercially), are composed of a pliable gel in a thin
plastic pouch, that can be stored in the freezer until ready to use. They may retain their cold for up to 30 minutes after applied. Vapocoolant sprays are available, containing either fluorimethane or ethyl chloride
and are useful to relieve pain of muscle spasm and trigger points. They must be used very carefully to prevent
tissue damage. Ice water is a good and inexpensive method of cold therapy, where the extremity or part to be
treated is immersed in ice water. The ice stick or block method involves moving an ice stick or block, back and
forth in a massaging manner, over the painful area.
- has been used since ancient times for the treatment of pain. Both direct (galvanic) current and
alternating current have been and are being used in the treatment of various pain syndromes. Transcutaneous
electrical nerve stimulation (TENS) is being used with varying degrees of success for pain relief. There is the
possibility of abuse both by the physician and the patient and its usefulness has been question in some studies.
Ionophoresis is a procedure, in which, molecules or atoms (ions) are force into the tissue using an electrical field.
- massage has been used since early times, and still plays an important role in pain management.
The physiologic effect of massage is to increase or regulate muscle tone. The therapist's hands, stimulates the transmission of impulses to the higher centers in the brain, producing, sensations of pleasure and well being. The mechanical effects include, increasing the circulation of blood and lymph, and produce muscular motion, stretching of adhesions and reducing the accumulation of fluid. Common techniques of massage are stroking,
kneading, rubbing and percussing. Indication for massage include reducing swelling, relieving pain, and mobilization
of contracted tissue. There are some contraindications for its use such as; infection at the site,
thrombophlebitis, burns, malignancies, and skin disease.
exercise - is a cornerstone on the treatment of sub-acute and chronic pain. Body
movement improves musculoskeletal function and helps to maintain a state of well-being. An exercise program that helps to increase
range of motion, increase elasticity of soft tissue, decrease spasm and tension, is usually followed by exercises that
increase strength and endurance. Some of the various types of exercises include isometric, isotonic, aerobic and
aquatic. Traction and passive manipulation are other modalities used. There are physical exercises that are used
for various part of the body, such as shoulder, neck and low back. Lists of the various modalities are listed in many
therapy - is used to help return the patient to work activity. When physical or occupational therapy are
ordered by the physician, it should be remembered that the therapist is a trained professional, and should be treated
as a member of the treatment team. The therapist will see the patient more often than the physician and therefore
may give insightful information regarding some physical and psychological problems. The order for therapy should include: evaluate and treat; specific requests by the physician; a working diagnosis; frequency of treatment; length of
time treatment is to be continued; possible contraindication to treatment and precautions.
- Hands on
therapy - depends on the skill of the therapist regarding dysfunction of muscles and joints.
- Programs to restore
function - are some where between, physical therapy and the fitness center type
programs. This may consist of physical conditioning with a group of patients. Patients attend such
a program two or three times a week, with sessions lasting up to two hours, during which time exercise
consists of stretching, strengthening and aerobatics. It may also include education and back to work
programs - usually begins as the physical therapy program is ending and the patient
continues to exercise in the gym independently. The gym can be and appropriately is a
part of the physical therapy department or may be private. Some supervision may be
provided, however, the individuals are usually on their own. It is important that they follow instructions from the therapist in order to prevent further injury.
rehabilitation - is used for those chronic pain patients who wish to return
to work and it should be an integral part of the pain management program. The effort
is to help these patients learn or relearn skills necessary for return to gainful employment.
Robert V. Plehn, M.D., DABA, FACA
Medical Director, DoctorsForPain.com
website design, text, graphics, the selection and arrangement
thereof are the copyrighted works of Doctorsforpain.com, © 2011.
All Rights Reserved.