Yup, in 21st century, some people still think that physical therapists are just some bunch of dignified masseur and masseuse. As primitive as that may sound, it’s still a fact, though to a lesser degree now than before.
So what sort of treatment would you expect when you go for physical therapy? First of all, it really depends on the condition. The physio will start off with interview and assessment to get all the details pertaining to your chief complaints. From there, the physical therapist will do one or more of these:
These are various interventions done with delicate and skilled maneuvers with the therapist’s hands. This is why the uniformed layman thinks we are just giving some form of massages. Ouch! But these hand works actually take years of learning and practice with scientific evidences to back them up. These techniques include joint mobilization or manipulation, myofascial releases, neurodynamic techniques, stretching and muscle energy techniques, and the list goes on depending on the physiotherapist’s training and expertise.
These are exercises designed to specific conditions. There are exercises for low back pain, and neck pains, and shoulder problems and scoliosis. There are exercises for Parkinson’s disease, stroke, and cerebral palsy. There are exercises to relive pain, correct posture, improve muscle control, increase strength and endurance, improve balance and stability, etc… you get the idea.
A physical therapist may choose to use some heating agents prior to doing manual techniques and giving exercises. Thermal modalities can provide temporary pain relief, increase local and systemic circulation which can be helpful in sub-acute and chronic stages of injury or inflammation, and increase tissue extensibility which is ideal prior to stretching. The most common heating agents today are hot packs and ultrasound. Hot packs can cover a larger area of the body and the feeling of warmth can give some relaxing effect. However, the effect is only superficial. Therapeutic ultrasound is thought to have a deeper effect and only applied for a few minutes. Again, these are adjunct treatment and at times may not be necessary.
As fancy as it may sound, it’s actually just the application of cold for therapeutic purposes. Icing is most commonly used in acute musculoskeletal injuries for the purpose of relieving pain and reducing swelling and inflammation. Some argue that since inflammation is the initial stage of the healing process of an injured tissue, icing can only disrupt and delay healing process. Again, depends on the therapist’s clinical decisioning. Where swelling and inflammation are severe, icing maybe one of the first line of treatments in acute injuries along with compression and rest with some controlled movement.
Neuromuscular Electrical Stimulation [NMES].
Use of low frequency currents to facilitate muscle contractions. NMES is basically used in patients with paralysis as a result of injury to the nervous system circuit. Muscles need to contract to maintain its integrity and facilitates circulation. A paralyzed muscle losses its ability to contract voluntarily and NMES is used to electrically induce muscle contractions. In the past, high frequency currents like TENS and Interferrential current is used to relieve musculoskeletal pain. With increasing manual therapy techniques which afford lasting pain relief, these modalities are now rarely used. Although some clinicians still rely on these modalities, be sure to consult therapists who actually do hands-on treatments. Passive modalities like TENS and heating agents are not effective for long-term pain relief. And remember that the site of pain is not always the source of dysfunction.
Not so many physical therapy clinics are equipped with a pool for aquatic therapy. But specialty clinics, especially those working among geriatrics and neurologic patients may have one. Water supports body weight, provides some resistance to range of motion, and eliminates the effect of gravity making exercising more tolerable.
So these are just some of the many physiotherapy treatments available to you. Again, the use of any of this will depend on your chief complaint, overall condition and further findings from your assessment. Except for manual therapy and therapeutic exercises which can, and should be, used in almost any, if not, all conditions. I would recommend that you ask the therapist if they do manual techniques in their treatment. Remember that modalities like hot packs, ultrasound, and electrical stimulators are only adjunct treatments and oftentimes not really necessary.
In recent years, many more new treatments are used in combination to the aforementioned treatments.
Examples of these are the following.
This the use of acupuncture needles to treat trigger points and muscle spasms and therefore relieves musculoskeletal pain. The therapist uses needles that pierce the skin to deactivate trigger points and the like in order to normalize the function of a certain muscle or joint and also to reduce the pain felt by the patient. Dry needling, in effect, releases the pain in the muscle and reduces the swelling and tension in that certain muscle area.
Muscle [Kinesio] Taping
While muscle taping is not new, what many therapists use now are the stretchable colored tapes you most likely see on athletes. It’s known by the name Kineseo Taping, to distinguish it from other kinds of muscle taping. These are durable tapes that can stay on the skin even for 2-3 days… or more. It is used for many muscle and joint problems to help relieve pain, improve joint stability, inhibit or facilitate a muscle or muscle groups, drain swelling, correct posture, and some believe it can improve sporting performance.
These are just few of the common treatments used by physical therapist. Again, treatment depends on the physiotherapist’s assessment on your condition, as well as the physio’s training and expertise. While two different physician will give same prescription for low back pain, two PTs may give different treatments for same condition.
Suffering from injury or simply want to be more active? Consult a physical therapist now…
UPDATE to this blog: More than a year since I wrote this blog, my approach to physical therapy treatment have changed. I didn’t take a course in dry needling and I am happy for it. It is invasive, some clients swear that it’s painful, while I have found a much simpler way to tone down tensed muscle. It’s just a matter of understanding pain neuroscience and applying it to your treatment strategies.
Also, use of electrophysical agents have been proven to have of no significant therapeutic effects. I prescribe it to clients as home treatment but 10-120 minutes of that in the clinic is a waste of time. Much can be accomplished with manual and movement therapies that produce more significant and long lasting improvement.