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The 8 Best Physical Therapy Methods Explained
From breaks to bruises to bursitis, physical therapists have a special knack for assessing the human body and helping restore it back to optimal performance. Armed with cutting edge equipment and a huge background of knowledge, PTs can help diagnose and treat many common ailments and movement disorders. But despite having a slew of cool toys (laser therapy anyone?), their most useful tool for treatment may be their hands. Read on for the need-to-know on the most popular treatment options for whatever injury might come along.
Let’s Get Physical — The Assessment
The first step in the treatment process of any good physical therapist is evaluation. Expect therapists to ask detailed questions about how the injury came about, but also do some expert sleuth work (since the injured area may be a result and not the starting point of poor movement). According to Dr. Mike Reinold, a Boston-based PT and therapist for the Red Sox, therapists may be able to reduce the pain quickly, but that will only be temporary unless they address the root cause of the problem.
Although patients may come to see therapists for a variety of causes, low back aches, knee pain, and overuse injuries are among the most common complaints. Following a thorough investigation, therapists will begin to lay out a treatment plan, which will commonly include passive modalities (ice, heat, laser therapy, and electrical stimulation to name a few). But more often than not, manual therapy — a term that includes many methods of restoring tissue function like massage, stretching, and exercise — is the foundation for the assessment and treatment of an injury, Reinold says. Just don’t anticipate hopping (or running, swimming, or lifting) back into activity right away. According to Dr. Eugene Babenko, a physical therapist based in New York City, the average length of care for musculoskeletal (read: bone and muscle injuries) can be anywhere from four to six weeks.
Putting the Pieces Together — The Treatment
Ready to get going on the road to recovery? Before heading to your local PT office blindly, Greatist consulted with Reinold and Babenko to break down the most effective treatment methods for a variety of ailments, big and small. Note: The following section covers general assessments, not meant to take the place of professional medical advice, which will vary on a case-by-case basis.
Best for: Any injury
This hands-on approach separates physical therapists from other health practitioners. Although manual therapy may refer to many things, therapists usually employ common tactics like stretching, massage, and hands-on strengthening exercises to reeducate the body into proper movement and mechanics. “Manual therapy is a prime method to removing movement restrictions and helping patients move better,” according to Dr. Reinold. He also advises that manual therapy should form the backbone of any treatment plan, not modalities like ice and electric stimulation.
Best for: Injuries involving inflammation and swelling
Ice can be a major component of injury treatment. By constricting blood vessels after application, ice is an effective way to reduce and even prevent inflammation immediately following an injury. Cold therapy can also leave the joint more mobile and enhance manual therapy. Although it’s difficult to nail down the most effective protocol, applying cold packs to inflamed areas has been shown to significantly reduce swelling in soft tissue injuries  .
Best for: Injuries involving muscular spasms and tightness
Applying heat has been shown to decrease pain and increase mobility after some injuries — mainly those involving soft tissue like muscles, tendons, and ligaments   . By making the tissue more pliable, the therapist can better stretch the affected area. Note: Heat is just one tool to help the therapist be more effective, Dr. Reinold says, it shouldn’t be the main focus of a treatment plan.
Best for: Connective tissue injuries
By using sound waves (undetectable to the human ear) to generate heat deep in the body, ultrasound therapy can help loosen up tissues in preparation for manual therapy or exercise. How it works: Therapists use a wand (unfortunately not the magic kind!) to apply the sound waves directly — and safely — to the skin. Ultrasound has also been shown to increase ligament-healing speed in our furry counterparts (read: rats), though more studies are needed to show whether the same holds true for us .
Best for: Muscular or connective tissue injuries
Laser therapy uses specific wavelengths of light to stimulate healing (well below the skin so you don’t feel a thing). Best-case scenario: The treatment can help reduce inflammation, muscle fatigue, and pain . It can also allow the therapist to move the affected joint around easier with less discomfort.
Best for: Disc herniation
When we stand, our spine is consistently bearing our weight making recovery from back pain difficult, Dr. Reinold says. Traction involves separating vertebrae to allow more space for nerves and less compression on disc cartilage. Some research shows that traction can be effective for reducing pain and enhancing quality of life in patients with a herniated lumbar disc . And since it doesn’t involve going under the knife, this can be an effective treatment option for those who can’t afford a long recovery.
Functional Electrical Stimulation
Best for: Restoring muscular strength
It’s electric — no really. Electrical stimulation, also referred to as ESTIM, is a common treatment option to restore muscular function following a traumatic injury. By applying a minor but steady electrical stimulus, therapists can cause contractions from muscles that may otherwise remain dormant. This leads to restoring proper movement and function sooner than relying on exercise alone. While ESTIM can’t restore movement in every case, research shows it can speed recovery following ACL and total knee replacement surgery over the course of a few weeks . Additional research confirms the use of ESTIM as an effective treatment option to restore function in hemiplegic patients (those with one side of the body paralyzed) .
Best for: Any injury to stay healthy after treatment
It may sound obvious, but exercise is a go-to strategy to treat and prevent pain. But these aren’t just any old run of the mill exercises — they’re hand-picked to help patients move better by strengthening targeted muscles and addressing any muscular imbalances that may exist, Dr. Babenko says. Also, keep in mind that many injuries can crop up (or recur) from a sedentary and repetitive lifestyle, Dr. Reinold explains. (Think: hunching over the computer or obsessing over that Instagram feed.) By performing any sort regular exercise, those with even the most sedentary day-to-day can avoid common nagging aches and pains.
Ready to get checked out? Many patients can be referred to therapy by their primary care physicians after an initial checkup. Additionally, new state-by-state direct access laws now allow those in pain to head straight to their local therapist (check your state guidelines for specifics).
Disclaimer: Remember that none of this information should substitute professional medical advice. Always check with a doctor or physical therapist first once those aches and pains arise!
Have you tried any of these therapies? Got any others to add? Share them in the comments below, or get in touch with the author on Twitter at @JeremeyD.
- Ice therapy: how good is the evidence? Mac Auley DC. Institute of Postgraduate Medicine and Health Science University of Ulster, Northern Ireland. International Journal of Sports Medicine, 2001 Jul;22(5):379-84.⤴
- The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Bleakley C, McDonough S, MacAuley D. Rehabilitation Science Research Group, University of Ulster at Jordanstown, Antrim, Ireland. American Journal of Sports Medicine, 2004 Jan-Feb;32(1):251-61.⤴
- Superficial heat or cold for low back pain. French SD, Cameron M, Walker BF, et al. Monash Institute of Health Services Research, Australasian Cochrane Centre, Monash Medical Centre, Clayton, VIC, Australia. Cochrane Database of Systematic Review, 2006 Jan 25;(1):CD004750.⤴
- The effect of heat applied with stretch to increase range of motion: a systematic review. Nakano J, Yamabayashi C, Scott A, et al. Unit of Physical Therapy and Occupational Therapy Sciences, Graduate School of Health Sciences, Nagasaki University, Nagasaki City, Nagasaki, Japan. Physical Therapy in Sport, 2012 Aug;13(3):180-8. Epub 2011 Dec 29.⤴
- Cold therapy of athletic injuries. Thorsson, O. Kliniskt fysiologiska laboratoriet, Universitessjukhuset MAS, Malmö. Lakartidningen, 2001 Mar 28;98(13):1512-3.⤴
- Effect of ultrasound therapy on the repair of Achilles tendon injuries in rats. Jackson BA, Schwane JA, Starcher BC. Department of Health and Kinesiology, University of Texas, Tyler, TX. Medicine and Science in Sports and Exercise, 1991 Feb;23(2):171-6.⤴
- Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Chow RT, Johnson MI, Lopes-Martins RA, et al. Nerve Research Foundation, Brain and Mind Research Institute, University of Sydney, Sydney, Australia. Lancet, 2009 Dec 5;374(9705):1897-908. Epub 2009 Nov 13.⤴
- Conventional physical therapy with lumbar traction; clinical evaluation and magnetic resonance imaging for lumbar disc herniation. Kamanli A, Karaca-Acet G, Kaya A, et al. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Firat University, School ofMedicine, Elazig, Turkey. Bratislava Medical Journal, 2010;111(10):541-4.⤴
- Neuromuscular electrical stimulation. An overview and its application in the treatment of sports injuries. Lake DA. Department of Physical Therapy, Northeastern University, Boston, MA. Sports Medicine, 1992 May;13(5):320-36.⤴
- Effects of functional electric stimulation on upper limb motor function and shoulder range of motion in hemiplegic patients. Wang RY, Yang YR, Tsai MW, et al. Faculty of Physical Therapy, National Yang-Ming University, Taipei, Taiwan, Republic of China. American Journal of Physical Medicine and Rehabilitation, 2002 Apr;81(4):283-90.⤴
Comments Leave a comment
@jrudolph17 So glad that you posted this. MobilityWOD is a great site and this article is a perfect example of why.
Thanks for this article. I was looking this morning for icing articles to share with a fellow runner.
As a practitioner of Chinese medicine I've ice to cause more problems than it resolves. Sure, it will numb the area in question. But, it completely locks down the micro-circulation. And that means it will take a lot longer for an injury to heal.
jrudolph17's link to http://www.mobilitywod.com/2012/08/people-weve-got-to-stop-icing-we-were... is very much worth a read.
And to see what a Chinese medicine practitioner thinks visit:
Remember-- Ice is for dead things!
It has been a really long time since I've had a chair massage and I really miss them. I've been wanting to find something nice for my wife and I for this Christmas. My wife recently had our first baby and I bet you anything she'd love this. How much would it be?
What about A.R.T.? I have found active release to be incredibly effective for certain types of muscular mishaps and neck/back/joint issues.