Traditional Physiotherapy Interventions for Pain Conditions

Welcome to PPA Pain Project. This page is being developed by participants of a project to populate the Pain section of Physiopedia.  The project is supervised and co-ordinated by the The Physiotherapy Pain Association.

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Tips for writing this page:

• What is the current evidence base for the use of the following traditional therapy modalities with patients in pain? :electrotherapy/acupuncture/manipulation/massage/relaxation
• What are the proported theraputic effects?
• Should they, and how can they,  be integrated with pharmacological, sociological and psychological interventions and approaches to managing pain experiences and re-integartion with function?
  
  

Original Editor - Kudzanayi Ronald Muzenda and Jo Etherton

Top Contributors - Kudzanayi Ronald Muzenda, Joanne Garvey, Kim Jackson, Evan Thomas, Jo Etherton, WikiSysop, Simisola Ajeyalemi, Lauren Lopez, Rachael Lowe, Lucinda hampton, Jess Bell and Yigit Unalan

Traditional Physiotherapy Modalities

Electrotherapy

The term electrotherapy and electrophyical agents have been used interchangeably to describe the modalities used in physiotherapy. Some suggest that the term electrotherapy implies modalities that use electric current only in treatment.

The following table categorizes various modalities into three groups, i.e. electrical stimulation agents, thermal agents, and non-thermal agents

Electrical stimulation agents and thermal agents are the most used in physiotherapy pain management. However, non-thermal agents, such as pulsed ultrasound, have been reported as having an analgesic effect.

Eectrical Stimulation

The exact mechanism of electrical stimulation’s beneficial effect remains controversial. Electrical stimulation is said directly block pain signals from reaching the brain so that the patient never experiences them. In addition, electrical stimulation has been shown to promote the release of endorphins which are natural painkillers produced by the body.Pain reduction occurs because the applied electrical fields act to close the body's "pain gate mechanism"TENS ( Transcutaneous Electrical Nerve Stimulation) is the widely used electical modality for chronic pain.

Thermal Agents

When applied in successive fashion, heat and cold are believed to exert a physiological effect on your body's pain gate mechanism, which temporarily alters pain signals traveling to and from your brain. This temporary reduction in pain is a welcome relief for those suffering long-standing complaints of the nervous and musculoskeletal systems.

Non-thermal agents are believed to work by...

Cur

.

Manual Therapy

Manual therapy is frequently used by physiotherapists, to assist with the treatment of pain. The following video is a useful literature review, based on the Cochrane report by Anita Gross in 2015.

Mobilization

Manual therapy can be broadly defined as

"...the use of hands in a curative and healing manner or a hands-on technique with therapeutic intent..."

A detailed explaination of Mobilisation and its effect on pain can be read on this Physiopedia page: Maitlands Mobilisations There is no convicing evidence indicating whether mobiisations or manipulation are more effective than each other. However regardless of this there is indication that neither of these therapies should be used in isolation, but as part of a wider treatment plan, mainly involving exercise.

Manipulation

A description of spinal manipulation is given on this Physiopedia page: Spinal Manipulation

There are variable results of research into the effectiveness of manipulation. There is a recent review by Rubinstein et al  that states:

"Spinal Manipulative Therapy (SMT) is no more effective in participants with acute low-back pain than inert interventions, sham SMT, or when added to another intervention. SMT also appears to be no better than other recommended therapies."

However, there is other work such as Bronfort et al that suggests Manipulation is a useful tool in the treatment of Low back pain.

Soft Tissue

Massage and soft tissue treatment, is often employed by physiotherapists to aid pain relief. Details of this can be found on this Physiopedia page: Massage

Patients often provide anectotal reports of its benefits, however recent research is not as supportive of its long-term benefits. Furlan et al states that:

"We have very little confidence that massage is an effective treatment for LBP. Acute, sub-acute and chronic LBP had improvements in pain outcomes with massage only in the short-term follow-up. Functional improvement was observed in participants with sub-acute and chronic LBP when compared with inactive controls, but only for the short-term follow-up"