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Physical Therapy Modalities & Managing Chronic Pain

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Physical therapy is a combination of therapeutic techniques and exercise. Each specific form of PT is referred to as modality, defined as a type of mechanical, electrical, or thermal energy meant to cause some type of change to the body and its systems. Many of the modalities that are part of a typical routine are performed in order to ease pain, improve circulation, minimize muscle spasms, reduce swelling, improve responses to other treatments, or deliver medication. Here’s how some of the common physical therapy modalities help manage chronic pain.


Treatment with ultrasound usually involves a handheld device that’s moved in circular motions over the affected area where pain is felt. Ultrasound works be producing sound waves that heat muscles, tendons, and other soft tissues. The heat produced improves circulation and blood flow, which helps with the process of tissue healing.


Phonophoresis is a treatment with ultrasound used to increase the effectiveness of topical medications. The gel or cream is rubbed into the patient’s skin before the use of the ultrasound device. The sound waves produced with phonophoresis dilate blood vessels and make it easier to absorb the topical medication.

Hot/Cold Therapy

Heat promotes circulation. Cold reduces swelling and inflammation. Hot and cold therapy can involve the use of cold and heat packs, heating pads, and warming or cooling gels and creams. Studies suggest moist heat from a warm bath or shower is especially effective at penetrating deeper into tissues to facilitate healing and improve functioning. The two techniques often work together to provide relief. For instance, heat may be applied prior to PT exercises to stimulate muscles and cold may be used as a post-exercise modality to minimize swelling as muscles relax.

Manual Therapy

Modalities of this nature are performed with hands-on techniques. Specific techniques may include various form of massage therapy, mobilization involving slow, measured movements, and tissue and joint manipulation. The goal with any type of manual therapy is to decrease pain, stimulate tissues, increase flexibility, and relax the patient.


Electrotherapy techniques such as TENS units, percutaneous electrical nerve stimulation (PENS), and repetitive transcranial magnetic stimulation (RTMS) work by disrupting pain signals sent by nerves. Electrotherapy modalities may be effective for chronic pain conditions directly or indirectly affecting nerves such as disc herniation in the lower back.

PT is often recommended for chronic pain management because of the many different modalities available. Finding the right combination of techniques is sometimes a trial and error process. For instance, a patient not responding well to hot and cold therapy may see better results with TENS units, injections, or massage therapy. Physical therapy exercises can also be tailored to patient-specific goals and abilities, although PT becomes even more effective when an accurate diagnosis of a patient’s pain is made.