Physical therapy has proven to be very effective in treating chronic pain. You might have also heard physical therapy referred to as physiotherapy. Physical therapy revolves around movement and strengthening of the body. A physical therapist will work with you and your individual needs, to give you the maximum range of movement and activity possible.
The World Confederation for Physical Therapy defines the purpose of physical therapy being to “develop, maintain and restore maximum movement and functional ability throughout the lifespan.”
How physical therapy improves chronic pain
- Reducing pain
Through a gradual build up to exercise and movement, physical therapy can help to retrain the brain away from pain. In the process the brain is being taught that each movement, when done gradually without causing a flare, does not need to cause pain.
Pain signals can then be reduced and even eliminated in response to these movements. This study states that physical therapy can reduce pain by, “resolving inflammation, facilitating tissue repair, activating temporary analgesia, altering nerve conduction, providing a counterirritant, modifying muscle tone, reducing the probability of maladaptive central neuropathic changes”.
- Reducing inflammation
Inflammation is common in chronic pain patients; it contributes to pain levels and lack of mobility. This study explains that, “Regular exercise is shown to exert anti-inflammatory effects”. As physical therapy teaches you to increase your levels of exercise, inflammation will be reduced.
- Strengthening your body
Physical therapy strengths your muscles and makes your body more flexible, reducing pain and giving you increased general fitness. Even with chronic pain conditions like osteoarthritis, wherein the joint is worn down, having strengthened muscles around that joint can reduce pain and give the worn joint more support.
- Relaxing muscles
Often with chronic pain muscles can become very tense and tight; this can be painful and uncomfortable. Physical therapy aids in relaxing these muscles, making patients more comfortable in the process.
- Improving your range of motion
When joints have been inactive for a long period of time, they often become stiff and lose their range of motion. This means that you are less flexible and struggle to carry out certain movements. Through physical therapy, this range of motion can be regained.
- Tackling fear avoidance
Acute pain indicates that the body is injured, so you take notice and rest! It’s normal to be focused on pain and to be concerned about it: usually this is a helpful behaviour. However, when behaviour becomes chronic, the pain is no longer indicating damage.
Often those with chronic pain will avoid exercise and activity due to fear that they are going to worsen their pain, or because they feel that they are not capable of engaging in activities. Fatigue can understandably also contribute to inactivity.
While this is totally understandable (nobody wants to make their chronic pain worse when they’re already struggling) it’s also unhelpful. This inactivity can lead to deconditioning, meaning that the muscles weaken, and the body becomes less fit, leading to more pain!
Physical therapy can recondition the body, reducing pain in the process. Patients can learn that they do not need to fear movement, giving them the confidence to engage in activity!
- Teaching you how to exercise safely
Exercise, while highly beneficial in reducing chronic pain, if overdone can cause flares in symptoms. A physical therapist (PT) will teach you how to pace yourself to avoid the boom/bust cycle.
- Teaching you how to perform daily tasks safely
A PT will walk you through daily tasks that you may find difficult, giving you education and advice on how to approach these tasks safely and with confidence.
- Building confidence
As you learn how to exercise and not fear movement, your confidence in your own abilities can grow. Physical therapy can allow you to feel in control of your body and your condition, expanding your level of functioning and giving you that quality of life back.
- Reducing stress
Physical therapy gives you the tools and confidence to engage in regular exercise. Exercise reduces stress levels by reducing levels of cortisol, otherwise known as the stress hormone, in your bloodstream as explained in this study. Reducing stress contributes to reducing pain by breaking the stress and pain cycle.
- Learning about the science behind pain
The pain education that often comes as part of physical therapy can help patients to gain a sense of confidence in moving despite their pain, as they learn that their chronic pain does not equal damage.
This study concluded that patient neuroscience education was effective in , “reducing pain and improving patient knowledge of pain, improving function and lowering disability, reducing psychosocial factors, enhancing movement, and minimizing healthcare utilization.”
What does physical therapy entail?
Typically, you will regularly visit your physical therapist (PT), perhaps once a week depending upon what is agreed between you. During your first visit you will chat to your PT about your symptoms. You may be asked various questions about your pain and will likely be given a physical examination.
During the physical examination you may be asked to carry out certain movements, or your PT may put pressure on certain areas of your body. If you are worried or feel that your pain is increasing, ask questions and talk to your therapist so that they can reassure you.
Your PT will go over your diagnosis and your medical history. They will try to establish how your chronic pain affects you, what makes it worse or better and how you currently cope with your pain. From there they will figure out how they can help you and you may talk about what your goals from treatment should be. Remember that this is about you and your life, so be sure to speak up if you have questions or there are certain goals you want to reach. Your PT will then develop an individual treatment plan for further appointments.
From there when you attend appointments your PT will guide you through various physical exercises and treatments in accordance with your treatment plan. Your PT will usually give you exercises to do at home, like homework, which you can practice between sessions to make progress in your own time. You will then build on this progress together in your next session.
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Passive and active treatments
Physical therapy usually revolves around two types of treatment. Passive treatments are those during which the PT does a lot of the work. For example, they may manipulate your joints and move areas of your body to stretch your muscles and strengthen specific muscle groups. They might offer massage or heat and cold therapies among other treatments. Passive treatments require your PT to be involved, meaning they cannot be done independently.
Active treatments are those in which you really get involved such as engaging in exercise therapy. You are actively in control of these types of treatments. Active treatments may be supervised by your PT or you may do the majority of this type of work at home unsupervised as explained in this study.
While passive treatments can be useful to get you started, active treatments give you the tools to manage your pain yourself in your day to day life. This study explains that, “Passive treatment can help with immediate pain relief, but active treatment keeps the patient functional in the long term.”
Physical therapy treatments
- Strengthening exercises
Your PT will go through a variety of strengthening exercises tailored to you individually. As you progress, the exercise will be increased in intensity and duration, as well as skill level. You may use exercise machines, resistance bands or exercises which target specific muscle groups.
- Flexibility exercises
Specific exercises to increase the flexibility of your joints and muscles will be demonstrated. Over time these exercises will be built upon to gradually increase your range of motion. These exercises may involve the PT physically manipulating certain areas of your body or could involve you being taught specific stretches, for example.
- Low impact exercise therapy
Exercise therapy involves you being guided through exercise workouts to target specific areas of your body. Typically gentle aerobic exercise is used. You will be given more exercise routines to practice at home.
- Massage
Deep tissue massage can help to relax the muscles, releasing tension and therefore reducing pain and increasing mobility. This entails the PT using pressure on specific areas of your body.
- Patient neuroscience education
Depending on your PT, education on the science behind pain itself, both acute and chronic, may be offered. This type of education gives you the knowledge to truly understand what is happening within your body when something hurts. This can often lead to less fear and more empowerment, particularly as patients learn that chronic pain is not damaging them and that it can be reduced.
- Advice on daily movements
Your PT may go through your daily activities, helping you to learn how to carry out movements safely. This may involve guidance on posture, how to lift things, how to get up from certain positions and even advise on specific sitting and lying down positions for optimum comfort.
The World Confederation for Physical Therapy explains that it’s the PT’s job to help with, “modifying environmental, home and work access and barriers to ensure full participation in one’s normal and expected societal roles”
- Ultrasound
A machine which creates targeted sound waves into your muscles is used during ultrasound treatment. Usually a wand, which is just a small device which is pressed on the painful area, is used to administer the ultrasound. This is usually painless. Ultrasound treatments can reduce swelling and stiffness by promoting better blood circulation.
- Laser therapy
Low strength lasers can be used to generate specific wavelengths of light which are thought to promote healing. The treatment is painless and typically only lasts a few minutes. This is often used during exercise therapy or manual manipulation to ease pain.
- Transcutaneous electrical nerve stimulation (TENS)
A TENS machine may be used during physical therapy, and you may be able to take it home with you to carry on the treatment. A TENS machine sends out a safe electrical signal via pads on specific areas of your body to stimulate your muscles and ease pain by disrupting the pain signals.
- Hydrotherapy
Some PT’s may use hydrotherapy pools, simply meaning that you are exercising while in the water. This water is often heated to reduce pain. Exercising while in water takes the weight off your joints, often making the movements less painful.
- Heat and cold therapy
A variety of hot and cold therapies may be offered such as cold and heat packs, ice treatments and heated whirlpools. Heat therapy helps to ease pain during other exercises, as well as encouraging more blood flow to the area. Cold therapies reduce pain and inflammation.
- Dry needling
A more recently introduced treatment, dry needling uses acupuncture techniques, using small thin needles to target specific muscles. This technique is thought to ease pain and relieve tension in the muscle, but more research is needed to establish its effectiveness.
- Iontophoresis
This is a newer treatment and is still being researched. Some PT’s may implement it depending on its availability and where you receive physical therapy. Iontophoresis is a type of electrical signal used to deliver medication through your skin, directly to the areas which are painful.
This study defines Iontophoresis as, “the permeation of ionized drug molecules across biological membranes under the influence of electrical current” More research needs to be done before this type of treatment becomes commonplace as explained here.
- Kinesiology taping
A flexible tape can be used to strengthen weakened joints during activity. The kinesiology tape is also thought to improve circulation, to reduce inflammation and to reduce pain by interrupting the nerve pathways which create pain.
- Multimodal treatment approaches
It’s become increasingly common for PT’s to incorporate other treatments to get the best results for their patients. Often cognitive behavioural techniques will be integrated into treatment, helping patients to replace negative thoughts and behaviours with positive ones. Combined with physical therapy, this can be a very empowering and impactful approach, incorporating both the mind and body into treatment of chronic pain.
Graded Exposure Therapy is often combined with physical therapy: situations which are painful or feared are tackled in a gradual, step by step way to retrain the brain away from pain and fear. Often this is combined with exercise during physical therapy.
Where you can access physical therapy
You can usually access physical therapy by being referred through your doctor. If you see a specialist, they may have a physical therapist as part of their team or may refer you to a PT within their clinic. Physical therapy can also be sought out privately if your resources allow.
Active physical therapy, meaning it is guided by a professional but you are taking the lead and carrying out exercises in your own time, can be accessed online through resources like the Pathways app (download links below) (update Aug 2023: Pathways is now a web app! Start our program here). This type of online pain therapy will guide you through safe, gradual exercises to build up your strength, flexibility and tolerance. Over time this will help you to regain your level of functioning and enable you to reduce your pain symptoms!
References
- Physiotherapy Theory and Practice, An International Journal of Physical Therapy, Volume 32, Issue 5, Adriaan Louw, PT, PhD, Kory Zimney, PT, DPT, Emilio J. Puentedura, PT, DPT, PhD, Ina Diener, PT, PhD, (2016), “The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature”
- World Confederation for Physical Therapy, (2017), “Policy statement: Description of physical therapy”
- Vinod Dhote, Punit Bhatnagar, Pradyumna K. Mishra, et al, (2012), “Iontophoresis: A Potential Emergence of a Transdermal Drug Delivery System”
- Journal of Orthopedic and Sports Physical Therapy, Volume 20, Number 6, Kent E. Tirnrn, PhD, PT, SCS, OCS, ATC, FACSM, (1994), “A Randomized-Control Study of Active and Passive Treatments for Chronic Low Back Pain”
- Global Advances in Healthy and Medicine, David Cosio, PhD, ABPP, Erica Lin, PharmD, BCACP (2018), “Role of Active Versus Passive Complementary and Integrative Health Approaches in Pain Management”
- Journal of Strength and Conditioning Research, Dean E Jacks, James Sowash, John Anning, et al (2002), “Effect of Exercise at Three Exercise Intensities on Salivary Cortisol”
- Brain, Behavior, and Immunity, Volume 61, Pages 60-68,Stoyan Dimitrova, Elaine Hultenga, Suzi Honga, (2017), “Inflammation and exercise: Inhibition of monocytic intracellular TNF production by acute exercise via β2-adrenergic activation”
- Physical Medicine and Rehabilitation Clinics of North America, Roger J. Allen, PhD, PT, (2006), “Physical Agents Used in the Management of Chronic Pain by Physical Therapists”
- The Journal of the American Board of Family Medicine, Leonid Kalichman, Simon Vulfsons, (2010), “Dry Needling in the Management of Musculoskeletal Pain”
- Practical Pain Management, Tiziano Marovino, DPT, MPH, DAIPM, (2018), “Physical Therapy and Rehabilitation”
- Practical Pain Management, Thomas G. Ciccone, (2019), “Using a Multimodal Approach to Physical Therapy for Chronic Pain”
- VeryWell, Brett Sears, PT, (2019), “12 Common Physical Therapy Treatments and Modalities”
- VeryWell, Brett Sears, PT, (2019), “How Kinesiology Tape Is Used in Physical Therapy”
- VeryWell, Brett Sears, PT, (2019) “Physical Therapy for Chronic Pain”
Please note: This article is made available for educational purposes only, not to provide personal medical advice.
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