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The Deep Relationship Between Physiotherapy and Pain Management

Souvik Paul
The Deep Relationship Between Physiotherapy and Pain Management

Physiotherapy is very effective for various types of pain management procedures. It can ease the pain that occurs due to injuries and other reasons. Let's check how Physiotherapy treatments help people to manage their pain.

Types of Physiotherapy Processes for Pain Management


To characterize the modalities employed in physiotherapy, the terms electrotherapy and electrophysical agents have been used interchangeably. Some argue that the word "electrotherapy" refers solely to therapeutic approaches that involve electric current.

The table below divides diverse modalities into three categories: electrical stimulation agents, thermal stimulation agents, and non-thermal stimulation agents.

The most often utilized physiotherapy pain treatment agents are electrical stimulation agents and heat agents. Non-thermal agents, such as pulsed ultrasound, have been shown to have analgesic properties.

Stimulation with electricity

TENS (Transcutaneous Electrical Stimulation) is a type of electrical stimulation that is

Electrical stimulation is supposed to prevent pain signals from reaching the brain, preventing the patient from feeling pain. Furthermore, electrical stimulation has been proven to increase the production of endorphins, which are natural painkillers generated by the body. Because the administered electrical fields operate to close the body's "pain gate mechanism," pain is reduced. TENS (Transcutaneous Electrical Nerve Stimulation) is a commonly utilized electrical pain treatment.

The following video demonstrates how TENS works:

Interferential Therapy (I.T.)

Interferential treatment is a type of electrical stimulation that is more intense and more pleasant for the patient.

Thermodynamic Agents

Heat and cold are thought to have a physiological impact on your body's pain gate mechanism, which momentarily modifies pain signals moving to and from your brain when delivered sequentially. For many who have had long-term problems with their neurological and musculoskeletal systems, this momentary pain alleviation is a great comfort. Cryotherapy (cold therapy) relieves pain by activating the body's "fight or flight" reaction, which boosts the creation of endorphins, reducing symptomatic pain perception.

Therapeutic heat (thermotherapy)

Cryotherapy (also known as ice or cold therapy) is a type of treatment in which the body is exposed to extreme cold


Heat treatment lowers pain and impairment in people with back pain that lasts shorter than three months, according to moderate evidence. The alleviation has only been proved to last for a brief period, and the effect is minor.

Exercise may be beneficial when used in conjunction with heat wrap treatment. There is presently insufficient data to support the use of cold therapy for low-back pain of any length or heat therapy for back pain that lasts longer than three months.

  • Agents that aren't thermal
  • Heat/cold is not used to exert a therapeutic effect with non-thermal drugs.
  • Ultrasound is used to treat a variety of ailments.
  • Low-Intensity Laser Therapy (LLLT)

Magnetic Therapy

Soft tissue - This is targeted at muscles that are morphologically shortened and/or fascial mobility that is limited. The following are some examples of techniques (this is not a complete list):

  • Techniques for myofascial release
  • Lymphatic drainage can be done manually.
  • Mobilization of soft tissues (Massage)
  • Mobilization for functional purposes
  • Constraint of strain

Active release treatment Craniosacral therapy Craniosacral therapy

MFR Graston massage, rolfing, self-massage with tennis balls, and even foam rolling are all options. This is aimed at muscles that are anatomically shortened and/or have reduced fascial mobility.

Neural mobilization, joint stretching, and/or muscle stretching are all examples of stretching.

There is often a problem with rotation (osteokinematics) as well as an irregular IAR. There is a requirement to restore tensile length and/or tensile load tolerance (distracting forces).

Joint Methodologies

The following are examples of joint techniques:

  • Mobilization of Allies
  • Techniques for increasing muscle energy
  • Mulligan Methodologies
  • Guidelines for Traction Manual Therapy
  • APA Clinical guide to cervical spine manual therapy practice in 2017
  • Clinical Practice Guidelines for Neck Pain


A detailed explanation of Mobilisation and its effect on pain can be read on this Physiopedia page: Maitlands Mobilisations There is no convincing evidence indicating whether mobilization or manipulation is more effective than each other.

Massage of the Soft Tissues

Physiotherapists frequently use massage and soft tissue therapy to help with pain reduction.

Patients frequently share anecdotal tales of its advantages, but new research has cast doubt on its long-term effectiveness.

Dry Needling/Acupuncture

Acupuncture is commonly used by physiotherapists to treat pain. Although there is still much to learn about its specific mechanics, patients frequently claim anecdotal proof of its benefits. Take a peek at this Acupuncture page on Physiopedia.

Despite the fact that acupuncture is extensively used and considered to be beneficial, there is a paucity of research to back it up.


Bracing and taping are two common methods. Self-traction at home for primary decompression concerns may also be included. Because this patient frequently has a low tolerance for tissue loading, this therapy is directed squarely at improving tolerance. This might involve blood flow-optimized placement.


For pain-dominant joints and spinal segments, this comprises Grade I and II joint mobilizations. The objective is not to restore joint translation (arthrokinematics) by deforming collagenous structures in the tissue. Excessive spasms and guarding are common symptoms of this condition. This might also involve post-isometric relaxation, which focuses on restoring the muscle spindle's resting tone, which could be physically shortened. To improve mobility, function, and/or discomfort, the patient may also require cognitive-behavioral/psychosocial methods such as relaxation.


This involves exercising to stabilize the muscular system. The objective is to increase cross-sectional area as well as the tissue's maximal force-generating capability and/or endurance. Because this tissue has a low degree of intolerance, the focus is on expanding the ideal loading zone and boosting the capacity for absorbing and producing force.

Stabilization is also widely used to test a spondylolisthesis pathoanatomic hypothesis (shear dysfunction), which can be validated by segmental testing and/or radiography. When facet gliding at the L4/5 segment, you may notice a huge neutral zone (laxity) and need to stabilize this segment.

Integration with Other Pain-Relieving Therapies

Other pain methods, such as pharmacological, psychological, exercise, and behavioral, can be incorporated with traditional physiotherapy pain techniques. Professional Physiotherapy Doctors are aware of these types of treatments that can effectively work to ease the pain of the patients.

Souvik Paul
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