Tag Archives: modalities

physical therapy knee pain

How Physical Therapy Helps Knee Rehabilitation

How physical therapy helps knee rehabilitation and how physical therapy provides knee rehabilitation.

Physical therapists can provide more than pre/post surgical knee rehabilitation for patients experiencing knee pain.

What Causes Knee Pain?
The knee is a relatively simple joint required to do a complicated job…to provide flexible mobility while bearing considerable weight. While walking down the street, our knees bear three to five times our body weight. When the knee is overstressed in sports or in everyday activities, these structures can break down — and a knee injury occurs.

Common Knee Problems Seen by Our Physical Therapists:

  • Strain / Sprain
  • Arthritis Pain
  • Muscle Weakness
  • Ligament Sprains
  • ACL Tears
  • Tendinitis (ie: Patellar, Pes Anserinus)
  • Chondromalacia Patella
  • Patellofemoral Syndrome / Knee Pain
  • Pre / Post Operative Therapy

How Physical Therapy Provides Knee Rehabilitation
Rehabilitation acutely after knee surgery or a knee injury primarily centers around decreasing swelling in the knee joint. Even a small amount of fluid inhibits the quadriceps muscle on the front of knee by slowing the signal for movement traveling from the brain to the muscle. Manual techniques to decrease muscle spasm and improve length tension relationships of soft tissue are also incorporated. Gradually, exercises to increase strength, range of motion and functional mobility are introduced.

Treatments Offered Include:

  • Comprehensive evaluation with an emphasis on determining the source of the problem
  • Individualized and specific exercise programs
  • Manual therapy (hands-on treatment)
  • Modalities as needed
  • Work and sport specific simulations
  • Progressive home program to help restore independence and self-management

Knee Rehabilitation Goals:

  • Reduce Pain
  • Improve Mobility
  • Movement Awareness/Gait Training
  • Functional Strength
  • Patient Education

For more information on knee injuries visit our PT & Me Knee Injury Center page by clicking here.

The PT & Me Injury Center goes over diagnoses on how physical therapists treat specific injuries.

To find or search for a local participating PT & Me physical therapy clinic in your local area please click here.

TMJ Pain

Physical Therapy Helps With TMJ Pain

TMJ Pain

Physical Therapy can help those suffering with pain associated with the facial region, head, and/or neck, including those struggling with Temporomandibular (TMJ) disorders.

The temporomandibular joint or TMJ, is a complex joint located in front of each ear. It is responsible for allowing mouth opening and closing. When the TMJ is not working correctly, you may experience jaw pain, clicking, popping, or locking of the joint. You may also experience headaches, neck pain, sinus pain, dizziness, and ear ringing or pain. TMJ pain or Temporomandibular Dysfunction (TMD) is not strictly limited to the jaw, jaw, it can also be influenced by activities, positioning, or alignment of the head and neck.


  • Excessive grinding or clenching of teeth
  • Joint stiffness
  • TMJ Disorders
  • Poor Posture or Ergonomics
  • Other neck conditions including pain and headache
  • Stress and muscle tension

TMJ Pain

Physical therapy treatment includes an in depth evaluation of the structures of the cervical spine, jaw joints and head. Treatment could include manual therapy techniques for the spine, jaw and soft tissues, exercise for the jaw and neck, and modalities. Evaluation focuses on the relationship of the muscles, joints and nerves of the jaw, head, neck and face and how they relate to each other. Manual therapy may be used to improve range of motion and mobility of the jaw and neck. Exercise is designed to restore the proper balance of the spine and head to take unnecessary stress off of sensitive tissues and to support the body so it can perform the activities of daily living efficiently and comfortably. Modalities will decrease the short-term discomfort and joint irritation. We will look at how you interact with your environment to see if there are activates you preform that put increase stress on your body which could cause increased pain. Most importantly, in addition to these techniques, the patient is provided with a home exercise program to aid in symptom reduction. Each treatment plan is based on a patient’s individual needs and the therapist, patient, and referring practitioner work as a team to reach the patients goals.

This information was written by Rehab Associates of Central Virginia, an outpatient physical therapy group with 13 locations in Central Virginia. Their physical therapists have advanced degrees in specialty orthopedic care from head to toe. From musculoskeletal headaches to lower back pain to heel pain syndrome, they can help take away your pain and help you return to normal activity. For more information click here.

chronic back pain

Effective Chronic Back Pain Treatment

Effective Chronic Back Pain treatment_FBsize Physical therapy for back pain

For chronic back pain, exercise, physical therapy, manual therapy and mindfulness-based stress reduction have the best evidence for effectiveness.

Chronic back pain is one of the most frequent reasons people visit the doctor — it’s estimated that 31 million Americans experience low-back pain at any given time. Yet doctors are finding drugs should actually often be the last line of treatment for it. A new guideline out Feb 14th 2017, from the American College of Physicians (ACP) suggests doctors recommend exercise and treatments like heat wraps, yoga, and mindfulness meditation to their patients before turning to medications like opioids or even over-the-counter painkillers. “That marks a big departure from previous guidelines,” Roger Chou, a professor at Oregon Health and Science University, told Vox1. (Chou’s evidence review can be found at: https://goo.gl/MWzWvK)

Why Send Patients to Physical Therapy for Chronic Back Pain?

It is the long term benefits of physical therapy interventions such as multifidus, transversus abdominus and pelvic floor neuromuscular reeducation that benefits your patients.
• Multifidus muscle recovery requires specific, localized, retraining.3
• PT + meds 30% recurrence versus 84% meds only (1 year follow-up).4
• PT + meds 35% recurrence versus 75% meds only (2-3 year follow-up).4
• Less likely to have further healthcare costs.4

Back Pain Conditions Commonly Seen by physical therapists include:
• Low Back Pain (LBP)
• Arthritis Pain
• Strains & Sprains
• Muscle Spasm
• Herniated Discs
• Degenerative Discs
• Radiculopathy/Sciatica
• Piriformis Syndrome
• Sacroiliac Joint Dysfunction
• Scoliosis
• Spondylosis
• Stenosis

In physical therapy our goals are to Improve:
Mobility — Knowledge of Safe Positions — Movement Awareness — Functional Strength — Coordination

“Exercise or alternative therapies, the ACP noted, can work as well as or better than medications, but don’t come with the side effects.1” Physical Therapy is a safe, proven way to treat patients experiencing back pain.

Evidence showed that acetaminophen was not effective at improving pain outcomes versus placebo. Low-quality evidence showed that systemic steroids were not effective in treating acute or subacute low back pain2. (ACP Newsroom)

back pain 3

We offer a comprehensive approach incorporating manual therapy, prescriptive therapeutic exercise and modalities. Our programs improve the patient’s physical condition and symptoms. We also provide the patient with movement awareness, knowledge of safe positions, functional strength, and coordination. All of this promotes the management of low back pain (LBP).

Treatments offered include:
• Comprehensive Evaluation with an emphasis on determining the source of the problem.
• Individualized & Specific Exercise Programs
• Manual Therapy (hands-on treatment)
• Modalities as Needed
• Progressive Home Program to help restore independence and self-management

Information provided by North Lake Physical Therapy – Portland, OR
To learn more about North Lake Physical Therapy click here.

1. http://www.vox.com/science-and-health/2017/2/14/14609508/doctors-admit-drugs-cant-fix-back-pain
2. https://www.acponline.org/acp-newsroom/american-college-of-physicians-issues-guideline-for-treating-nonradicular-low-back-pain
3. Spine (Phila Pa 1976). 1996 Dec 1;21(23):2763-9. Hides JA, Richardson CA, Jull GA.
4. Spine (Phila Pa 1976). 2001 Jun 1;26(11):E243-8. Hides JA, Jull GA, Richardson CA.


For more information about back pain physical therapy click the links below.

Low Back Pain Physical Therapy  beware bed rest for back pain  low back pain relief

Modalities: What They Are and Why We Use Them

Every treatment is truly a modality with exercise (including Therapeutic Exercise, Therapeutic Activities and Neuromuscular Re-education) being the most popular and effective.

ULTRASOUND: Can be performed for thermal or non-thermal benefits. A crystal in the sound head vibrates at a specific frequency (usually 1 or 3 MHz) when an electrical current is passed through the crystal. The ultrasound waves that are produced are absorbed best by high collagen content tissues (tendon, ligament, and muscle). The frequency controls the depth of penetration with 3 MHz being more superficial and heating up more quickly than 1 MHz. An effective treatment area is no greater than twice the area of the ultrasound head (5cm^2 US head). Physical therapists use ultrasound frequently on tendinosus injuries, or plantar fasciitis as well as ligament injuries, and in conjunction with transverse friction massage and exercise.

ELECTRICAL STIMULATION: Most often performed in outpatient orthopedic PT clinics for muscle re-education or pain control. The waveform, frequency and wavelength are different depending on the reason for using this modality.

With neuromuscular estim (NMES) two electrodes are typically used. Physical therapists use NMES to the quadriceps (specifically VMO) to regain quadriceps control to restore active terminal knee extension. There is an on and off time with NMES, and the patient is usually performing a quadriceps exercise during the time the NMES is on.

When electrical stimulation is used for pain control the term TENS is commonly used, which stands for Transcutaneous Electrical Nerve Stimulation, but even NMES is technically TENS. With TENS various set-ups can be used, but the most common is IFC (Interferential Current) at 80-150 Hz with 40% scan. This requires 4 electrodes in a crossed-diagonal pattern with the treatment area in the middle. An interference pattern is created, and varies throughout the treatment giving the sensation that the current is moving around, and preventing the patient from becoming too accustomed to the sensation. There can be some carryover of pain-relieving TENS effects between sessions, but I generally consider this to have a temporary effect lasting for up to 2-3 hours after the session. Often heat or ice is applied during the treatment as well. If you want to prescribe a home TENS unit for a patient for pain management we are happy to assist by working with vendors to obtain a device for a patient, and to teach them how to use the device.


TRACTION: Static (constant tension) traction is most commonly used, unless the patient’s condition is very reactive, and then intermittent traction may be used. A home traction unit may also be ordered for a patient, and we can train the patient in the set-up and usage of those devices. They are available for both cervical and lumbar traction, but lumbar traction is much less commonly used. A patient must be able to tolerate 20# of cervical traction, typically, for insurance to cover a home device.

PHONOPHORESIS AND IONTOPHORESIS: Both of these are drug delivery methods. Iontophoresis uses direct current electricity to drive a charged medication deeper into the tissues while phonophoresis is the usage of a medication in an ultrasound gel or cream. The research support is better for iontophoresis than phonophoresis, but neither are very good. Iontophoresis most often is done with dexamethasone with a negative polarity and the medication is placed under the negative electrode. With phonophoresis the US, at least theoretically, opens up channels to allow the medication to be absorbed more readily, but in doing US with a medication, the ultrasound transmission is not as good as with the normal ultrasound gel.

WHIRLPOOL: Cold or warm whirlpools are somewhat common still in athletic training rooms, but not utilized nearly as much in a PT clinic. They also used to be used very commonly for wound debridement, but the time and expense of the water and sterilizing the whirlpool after use, coupled with the existence of good medicinal/chemical methods for wound care have made whirlpool use for that purpose much less common.