Have you ever gone to the physiotherapist, had some treatment for your back or knee and felt better, but have not actually been sure of what has been done? The aim of this blog post today is to educate you, the reader, on some of the most common physiotherapy pain management techniques and how they work.

Manual Therapy

Manual therapy is a fundamental “bread and butter” component of physiotherapy that involves hands-on techniques to manipulate muscles and joints. Manual therapy is an all-encompassing term that includes muscle release, soft tissue massage, joint movements and combinations of these to alleviate pain or reduce tightness. Research has shown that manual therapy can effectively reduce pain and improve mobility in patients with musculoskeletal conditions. A systematic review published in the Journal of Manual & Manipulative Therapy found that manual therapy, combined with exercise, significantly improves pain and function in patients with low back pain.

Exercise Therapy

Exercise therapy is a personalized program of physical activities designed to restore strength, flexibility, and balance. These are prescribed often to anyone we see and if you have seen a physio before, you know that it is a common expectation to walk away with some exercises at least. Exercise programs are supported by extensive research indicating its effectiveness in managing chronic conditions like osteoarthritis, rheumatoid arthritis, and fibromyalgia. Specific exercise programs like the GLA:D program for hip and knee osteoarthritis are highly effective at reducing pain in joints and improving overall function. Exercise therapy is highly personalised and can range from simple stretches to complex strength-training routines, all tailored to the patient’s specific needs and abilities.

Heat and Cold Therapy

While not necessarily as common as in clinic treatment options as much as it used to be, the application of heat and cold is a simple yet effective technique for managing pain and inflammation. Heat therapy increases blood flow and relaxes muscles, which can alleviate chronic pain and stiffness. Conversely, cold therapy reduces swelling and numbs acute pain, making it ideal for injuries and post-operative recovery. A combination of the two, known as contrasting, can also be useful for various presentations.

Electrotherapy

Electrotherapy involves the use of electrical energy to stimulate nerves and muscles. Techniques like Transcutaneous Electrical Nerve Stimulation (TENS) have been widely studied and are shown to provide pain relief for various conditions, including neuropathic pain and postoperative pain. According to a review in the Cochrane Database of Systematic Reviews, TENS is effective in reducing pain and improving physical function in adults with chronic pain conditions. However, people respond differently to TENS and some get better results than others.

Education and Self-Management

Perhaps a physiotherapist's most underrated treatment method, education, is a crucial aspect of physiotherapy, empowering patients with knowledge about their conditions and teaching self-management techniques. Therapeutic alliance and trust between the practitioner and physiotherapist is a cornerstone for results-based treatment. A patient’s active participation in their recovery journey significantly enhances the outcomes. Patient education, coupled with therapeutic exercises, leads to better pain management and functional improvement than just exercise. As a practitioner, this is the skill that I value the most as it is essential for changing behaviours and addressing longstanding problems, that sometimes the other techniques above cannot address.