Rehabilitation Therapy

Rehabilitation, or rehab, therapy refers to the therapeutic, healing treatment a patient receives after an illness or injury. The illness or injury could be cancer, a stroke or an automobile or skiing accident. Drug rehabilitation therapy is treatment that drug addicts receive to help them learn to live without a dependence on drugs to be at their physical, emotional and mental best. All forms of rehabilitation therapy strive to help people recover from challenges or problems and function at their best ability.


Physical therapy focuses on strengthening muscles and relieving pain. Physical rehabilitation treatments often include massage and exercise. If a patient is too weak to exercise on his or her own, a qualified physical therapist may gently move the patient's arms or legs to help build strength. Patients with more physical strength may lift weights to build muscle, while others hurt in an accident may need a cane or other device to help them walk. Patients in wheelchairs are often taught to do exercises made to do in a wheelchair in physical therapy.

Speech rehabilitation therapy helps stroke patients and others with speaking difficulties relearn to communicate. Speech rehab also helps those who have experienced damage to their language skills such as some brain injury patients. Patients who experienced memory loss may have difficulty with the reasoning skills needed for forming coherent language. A qualified speech therapist may be able to help patients with memory loss and other conditions improve their ability to speak clearly with the aid of reading comprehension materials and other learning devices.

Drug rehabilitation therapy may include several components, such as counseling and medication. Inpatient drug rehab programs may be short term or long term. Drug treatment centers typically offer residential drug rehabilitation therapy for at least a month and up to a year. Outpatient drug rehab usually follows a residential stay in a treatment center and continues to try and help people cope with life and avoid substance abuse. A weekly counseling session that may be individual or in a group setting is often a large part of outpatient drug rehabilitation.


One person may require different kinds of rehabilitation therapy. For example, a person with a substance abuse problem who is involved in a motorcycle accident could need both drug rehabilitation and physical therapy. A stroke patient who is paralyzed in his or her face and other areas of the body may need physical as well as speech therapy. Rehab therapists may work together on a patient's case in order to coordinate an effective therapy program.

Welcome to the School of Rehabilitation Therapy at Queen’s University! The School is well known for high quality professional programs in Occupational Therapy and Physical Therapy and excellent masters and doctoral research programs in Rehabilitation Science. Offering a unique fraternal Queen’s environment, study at the School gives students a high quality academic experience while building life-long friendships.

The mission of the School of Rehabilitation Therapy is “To educate leaders in Occupational Therapy, Physical Therapy and Rehabilitation Science by developing skills and competencies in rehabilitation; by facilitating problem-solving; self-directed learning and acquisition of attitudes and skills for lifelong learning; by fostering the development of human qualities and attitudes that promote commitment to clients and their communities throughout the world; and by conducting research in the promotion, restoration and maintenance of health through rehabilitation.”

There are four programs at the School, all at the graduate level. There are two-year, twenty-four month masters professional programs in Occupational Therapy leading to the degree of MSc (OT) and in Physical Therapy leading to the degree of MSc (PT), each being the entry-level degree to practice. Sixty-six students are admitted to each program each year. There are masters and doctoral research programs in Rehabilitation Science, leading to the degree of MSc (Rehabilitation Science) and PhD (Rehabilitation Science) respectively. Two fields are offered: Human Motor Performance and Disability and Wellness in the Community. While students vary in their times to completion, the master’s program usually requires two years and the doctoral program about four years to complete.

Whatever your reason for seeking information about the School of Rehabilitation Therapy, we welcome you and would be happy to have contact with you. 


Speed, instant gratification, accessibility — these are a few of the appealing hallmarks of digital technology. It’s no coincidence that we love our smart wireless devices: Humans are a notoriously impatient species, born with a preference for immediate rewards.

The Digital Doctor

In this special issue of Science Times, we look at some of the many ways that technology is changing the world of medicine.
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But the virtues of the digital age are not always aligned with those of psychotherapy. It takes time to change behavior and alleviate emotional pain, and for many patients constant access is more harmful than helpful. These days, as never before, therapists are struggling to recalibrate their approach to patients living in a wired world. 

For some, the new technology is clearly a boon. Let’s say you have the common anxiety disorder social phobia. You avoid speaking up in class or at work, fearful you’ll embarrass yourself, and the prospect of going to a party inspires dread. You will do anything to avoid social interactions. 

You see a therapist who sensibly recommends cognitive-behavioral therapy, which will challenge your dysfunctional thoughts about how people see you and as a result lower your social anxiety. You find that this treatment involves a fair amount of homework: You typically have to keep a written log of your thoughts and feelings to examine them. And since you see your therapist weekly, most of the work is done solo.
As it turns out, there is a smartphone app that will prompt you at various times during the day to record these social interactions and your emotional response to them. You can take the record to your therapist, and you are off and running. 

Struggling with major depression? Digital technology may soon have something for you, too. Depressed patients are characteristically lacking in motivation and pleasure; an app easily could lead patients through the day with chores and activities, like having a therapist in one’s pocket. Not just that, but the app might ask you to rate depressive symptoms like sleep, energy, appetite, sex drive and concentration in real time, so that when you next visit your psychiatrist, you can present a more accurate picture of your clinical status without having to worry about your recall. 

When it comes to collecting and organizing data, software is hard to beat. But information has a tendency to spread, especially digital information. To wit, electronic medical data containing sensitive personal information can be released, either accidentally or deliberately, and disseminated. Anyone who has followed the hacking of supposedly secure and encrypted financial databases knows this is not a remote possibility.
More worrisome to therapists, perhaps, is that technology also enables access: These days patients reach out via text, e-mail, Facebook, Twitter. For some of them, the easy connectivity that technology makes possible is a decidedly bad idea. 

Take a patient who has a fundamental problem in maintaining intimate relationships and who can’t tolerate being alone without feeling bored or anxious — in other words, a patient with typical features of borderline personality disorder. Not surprisingly, such a patient would love instant access to a therapist whenever an uncomfortable feeling arises. 
 
In this case, connectivity would interfere with the central goal of any reasonable treatment, namely acquiring the skills to manage painful feelings by oneself and the ability to tolerate some degree of disappointment. Access-on-demand would mitigate efforts to develop patience and frustration tolerance, and might encourage a sense of entitlement and an illusory notion of power and control. 

But perhaps the more difficult challenge is this: By removing barriers to access, digital technology can make therapists more real and knowable to their patients. This cuts both ways.
Recently, a patient I had treated for depression was struggling with the approaching death of his beloved dog. Just divorced, he was dreading another loss. One night while surfing the Internet, he came across a piece I wrote years ago about the death of my own dog. 

“So you understand what it’s like,” he said during one of our sessions. This discovery made him feel understood and comforted. 

Sometimes, though, digital technology can undermine the clinical rationale for a therapist to maintain distance.
For example, in insight-oriented psychotherapy, which focuses on unconscious processes at the root of personal conflicts, the patient essentially uses his relationship with the therapist to understand how he structures relationships with people in general. The therapist must be free to “become” many different important people in the patient’s life; the more the patient knows of the therapist’s real life, the likelier it is that the treatment will be confounded. 

Imagine how you might feel if you had a philandering parent and were having trouble in your own relationships, and you discovered that your own therapist was married and having an affair. It would be hard to believe this would not affect your relationship with your therapist. 

Many patients don’t want to know how their therapists feel or the details of their personal lives, and for a good reason: It can undermine the perceived authority of the therapist, making patients feel less secure. And it can inhibit patients from being open for fear of hurting or upsetting their therapists.
I wonder if it’s even possible for therapists to remain anonymous in the age of the Internet, where we can all be found in the electronic cloud. A Google search might not reveal a therapist’s deep, dark secrets, but even basic information begins to alter the relationship. 

Last summer, a patient learned that I was swimming in a benefit race in Cape Cod because I’d written something about it that was available online.
“Be careful, Dr. Friedman,” he said with a smile on the way out of my office. “I heard there were sharks out there.” Beneath the humor was anxiety — or perhaps something darker.
Digital technology has the potential to either enhance or confound therapy, but much depends on the patient and the condition being treated. Some patients will find that the glowing screen only feeds their psychopathology. Others will find digital technology a boon to self-esteem and assertiveness. We are only beginning to figure out which patients are which.


In the world of health care, Nintendo Wii golf is more than a high-tech toy. The video game has become a tool in physical, occupational and neurological rehabilitation. 

“It really is helpful as an adjunct to what we do in physical therapy,” said Dean Beasley, the director of inpatient rehabilitation at Doctors Hospital in Augusta, Ga. “It allows the patient to put into practical application what they’ve done in therapy and, in some cases, it helps them know if they could still play golf.”
Balance and movement are common concerns for those recovering from brain injuries or strokes. Others may be working to improve range of motion or gross motor coordination, like walking and lifting. 

Although the treatment for each patient is different, Wii golf brings an element of pleasure into physical therapy, which is often abbreviated as P.T. and sometimes referred to by patients as “pain and torture.”
“If it’s something like golf that they previously enjoyed, the patients are more motivated to do it,” said Michaela St. Onge, an occupational therapist at Aroostook Medical Center in Presque Isle, Me. “They like it because it’s a change of pace from the normal exercises we give them in therapy.” 

To play the game, a patient swings the Wii’s wireless hand-held motion-sensitive wand in front of animated screens that simulate holes on a course. Physical therapists have marveled at the ease in coaxing patients into movements that could have taken more time to achieve in the traditional manner. Patients may gain the ability to coordinate by pressing buttons on the wand and maintain balance while looking at the screen. 

Two years ago, Aroostook’s inpatient and outpatient units added Wii Sports, which includes golf, baseball, bowling, boxing and tennis games.
“I have to give some credit to this Wii game,” said Mike Pelletier, who had a stroke in June and spent four weeks at Aroostook. “It helped me work on my balance.”
Pelletier, who struggles with balance and double vision, played Wii golf from his wheelchair during occupational therapy sessions. Now he returns to Aroostook twice a week for outpatient physical therapy.
Pelletier said he also played Wii golf at home and competed with his granddaughter. He said that the game helped him become less dependent on the physical therapists in improving his balance and also motivated him to stay active. 

“I made it my own challenge to try to beat my previous score,” Pelletier said. “The game is fun, but it’s also constructive.”
Scoring provides immediate feedback to patients as their motor skills, range of motion, balance and coordination improve with activity, said Renee Guerette, program manager for Aroostook’s neurological rehabilitation unit. 

“We used to use board games with patients, but it didn’t have the same feedback as the Wii,” Guerette said. “It’s nice to offer something that has a positive, fun approach that can be shared with family members at home.”
Guerette observed that when recuperating patients played Wii golf at home, they did not regard it as exercise. Still, the repetition of movement and the practice of balance have had a positive effect.
“We have seen it actually speed up their recovery time when patients elected to come to the rehab center in their free time to play Wii golf,” St. Onge said. “Every little bit helps with recovery.” 

Dr. Arlene McCarthy, the director of the neurological physical therapy residency program at Kaiser Permanente in Redwood City, Calif., was convinced of the therapeutic value of Wii golf after observing a class for stroke patients there. She said she saw them “cheering each other on as they watched each other use the Wii.” 

McCarthy also witnessed a sense of competition among the patients.
“In using Wii golf as therapy, you are asking a patient to practice a skill in something they might already be interested in doing,” she said. “As they watch their score, they get feedback right away if they’ve done it correctly.” 

In her experience, McCarthy said, the Wii game has attracted golfers and nongolfers.
But, she said, “The weight shifting that is used in Wii golf may come more naturally to someone who has actually played golf.”
She added, “If you think about sports, it’s about skills that you are learning coupled with practice and repetition. Patients are more willing to do the practice and repetition we’re asking them to do in therapy if they are having fun.”
McCarthy acknowledged that she could design patients’ workouts using more traditional therapy and achieve the same results. 

“The difference is that by using the Wii, it’s more fun for the patient,” she said. “I believe therapy should be fun and meaningful for the individual, and if they are having a good time while getting better, it’s another tool in our toolbox that we can use.”
Kaiser Permanente’s neurological physical therapy program added Wii golf more than two years ago. Since then, McCarthy has seen patients use the game to move beyond medically supervised rehabilitation — often buying the units for personal entertainment at home. She has also seen Wii golf used as a regular activity to keep seniors engaged and exercising.
“It’s so important to keep people moving, and this game achieves that,” McCarthy add

Therapeutic Exercise

Initial Evaluation:
During the initial evaluation, a physical therapist will meet with the patient one-on-one. The evaluation includes a thorough history of your injury as well as your past medical history. Your full assessment will include posture, soft tissue, range of motion, strength and gait assessments. At this time, you will be instructed in some exercises to help you with your injury.


How To Relieve Pain Without Medicine

What Are Some of The Ways I Can Relieve Pain Without Taking Medicine?For some people, pain can be relieved without using medicine. They use relaxation, imagery, distraction, and skin stimulation. You may need the help of health professionals to learn to do these for yourself. Friends or family members can help with some of them. The techniques are also useful along with pain medicines. Information about nondrug treatments for pain also may be available at a local hospice, cancer treatment center, or hospital pain clinic.

How Does Relaxation Work?Relaxation relieves pain or keeps it from getting worse by reducing tension in the muscles. It can help you fall asleep, give you more energy, make you less tired, reduce your anxiety, and make other pain relief methods work better. Some people, for instance, find that taking a pain medicine or using a cold or hot pack works faster and better when they relax at the same time.


Are There Any Basic Guidelines for Using Relaxation Techniques?
  • Understand that your ability to relax may vary from time to time and that relaxation cannot be forced.
  • Remember that it may take up to 2 weeks of practice to feel the first results of relaxation.
  • Try several relaxation methods until you find one that works for you.
  • Stick with the same method so that it becomes easy and routine for you. Use it regularly for at least 5 to 10 minutes twice a day.
  • Check for tension throughout the day by noticing tightness in each part of your body from head to foot. Relax any tense muscles. You may use a quick technique such as inhale/tense, exhale/relax, described below.
  • If you have any lung problems, check with your doctor before using any relaxation technique that requires deep breathing.
Is There Any Special Position I Should Be in When I Am Doing Relaxation Exercises?Relaxation may be done sitting up or lying down. Choose a quiet place whenever possible. Close your eyes. Do not cross your arms and legs because that may cut off circulation and cause numbness or tingling. If you are lying down, be sure you are comfortable. Put a small pillow under your neck and under your knees or use a low stool to support your lower legs.

How Do I Use Relaxation?There are many methods. Here are some for you to try:
Visual concentration and rhythmic massage:
  • Open your eyes and stare at an object, or close your eyes and think of a peaceful, calm scene. With the palm of your hand, massage near the area of pain in a circular, firm manner. Avoid red, raw, swollen, or tender areas. You may wish to ask a family member or friend to do this for you.
Inhale/tense, exhale/relax:
  • Breathe in (inhale) deeply. At the same time, tense your muscles or a group of muscles. For example, you can squeeze your eyes shut, frown, clench your teeth, make a fist, stiffen your arms and legs, or draw up your arms and legs as tightly as you can.
  • Hold your breath and keep your muscles tense for a second or two.
  • Let go! Breathe out (exhale) and let your body go limp.
Slow rhythmic breathing:
  • Stare at an object or close your eyes and concentrate on your breathing or on a peaceful scene.
  • Take a slow, deep breath and, as you breathe in, tense your muscles (such as your arms).
  • As you breathe out, relax your muscles and feel the tension draining.
  • Now remain relaxed and begin breathing slowly and comfortably, concentrating on your breathing, taking about 9 to 12 breaths a minute. Do not breathe too deeply.
  • To maintain a slow, even rhythm as you breathe out, you can say silently to yourself, “In, one, two; out, one, two.” It may be helpful at first if someone counts out loud for you. If you ever feel out of breath, take a deep breath and then continue the slow breathing exercise. Each time you breathe out, feel yourself relaxing and going limp. If some muscles are not relaxed such as your shoulders, tense them as you breathe in and relax them as you breathe out. You need to do this only once or twice for each specific muscle group.
  • Continue slow, rhythmic breathing for a few seconds up to 10 minutes, depending on your need.
  • To end your slow rhythmic breathing, count silently and slowly from one to three. Open your eyes. Say silently to yourself: “I feel alert and relaxed.” Begin moving about slowly.
Other methods you can add to slow rhythmic breathing:
  • Imagery.
  • Listen to slow, familiar music through an earphone or headset.
  • Progressive relaxation of body parts. Once you are breathing slowly and comfortably, you may relax different body parts, starting with your feet and working up to your head. Think of words such as limp, heavy, light, warm, or floating. Each time you breathe out, you can focus on a particular area of the body and feel it relaxing. Try to imagine that the tension is draining from that area. For example, as you breathe out, feel your feet and ankles relaxing; the next time you breathe out, feel your calves and knees relaxing, and so on up your body.
Relaxation tapes: Ask your doctor or nurse to recommend commercially available relaxation tapes. These tape recordings provide step-by-step instructions in relaxation techniques.
Will I Have Any Problems With Using Relaxation TechniquesSome people who have used relaxation for pain relief have reported the following problems and solutions to them:
  • Relaxation may be difficult to use with severe pain. If you have this problem, use a quick and easy relaxation method such as visual concentration with rhythmic massage or breathe in/tense, breathe out/relax.
  • You may have a feeling of “suffocation.” If so, take a deep breath.
  • Sometimes breathing too deeply for a while can cause shortness of breath. If this is your problem, take shallow breaths and/or breathe more slowly.
  • You may fall asleep. If you do not wish to fall asleep, sit in a hard chair while doing the relaxation exercise or set a timer or alarm.
  • You might get feelings of depression or withdrawal. Sometimes being relaxed makes you aware of problems you have been worrying about subconsciously. If this happens, talk to someone who can help you sort out your feelings.
If you have trouble using these methods, ask your doctor or nurse to refer you to a therapist who is experienced in relaxation techniques. Do not continue any relaxation technique that increases your pain, makes you feel uneasy, or causes any unpleasant effects.

What Is Biofeedback?With the help of special machines, people can learn to control certain body functions such as heart rate, blood pressure, and muscle tension. Biofeedback is sometimes used to help people learn to relax. Cancer patients can use biofeedback techniques to reduce anxiety and help them cope with their pain. Biofeedback usually is used with other pain-relief methods.

What Is Imagery, and How Does It Work?Imagery is using your imagination to create mental pictures or situations. The way imagery relieves pain is not completely understood. Imagery can be thought of as a deliberate daydream that uses all of your senses - sight, touch, hearing, smell, and taste. Some people believe that imagery is a form of self-hypnosis. Certain images may reduce your pain both during imagery and for hours afterward. If you must stay in bed or can’t go out of the house, you may find that imagery helps reduce the closed-in feeling; you can imagine and revisit favorite spots in your mind. Imagery can help you relax, relieve boredom, decrease anxiety, and help you sleep.

How Do I Use the Technique of Imagery?Usually, imagery for pain relief is done with the eyes closed. A relaxation technique may be used first. The image can be something such as a ball of healing energy or a picture drawn in your mind of yourself as a person without pain (for example, imagine that you are cutting wires that transmit pain signals from each part of your body to your brain). Here is an exercise with the first image - the ball of energy. It is a variation of the technique credited to Dr. David Bresler at the Pain Control Unit, University of California, Los Angeles (UCLA).
  • Close your eyes. Breathe slowly and feel yourself relax.
  • Concentrate on your breathing. Breathe slowly and comfortably from your abdomen.
  • As you breathe in, say silently and slowly to yourself:
    “In, one, two.” As you breathe out, say: “Out, one, two.” Breathe in this slow rhythm for a few minutes.
  • Imagine a ball of healing energy forming in your lungs or on your chest. It may be like a white light. It can be vague. It does not have to be vivid. Imagine this ball forming, taking shape.
  • When you are ready, imagine that the air you breathe in blows this healing ball of energy to the area of your pain. Once there, the ball heals and relaxes you.
  • When you breathe out, imagine the air blows the ball away from your body. As it goes, the ball takes your pain with it. (Be careful: Do not blow as you breathe out; breathe out naturally.)
  • Repeat the last two steps each time you breathe in and out.
  • You may imagine that the ball gets bigger and bigger as it takes more and more discomfort away from your body.
  • To end the imagery, count slowly to three, breathe in deeply, open your eyes, and say silently to yourself: “I feel alert and relaxed.” Begin moving about slowly.
Are There Any Problems With Using Imagery?
The problems are similar to the ones that may occur with relaxation techniques.

What Is Distraction, and How Does It Work?Distraction means turning your attention to something other than the pain. Many people use this method without realizing it when they watch television or listen to the radio to “take their minds off” the pain. Distraction may work better than medicine if pain is sudden and intense or if it is brief, lasting only 5 to 45 minutes. Distraction is useful when you are waiting for pain medicine to start working. If pain is mild, you may be able to distract yourself for hours. Some people think that a person who can be distracted from pain does not have severe pain. This is not necessarily true. Distraction can be a powerful way of temporarily relieving even the most intense pain.
 
How Can I Use Distraction?Any activity that occupies your attention can be used for distraction. If you enjoy working with your hands, crafts such as needlework, model building, or painting may be useful. Losing yourself in a good book might divert your mind from the pain. Going to a movie or watching television are also good distraction methods. Slow, rhythmic breathing can be used for distraction as well as relaxation. You may find it helpful to listen to rather fast music through a headset or earphones. To help keep your attention on the music, tap out the rhythm. You can adjust the volume to match the intensity of pain, making it louder for very severe pain. This technique does not require much energy, so it may be very useful when you are tired.

Are There Any Drawbacks To Using Distraction for Pain Relief?After using a distraction technique, some people report that they are tired, irritable, and feel more pain. Some also find that other people do not believe they are in pain if distraction provides pain relief. If these are problems for you, you may not wish to use distraction or you may simply be careful about which distraction methods you use and when you use them.

What Is Skin Stimulation, and How Does It Work To Relieve Pain?Skin stimulation is the use of pressure, friction, temperature change, or chemical substances to excite the nerve endings in the skin. Scientists believe that the same nerve pathways transmit the sensations of pain, heat, cold, and pressure to the brain. When the skin is stimulated so that pressure, warmth, or cold is felt, pain sensation is lessened or blocked. Skin stimulation also alters the flow of blood to the affected area. Sometimes skin stimulation will get rid of the pain, or the pain will be less during the stimulation and for hours after it is finished. Note: If you are having radiation therapy, check with your doctor or nurse before using skin stimulation. You should not apply ointments, salves, or liniments to the treatment area, and you should not use heat or extreme cold on treated areas.

Where Is Skin Stimulation Done?Skin stimulation is done either on or near the area of pain. You also can use skin stimulation on the side of the body opposite to the pain. For example, you might stimulate the left knee to decrease pain in the right knee. Stimulating the skin in areas away from the pain can be used to increase relaxation and may relieve pain.

What Is Used To Stimulate the Skin?Massage, pressure, vibration, heat, cold, and menthol preparations are used for skin stimulation.

How Do I Use Massage for Pain Relief?For pain relief, massage is most effective when using slow, steady, circular motions. You can massage over or near the area of pain with just your bare hand or with any substance that feels good such as talcum powder, warm oil, or hand lotion. Depending upon where your pain is located, you may do it yourself or ask a family member or friend to give you a massage. Remember, having someone give you a foot rub, back rub, or hand rub can be very relaxing and may relieve pain. Some people find brushing or stroking lightly more comforting than deep massage. Use whatever works best for you. Note: If you are having radiation therapy, avoid massage in the treatment area.

How Do I Use Pressure?Pressure can be applied with the entire hand, the heel of the hand, the fingertip or the knuckle, the ball of the thumb, or by using one or both hands to encircle your arm or leg. You can experiment by applying pressure for about 10 seconds to various areas over or near your pain to see if it helps. You can also feel around your pain and outward to see if you can find “trigger points,” small areas under the skin that are especially sensitive or that trigger pain. Pressure is usually most effective if it is applied as firmly as possible without causing pain. You can use pressure for up to about 1 minute. This often will relieve pain for several minutes to several hours after the pressure is released.

How Do I Use Vibration? Vibration over or near the area of pain may bring temporary relief. For example, the scalp attachment of a handheld vibrator often relieves a headache. For low back pain, a long, slender battery operated vibrator placed at the small of the back may be helpful. You may use a vibrating device such as a small battery operated vibrator, a handheld electric vibrator, a large heat-massage electric pad, or a bed vibrator.

Which Is Better for Relieving Pain - Cold Or Heat?As for any of the techniques described, you should use what works best for you. Heat often relieves sore muscles; cold lessens pain sensations by numbing the affected area. Many people with prolonged pain use only heat and have never given cold a try. Some people find that cold relieves pain faster, and relief may last longer.

What Are Some Comfortable and Convenient Ways To Use Cold or Heat?For cold, try gel packs that are sealed in plastic and remain soft and flexible even at freezing temperatures. Gel packs are available at drugstores and medical supply stores. They are reusable and can be kept in the freezer when not in use. Wrap the pack with a layer of towels so that it is comfortable for you. An ice pack or ice cubes wrapped in a towel can be just as effective. To use heat for pain relief, a heating pad that generates its own moisture (Hydrocolater) is convenient. Gel packs heated in hot water, hot water bottles, a hot, moist towel, a regular heating pad, or a hot bath or shower can also be used to apply heat. For aching joints such as elbows and knees, you can wrap the joint in lightweight plastic wrap (tape the plastic to itself). This retains body heat and moisture. Note: Do not use heat or cold over any area receiving radiation therapy.

What Are Menthol Preparations?Many menthol preparations are available for pain relief. There are creams, lotions, liniments, or gels that contain menthol. Brands include Ben Gay, Icy Hot, Mineral Ice, and Heet. When they are rubbed into the skin, they increase blood circulation to the affected area and produce a warm (sometimes cool) soothing feeling that lasts for several hours.

How Do I Use Menthol Preparations?First, test your skin by rubbing a small amount of the menthol preparation in a circle about 1 inch in diameter in the area of pain (or the area to be stimulated). This will let you know whether the menthol is uncomfortable to you or irritates your skin. If the menthol does not create a problem, rub some more into the area. The sensation caused by the menthol gradually increases and remains up to several hours. To increase the intensity and duration of the menthol sensation you can open your skin pores with heat (e.g., shower, sun) or wrap a plastic sheet over the area after the menthol application. (Don’t use a heating pad because it may cause a burn.) If you’re afraid others will find the odor offensive, you can use the menthol product when you are alone, or perhaps in the evening or through the night. Note: Many menthol preparations contain an ingredient similar to aspirin. A small amount of this aspirin-like substance is absorbed through the skin. If you have been told not to take aspirin, do not use these preparations until you check with your doctor.

What Precautions Should I Take if I Use Skin Stimulation?Heat and cold can easily damage your skin. It is easy to burn the skin with hot water from the tap or with settings too high on the heating pad. Extreme cold can also burn your skin.
  • Never use a heating pad on bare skin.
  • Never go to sleep for the night with the heating pad on.
  • Be very careful while using a heating pad if you are taking drugs or medicines that make you sleepy or if you do not have much feeling in the area.
  • Limit heat or cold application to 5 to 10 minutes.
  • Do not use heat or cold over any area where your circulation or sensation is poor.
  • If you start to shiver when using cold, stop using it right away.
  • Do not use cold so intense or for so long that the cold itself causes pain.
  • Do not use heat over a new injury because heat can increase bleeding. Wait at least 24 hours.
  • Do not rub menthol preparations over broken skin, a skin rash, or mucous membranes (such as inside your mouth or around your rectum). Make sure you do not get the menthol in your eyes.
  • Avoid massage and vibration over red, raw, tender, or swollen areas.
  • If skin stimulation increases your pain, stop using it.
  • As noted earlier, if you are undergoing (or have undergone) radiation treatments, do not use any skin stimulation method without first checking with your doctor or nurse. 

Physical Pain Relief Techniques


Many patients arrive at their first physical therapy appointment expecting to receive hot packs, ultrasound and instructions on how to complete a series of exercises. These modalities are warranted in many instances and most therapists would agree that exercise is needed to help restore muscle imbalances. However, many therapists now approach the restoration of function from a different perspective. These therapists are interested in why a muscle isn’t functioning properly and view back exercise not as the driving mode of recovery but as a complement to manual therapy. They may, for instance, look to restore proper sacroiliac or lumbar joint function to treat piriformis syndrome rather then directly manipulate the piriformis muscle through exercise.


Manual physical therapy is a specialized form of physical therapy delivered with the hands as opposed to a device or machine. In manual therapy, practitioners use their hands to put pressure on muscle tissue and manipulate joints in an attempt to decrease back pain caused by muscle spasm, muscle tension and joint dysfunction.

Manual Physical Therapy is Less Established for Back Pain Management

 

While all physical therapists have the option to use manual therapy in their practices, many don’t spend the time or the resources to become efficient in this area of practice. Patients should be aware that it is a lesser known physical therapy technique among physicians and may not be as commonly prescribed. Also, many of the conditions that practitioners treat with manual therapy are not demonstrated with imaging or lab tests but rather during motion testing and treatment, and therefore insurance company reimbursement may be limited.

While patients may be referred for physical therapy treatment by their primary care doctor, an orthopedic surgeon, or other doctor involved in their back care, most states have direct access laws permitting patients to seek help for low back pain from a licensed physical therapist without having to seek a written referral.
In This Article:
  • Manual Physical Therapy for Pain Relief
  • Specific Manual Physical Therapy Techniques

Manual Physical Therapy can Offer Pain Relief for Acute and Chronic Back Pain


Watch Acute vs Chronic Back Pain Video
Manual therapy can be helpful for the treatment of joints that lack adequate mobility and range of motion in certain musculo-skeletal conditions. This limitation can cause discomfort, pain, and an alteration in function, posture, and movement. Manual physical therapy involves restoring mobility to stiff joints and reducing muscle tension in order to return the patient to more natural movement without pain. Thus, manual physical therapy may provide back pain relief both for patients with chronic back pain involving joint problems, such as sacroiliac joint dysfunction , and acute back pain from soft tissue injuries such as a back muscle strain or a pulled back ligament. Although extensive clinical studies have yet to be performed on all areas of manual therapy, limited clinical data and patient reports support the assertion that manual physical therapy can be effective in relieving back pain for certain patients.
As a group, manual physical therapy techniques are aimed at relaxing tense back muscles and restricted joints in order to decrease back pain and increase flexibility. In general, manual physical therapy techniques employ the following types of movement:
  • Soft tissue work, including massage, which applies pressure to the soft tissues of the body such as the muscles. This pressure can help relax muscles, increase circulation, break up scar tissue, and ease pain in the soft tissues.
  • Mobilization/manipulation, which uses measured movements of varying speed (slow to fast), force (gentle to forceful), and distances (called ‘amplitude’) to twist, pull, or push bones and joints into position. This can help loosen tight tissues around a joint, reduce pain in a joint and surrounding tissue, and help with flexibility and alignment.
The following page covers the specific manual physical therapy techniques that are designed to alleviate low back pain related to muscle spasm, muscle tension and joint problems.


Before beginning manual therapy or any type of physical therapy, the practitioner usually performs a full assessment of the blood and nerve supply in the area, as well as a bone and muscle assessment, in order to decide whether or not there is an increased risk of complications from the use of these back pain management techniques. Depending on the results of that assessment and each individual back pain patient’s particular situation, the healthcare provider may perform some or a combination of the following types of manual physical therapy:

Soft Tissue Mobilization


It is important to recognize the role of muscles and their attachments around the joints. Muscle tension can often decrease once joint motion is restored, but many times the spasm will continue to be present. In such cases, muscle tension should be addressed or the joint dysfunction may return. The goal of soft tissue mobilization (STM) is to break up inelastic or fibrous muscle tissue (called ‘myofascial adhesions’) such as scar tissue from a back injury, move tissue fluids, and relax muscle tension. This procedure is commonly applied to the musculature surrounding the spine, and consists of rhythmic stretching and deep pressure. The therapist will localize the area of greatest tissue restriction through layer-by-layer assessment. Once identified, these restrictions can be mobilized with a wide variety of techniques. These techniques often involve placing a traction force on the tight area with an attempt to restore normal texture to tissue and reduce associated pain.

Strain-Counterstrain

This technique focuses on correcting abnormal neuromuscular reflexes that cause structural and postural problems, resulting in painful ‘tenderpoints’. The therapist finds the patient’s position of comfort by asking the patient at what point the tenderness diminishes. The patient is held in this position of comfort for about 90 seconds, during which time asymptomatic strain is induced through mild stretching, and then slowly brought out of this position, allowing the body to reset its muscles to a normal level of tension. This normal tension in the muscles sets the stage for healing. This technique is gentle enough to be useful for back problems that are too acute or too delicate to treat with other procedures. Strain-counterstrain is tolerated quite well, especially in the acute stage, because it positions the patient opposite of the restricted barrier and towards the position of greatest comfort.
In This Article:
  • Manual Physical Therapy for Pain Relief
  • Specific Manual Physical Therapy Techniques

Joint Mobilization

Patients often get diagnosed with a pulled muscle in their back and are instructed to treat it with rest, ice and massage. While these techniques feel good, the pain often returns because the muscle spasm is in response to a restricted joint. Joint mobilization involves loosening up the restricted joint and increasing its range of motion by providing slow velocity (i.e. speed) and increasing amplitude (i.e. distance of movement) movement directly into the barrier of a joint, moving the actual bone surfaces on each other in ways patients cannot move the joint themselves. These mobilizations should be painless (unless the operator approaches the barrier too aggressively).

Muscle Energy Techniques

Muscle energy techniques (MET’S) are designed to mobilize restricted joints and lengthen shortened muscles. This procedure is defined as utilizing a voluntary contraction of the patient’s muscles against a distinctly controlled counterforce applied from the practitioner from a precise position and in a specific direction. Following a 3-5 second contraction, the operator takes the joint to its new barrier where the patient again performs a muscle contraction. This may be repeated two or more times. This technique is considered an active procedure as opposed to a passive procedure where the operator does all the work (such as joint mobilizations). Muscle energy techniques are generally tolerated well by the patient and do not stress the joint.

High Velocity, Low Amplitude Thrusting

The goal of this procedure is to restore the gliding motion of joints, enabling them to open and close effectively. It is a more aggressive technique than joint mobilizations and muscle energy techniques that involves taking a joint to its restrictive barrier and thrusting it (low amplitude of less the 1/8 inch) to, but not past, its restrictive barrier. If utilized properly, increased mobility and a decrease in muscle tone about the joint should be noticed. This technique is utilized for restoration of joint motion and does not move a joint beyond its anatomical limit. Therefore, no structural damage takes place and the patient should not have an increase in pain following the treatment.

Maintaining Back Pain Relief Long-Term

To continue the healing process and prevent recurring pain, back pain patients are encouraged to engage in other appropriate treatments (including an exercise program) during and after manual therapy treatment. Exercise programs for back pain usually include stretching and strengthening exercises and low-impact aerobic conditioning, and should include a reasonable maintenance exercise program for patients to do on their own. The goal is to maintain the right type and level of activity to prevent the pain from re-occurring and avoid the need for frequent return visits to the therapist.

Pain is a very common condition. At any given time, around one-third of Australians are in pain, with one in five reporting that their pain is constant. The incidence of pain rises as people get older and women are more likely to be in pain than men. Pain management strategies include pain-relieving medications, physical or occupational therapy and complementary therapies (such as acupuncture and massage).

Studies suggest that a person’s outlook and the way they emotionally cope with long-term (chronic) pain can influence their quality of life. Counselling can help support you to manage the emotional and psychological effects of chronic pain. Understanding the causes of your pain can help reduce your fear and anxiety.

Causes of pain


Pain may be anything from a dull ache to a sharp stab and can range from mild to extreme in severity. It may be located in one part of the body or be widespread.

Causes of pain in adults include medical conditions (such as cancer, arthritis and back problems), injuries and surgery. The most commonly reported pain is back pain. Pain involving the limbs, shoulder, neck and head is also common.

See your doctor if pain continues


Seven out of 10 people seek professional help for their pain, mostly from a registered medical doctor (GP). For some people, the cause of the pain won’t be found or there will be no available treatment for it. In other cases, the cause may be remedied but the associated pain lingers on. Always see your doctor for diagnosis and treatment of persistent pain.

How pain affects the body


There are two types of pain depending on how long a person has it. Acute pain is a normal response to tissue injury, which starts suddenly and is usually short lived. Chronic (ongoing) pain persists beyond the normal time of healing and generally lasts for longer than three months. The vast majority of people with chronic pain have it for more than a year. This type of pain is usually the result of an injury (for example, a sports or work accident), illness or other health problem. The cause is unknown in around one-third of cases.

The body’s reaction to unrelieved pain includes:
  • Increased heart rate and blood pressure
  • Changes to blood gases, namely reduced oxygen and increased carbon dioxide
  • Higher levels of stress hormones including cortisol and adrenaline
  • Gastrointestinal problems such as slowed digestion
  • Musculoskeletal problems such as tension and fatigue
  • Emotional problems such as anxiety and depression.

Pain-relieving medicines


Medications available for the management of pain include:
  • Paracetamol
  • Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen – these medicines reduce inflammation (redness and swelling)
  • Opioid drugs, such as codeine and morphine – these medicines treat moderate to severe pain
  • Local anaesthetics.

Choosing the right medicine


The right choice of medication for you will depend on your pain. Issues you need to discuss with your doctor include:
  • The location, intensity and type of pain
  • Any activities that ease the pain or make it worse
  • The impact your pain has on your lifestyle, such as how it affects your appetite or quality of sleep.

Your other medical conditions and the medicines you take can also determine which pain-relieving medication is right for you. You should discuss these with your doctor so that you choose the safest and most effective option.

Managing your medications effectively


Always follow instructions for taking your medications safely and effectively. By doing so, your pain is more likely to be well managed, you are less likely to take larger doses of painkillers and you can reduce your risk of side effects.

Medications for chronic pain are best taken regularly. Talk to your doctor or pharmacist if your medicines lose their ability to reduce your pain or are causing you other problems, such as side effects. These are more likely to occur if you are taking pain-relieving medications for a long time.

People can lower their levels of felt pain by learning self-management skills, such as coping with depression and stress. Some studies have shown that medication can undermine the value of developing these skills. It is important to learn the skills you need to cope with your pain and not rely on medications alone to do this.