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.