Physical Medicine and Rehabilitation: Modalities and Exercise

Abstract

Function is the marker by which those in the medical profession treating patients with pain strive to improve. The profession of physical medicine and rehabilitation has, at its tenet, the goal of improving or even restoring physical function and therefore plays an integral role in the care of patients with pain. Physical modalities such as temperature therapy with both heat and cold; manual therapies, including manipulation, mobilization, massage, traction, and transcutaneous electrical nerve stimulation; and kinesio taping, are important adjunct therapies often employed in comprehensive rehabilitation programs. Although there is in general a lack of rigorous scientific evidence to support the use of these alternative modalities individually, their low-risk profiles, low cost, and ease of application combined with plenty of anecdotal evidence for their efficacy make them indispensable to the pain practitioner. Incorporating these adjunct therapies in conjunction with appropriate exercise protocols along with pharmacologic and interventional tools may place the pain patient at a distinct advantage, improving function and pain perception. In the following review, we introduce these concepts to allow guidance for incorporation into the treatment algorithm of common pain conditions. This review contains 16 figures, 2 tables and 79 references Key words: cryotherapy, exercise, manipulation, manual, massage, mobilization, temperature, traction, transcutaneous electrical nerve stimulation