Therapists treat pain and inflammation. Such treatment makes movement easier and enables people to participate more fully in rehabilitation. Techniques used include heat therapy, cold therapy, electrical stimulation, traction, massage, and acupuncture. For therapists, whether to use heat or cold therapy is often a personal choice, although cold therapy seems to be more effective for acute pain.

Heat therapy: Heat increases blood flow and makes connective tissue more flexible. It temporarily decreases joint stiffness, pain, and muscle spasms. Heat also helps reduce inflammation and the buildup of fluid in tissues (edema). Heat therapy is used to treat inflammation (including various forms of arthritis), muscle spasm, and injuries such as sprains and strains.

Heat may be applied to the body's surface or to deep tissues. Hot packs, infrared heat, paraffin (heated wax) baths, and hydrotherapy (agitated warm water) provide surface heat. Heat may be generated in deep tissues by electric currents (diathermy) or high-frequency sound waves (ultrasound).

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Types of Heat Therapy Type Description Comment Uses Heat applied to the body's surface Infrared heat Heat applied with a lamp Care needed to avoid burns Not used in people with a severe heart, liver, or kidney disorder, peripheral vascular disease, or reduced skin sensation Arthralgia Arthritis (various forms) Back pain Fibromyalgia Muscle spasm Myositis Neuralgia Sprains Strains Tenosynovitis Whiplash injuries Hot packs Cotton cloth containers filled with silicate gel, usually warmed in a microwave oven Same as for infrared heat Paraffin bath Dipping in, immersion in, or painting with melted wax Usually applied to small joints, such as those of the hand, knee, or elbow Not used for open wounds Hydrotherapy Immersion in agitated warm water in a large industrial whirlpool Enhances wound healing by stimulating blood flow and helping clean out burns and wounds Relaxes muscles and relieves pain Helps with range-of-motion exercises Heat applied to deep tissues Diathermy, shortwave Heat produced by an oscillating, high-frequency electromagnetic field Not used in people with cancer, bleeding disorders, peripheral vascular disease, reduced skin sensation, nonremovable prostheses, or implanted metal devices (such as pacemakers) Pain due to kidney stones, pelvic infections, or sinusitis (short-term or chronic) Diathermy, microwave Heat produced by microwaves Simpler to apply and more comfortable than shortwave diathermy Evenly warms deep tissues (such as muscles) without undue heating of the skin Same limits to use as for shortwave diathermy Ultrasound High-frequency sound waves to penetrate deep into tissues, vibrating them and producing heat, which draws blood (with oxygen and nutrients) to the area Not applied to tissues whose blood supply has been reduced (ischemia), numbed or actively infected areas, bones that are healing, or certain parts of the body (such as the eyes, brain, spinal cord, ears, heart, or reproductive organs) Not used in people with a tendency to bleed or cancer Bone injuries Bursitis Complex regional pain syndrome Contractures Osteoarthritis Tendinitis

Cold therapy (cryotherapy): Applying cold may help numb tissues and relieve muscle spasms, acute low back pain, and acute inflammation. Cold may be applied using an ice bag, a cold pack, or fluids (such as ethyl chloride) that cool by evaporation. The therapist limits the time and amount of cold exposure to avoid damaging tissues and reducing body temperature (causing hypothermia). Cold is not applied to tissues with a reduced blood supply (for example, when the arteries are narrowed by peripheral arterial disease).

Electrical stimulation: If muscles lack proper nerve input (because of a peripheral nerve injury, spinal cord disorder, or stroke), the muscles quickly waste away (atrophy), and become stiff and contracted (spastic). Electrical stimulation by electrodes placed on the skin causes the muscles to contract, providing a form of exercise that helps prevent atrophy and spasticity.

One form of electrical stimulation—called transcutaneous electrical nerve stimulation (TENS)—uses low current that does not cause muscles to contract. TENS may be useful for chronic back pain, rheumatoid arthritis, a sprained ankle, shingles, or a localized area of pain. For TENS, a handheld, battery-powered device produces the current, which is applied through electrodes placed on the skin. The device produces a tingling sensation but is not painful.

TENS may be applied several times a day for 20 minutes to several hours, depending on the severity of the pain. Often, people can be taught to use the TENS device at home as needed. Most people tolerate the therapy well, but not all people experience pain relief. TENS may cause abnormal heart rhythms (arrhythmias). Thus, people who have a severe heart disorder or a pacemaker should not use it. TENS should not be applied to or near the eyes.

Traction: Neck (cervical) traction may be used in a hospital, rehabilitation center, or at home to treat chronic neck pain due to cervical spondylosis, disk prolapse, whiplash injuries, or torticollis. Traction is more effective when people are sitting than when they are lying in bed. A system that uses a motor is usually most effective. Typically, traction is combined with other physical therapy, including exercises and manual stretching. Although cervical traction devices are available through consumer catalogues, therapists should select the type of device and determine the amount of weight to be used. People should not use such devices alone. A family member should be available to release the weight gently, which reduces the risk of injury.

Massage: Massage may relieve pain, reduce swelling, and help loosen tight (contracted) tissue. Only a licensed massage therapist should perform massage for treatment of an injury. Massage should not be used to treat infections or thrombophlebitis.

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Some Uses for Massage Amputation Arthritis Bruises Bursitis Cerebral palsy Fibromyalgia Fractures Hemiplegia Joint injuries Low back pain Multiple sclerosis Neuritis Paraplegia Periarthritis Peripheral nerve injuries Quadriplegia Sprains Strains Tight (contracted) tissues

Acupuncture: Thin needles are inserted through the skin at specific body sites, often far from the site of pain. The needles may be twirled rapidly and intermittently for a few minutes, or a low electric current is applied through the needles. Acupuncture may stimulate the brain to produce endorphins. Endorphins, produced naturally in the brain, block pain sensations and reduce inflammation (see Complementary and Alternative Medicine (CAM): Acupuncture). Acupuncture is sometimes used with other treatments to manage chronic pain and to help with rehabilitation after stroke. Acupuncture should be done by a certified acupuncturist and with sterile needles.

Last full review/revision July 2007 by Masayoshi Itoh, MD, MPH; Mathew H. M. Lee, MD