Professional rehabilitation therapists treat pain and inflammation. Such treatment makes movement easier and enables people to participate more fully in rehabilitation Overview of Rehabilitation Rehabilitation services are needed by people who have lost the ability to function normally or have pain. Loss of function may be due to fracture, amputation, stroke or another neurologic disorder... read more . These treatments are often used before and after exercise therapy and are components of the overall rehabilitation plan. Techniques used include
For therapists, whether to use heat or cold therapy is often a personal choice made together with the person being treated, although cold therapy seems to be more effective for acute pain. When heat therapy and cold therapy are used, caution must be used to avoid burns Burns Burns are injuries to tissue that result from heat, electricity, radiation, or chemicals. Burns cause varying degrees of pain, blisters, swelling, and skin loss. Small, shallow burns may need... read more and cold injuries Overview of Cold Injuries The skin and the tissues under it are kept at a constant temperature (about 98.6° F, or 37° C) by the circulating blood and other mechanisms. The blood gets its heat mainly from the energy given... read more .
Heat increases blood flow and makes connective tissue more flexible. It temporarily decreases joint stiffness, pain, and muscle spasms. Heat also may help reduce the buildup of fluid in tissues (edema Swelling Swelling is due to excess fluid in the tissues. The fluid is predominantly water. Swelling may be widespread or confined to a single limb or part of a limb. Swelling is often in the feet and... read more ). Heat therapy is used to reduce pain and stiffness in people with some forms of arthritis, and reduce muscle spasm with 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 high-frequency sound waves (ultrasound).
Low-level laser therapy (cold laser)
Low-level laser therapy applies light energy to deeper tissues to treat conditions including sprains, strains, neck and back pain, shoulder pain, and fibromyalgia Fibromyalgia Fibromyalgia is characterized by poor sleep, fatigue, mental cloudiness, and widespread aching and stiffness in soft tissues, including muscles, tendons, and ligaments. Poor sleep, stress, strains... read more . It should not be used over the eyes, the site of a known cancer, a developing fetus, a pacemaker or other implanted device, or the thyroid gland. The light can trigger a seizure in people with epilepsy who are photosensitive. People in the room during this therapy, including the patient and health care professionals, should wear appropriate safety eyewear.
Cold therapy (cryotherapy)
Applying cold may help numb tissues and relieve muscle spasms, pain due to injuries, and low back pain or inflammation that has recently developed. 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 Hypothermia Hypothermia (dangerously low body temperature) is often regarded as a cold injury, because it can be caused or made worse by exposure to cold surroundings. Being in an environment that is too... read more ). Cold is not applied to tissues with a reduced blood supply (for example, when the arteries are narrowed by peripheral arterial disease Overview of Peripheral Arterial Disease Peripheral arterial disease results in reduced blood flow in the arteries of the trunk, arms, and legs. Most often, doctors use the term peripheral arterial disease to describe poor circulation... read more ).
If muscles lack proper nerve input (because of a peripheral nerve injury Overview of the Peripheral Nervous System The peripheral nervous system refers to the parts of the nervous system that are outside the central nervous system, that is, those outside the brain and spinal cord. Thus, the peripheral nervous... read more , spinal cord disorder Overview of Spinal Cord Disorders Spinal cord disorders can cause permanent severe problems, such as paralysis or impaired bladder and bowel control ( urinary incontinence and fecal incontinence). Sometimes these problems can... read more , or stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction). Symptoms occur suddenly... read more ), 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 Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more , a sprained ankle, shingles Shingles Shingles is a painful skin rash caused by a viral infection that results from reactivation of the varicella-zoster virus, the virus that causes chickenpox. What causes the virus to reactivate... read more , 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.
Transcutaneous electrical nerve stimulation 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 Overview of Abnormal Heart Rhythms Abnormal heart rhythms (arrhythmias) are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart. Heart disorders are... read more (arrhythmias). Thus, people who have a severe heart disorder or an artificial pacemaker Artificial Pacemakers There are many causes of abnormal heart rhythms (arrhythmias). Some arrhythmias are harmless and do not need treatment. Sometimes arrhythmias stop on their own or with changes in lifestyle,... read more should not use it. TENS should not be applied to or near the eyes.
Neck (cervical) traction may be used in a hospital, rehabilitation center, or at home to treat chronic neck pain due to degeneration of bones in the neck (cervical spondylosis Cervical Spondylosis Cervical spondylosis is degeneration of the bones in the neck (vertebrae) and the disks between them, putting pressure on (compressing) the spinal cord in the neck. Osteoarthritis is the most... read more ), a ruptured disk, whiplash injuries, or spasm of the neck muscles (torticollis—see Focal and segmental dystonias Focal and segmental dystonias ). 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 Physical Therapy (PT) Physical therapy, a component of rehabilitation, involves exercising and manipulating the body with an emphasis on the back, upper arms, and legs. It can improve joint and muscle function, helping... read more , including exercises and stretching exercises. 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 Therapy In massage therapy (a manipulative and body-based practice), body tissues are manipulated to reduce pain, relieve muscle tension, and reduce stress. Massage therapy involves a variety of light-touch... read more may relieve pain, reduce swelling, and help loosen tight (contracted) tissue. Only a licensed massage therapist should use massage to treat an injury. Massage should not be used to treat infections or inflammation due to blood clots (thrombophlebitis).
Some Uses for Massage
In acupuncture Acupuncture Acupuncture, a therapy within traditional Chinese medicine, is one of the most widely accepted CAM therapies in the Western world. Licensed practitioners do not necessarily have a medical degree... read more , 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. Acupuncture is sometimes used with other treatments to manage recently developed or chronic pain Chronic Pain Chronic pain is pain that lasts or recurs for months or years. Usually, pain is considered chronic if it does one of the following: Lasts for more than 3 months Lasts for more than 1 month after... read more and arthritis Joint Disorders . Acupuncture should be done by a certified acupuncturist and with sterile needles.
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