Why I Don't Use Passive Modalities for Treatment
Modalities have been a staple in most physical therapy clinics for as long as I can remember. Hot/cold packs, e-stim units, ultrasound and more, are almost expected as part of a treatment session. In fact, these treatment methods are taught throughout the doctorate program (at nauseum) and you are responsible for it’s content on the national boards examination. However, many experts have drifted away from using these modalities in their clinics.
Restore Physical Therapy is one of those clinics, so let me tell you why!
Each of these modalities are utilized for a specific response. In this article, we will break down what these tools are good for and how we have been able to use more useful & productive methods to get faster results for our clients. Most importantly, I am a strong believer that my 7 years of schooling to obtain a Doctorate degree and countless hours of internship, should be put to better use than hooking my clients up to a machine and walking away for 5-10 minutes.
Heat & Ice Packs
Hot and cold packs are typically used at the beginning and/or end of treatment sessions (sometimes in conjunction with e-stim...a double whammy!) Heat will help to loosen up the tight muscles that are being targeted in that session, while hopefully decreasing pain. Cold packs are utilized to decrease inflammation either at the beginning of the session so the client can tolerate PT, or at the end of a session to reduce the risk of post-treatment irritation/pain. Sounds great doesn't it? You’re not wrong, however for the amount of money you spend on physical therapy, we believe that your hard-earned cash is better spent with a doctor who will use their hands to directly make changes for the client. By performing a passive range of motion exercise protocol or including a dynamic warm-up, research has shown that target muscles will reach equal extensibility, in comparison to a hot pack. In addition, cool-down exercises such as static stretching or self-mobilizations are a great way to reduce pain and teach the client how to become more independent & in-control of their symptoms...which is the ultimate goal of a physical therapy program.
Research Article: Heat vs Exercise
Electrical Stimulation Units (E-stim)
It is very common for physical therapy sessions to begin with some form of electric stimulation, where the therapist or aid will place pads onto the target area and allow the machine to work it’s magic. The e-stim units are effective at improving local blood flow to those muscles, while reducing pain by essentially overriding the superficial pain receptors of the skin. However, research has shown that a passive program (E-stim alone), exercise-only program, or combined program, provide no significant difference in performance. Therefore, we can conclude that the same effects of the e-stim unit can be gained simply by movement and exercise!
Research Article: E-Stim vs Exercise
Ultrasound (US)
Ultrasound is commonly misunderstood by clients who receive this modality. US is a heat modality! It uses a concentrated, forced sound wave to create mini-vibrations into the target muscle. These waves produce heat, which then warms the tissue, thus decreasing pain and improving tissue extensibility. However, much like the above modalities, research has proven that this is not necessary to receive similar effects. In fact, a study in 2015 showed that US + exercise was equally effective as the control group which was given a “sham” US treatment (the machine was never turned on) + exercise. This proves that exercise alone can provide the same effects, without wasting time on ultrasound.
Research Article: Ultrasound vs Exercise
The moral of the story is that movement is medicine. No amount of fancy tools, devices or technology can supplement the body's needs to get up and exercise. I encourage you all to question your treatment methods and decide if your time in the physical therapy office is truly being well-spent. Experienced therapists will agree that a more direct approach is much more beneficial than passive modalities such as heat/ice, e-stim or ultrasound.
If you are currently suffering from an injury that is unresolved, or you are unsatisfied with your current physical therapy treatment, do not hesitate to contact Restore Physical Therapy today! The expert staff will help diagnose your injury, utilizing a full-body screen and evaluation. Let us help you get to the root cause of your problems and fix them! Our goal is to help you get back to all of your favorite activities, pain-free!
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