Modalities: Physical Therapy

The work “modalities” refers to passive treatments that can often be instrumental in breaking the cycle of pain, which can cause spasm, which can cause more pain, etc. These treatments include orthopaedic manipulation, electrical stimulation, myofascial release, ultrasound and heat/ice.

Orthopaedic Manipulation: Manual Therapy

Manual therapy includes manipulation and mobilization. This therapy involves restoring mobility (eg range of motion) to stiff joints and alleviating pain. Manipulation is a passive, specifically controlled movement to release a joint back into correct position and/or reduce muscle spasms that may cause or contribute to spinal nerve irritation.

Often prior to manipulation, modalities like heat or ultrasound may be applied to relax and warm the soft tissues.

Electrical Stimulation

Electrical stimulation is also known as Transcutaneous Electrical Nerve Stimulation (TENS). TENS delivers a painless electrical current through the patient’s skin to specific nerves. The current produces mild heat that works to relieve stiffness and pain and helps to improve range of motion (mobility). This treatment is non-invasive with no known side effects. It may be used to control acute pain and chronic pain.


Ultrasound is a common non-invasive therapy used to treat back and neck pain, tendon and ligament injury, muscle spasms, joint problems and other spine related conditions.

After applying some gel to the patient’s skin, the physical therapist can use the ultrasound probe over the affected area. Ultrasound uses high-frequency sound waves to deliver heat deep into tissues (eg muscles). This therapy promotes circulation and healing, relaxes muscle spasm, decreases inflammation and helps to alleviate pain.

Ice and Heat Therapies

Cold treatments are never applied directly to the skin. Ice (cold) can burn. A barrier such as toweling is placed between the skin and the cold source. Ice helps to reduce blood flow thereby decreasing swelling, inflammation and pain.

Heat therapy options include heat packs (plus skin barrier) and ultrasound. Warm moist heat increases circulation to the affected area. Blood carries needed nutrients to the area and flushes away toxins. Heat helps to relax stiff, sore muscles.