Traction is the process in which force is applied to the body in a way that causes a slight separation in the joints of the vertebral column. Such force can be performed manually, by a trained medical professional, or mechanically, by a machine. Traction is most often used when the patient has low back, neck or radiating pain into the arms or legs, usually caused by vertebral disc protrusion, degenerative changes or nerve impingement. Common effects of traction include joint distraction, a reduction in protrusion or bulging of discs, stretching and relaxation of surrounding muscles, which limits muscle spasm, a decrease in joint inflammation and alleviation of nerve root impingement symptoms. Traction should not be used on a patient that has a tumor in the area, infection, vascular disorders, joint instability, rheumatoid arthritis, osteoporosis, or other bone density disorder, or is pregnant.
Moist Heat/Hot Packs
Application of moist heat has been used for many years as a safe, inexpensive treatment for pain and muscle spasm. Moist heat decreases muscle spasm and the sensation of pain by promoting muscle relaxation. Moist heat increases blood flow by dilating capillaries, bringing increased nutrients and oxygen to tissues and speeding the healing process. Dry heat, such as an electrical heating pad, isn’t as effective because it does not penetrate as deeply as moist heat, which can penetrate 1-5 mm into tissues. Heat is used on sub-acute or chronic injuries (at least 48 hours after an injury occurs). The use of heat is cautioned on areas where swelling or bruising is present, because it may promote further leakage of small capillaries, causing further edema or bruising. Caution should also be used in areas of impaired sensation. Moist heat is generally not recommended over malignant tumors.
Cold/ Ice Packs
Cold packs or ice is often used therapeutically to reduce pain, swelling, muscle spasm and inflammation. Cold decreases the sensation of pain by reducing the ability of the nerves to conduct pain impulses. The lowered temperature also causes vasoconstriction, narrowing of the blood vessels, and decreases the flow of fluids to the areas being treated. This, in turn, reduces the release of histamines, the body’s chemicals that promote inflammation. Cold treatments can be used on acute to chronic conditions. A physical therapist determines the best treatment for each condition based on a variety of factors.
Cold packs are administered by wrapping gel cold packs in a wet towel and applying them to the affected area for approximately 15-20 minutes. Ice can also be massaged directly on the skin for a more concentrated treatment. Skin integrity is monitored throughout these treatments to prevent the possibility of frostbite, however cold treatment is generally well tolerated.
Therapeutic ultrasound involves the use of high frequency sound waves that penetrate deeply into the tissues producing heat, decreasing inflammation and increasing soft tissue extensibility. The waves cause the molecules in the tissue to vibrate, which produces heat and increases the movement of the fluid surrounding the tissue. Heating of the deep tissues increases blood flow to the area, increasing extensibility of muscle and connective tissue and fluid movement, which promotes a decrease in inflammation. All of these effects encourage the healing process. Ultrasound waves can penetrate as deeply as 5 centimeters into tissues.
Ultrasound is a very comfortable, well-tolerated treatment. It is usually administered in a comfortable sitting or lying position to a localized area through the use of an ultrasound machine, with an applicator containing a quartz crystal that produces sound waves. A conductive gel is placed on the skin during the treatment to aid in the transmission of the ultrasound waves. Patients will often have only a very mild warmth sensation during the treatment, however sometimes heat may not be perceptible at all. Ultrasound treatments are generally 5-10 minutes in duration, depending on the desired effect of the therapist and the size of the treatment area.
Electrical stimulation uses a mild electrical current to stimulate muscle and nerve fibers to reduce the sensation of pain, increase muscle strength, improve range of motion and/or decrease inflammation. Electrodes are placed superficially on the area or muscle(s) to be treated. The electrodes are attached to a machine that produces a specific electrical current, as set by a physical therapist. Electrical stimulation machines allow a therapist to manipulate the various characteristics of the electrical output depending on patient tolerance and the desired therapeutic effect. Treatment duration varies depending on patient tolerance and the desired outcome of the specific therapy.
Transcutaneous Electrical Nerve Stimulation (TENS) is a type of electrical stimulation used for pain management. A mild current stimulates the nerves, blocking the pain signals before they can be transmitted to the brain. Machine modes, settings and intensities vary according to individual patient comfort and response. Patients using TENS will usually experience a comfortable, mild tingling sensation. TENS is available for home use, if indicated.
Neuromuscular Electrical Stimulation (NMES) is the use of electrical current to stimulate motor nerves, causing the corresponding muscles to contract. Such contractions can be used to build muscle strength, reduce muscle atrophy, increase range of motion, decrease the occurrence of muscle spasm by fatiguing the muscle and/or decrease inflammation by “pumping” fluid out of the area tissues. NMES can be used along with active exercises to intensify weak contractions and encourage muscle re-education. NMES treatment is comfortable for most patients.
Iontophoresis is the administration of a medication transcutaneously (through the skin) with the use of an ion-based electrical current. This is used as a non-invasive means of delivering a medication directly to a treatment area. Iontophoresis is most commonly used to control pain and inflammation in a small localized area. It uses a low intensity electrical current to push medication through the patient’s skin. The medication is often mixed with water or a water-soluble gel to form an ionic solution. It uses Coulomb’s Law, “like charges repel one another.” The medicated solution is placed under the electrode, through which a current with the same polarity is applied. The medication is pushed through the skin following the path of least resistance. During the treatment, the patient may experience a mild tingling or prickly sensation. The intensity of the current can be adjusted to accommodate the patient’s comfort level. Iontophoresis should not be used over broken or irritated skin. It is also contraindicated in patients with a pacemaker, a history of stroke, decreased sensation or extremely sensitive skin, and in pregnant women or near areas where a blood clot is present.