Manual Therapy, Electrotherapy and Movement!

We we talk about Physiotherapy in society, like a bunch of other professions, you can get good physio’s and not so good physio’s. Here at The Movement Team, we like the fact we are different from most physiotherapy practices out there. But before explaining how we are different, I want to highlight some things that most physiotherapist’s have in their ‘toolbox’ to help treat a patient.

 

We we arrive fresh faced at Physiotherapy School, we get taught the standard Anatomy, Physiology, Biochemistry, but then also how to assess an area of the body, and also how to treat an area of the body. For the purpose of this blog, I’m going to be talking about Musculoskeletal Physiotherapy as this is what you will mostly likely find in private practice (as opposed to other branches of physiotherapy e.g. paediatric, cardiothoracic, Neurorehababilitation).

 

When it comes to treatment options, there are a variety of things that a Physiotherapist can do to help with treating a patient. The most common of these is Manual Therapy.

 

In the Physio world, manual therapy is any technique where the therapists hands are on your body. This includes massage, joint/muscle stretches, joint mobilisations (the art of pushing on a joint to make it move), joint manipulations (usual quick high velocity mobilisations which usually cause an audible cavitation or ‘click’ or ‘crack’ sound), and muscle energy techniques (using muscles to help mobilise a joint) to name a few. 

Manual Therapy

 

Now when patients present at the clinic with pain, manual therapy techniques are for the most part symptoms relievers. This is why: We have neurons that receive information from our sensory organs and transmit this input to the central nervous system (CNS) which are called afferent neurons. These afferent neurons are what tells our brains that something is painful. On the other side neurons that send impulses from the central nervous system to your limbs and joints to make things move or gain/release tension are called efferent neurons. Manual techniques like those stated above are designed to modulate the afferent input to our CNS. This is why you can get pain relief from a Physiotherapist pushing around on your joint for a while, or from a massage therapist working on your muscles. This input modulation can then also have an efferent effect on that area from the CNS. This change might be muscle relaxation or tension reduction or increased movement in the joint as an example. This may further improve afferent pain levels, and so a cycle can begin.

 

Neck manual therapy.

Sounds great right?! However, as most people would know, this effect may only last a few hours, a few days, or a week, and things usually start to tighten up again at some point. Did we fix the issue? Unlikely. But it helped you feel better while it lasted. Then how do we get the effects to last? I’ll touch more on this further down…

 

Electrotherapy encompasses the use of a machine which is placed on a patients body. These include but aren’t limited to: ultrasound therapy, TENS, and interferential which are probably the most used in Physiotherapy private practices.

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Therapeutic ultrasound involves applying a round-headed instrument to the skin of the painful area, to deliver ultra sound waves that are absorbed by the underlying tissues, in the effort to help relieve pain and lessen disability. Any sports people out there might have had a physio use ultrasound on their ankle sprain or other ligament sprain in the past. I must admit that earlier in my career, I have used it on people also. To the patient it probably didn't feel like it was doing much, and that is probably because it is likely not making a difference! To date, there is still very little evidence to explain how ultrasound causes a therapeutic effect in injured tissue. Research of clinical trials into the use of ultrasound for a variety of musculoskeletal injuries conclude “no support for the existence of therapeutic effects” or “insufficient biophysical evidence” or “no high quality evidence available” or “potential treatment effects of ultrasound appear to be very small”. Which is interesting because A LOT of practices still use this machine! 

 

The basic principle of Interferential Therapy (IT) is to utilise the significant physiological effects of low frequency (<250pps) electrical stimulation of nerves via the use of typically 4 pads surrounding the painful joint. Usually, you connect the electrodes from the machine to your skin, which passes an electrical current into the area. There is evidence that IT can help with reducing swelling and therefore lead to reduction pain and improved movement in those joints immediately post trauma or surgery. The effect is therefore usually only beneficial in the very early stages of rehab.

 

In Trans-Electrical Nerve Stimulation (TENS), two electrodes are often placed directly on the area of pain. In using it you will feel a ‘buzzing’ sensation and an intensity which is comfortable for you. TENS is used to reduce pain levels by way of electricity stimulating the nerves in a painful area. This stimulation then sends signals to the brain that block or "scramble" normal pain signals, that area is producing. The theory is called the “Pain Gate Mechanism” - which is similar to the pain relieving effect of wanting to rub your elbow when you hit your funny bone. It almost ‘distracts’ the brain of the pain for a short time. It shows evidence in temporary pain relief only, and it mainly used in those with chronic pain as an alternative to medication. It will not fix your injured area!

The Pain Journey

 

So what do these things have in common? They all (probably besides ultrasound) have a pain relieving effect. In my opinion, electrotherapy devices get overused in most clinical practices because the effect and evidence for use is usually small. I’ve worked in places where every session would require placing one of the machines on a patient, regardless of what they were there for, or the stage of recovery. Now think what you like about that fact, but there is a reason we don't have these machines in our clinic for regular use.

 

Here at The Movement Team we are more likely to use our hands as the therapy over machines because besides the symptoms relieving effects, it aids us in ‘feeling’ how your body moves, how your tissues and joints respond to manual therapy as we are treating you, and the effects seem to be almost immediate.

 

However as I have said above, manual therapy (and electrotherapy) are symptoms relievers only! They alone are unlikely to fix your issue, but will make you feel better in the short term. Which is fine if that is what you want, however if you want longer term effects then the best way to ensure that the issue is less likely to return is…….. exercise and movement!

 

With a name like The Movement Team, that should be no surprise! And this is likely what sets us apart from your more typical Physiotherapy clinic. We have a big gym area which is equal to the size of our four treatment rooms combined for a reason. It is also likely that when seeing us, you will be heading into that area at some stage. It might be the first session, it might be the 5th session, but its usually inevitable! 

 

Now this is not to say that manual therapy (and to a lesser degree electrotherapy) does not have a place at all. These techniques have a place in allowing enough pain relief or muscles relaxation to occur which then allows you to begin movement and exercise therapy more comfortably. But that is also the key! “Allows you to begin movement and exercise therapy more comfortably”, not all Physio practices will use them in this way. If your practitioner is only doing manual therapy or electrotherapy without the addition of giving you exercises or movement plan, just have a think about whether feel you are progressing, or do you feel that you always seem to be coming back again and again for another round…

 

At The Movement Team we will use a combination of manual and exercise therapy to help with whatever issue you require, but in the end, the treatment plan will always be heading towards a more movement and exercise based solution in order to sort you out for the long term.

 

Now in saying that, I’ve had a few patients that have flat out said they didn't want to progress to an exercise based plan, or that they are happy to keep coming back every month for whatever reason. Now this is absolutely your choice and is fine as long as you know that the long term changes happen with movement and exercise.

 

Chari

B.Phty, PGD Health Sc, M.Phty (Sports)

Chari has 9 years of Physiotherapy experience, across 2 countries, has completed 2 post graduate degrees including a Masters of Physiotherapy (Sports) and works with the Queensland Academy of Sport and Queensland Rugby Union.