Cold and ice

Ice and cold packs are used in physical therapy to relieve pain, swelling, and inflammation from injuries and other conditions such as arthritis. Ice can be used for 10 to 20 minutes at a time. In some cases, ice may be used several times a day.^{5, 6} For more information, see:

• Using ice and cold packs.
• Ice massage.
• Rest, ice, compression, and elevation (RICE).
• Ice or cold packs for children.

Heat

Heat can help relax and heal your muscles and soft tissues by increasing blood circulation.⁵ This can be especially helpful if a joint is stiff from osteoarthritis or from being immobilized, or to relax the muscles before exercise. However, heat can also increase swelling in an injured area if it is used too soon after the injury. Most experts recommend waiting at least 48 hours after an injury before using heat. For more information, see:

• Heat after an injury.
• Paraffin wax for osteoarthritis.

Hydrotherapy

Hydrotherapy is the use of water to treat a disease or to maintain health. The term "hydrotherapy" (water therapy) can mean either exercise in the water or using water for care and healing of soft tissues.⁷ This type of therapy is based on the theory that water has many properties that give it the ability to heal:

• Water can store and carry heat.
• Water is found in different forms, such as ice, liquid, or steam. Ice may be used to cool, liquid is used in baths and compresses at varying pressures or temperatures, and steam is used in steam baths or for breathing in.
• Water can help blood flow.
• Water also has a soothing, calming, and relaxing effect on people, whether in a bath, shower, spray, or compress.
• Exercise in water takes the weight off a painful joint while also providing resistance.

For more information, see hydrotherapy.

Ultrasound

Ultrasound therapy uses high-pitched sound waves to ease muscle spasms and relax and warm muscles before exercise, to help relieve pain and inflammation, and to promote healing. Although the use of ultrasound is common, some studies show a benefit from this treatment and others do not.⁵ Some physical therapists do not recommend deep-heating techniques. Discuss the benefits and risks with your physical therapist or doctor before starting this therapy. This type of treatment is not generally used for children.

Electrical stimulation

Electrical stimulation is the general term that describes the use of electrical current to create an effect in the body. There are several uses for electrical stimulation.⁸

• Physical therapists sometimes use electrical stimulation at low levels to reduce the sensation of pain. It may work by either "scrambling" pain signals to mask feelings of pain, or by causing the body to produce natural pain-killers called endorphins.
• Physical therapists can also use electrical stimulation to cause muscles to contract (tense). This type of therapy can help maintain muscle tone when muscles would otherwise lose strength or help teach muscles to contract again. Examples of this type of therapy include:
  • Electrical stimulation after a stroke to maintain some tone in the shoulder muscles so they hold the joint together better and prevent pain.
  • Electrical stimulation to maintain leg strength in a person who has severe arthritis of the knee and whose pain increases with exercise.
  • Electrical stimulation to get muscles at the front of the thigh working in the proper order after knee surgery.
• Electrical stimulation is being studied as a way to help with healing of wounds and broken bones.

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Physical Therapy  Types of Physical Therapy