Physical Therapy for Chronic Pain

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You hear that you're supposed to stay active through your chronic pain and you think—'But how? Most activities make my pain worse! Sometimes, just getting through the day at work is agony, and now the doctor expects me to do extra activities after work?' This is where a physical therapist can help. He or she can give you a personalized strengthening and exercise plan, in addition to helping you learn how to manage your "daily life" pain.
Older woman in a physical therapy sessionThe physical therapist will do a detailed physical evaluation to assess your chronic pain and its effect on your life. Photo Source:

Physical Therapy is Personalized

Chronic pain comes in many forms, so effectively treating your pain requires a plan just for you. The physical therapist will do a detailed physical evaluation to assess your chronic pain and its effect on your life. He or she will also ask about your treatment goals: do you want to learn how to better manage your pain at the office? Are you eager to start exercising but feel your pain is limiting that? What would be most helpful to learn in physical therapy?

Using that information, the physical therapist will develop a therapy plan for you.

Physical Therapy is Passive and Active

Physical therapy includes both passive and active treatments. Passive treatments help to relax you and your body. They're called passive because you don't have to actively participate.

Your physical therapy program may start with passive treatments, but the goal is to get into active treatments. These are therapeutic exercises that strengthen your body and help you deal with the chronic pain.

Passive physical therapy treatments include:

  • Deep Tissue Massage: This technique targets spasms and chronic muscle tension that perhaps builds up through daily life stress. You could also have spasms or muscle tension because of strains or sprains. The therapist uses direct pressure and friction to try to release the tension in your soft tissues (ligaments, tendons, muscles).
  • Hot and Cold Therapies: Your physical therapist will alternate between hot and cold therapies. By using heat, the physical therapist seeks to get more blood to the target area because an increased blood flow brings more oxygen and nutrients to that area. Blood is also needed to remove waste byproducts created by muscle spasms, and it also helps healing.

    Cold therapy, also called cryotherapy, slows circulation, helping to reduce inflammation, muscle spasms, and pain. You may have a cold pack placed upon the target area, or even be given an ice massage. Another cryotherapy option is a spray called fluoromethane that cools the tissues. After cold therapy, your therapist may work with you to stretch the affected muscles.
  • TENS (transcutaneous electrical nerve stimulation): A TENS machine stimulates your muscles through variable (but safe) intensities of electrical current. TENS helps reduce muscle spasms, and it may increase your body's production of endorphins, your natural pain killers. The TENS equipment your physical therapist uses is relatively large. However, a smaller machine for "at home" use is also available. Whether large or small, a TENS unit can be a helpful therapy.
  • Ultrasound: By increasing blood circulation, an ultrasound helps reduce muscle spasms, cramping, swelling, stiffness, and pain. It does this by sending sound waves deep into your muscle tissues, creating a gentle heat that enhances circulation and healing.

Passive therapies, such as those listed above, are generally done in conjunction with active therapies. In the active part of physical therapy, your therapist will teach you various exercises to improve your flexibility, strength, core stability, and range of motion (how easily your joints move).

Remember: Your physical therapy program is individualized, taking into consideration your health and history. Your exercises may not be suitable for another person with chronic pain, especially since chronic pain is such a subjective, personal experience.

Other Aspects of Physical Therapy

If needed, you will learn how to correct your posture and incorporate ergonomic principles into your daily activities. This is all part of the "self-care" or "self-treatment" aspect of physical therapy: through physical therapy, you learn good habits and principles that enable you to take better care of your body.

Your physical therapist may also suggest a personalized exercise program for you. As you can read in the Exercise and Chronic Pain article, staying active is an important part of chronic pain treatment. The physical therapist can help you figure out the best type of exercise for you.

Updated on: 08/01/19
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Steven Richeimer, MD
Chief, Division of Pain Medicine
Keck School of Medicine
University of Southern California
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