The Use of Modalities in the Physical Therapy Office: Are They Warranted?

Many physical therapy services make use of a modality in their approaches to rehabilitation. In fact, the use of one type of modality or another is almost a given at any PT office. However, some professionals feel that modalities are not always necessary.

Often, the use of traditional therapeutic exercises and techniques can accomplish what a modality accomplishes, and typically with better results. So are modalities necessary? Or are they obsolete? The answer is neither. Here is why.

The Use of Modalities in the Physical Therapy  Office: Are They Warranted? Blog

What is a Modality?

In general, a therapeutic modality is any device that performs a therapeutic technique. In practice, these devices administer things like shock, heat, cold, sound, or other forms of stimulation. The aim is to help loosen muscles, decrease swelling, relieve pain, and various other things related to physical therapy rehabilitation. The most common types include the following:

  • Electrical stimulation
  • Thermal stimulation
  • Sound energy
  • Laser and light therapies
  • Mechanical

Basically, if some kind of machine or device is involved, then it’s a modality. But some of the modalities often require traditional therapeutic methods alongside them to make them effective. This puts modalities into two major categories.

Attended – An attended modality involve the help of a professional. The physical therapist may have to partially help or stay through the whole process and apply the therapy.

Non-attended – A non-attended modality allows people to tend to the therapy themselves. This can occur either at the PT office or at home.

What Does a Modality Treat?

A modality can treat a wide variety of issues. They also help to ease a lot of issues as well. Depending on the method of the modality, it’s possible for a modality to represent a full treatment regimen. There are many very specific conditions that certain modalities have uses for. Here are some of the more general reasons physical therapists apply a modality.

  • Pain relief
  • Improving circulation
  • The reduction of swelling
  • Relief of inflammation
  • Reducing muscle spasms
  • Relaxing muscles
  • Relaxing soft tissue
  • Tissue scar softening
  • Muscle re-education
  • Muscle strengthening

Despite all of these applications and more besides, a school of thought says manual therapy and exercise can do more.

What about Manual Therapy?

As stated, many manual therapy techniques actually rely on the assistance of a modality. The key here is that it is not the modality alone that can cause the greatest improvement. The main difference is that manual therapy methods require direct contact with a patient. So these are never “non-attended” methods.

In their purest forms however, manual therapy rely strictly on the skill and care of the physical therapist. Manual therapy includes,

  • Joint mobilization
  • Soft tissue mobilization
  • Massage
  • Spinal traction and mobilization

There are many more techniques and all of them are designed to do exactly what a modality does. What makes manual therapy methods a good choice in most cases is that these methods allow the professional to directly interact with and adjust the methods to the patient.

A skilled physical therapist can pinpoint muscles that need special attention. They can dig down and find the specific clusters of scar tissue that need loosening. These techniques are personal and can help make the rehabilitation process far more effective than by using a modality alone.

Bringing it Together with Therapeutic Exercise

Therapeutic exercises are any exercises designed to help patients achieve range of motion, strength, balance, and stabilization. These are an important part of any physical therapy regimen. They can occur both at home and at the physical therapy facility.

These exercises can be both assisted and unassisted by either the physical therapist or a modality. Because therapeutic exercises can encompass aspects of all modalities and techniques, they play an extremely strong role in rehabilitation.

While a modality can serve as adequate auxiliary tools to physical therapy, the manual therapy and exercise have shown the greatest effects. These effects are backed by study and research. The effectiveness of many a modality remains in question.

In fact, if the wrong modality is applied, it can actually cause detrimental effects to the healing process. But that does not mean modalities are ineffective or unwarranted. It just means that they need to be a part of an overall process that includes more interaction with the physical therapist and therapeutic exercises.

There are actually many programs that try to incorporate some aspects of all three therapy methods. That’s because everybody is different. Sometimes it takes a combination of exercise, a therapy modality, and monitoring from professionals to achieve the proper results.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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