Tag Archives: modality

Exercise, the Other Modality

I have discussed some of the physiotherapy modalities that we use in our clinic.  I’d like to discuss a modality that most people don’t consider a modality, exercise.  Exercise when used in my clinic is usually used as a form of specific rehab with a specific goal in mind.  I will always recommend exercise as home care or a lifestyle change because your body heals faster when you’re in peak condition.  Exercise in my office though, will be used to improve balance, decrease recovery time, strengthen weak areas, or for motion retraining.

The most obvious example is the slumped shoulders that we all get from working on computers too much.  Your muscles in the front get strong and short, but your back muscles are stretched long and are weak.  We would do exercises to retrain that to normal.   As chiropractors we try to care for the whole body and get to the root cause of problems rather than just treating symptoms.  If you have a muscular imbalance that is causing your spine not to function properly a chiropractor would be remiss if he just adjusted the spine over and over without addressing the muscles causing the problem.  That is not to say that all spinal problems are cause by muscles, but it is hard to separate the two components.

Retraining exercises teach your brain how to use muscles and joints properly.  It takes time to break bad habits, but exercising properly along with adjustments will help much faster.  When you have improved enough, you should be able to maintain your health on your own with proper diet and fitness.  Life happens and you may need to come back for a little extra help, but one of my goals is to educate patients to take care of themselves.  Education is true preventative medicine.

Heat or Ice


Ice and heat are two more of the modalities that we use in our office to help provide symptomatic relief to patients.  There is a long standing debate as to which is better to use for musculoskeletal injuries hot packs or ice.  Some people only use ice, some only heat, and still some say that you should rotate using Ice for 20 min. then heat for 20 or vice versa.

The easiest way to explain when and which to use is to tell you what they do.  Ice is generally used in acute injuries, so within the first 48-72 hours after you get hurt.  We use it then to control the swelling, reducing the inflammation, relieving the pain and reducing the risk of secondary injury.  Ice can do this because the cold causes the blood vessels to contract thus reducing the amount of fluid/blood that can get to the area.

Heat is generally used to improve healing by bringing more blood flow through the area. Just the opposite of ice, heat dilates the blood vessels increasing the amount of blood that can come into and out of the area treated.  We use heat for chronic problems or after any inflammation is under control.

Most people prefer heat to ice, but both will provide some temporary pain relief, so if you have a preference go with that.  If you find that using one or the other provides relief during the application, but then increases the problem after; discontinue it’s use.  The best example of this is taking a hot shower, if you have an acute injury it will feel good, but as soon as you start to cool down you’ll notice that the blood is not getting out of the problem area and just swelling causing more pain.  So if you have just worked out and might be sore or just injured yourself, ice.  If you need to warm up or have a chronic problem that needs to heal, heat.

What is E-Stim?

Patients often wonder what the modalities that we use are doing to their body.  While we are training a new assistant in our office I thought I would take the time to write this down for their benefit and answer some questions that I get from patients here on the blog.

IFC, TENS, Electrical Stimulation

Usually referred to as “electric stim” it goes by many other names and there are different types and reasons for using this modality.  (Feel free to add uses to the comments)  The primary use of this tool in our office is for muscle relaxation and pain relief.

To start four conducting pads are placed around the treatment area.  The intensity is then increased slowly allowing the current to flow through you to the opposite pads.  This causes kind of a numb or tingly feeling in the area.  IFCThe treatment improves healing in the area, causes the muscles to relax, releases chemical pain relievers and temporarily confuses the nervous system so that it is not able to transmit pain signals as well.  In essence you get temporary pain relief and improved healing.  While some people like to show how tough they are, more is not always better.  We will usually try to find a setting that is comfortable, even pleasant, for you.

If done before, it allows the adjustment to be more comfortable for the patient.  Because the muscles are relaxed it can make it easier for the chiropractor to do the actual adjustment and decrease the risk of muscle strain.  It also has been shown to improve recovery times.

There are possible negative effects from this treatment.  They are rare and minimal.  Some people may be allergic to the adhesive in the pads and the skin may become irritated or develop a rash.  If a pad comes loose during a treatment (most machines are designed to shut off if this happens) the electricity may arc and give you a little jolt, kind of like licking a 9-volt battery or even a minor electrical burn.

E-stim should never be used with an electrical implant such as a pace maker, over the heart or the front of the neck.  You should not use e-stim over known cancer or infection, as it may increase the growth (not good).  Lastly because the risks are just not known it is not recommended to use during pregnancy.