What are physical therapies and how do they work?

The best way to reduce pain and improve function is through the 3P approach – that is, physical, psychological and pharmacological therapies. Physical therapies are a key element in managing persistent pain.

There are two main types of physical therapies – active and passive. The main difference between these therapies is how much effort you need to put in.

  • Active therapies need your participation – in other words, you do the exercises.

  • Passive therapies are often done to you by a healthcare provider or don’t require movement – in other words, you receive the therapies.

Active therapies

Active therapies make your muscles, bones, heart and lungs stronger so you are more fit and able to do more activities. There is strong evidence that they have long-term benefits for people with chronic pain. This is because active physical therapies, for example exercise, release hormones such as endorphins that act as natural painkillers. As well as helping to reduce pain, endorphins can help to improve your mood and energy level and help you sleep better.

Passive therapies

These therapies can be used to relieve pain in the very short term, but there is no evidence that their effects last once the therapy session is done. Ask your healthcare team if passive therapies would be a safe and worthwhile option for you to try. If you do use them, they work best alongside active therapies.

Evidence for active and passive therapies

Over the following pages we describe a number of active and passive therapies and the type of evidence that supports them.

Much of the evidence comes from a type of research study called a randomized controlled trial (RCT). This type of study involves randomly putting people into two groups: one that receives an intervention, in this case a type of physical therapy, and another that does not (called a control group). The purpose of this type of study to compare the two groups to see if the intervention makes a difference in people’s lives. To make sure the study works as it should, participants from both groups are carefully observed throughout the study and their outcomes are compared (for example, their pain levels). The RCT is considered the “gold standard” or best study design for evaluating treatment interventions.

In this section, we will describe the level of evidence to indicate the number of published RCTs supporting each type of treatment. This format lets you see how much proof exists that a particular treatment is effective for chronic pain.

  • Weak or no evidence means that there were no RCTs found to support benefits.

  • Moderate evidence means that at least one RCT was found to support benefits.

  • Strong evidence means that multiple RCTs or a review of RCTs were found to support benefits.

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