Group Take-Home Statements

NMES

In a group of patients with shoulder instability, NMES is effective in improving motor function, strength, ROM, and reducing degrees of subluxation compared to traditional rehabilitation alone.

In a group of patients post ACLR or TKA, NMES was effective in improving quadriceps strength and functional mobility, and minimizing muscle atrophy compared to standard rehabilitation alone

NMES is effective at improving function, strength, and ROM in post-operative, post-stroke individuals, and instability in both the upper and lower extremities

estim for pain modulation

In relation to patients with chronic LBP, evidence is mixed on the short-term effects of electrical stimulation for pain modulation, but long-term (~4 wks) use of TENS was found to improve average pain, disability, anxiety, depression, and sleep quality.

Electrical stimulation does not have significant evidence for use in the prevention/treatment of direct post stroke shoulder pain or symptomatic knee OA pain compared to the control group

aquatic therapy

The benefits of aquatic therapy appear to be less dependent on the intensity of exercise and more so related to the modality itself

Aquatic therapy appears to be beneficial for improving functional outcomes (balance, ADLS, return to sport, power) and QOL (pain, fear-avoidant behaviors, fatigue) in various chronic pathological conditions when compared to traditional land based methods

cervical traction

For individuals with cervical pathologies, cervical mechanical traction can be effective with studies suggesting that strengthening exercises in addition to cervical mechanical traction can be more effective than exercise alone, mechanical cervical traction is more effective than manual traction for managing pain and reducing disability, and cervical traction was more effective when utilized with higher loads rather than lesser loads

Multimodal approach is best

dry needling and electrical stimulation

High frequency PENS (percutaneous electrical nerve stimulation) and low frequency PENS with dry needling showed similar effects in immediate neck pain relief, since no differences between groups were observed on any of the outcome measures

Dry needling with electrical stimulation showed quicker improvements faster but dry needling alone showed more gradual improvements, however, at the end their results were about the same.

Dry needling with stimulation in a comprehensive approach with conventional PT showed great improvements.

laser

Various forms of laser therapy (including HILT, LLLT, and laser acupuncture) consistently outperform or significantly enhance standard treatments in reducing pain and improving functional outcomes across a range of chronic musculoskeletal and neuromuscular conditions

lumbar traction

When compared to mechanical lumbar traction, a stabilization and extension based program is more effective at reducing pain and disability in chronic low back pain patients.

When looking at traction alone, 40-50% body weight at 10 minute intervals was effective at decreasing pain in the short term.

As a whole, there was no difference in functional outcomes after lumbar traction, in acute or chronic patients.

Overall, traction is not beneficial long term, but may allow for patients to participate in therapy due to decreased pain.

ultrasound

Ultrasound is an effective modality when taking a multimodal approach in physical therapy

Ultrasound when in combination with other modalities and exercise resulted in increased functional performance in patients with calcific shoulder tendinitis, knee OA, lateral epicondylitis, and plantar fasciitis

Ultrasound has mixed results with reducing short-term and long-term pain when compared to other modalities which include therapeutic exercise, FSWT, splinting, and pulsed short-wave diathermy dependent on patient population.