Physiotherapy for Muscle Pain
Neck, shoulder, lower back and knee: current evidence and international guidelines agree that active exercise therapy, manual therapy and pain education are the first-line treatment for chronic pain, and passive electrotherapy and ultrasound are at most a supplement for short-term relief of symptoms. Our registered physiotherapists in Hong Kong visit the home to find the source of the pain and then deal with it at its root through exercise, and do not rely only on devices.
- Registered physiotherapists in Hong Kong
- Home visits across Hong Kong
- 1 hour $1,000 · 1.5 hours $1,300
- Active exercise · treating the source of pain
Musculoskeletal pain is very common and often gets in the way of daily life and work. The evidence consensus in international medicine is now quite clear:active exercise therapy, manual therapy and pain education are the first-line approach to chronic pain (especially low back pain and neck pain), while passive devices such as electrotherapy (TENS) and ultrasound lack enough supporting evidence and are suitable only for short-term relief. The sections below first explain why physiotherapists put exercise first and devices second, and then describe the direction of assessment and treatment for each part of the body.
The UK NICE NG59 guideline states clearly:ultrasound, TENS (transcutaneous electrical nerve stimulation), percutaneous electrical nerve stimulation (PENS) and interferential therapy should not be used to treat low back pain. The Cochrane systematic review also concluded that the available medical evidence does not support therapeutic ultrasound for chronic low back pain (Ebadi et al., 2020). Whether treatment works depends on finding the real source of the pain, so physiotherapy must begin with a detailed assessment and be built mainly around exercise training.
How common muscle pain is, and research data on exercise therapy
Making exercise a first-line treatment rests on the highest level of medical evidence (systematic reviews and large meta-analyses). The figures below show the facts best.
Overall, pain is a far-reaching problem, and exercise is one of the few interventions that can clearly reduce pain and improve physical functionat the same time. By contrast, current evidence does not support routine use of passive ultrasound for chronic low back pain.
Active exercise therapy compared with passive electrotherapy
The two do not exclude each other. They simply have different roles. Understanding the difference explains why a physiotherapist puts time into exercise guidance and manual therapy, and does not let the patient rely on passive devices for long periods.
- Evidence base: supported by Cochrane reviews and several meta-analyses, with clear reduction of pain and improvement of function in chronic low back pain and neck pain
- Deals with the source of pain: strengthens weak muscles, corrects imbalance and improves joint movement, reducing recurrence at its root
- Sustainable: once the exercise prescription is learned it can be kept up at home, and the benefit carries over into daily life
- Safe: progressing step by step under the therapist's guidance, with very few adverse effects (Geneen et al., 2017)
- Evidence base: NICE NG59 recommends not using TENS or ultrasound for low back pain; Cochrane does not support ultrasound (Ebadi et al., 2020)
- Relieves symptoms only: reduces pain for a while and does not change the underlying cause
- Dependence: the effect fades when the course ends, and is hard to continue on one's own
- Role: at most a short-term supplement alongside exercise, so that active rehabilitation can begin
Common sites of pain and the direction of treatment
Pain is often the result of several factors layered together (such as poor posture, muscle imbalance, structural degeneration and psychological stress), and each part of the body has its typical causes and treatment methods. The physiotherapist first carries out a detailed assessment and then designs an exercise plan to suit the patient.
- Neck pain (looking down at phones, cervical degeneration)
- Looking down at a phone or computer for a long time pushes the head forward and adds load on the cervical spine. The upper trapezius and levator scapulae become over-tense and the deep neck flexors become weak. Treatment focuses on chin tucks to strengthen the deep neck flexors and thoracic extension to improve a stooped back, together with adjusting the screen to eye level.
- Shoulder pain (frozen shoulder, rotator cuff)
- Shoulder pain is common in frozen shoulder, tendinitis or tears of the rotator cuff, and subacromial impingement. Treatment is mainly progressive range-of-motion work and rotator cuff strengthening exercises, with manual therapy to loosen stiff joints.
- Lower back pain (disc herniation, sciatica)
- Prolonged sitting shortens the hip flexors and weakens the core (especially transversus abdominis) and gluteus maximus, and incorrect lifting posture adds to this. Treatment focuses on core stability, glute bridges to strengthen gluteus maximus, and hip flexor stretching, with exercise therapy as the first line (Foster et al., 2018).
- Knee pain (osteoarthritis)
- Knee pain is common in osteoarthritis, softening of the cartilage under the kneecap, and ligament and meniscus injuries. Treatment concentrates on strengthening the quadriceps at the front of the thigh and the muscles of the buttocks, together with low-impact aerobic exercise. Exercise is the first-line treatment for knee osteoarthritis and does not speed up joint wear.
Assess first to find the source of the pain
Treatment can only work if a detailed assessment comes first. The physiotherapist looks at the patient from several angles to find the source of the pain and then treats accordingly.
History and movement tests
- Find out when the pain began, what kind of pain it is, and which movements make it worse or better
- Observe posture: watch the patient's posture when standing, sitting and moving
- Movement tests: check the range of joint movement, muscle strength and nerve function
- Special tests: check whether nerves (such as the sciatic nerve) are compressed or tight, and whether joints are stable
Benefits of a home assessment
- The therapist can check, at the desk or work table the patient actually uses, whether the height of table and chair is suitable, and adjust the patient's sitting posture and screen height on the spot
- The pillow, mattress and sleeping position the patient actually uses can be checked on site, with specific suggestions to improve the pain
- The patient does not have to travel out with difficulty, because going out is tiring for people in pain and often makes the pain worse
- Being in the familiar home environment is more relaxing, which helps treatment work better and makes the correct exercise posture easier to pick up
Main treatment: exercise training combined with manual therapy
Once the cause of the pain is found, treatment centres on a personalised exercise prescription, with manual therapy to loosen joints and soft tissue. Research indicates that manual therapy combined with exercise works better than usual care(Domingues et al., 2019). Among types of exercise, strengthening and endurance training are the most effective, and stretching alone has limited effect (Gross et al., 2015).
| Personalised exercise prescription (core) | A combination of strengthening, stretching and stability exercisesis put together from the assessment results, to correct muscle imbalance, strengthen weak muscles and improve posture. The therapist teaches the correct movement technique so that the exercises can be continued safely and effectively at home. |
| Manual therapy | The therapist uses techniques such as massage, myofascial release and trigger point treatment to relax tight muscles, and uses joint mobilisation to increase joint range and ease stiffness, so that the body is ready for exercise training. |
| Pain neuroscience education | Helping the patient understand how pain works breaks the vicious circle of “pain, stress and muscle tension”. Research shows that pain education helps to reduce pain, improve function, and lower disability and catastrophic thinking about pain (Louw et al., 2016). |
Stress, anxiety and low mood keep muscles tight for long periods, and make pain worse or last longer. Many patients with long-term pain fall into a vicious circle of pain, high stress and tighter muscles. A key step in breaking the circle is to understand that feeling pain does not always mean the body tissue is being damaged. Besides guiding the patient through exercise, the physiotherapist therefore also helps the patient with this psychological hurdle.
Devices (TENS, ultrasound, heat packs): short-term supplements only
The idea that “physiotherapy means electrotherapy and an infrared lamp” is out of date, and passive devices are not a core treatment that deals with the root cause.The NICE NG59 guideline recommends not using ultrasound or TENS for low back pain, and the Cochrane review does not support ultrasound for chronic low back pain either(Ebadi et al., 2020). At most, these devices are supplementary tools used alongside exercise for short-term relief of discomfort, and they can never replace exercise.
- Electrotherapy (TENS and interferential current)—TENS uses electrical current to stimulate nerves and temporarily block pain signals going up to the brain, and it can be used for short-term pain relief. However, the UK NICE NG59 guideline does not recommend it for low back pain, and it is not a treatment of the root cause.
- Ultrasound and shortwave diathermy—Ultrasound is a passive device. The Cochrane systematic review states that the available medical evidence does not support using ultrasound for chronic low back pain, so it should not replace active exercise training (Ebadi et al., 2020).
- Heat and cold packs—Heat can help tight muscles relax and ease stiffness, and suits long-term pain or use before exercise. Cold suits the time just after an injury, when the area is red, swollen and inflamed, for about 15–20 minutes at a time. Both only give temporary relief of discomfort and are not long-term solutions.
Preventing pain in daily life
Besides treatment, good daily habits also reduce the chance of pain coming back. During home physiotherapythe therapist looks at the patient's actual home environment and gives specific suggestions for improvement.
Work habits
- Get up and walk around every 30–45 minutes of sitting, and do a few simple stretches
- Keep a good sitting posture, and set the computer screen at the same height as the line of sight
- Avoid staying in the same posture for long periods, and do not sit with legs crossed or leaning to one side
- Choose back cushions, pillows and mattresses with suitable support
Regular exercise
- Build up about 150 minutes of moderate-intensity exercise a week
- Include both aerobic exercise and strength training, and strengthen the muscles of the lower back and abdominal core
- Warm up well before exercise, and stretch and cool down afterwards
- Exercise within your ability. If pain appears, stop first, and let the therapist set a suitable starting amount of exercise
Warning signs: if lower back pain comes together withweakness or numbness in both legs, loss of control of bladder or bowels, a persistent fever, unexplained weight loss, or pain that is especially bad at night, see a doctor for examination as soon as possible, and do not try to handle it by yourself with exercise or home devices.
Frequently asked questions
Pain does not have to rely on electrotherapy and heat lamps. Our registered physiotherapists in Hong Kong visit the home to find the source of the pain, with active exercise and manual therapy at the core, to reduce pain, build muscle and prevent recurrence at the root.
WhatsApp for a free enquiry and assessmentDisclaimer: This article is general health information and is not professional medical advice. If you have any health concerns, please consult a qualified healthcare professional.
References
- Hayden, J. A., Ellis, J., Ogilvie, R., Malmivaara, A., & van Tulder, M. W. (2021). Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews, (9), CD009790. PubMed
- Gross, A., Kay, T. M., Paquin, J. P., et al. (2015). Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews, (1), CD004250. PubMed
- Cho, W. S., Park, C. B., & Kim, B. G. (2023). Effects of exercise therapy on pain and disability in patients with non-specific neck pain: a systematic review and meta-analysis. Journal of Bodywork and Movement Therapies, 36, 339–349. PubMed
- Domingues, L., Pimentel-Santos, F. M., Cruz, E. B., et al. (2019). Is a combined programme of manual therapy and exercise more effective than usual care in patients with non-specific chronic neck pain? A randomized controlled trial. Clinical Rehabilitation, 33(12), 1908–1918. PubMed
- Ebadi, S., Henschke, N., Forogh, B., et al. (2020). Therapeutic ultrasound for chronic low back pain. Cochrane Database of Systematic Reviews, (7), CD009169. PubMed
- Foster, N. E., Anema, J. R., Cherkin, D., et al. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, 391(10137), 2368–2383. PubMed
- Hartvigsen, J., Hancock, M. J., Kongsted, A., et al. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356–2367. PubMed
- Chou, R., Deyo, R., Friedly, J., et al. (2017). Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians clinical practice guideline. Annals of Internal Medicine, 166(7), 493–505. PubMed
- Geneen, L. J., Moore, R. A., Clarke, C., Martin, D., Colvin, L. A., & Smith, B. H. (2017). Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews, (4), CD011279. PubMed
- Louw, A., Zimney, K., Puentedura, E. J., & Diener, I. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review of the literature. Physiotherapy Theory and Practice, 32(5), 332–355. PubMed
- National Institute for Health and Care Excellence (NICE). (2020). Low back pain and sciatica in over 16s: assessment and management. NICE guideline [NG59]. NICE