When Modalities Play A Role In Recovery And Performance

In the fitness and healthcare industry, new pieces of equipment are continually being offered to enhance recovery as well as improve performance. Massage guns, shockwave therapies, hyperbaric chambers, just to name a few. However, the real question is….do these fancy pieces of equipment actually cause physiological changes within the human body to speed up recovery or make someone perform at a higher level? A couple of weeks ago, Sherif and Craig from Team [P]Rehab hit the reset button at Reset By Therabody, located in Philadelphia, PA, where they were exposed to some awesome recovery products. Follow along in this article as we take you through some of our experiences, while also educating you on the topic of modalities and recovery!

 

What Are Modalities?

A modality is defined as the application of a particular therapeutic agent that is expected to produce a specific physiological response within the human body. They commonly are used to provide pain relief, improve outcomes after an injury, and to enhance different processes that occur in the body. Modalities can be a touchy subject for some in the rehab space, as depending on who you talk to, there is no time and space for them. Moreover, there has been a shift in the approach to rehab, as physiotherapists, athletic trainers, and other movement specialists are placing more of an emphasis on exercise, activity modification, and active interventions to optimize the rehab experience. However, in some instances, and under the right circumstances, modalities can be utilized as a helpful adjunct to care.

 

Cold Therapy

A cold modality such as the local application of ice is expected to constrict blood vessels, thus impeding blood flow, reducing swelling and inflammation, and also acts as an analgesic, AKA pain-reliever. It was originally thought that ice or other cold therapies had the ability to constrict blood flow down deep to several layers of tissue in the human body; however, recent evidence has negated this. What is interesting is that recent evidence is no longer supporting the use of ice in the recovery process after an injury. However, like we said it can help with pain management, thus clinicians & patients still use it to this day. Bleakley et. al has done some excellent work surrounding the research of ice. Want to learn more? Check out this blog below.

LISTEN: DOES ICE HELP IMPROVE RECOVERY?

The truth about icing modalities and recovery the prehab guys

 

Dry Needling

Dry needling, similar to acupuncture, is another type of modality that is gaining popularity and traction within the healthcare space. This modality is thought to cause a physiological change by decreasing muscle spasms or ‘trigger points’ within the body. There has been sparse research regarding the effects of dry needling as it has not been utilized as much as other modalities, and also will vary from each state on if a professional is allowed to practice utilizing this modality. In a study by Matsel et al, ‘trigger point’ dry needling was utilized on patients with shoulder pain. This was used separately from and in addition to therapeutic exercise and manual therapy interventions. The study revealed that while dry needling assists patients in short term pain relief, it was not any more beneficial than exercise and manual therapy for long-term pain relief. If you want to learn more about dy needling, check out this article HERE!

Example Of Dry Needling

 

Electrical Stimulation (TENS)

Transcutaneous Electrical Nerve Stimulation (TENS) utilizes electrical currents to block the perception of pain to the brain. This phenomenon of pain inhibition is known as the gate control theory, as shown below.

Gate Control Theory

tens unit modalities and recovery gate control theory the prehab guys

From Tashani et al. 2009

There are many different devices that can deliver the use of TENS, as well as various set ups that one can utilize. The most common type is conventional TENS, in which low-intensity pulsed currents are delivered at high frequencies around the area of pain. What one will feel is a sensation of tingling, and once that sensation is felt at a tolerable level, the threshold is then set. There have been many studies on the modality of TENS, evaluating its effectiveness for a variety of different ailments and medical needs; the findings suggest as an intervention for pain relief it may be more effective in some circumstances than others. In this critical review published in 2017 it concluded that there is moderate evidence from systematic reviews to support TENS during postoperative care and that “it seems reasonable to offer TENS as an adjunct to core treatment for surgical pain.” In summary, similar to other modalities, some may find a short-term benefit with using TENS to help ‘take the edge off’, with this reduction in pain allowing them to then complete the active intervention designed to solve the root cause of the problem.

 

Let’s Play Devil’s Advocate

Now is a good time to bring this up as we’ve shared a few modalities and there are more to come. Are you seeing a common trend yet? Treating the symptoms, not the underlying cause. That tends to be the case with most modalities, thus, shouldn’t we focus on the underlying cause to avoid the symptoms in the first place? Yes, we should, but at the same time have you considered the following?

  • What if the symptoms are too intense to treat the cause? What if a modality helps to provide a window of opportunity to treat the underlying cause?

 

  • What if you have to wait to treat the underlying cause because you need help figuring out the solution (waiting on a doctor’s appt, your schedule is too busy, financial limitations) and you can only get through your day with decreasing your symptoms?

 

  • What if you know the underlying cause, but you don’t want to change and you’re ok with managing the symptoms?

 

  • What if the underlying cause is best treated with the direct use of the modality in combination with an active intervention?

 

Have you ever taken Advil because you were hungover and your head hurt? You know the cause, but you still had one too many drinks! You may not agree with all of these questions, but that’s the goal here, to share contentious opinions and provoke debate! Keep this in mind as you continue reading!

 

Heat

The purpose of a heat modality is to improve circulation throughout the body, thus increasing body temperature. Different examples of heat therapy are a hot pack, heat wraps, sauna, paraffin, or infrared therapy. Research has supported that heat may inhibit the pain response from our brain, as well as provide relaxation to our muscles and other tissues of the body. It has been inconclusive whether or not the application of heat can cause increases in muscle length of a particular tissue. Although heat may improve blood flow, exercise is the best way to increase the movement of blood to muscles throughout our body. The use of heat does indeed increase superficial tissue temperature, which releases chemicals such as histamine for example, which helps open up (dilate) our blood vessels. However, histamine and other chemicals do not majorly affect the movement of blood in skeletal muscle, as this is influenced by other physiological factors within the human body, which is created by movement.

The bottom line is that heat can often be a great tool that can allow someone who is experiencing pain or stiffness to engage in an active warm-up for adequate training preparation. This should always be the goal, rather than throwing a hot pack on your body for a few minutes in order to stimulate cellular activity and blood flow without then using movement as your key preparation tool. Looking for the ultimate warm-up? Check this out!

 

To Use Heat Or Ice?

Watch this video below for a quick explanation on this common question.

Simply put, both will help provide pain relief by essentially ‘blocking’ the pain response sent to the brain from a particular area of the body. In more acute situations, such as immediately after an injury for the first 48 hours, ice can be utilized to help reduce swelling, inflammation, and pain, whereas heat is generally more indicated after that acute time period. With that being said, if heat or ice feels better to you individually, use it! Just know that their use in combination with active solutions will be the best way to overcome whatever injury or body ailment you are dealing with. 

To understand more about tissue healing timelines and what happens after an injury, read this article.

 

Modalities At Reset By Therabody

Now that you have an idea of what modalities are, let’s dive into the questions of whether or not these actually make a difference in recovery as well as performance, while sharing Sherif and Craig’s awesome experiences with Therabody!

While at Reset By Therabody, the modalities we were able to be exposed to included:

  • A full-body, Theragun massage

 

  • Pulsed Electromagnetic Therapy (PEMF)

 

  • Infrared Sauna (Light Therapy)

 

  • Cryotherapy Chamber (Cold Therapy)

 

Team [P]Rehab At Reset By Therabody

modalities and recovery the prehab guys therabody

Reset By Therabody Located in Fishtown, Philadelphia

Percussive Therapy

As massage guns have become popular must-have items, the origin and scientific premise of Percussive Therapy has become lost, but the team at Therabody is committed to helping people understand the current science as well as actively pursuing new research. Scientifically, Theragun Percussive Therapy can be defined as the rapid and repetitive application of pressure perpendicular to the body. This causes the tissues to experience both pressure (think myofascial intervention) and local vibration. diving into the literature we know these stimuli increase circulation, reduce pain/soreness, increase range of motion, and more recently research has shown the benefits for recovery and performance. Hence, there may be a time and place for percussive therapy  before, during, & after physical activity, but it will never replace the benefit of exercise.

Theragun Massage

Sherif is getting some dual-wield action here with use of the Theragun Pro Massage Gun! Not gonna lie, we felt awesome afterward. Our take-home point – some people love massages & others do not enjoy them, that’s the reality folks! So if you enjoy massage and feel like it helps with your body maintenance & performance, 100% go for it and be sure to try out a Theragun at some point in your life. We have an entire blog dedicated to the topic of massage therapy that you can read HERE.

 

Prioritize Your Recovery

Take time to prioritize what should be most important to you and your recovery process. Particular aspects of recovery are going to hold more weight for some individuals versus others. For example, some individuals may receive great benefit from using a massage gun after a run, whereas other people may place more weight on nutrition or sleep. Overall, ensuring that your recovery approach is well-rounded, without reliance on a singular aspect of the pyramid will help optimize your movement experiences.

Recovery Pyramid

modalities and recovery pyramid the prehab guys

From NSCA Essentials of Sports Science

 

If you are interested in learning more about the benefits of sleep, listen to our [P]Rehab Audio Experience below!

LISTEN: THE IMPORTANCE OF SLEEP IN RECOVERY

sleep the prehab guys modalities and recovery

 

Pulsed Electromagnetic Therapy (PEMF)

Pulsed Electromagnetic Therapy (PEMF), is a type of stimulation therapy, which delivers shock-like sensations throughout your body. The purpose of this is to generate global pain relief with utilization of magnetic stimulation. It is thought to serve as a better alternative to other forms of modalities because it works at a lower power and lower frequency.

PEMF Therapy

The mat that is on top of Craig in this video is what is delivering the PEMF to his body, as he is also laying down on a mat underneath of him. These mats have magnetic fields within them that help to deliver the modality. Listen closely and you can hear the sound of the PEMF being delivered.

Insight on Craig’s experience – Craig has been dealing with some hip pain related to running & golfing. What was interesting with the PEMF is that it felt the most intense & uncomfortable when he directed it towards his left hip! Sitting, especially while driving, has been an aggravating factor. After this entire experience, Craig’s hip felt much better sitting in the car!

An analogy for PEMF is one of a gas tank. When our car is approaching empty, it needs gas to be fueled and to work at its optimal level. The same can be said for the human body, which is made up of millions of cells, all of which need energy as well. The electromagnetic therapy utilized by this modality essentially aids in cellular recovery.

A randomized, double-blind, placebo-controlled clinical trial  from The Journal of Pain Research and Management corroborated that PEMF can be utilized as a therapeutic option for individuals with chronic pain, particularly individuals with fibromyalgia, where central sensitization may dominate the origin of pain. Not sure what central sensitization is? If you want to learn more about chronic pain and how you can treat as well as manage it, read this awesome article below.

READ: HOW TO MANAGE YOUR CHRONIC PAIN

the science of pain the prehab guys

 

 

Infrared Sauna (Light Therapy)

Infrared saunas utilize light to create a heating mechanism. You may have experienced a traditional sauna that will heat up the air, and about 10 minutes in, your body is dripping sweat as you make a B-line to the door for an exit! However, in an infrared sauna, the light heats your body directly without heating the air around you. As explained by Anders et. al, infrared therapy, which is also known as low-level light therapy (LLLT), provides positive outcomes therapeutically, including wound healing, tissue regeneration, reduction of pain, and reduction of inflammation.

Infrared Sauna

What has also been researched by Hamblin in 2016 in regards to light therapy is that the radiation has the potential to enhance growth factors as well as cellular activity in the brain for individuals with particular brain disorders, such as traumatic brain injuries (TBI), Alzheimer’s disease, cerebrovascular accidents (strokes), and Parkinson’s disease.

 

Cryotherapy

The best was saved for last with the Therabody Experience. Picture yourself in the middle of a blizzard with minimal clothing…that is essentially what a cryotherapy chamber feels like. Sounds daunting right? Who in their right mind would want to put themself through that kind of torture?! Craig and Sherif did, as do many others, with actually a good reason! Cryotherapy is an excellent adjunct in the recovery process that is gaining popularity.

Entering The Cyrotherapy Chamber

So how does it work? The temperature inside of a cryotherapy chamber can drop to as low as about -150 to -160 degrees Celcius (COLD!). The chamber concentrates the cold mechanisms into a condensed space, and as a result, the same mechanisms of a cold modality occurs, but at a much quicker rate. Blood flow is impeded from the extremities and rushes to the organs in our body to protect our body naturally. Because it is a very cold chamber, it is only recommended to stay in the chamber for 3 and a half minutes maximum (Yes Craig and Sherif stayed in for the whole time!).

Exiting The Cryotherapy Chamber

Once stepping out of a cryotherapy chamber, there is a transition between sympathetic nervous system activity (fight or flight) to parasympathetic nervous system (calm, cool, and collected) activity. The blood vessels open up, heart rate and respiratory rate begin to reduce, and the oxygenated blood returns throughout the body to kickstart the healing process.

Craig’s Whoop data from the Cryo experience

You can really appreciate this sympathetic & parasympathetic nervous system response with Craig’s Whoop data! Pretty crazy right?!

In regards to the research surrounding Cryotherapy, there have been limited studies, which have mostly included athletes as their sample populations. In a review of literature by Lombardi et al. in 2017, evidence suggested that whole-body cryotherapy can assist in the alleviation of inflammatory conditions that may affect athletes. Some of the parameters that have been studied include reduction of muscle damage markers including cytokines as well as a reduction of inflammatory and stress hormones such as cortisol. It is suggested that a reduction in inflammatory markers from the use of cryotherapy may assist in the reduction of post-exercise induced soreness within the body, thus expediting the recovery process. It is currently unknown how many consecutive sessions one must engage in Cryotherapy in order to cause significant physiological changes, with some studies suggesting 20, even 30 sessions.

 

We All Want Some Peace and Love

Want to learn more about ice and its role in recovery? Watch this video!

 

Closing Thoughts

If you know us and what we value at Team [P]Rehab, we are all about enhancing ownership of your own body, and giving you the keys to understanding how to enhance your movement system! With that being said, we are aware of times when modalities can be used in conjunction with an exercise program to help recover after a hard workout, or to simply give the body some TLC. As always, educate yourself on what specific modalities you are going to use if you so choose, while also understanding that an ice pack or TENS unit will not solve the issue that you are dealing with on your own!

 

References

  1. Thomas AW, Graham K, Prato FS, et al. A randomized, double-blind, placebo-controlled clinical trial using a low-frequency magnetic field in the treatment of musculoskeletal chronic pain. Pain Research and Management. 2007;12(4):249-258. doi:10.1155/2007/626072
  2. Lombardi G, Ziemann E, Banfi G. Whole-body cryotherapy in athletes: From therapy to stimulation. an updated review of the literature. Frontiers in Physiology. 2017;8. doi:10.3389/fphys.2017.00258
  3. Hamblin MR. Shining light on the head: Photobiomodulation for brain disorders. BBA Clinical. 2016;6:113-124. doi:10.1016/j.bbacli.2016.09.002
  4. Anders JJ, Lanzafame RJ, Arany PR. Low-level light/laser therapy versus photobiomodulation therapy. Photomedicine and Laser Surgery. 2015;33(4):183-184. doi:10.1089/pho.2015.9848
  5. C. M. Bleakley & J. T. Hopkins (2010) Is it possible to achieve optimal levels of tissue cooling in cryotherapy? Physical Therapy Reviews, 15:4, 344-350
  6. Bleakley CM, Glasgow P, MacAuley DC. Price needs updating, should we call the police? Br J Sports Med2012;46: 220-1
  7. Duchesne E, Dufresne SS, Dumont NA. Impact of inflammation and anti-inflammatory modalities on skeletal muscle healing: From fundamental research to the clinic. Phys Ther Sport2017;97: 807-17.
  8. Johnson, M. I. (2017). Transcutaneous electrical nerve stimulation (TENS) as an adjunct for pain management in Perioperative Settings: A critical review. Expert Review of Neurotherapeutics, 17(10), 1013–1027. https://doi.org/10.1080/14737175.2017.1364158

About The Author

Sherif Elnaggar, PT, DPT, OCS 

[P]Rehab Head of Content

sherif elnaggar the prehab guysSherif graduated from Temple University with a Bachelor’s of Science Degree and a concentration in Kinesiology. He then received his Doctorate of Physical Therapy Degree from DeSales University, graduating with honors of the professional excellence award and research excellence award. After his graduate studies, he served as Chief Resident of the St. Luke’s Orthopedic Physical Therapy Residency Program. Sherif is a Board Certified Orthopedic Clinical Specialist. Sherif focuses on understanding how movement impairments are affecting function while also promoting lifestyle changes in order to prevent recurrences of injury. His early treatment interests include running related injuries, adolescent sports rehab, and ACL rehab in lower extremity athletes. He also has been involved in performance training for youth soccer players. Outside of working as a physical therapist, he enjoys traveling, running and cycling, following Philadelphia sports teams, and spending time with his family.

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.

 

 

2 Comments
  • Dr. Tom Hewitt DC
    Posted at 10:35h, 19 November Reply

    Great content guys! Thanks – I will be sharing this info with the colleagues, patients and athletes I work with – and it’s also helpful to add an extra layer of credibility to the modalities I LOVE (in addition to therapeutic exercise and mobility etc. – the {P}rehab Library is AWESOME!!).
    Thanks!

    Dr. Tom Hewitt DC

    • Team [P]Rehab
      Posted at 07:03h, 20 November Reply

      Hi Tom!

      Thank you so much for not only taking the time to read our content, but also share it with your colleagues, patients, and athletes! We are so appreciative of your continual support, and wish you the best with your endeavors!!

      All the best,

      Team [P]Rehab

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