Physical therapists choose from dozens of treatment options. But all treatments are not equal. And the popular physical therapy treatments aren’t always the best.
Here are 10 popular physical therapy treatments, ranked from best to worst:
1) Repeated Movements: A+
The right repeated movement immediately relieves pain and increases range of motion.
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Also known as McKenzie Exercises, this approach empowered me to overcome my chronic back pain and get back to golf, running, and heavy lifting.
Repeated movements work best for spine pain. Skilled PTs also use them to relieve patients’ shoulder pain, elbow pain, hip pain, knee pain, and ankle pain.
Patients can perform these at home, which gives them independence and control over their pain. This approach works fast and empowers patients. It’s my #1 treatment.
Read more about repeated motions here:
3 Simple Exercises for Immediate Back Pain Relief
2) Load Management: A+
Physical therapists treat a lot of overuse injuries. Appropriate loading is crucial for recovery.
Too much load will cause pain and irritation. Too little load results in atrophy and weakness.
Skilled physios teach patients how much load is appropriate and how to train around pain.
3) Strength Exercises: A
Building strength is a key aspect of rehab. Strength creates durability.
That’s why rotator cuff strengthening is a must for beating shoulder pain. And why many experts consider deadlifts the best low back pain exercise. (Even though plenty of people experience low back pain after deadlifts)
Strength exercises work best for mild to moderate pain. Strengthening can exacerbate hyper-irritable symptoms.
4) Aerobic Exercise: A-
Aerobic exercise confers countless benefits. That’s why expert physios encourage patients to stay as active as possible during rehab.
Aerobic exercise relieves pain through exercise-induced analgesia. Plus, it improves sleep and lowers stress levels. And we know stress is linked to pain.
Doing aerobic exercise doesn’t mean you have to crush a 15 mile run. (Your PT doesn’t want you running that far if you’re dealing with a back or leg injury!)
Instead, you may be better off with one of these low-impact cardio exercises.
A quick aside: Notice that the top 4 treatments are active. (Done by the patient.) You’ll see that 5 of the bottom 6 treatments are passive. (Done to the patient.)
There’s a place for passive treatments, but active treatments work best and form the foundation of an effective rehab program.
5) Dry Needling: B+
Trigger point dry needling is like massage on steroids. One of the hottest, most popular physical therapy treatments, dry needling is a fantastic treatment for muscle pain.
It’s beneficial for low back problems, neck pain, TMJ issues, hip discomfort and plantar fasciitis.
Learn more about this powerful technique in The Authoritative Guide to Dry Needling
6) Manual Therapy: B+
Manual therapy is skilled, hands-on treatment to mobilize tight joints and muscles.
It includes everything from gentle massage to making the spine snap, crackle, and pop (spinal manipulation therapy).
Manual therapy is best served as a side dish to exercise. It’s less effective à la carte.
Percussion therapy (via massage gun) also belongs in this category.
Related: Do Massage Guns Even Work? The Science of Percussion Therapy
7) Static Stretching: B-
Stretching for the sake of stretching is overrated. But stretching to regain lost range of motion is a key part of PT.
For example, stretching is crucial for frozen shoulder rehab or post-op recovery after a joint replacement. And it’s a powerful treatment for healing plantar fasciitis.
But if stretching isn’t aimed at specific motion limitations, it’s probably a waste of time. Haphazard static stretching reduces strength and can increase injury risk.
8) Spinal Decompression (Traction): C-
This antiquated treatment dates back thousands of years. And it’s way overused.
Lumbar traction is only useful for 7.3% of patients with sciatica (Albert 2012). And neck decompression is occasionally beneficial for cervical radiculopathy.
That’s about it.
Instead, you’re better off working with a McKenzie-trained physical therapist who may recommend one or two of these exercises for sciatica relief.
9) Electrical Stimulation: D
Doing electrical stimulation (e-stim, TENS, NMES) at physical therapy is a poor use of time. TENS units can provide short-term pain relief.
And that’s fine for super sensitive symptoms. But you can buy a TENS unit on Amazon instead of getting it done at the PT office.
10) Ultrasound: D-
Ultrasound is useful for visualizing tendons and unborn babies. But it’s one of the worst popular physical therapy treatments. Several treatment guidelines recommend against using ultrasound to relieve pain during rehab.
One ironic study showed that ultrasound is highly influenced by expectations and the placebo effect, which accounts for much of its perceived effectiveness (Louw 2016). I don’t use ultrasound in my PT practice.
Honorable Mention
These popular physical therapy treatments didn’t fit into the rankings. Here’s how they stack up:
Yoga: A-
Pilates: A-
Education: B+
Heat and Ice: C+
Readers: What do you think of the rankings? Any surprises at the top or bottom? Have you experienced high-quality physical therapy? Or did your rehab consist of mostly passive treatments? Share your thoughts in the comments.
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