Pain-Relief Modalities
“Pain-relief modalities” is our shorthand for the drug-free comfort measures — heat, cold,
and TENS — that we use to settle pain enough for you to move well again.
What they are
Cold therapy narrows blood vessels, which numbs pain and limits swelling, bruising, and bleeding — it's the right first choice for new injuries and recent flare-ups. Heat therapy does the opposite: it increases blood flow, relaxes tight muscles, and eases stiffness — better for lingering aches, stiff joints, and muscle tension.³ TENS (covered in full under electrical stimulation) can be layered in for persistent pain.
When we may recommend it
• Ice for acute sprains, fresh injuries, swelling, and inflamed tendons — early on, while swelling and inflammation are present.³
• Heat for chronic aches, arthritic stiffness, tight or knotted muscles, and joints that don't move well.³
• Alternating both for strains and sprains: cold first to limit inflammation, then heat for stiffness at the injury site.³
Expected outcomes
These modalities are supporting players. They can lessen pain severity and make movement easier in the short term, but they rarely resolve pain on their own — we use them to open a window for active treatment: movement, strengthening, and manual therapy. If ice and heat aren't touching your pain, that's useful information, and we'll reassess.
Sources
1. Cleveland Clinic — Functional Electrical Stimulation (FES) —
https://my.clevelandclinic.org/health/treatments/21163-functional-electrical-stimulation-fes
2. Cambridge University Hospitals — Advice on Using a TENS Machine — https://www.cuh.nhs.uk/patient-infor
mation/advice-on-using-a-transcutaneous-electrical-nerve-stimulation-tens-machine/
3. Cleveland Clinic — Should You Use Ice or Heat for Pain? —
https://health.clevelandclinic.org/should-you-use-ice-or-heat-for-pain-infographic
4. Physiopedia — Gait Training in Stroke — https://www.physio-pedia.com/Gait_Training_in_Stroke
5. Cleveland Clinic — Gait Disorders — https://my.clevelandclinic.org/health/diseases/21092-gait-disorders
6. Cleveland Clinic — Vestibular Rehabilitation Therapy —
https://my.clevelandclinic.org/health/treatments/15298-vestibular-rehabilitation
7. Johns Hopkins Medicine — Vestibular Therapy — https://www.hopkinsmedicine.org/physical-medicine-rehabi
litation/specialty-areas/physical-therapy/vestibular-therapy
8. Guy's and St Thomas' NHS Foundation Trust — Extracorporeal Shockwave Therapy — https://www.guysandst
thomas.