Musculoskeletal Therapies: Adjunctive Physical Therapy.

Physical therapy (PT) modalities are a diverse group of treatments for musculoskeletal pain. Iontophoresis, phonophoresis, kinesiology taping, laser therapy, and myofascial release are some of the most commonly used and are best considered as adjuncts to exercise. Each modality is relatively safe, but none is supported by high-quality evidence in the management of most musculoskeletal conditions. Individual patient response to such modalities is variable. Neither iontophoresis nor phonophoresis has been shown to have greater benefits for neck or back pain than supervised PT. However, use of phonophoresis has been shown to result in a small improvement when added to therapeutic exercise. Kinesiology taping improves symptoms for patients with plantar fascia pain, pes anserine bursitis, and low back pain (LBP). Laser therapy has shown small benefit in chronic LBP and shoulder disorders including adhesive capsulitis, calcific tendinitis and rotator cuff tendinopathies. Myofascial release, has been found to improve symptoms of neck pain. These modalities should never replace active PT, but their use should not be discouraged as part of a comprehensive program. A concern is cost because many health insurance companies consider these therapies to be medically unnecessary or experimental.