What physiological therapeutic procedures are
Physiological therapeutic procedures, often called modalities, are treatments that use a physical agent such as a mild electrical current, sound waves, heat or cold to influence how tissues feel and behave. They are applied to the skin over the area being treated and do not involve needles, medication or surgery.
Their main role is supportive. A modality may help quiet pain and muscle spasm enough for an adjustment to be more comfortable, or prepare stiff tissue before stretching and exercise. On their own, passive treatments rarely change a problem for the long term, which is why they are paired with active care.
Which procedure is used, if any, depends on your condition, how recently it started, and what your exam shows. Some people never need a modality, while others find a short course helps them get through a painful phase.
Common types of procedures
Procedures in this category commonly include the following. Which ones are available and suitable for you is explained at your visit, based on your exam and screening. TODO: confirm with client (which modalities are offered)
- Transcutaneous electrical nerve stimulation (TENS)
- Small pads on the skin deliver a gentle electrical current that produces a tingling sensation. It is mainly used to help reduce the perception of pain during and shortly after treatment.
- Electrical muscle stimulation
- A current set to make muscles contract and relax rhythmically. It is sometimes used to ease muscle spasm or to help reawaken muscles that have become inhibited after injury.
- Interferential current
- A form of electrical stimulation that combines two currents beneath the skin. Many people find it a comfortable option for larger areas such as the low back.
- Therapeutic ultrasound
- A handheld head glides over gel on the skin, delivering sound waves into the tissue. People often feel mild warmth or nothing at all.
- Heat and cold
- Simple but useful. Heat may relax tight muscles and ease stiffness, while cold may help calm a fresh flare of pain and swelling.
What to expect
Procedures are quick, and you stay comfortably positioned throughout.
Screening
Before any electrical or ultrasound treatment, Dr. Okhowat checks for conditions that make it unsuitable, such as a pacemaker, pregnancy, areas of reduced sensation, or a history of cancer near the treatment site.
Setup
You lie or sit in a supported position. Pads, gel or packs are placed over the treatment area, and the intensity is raised gradually until it feels noticeable but comfortable.
During the procedure
Most procedures last several minutes. You may feel tingling, gentle pulsing, mild warmth or coolness. Say so right away if anything feels sharp, burning or unpleasant, and the settings will be changed or the treatment stopped.
Moving on to active care
Modalities are usually followed by an adjustment, soft tissue therapies or exercise while the area feels calmer. As your symptoms settle, passive treatments are reduced and active work takes over.
How these procedures may help
Modalities are most useful as a bridge to movement. Within that role, people often notice the following.
- May temporarily reduce pain so you can move and exercise more comfortably.
- Can help relax muscle spasm and guarding around a sore area.
- May make hands-on care and stretching feel more tolerable during a flare-up.
- Offers a drug-free, non-invasive addition to a broader care plan.
- Heat and cold strategies can be continued at home between visits.
Is this right for me?
These procedures may suit you if pain or muscle tightness is making it hard to move, sleep or begin exercise, and serious causes have been considered. They are not a stand-alone treatment, and Dr. Okhowat will explain why a particular procedure is being used and when it will be phased out.
Some health conditions rule out electrical stimulation or ultrasound, and some symptoms need a physician's attention before any chiropractic care. Please check with your physician first if any of the following apply.
Often a good fit
- Muscle spasm or guarding that limits movement
- A painful flare-up of a known back, neck or shoulder problem
- Pain that makes it hard to begin exercises or tolerate hands-on care
- You prefer non-drug ways to manage pain in the short term
See a physician first
- A pacemaker, implanted defibrillator or other implanted electrical device
- Pregnancy, if treatment would be near the abdomen or low back
- Active cancer or a history of cancer in the area to be treated
- Suspected blood clot: a swollen, warm, painful calf
- Areas of numbness or poor sensation, or open wounds and skin infections
- Severe new pain after trauma, or pain with fever or unexplained weight loss
If you have any of these, please see a physician or go to urgent care before booking. In an emergency, call 911.
How Dr. Okhowat uses therapeutic procedures
For Dr. Okhowat, a Doctor of Chiropractic from Cleveland Chiropractic College with over 19 years of experience, modalities are meant to be supporting players. They are used when they make the active parts of care more effective, not to fill time on the table.
His training as a Diplomate of the College of Manipulative and Body Based Practices with the American Association of Integrative Medicine centers on hands-on and movement-based care, and procedures are chosen to support that. The office on Wilshire Boulevard is a short drive from the Fairfax District, which can make focused visits easier to work into the week.
- DC, Cleveland Chiropractic College
- AAIM Fellow
- AAIM Diplomate, Manipulative and Body Based Practices
- Over 19 years of experience
Questions patients ask
What is a TENS unit, and does it hurt?
TENS stands for transcutaneous electrical nerve stimulation. Small pads deliver a mild current that most people feel as tingling or buzzing. It should never feel painful, and the intensity is always adjusted to your comfort.
Is electrical stimulation safe?
For most people, yes, when screened properly. It is avoided with pacemakers and other implanted electrical devices, over the front of the neck, over areas of active cancer, and over the abdomen during pregnancy. Skin irritation under the pads is the most common minor side effect.
What does therapeutic ultrasound feel like?
Usually very little. You feel the cool gel and the smooth movement of the handheld head, sometimes with mild warmth. It is different from diagnostic ultrasound used for imaging; this type is applied for treatment only.
Should I use heat or ice for my pain?
A general rule is cold for a fresh flare with swelling and heat for stiffness and muscle tightness, but personal preference matters too. Limit either to about 15 to 20 minutes with a cloth between the pack and your skin.
Will I need these procedures at every visit?
Not necessarily. They are most useful during painful phases and are reduced as you improve. Many plans start with modalities and shift toward adjustments and exercise as symptoms settle.
How long does a modality treatment take?
Most procedures take only several minutes and are typically part of a broader visit. The time spent depends on the procedure and the area being treated, and it is usually combined with other parts of your care.
Can I buy a home TENS unit?
Home units are widely available. If you are considering one, ask Dr. Okhowat how to use it safely for your condition and check with your physician if you have any implanted devices or heart conditions.
Are these procedures the same as physical therapy?
Physical therapists use many of the same modalities. Here, they are applied within chiropractic care and combined with adjustments and exercise. That does not make them physical therapy, which in California is provided by licensed physical therapists. See rehabilitative treatments for the active rehabilitation side of chiropractic care.
Can these procedures help after a sports or work injury?
Once a physician has ruled out fractures and other serious damage, modalities may help ease pain and muscle guarding in the early stages of recovery. They are then phased out as strength and movement return through exercise and hands-on care.