Physical therapies and how they work

PDF download is not available for Arabic and Urdu languages at this time. Please use the browser print function instead.

Physical therapies are treatments that affect the body's tissues (muscles, joints, bones and nerves) to reduce pain and improve your physical function and overall wellbeing. They can restore the body’s ability to move, which helps you to live your life at home, at school, and with your friends.

In this way, physical therapies can help reduce the negative aspects of living with chronic pain. You might sometimes feel worried, sad or depressed because your day-to-day activities are restricted by your pain. Physical therapies can help you to live a more active life, which can improve your mood, sleep and energy level as well as reduce your pain.

Throughout this section, you will learn about:

  • different types of physical therapies
  • the evidence that exists for different types of physical therapies.
3Ps of pain management: physical, psychological and pharmacological

The best way to reduce pain and improve function is through the 3P approach – that is, physical, psychological and pharmacological therapies. Physical therapies are a key element in managing persistent pain.

There are two main types of physical therapies, active and passive. The main difference between these therapies is how much effort you need to put in.

  • Active therapies need your participation – in other words, you do the exercises.
  • Passive therapies are often done to you by a healthcare provider or don’t require movement – in other words, you receive the therapies.

Active therapies

Active therapies make your muscles, bones, heart and lungs stronger so you can become fitter and better able to do more activities. There is strong evidence that they have long-term benefits for people with chronic pain. This is because active physical therapies, such as exercise, release endorphins and other hormones that act as natural painkillers. As well as helping to reduce pain, endorphins can help to improve your mood and energy level and help you sleep better.

Passive therapies

Passive therapies ​can be used to relieve pain in the very short term, but there is no evidence that their effects last after the therapy session is done. Ask your healthcare team if passive therapies would be a safe and worthwhile option for you to try. If you do use them, they work best alongside active therapies.

Evidence for active and passive therapies

Over the following pages we describe a number of active and passive therapies. Each therapy includes a summary of the research evidence that supports it.

Much of the evidence comes from a type of research called a randomized controlled trial (RCT). This style of research involves randomly putting people into different groups: one that receives an intervention, in this case a type of physical therapy, and another that does not (the control group). The research compares the two groups to see if the intervention makes any difference. To make sure the research works as it should, participants from both groups are carefully observed throughout the study and their outcomes (for example, their pain levels) are compared. The RCT is considered the highest standard of study design for evaluating treatments.

On this website, we use one of the images below to indicate the number of published RCTs that support each treatment. This lets you see how much proof exsists that a particular treatment is effective for chronic pain.

Weak or no evidence
No RCTs were found to support the benefits that were claimed
Moderate evidence
At least one RCT was found to support the benefits that were claimed
Strong evidence
Multiple RCTs or a review of RCTs were found to support the benefits that were claimed
Last updated: May 2nd 2016