At Modal Pain Management NYC in Midtown Manhattan, physical therapy is part of the same plan as any injection or procedure. Our in-house physical therapists work on the same floor as Dr. Alex Movshis, Floor 25 at 369 Lexington Avenue, and plan with him directly, so the exercise program is built around the diagnosis, and an injection, when one is needed, is timed to open a window for the work rather than replace it. For most musculoskeletal pain, exercise is the treatment with the most trial evidence behind it. Injections rarely change the long-term course on their own.
The Role of Physical Therapy in Pain Management
Physical therapy treats what pain leaves behind: weakness, stiffness, guarded movement and lost confidence in the painful area. The evidence is strongest for chronic low back pain and for knee and hip arthritis. In a Cochrane review of 249 trials, exercise reduced chronic low back pain by about 15 points on a 100-point scale compared with no treatment, usual care or placebo, although its effect on function was smaller (Hayden 2021). The American College of Physicians recommends exercise and other non-drug treatments as first-line care for chronic low back pain (Qaseem 2017). Starting physical therapy very early in a new back pain episode helps less than people expect. In a randomized trial, four early sessions improved disability only modestly compared with usual care (Fritz 2015).
When an injection reduces pain, it can make the exercise program possible. When the exercise program works, it can make repeat injections less necessary. That is the reason the two are planned together here.
Conditions We Treat with Physical Therapy
Our physical therapy programs cover the spine, joints and soft tissues: low back and neck pain, shoulder and rotator cuff problems, hip and knee pain, tendon problems, and recovery after procedures. For knee osteoarthritis, exercise reduced pain by about 12 points and improved function by about 10 points on 100-point scales, with part of the benefit still present months after the program ended (Fransen 2015). For hip osteoarthritis the effect was smaller but sustained, about 8 points for pain (Fransen 2014). For chronic neck pain, a Cochrane review found moderate-quality evidence that neck, shoulder and upper-back strengthening reduces pain, while stretching alone may not help (Gross 2015). For lateral hip pain from gluteal tendinopathy, an education and exercise program did better than a cortisone injection on overall improvement at 8 weeks and at one year (Mellor 2018).
Our Approach to Physical Therapy
Each program starts with an assessment of how you move, what is weak or stiff, and what you need to get back to. Treatment combines strengthening, manual therapy such as joint mobilization and soft tissue work, mobility work, and functional training for daily life and sport. Load increases gradually as your body adapts. Education runs through every session: why a movement hurts, what flare-ups mean, and how to adjust activity without stopping it.
What to Expect
Sessions usually last 45 to 60 minutes, one to three times a week depending on the condition and the stage of recovery. The first sessions set a baseline. Early work focuses on pain control, gentle mobility and strengthening in protected positions, and later sessions become harder and more specific to your goals. Progress is measured at regular intervals. A home exercise program is part of the plan from the start, because what you do between sessions matters as much as what happens in the clinic. Many people need 6 to 12 weeks of consistent work, and the range is wide.
Benefits of Integrated Treatment
Exercise can sometimes take the place of surgery, and it is worth trying first in the right patient. In a randomized trial of people with lumbar spinal stenosis who were surgical candidates, physical therapy and decompression surgery produced similar improvements in physical function at two years, although more than half of the physical therapy group crossed over to surgery (Delitto 2015). In a trial of people with knee arthritis eligible for knee replacement, replacement gave more relief at one year, but most of those assigned to a 12-week exercise and education program did not have the operation within that year, and they had fewer serious adverse events (Skou 2015). Back pain care in general is moving toward active treatments and away from passive ones and opioids (Foster 2018).
Building Long-Term Resilience
The goal is that you leave with a program you can run yourself. Your therapist adjusts the home exercises as your needs change, teaches you to recognize the early signs of a flare, and shows you how to respond to one before it becomes a setback. Keeping the strength work going after formal therapy ends is the part most people drop first, and it is the part that protects the gains.
References
- Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368–2383. doi:10.1016/S0140-6736(18)30489-6 · PubMed
- Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514–530. doi:10.7326/M16-2367 · PubMed
- Fritz JM, Magel JS, McFadden M, et al. Early Physical Therapy vs Usual Care in Patients With Recent-Onset Low Back Pain: A Randomized Clinical Trial. JAMA. 2015;314(14):1459–67. doi:10.1001/jama.2015.11648 · PubMed
- Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9(9):CD009790. doi:10.1002/14651858.CD009790.pub2 · PubMed
- Gross A, Kay TM, Paquin JP, et al. Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 2015;1(1):CD004250. doi:10.1002/14651858.CD004250.pub5 · PubMed
- Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med. 2015;49(24):1554–7. doi:10.1136/bjsports-2015-095424 · PubMed
- Fransen M, McConnell S, Hernandez-Molina G, Reichenbach S. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev. 2014;2014(4):CD007912. doi:10.1002/14651858.CD007912.pub2 · PubMed
- Skou ST, Roos EM, Laursen MB, et al. A Randomized, Controlled Trial of Total Knee Replacement. N Engl J Med. 2015;373(17):1597–606. doi:10.1056/NEJMoa1505467 · PubMed
- Delitto A, Piva SR, Moore CG, et al. Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med. 2015;162(7):465–73. doi:10.7326/M14-1420 · PubMed
- Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. Br J Sports Med. 2018;52(22):1464–1472. doi:10.1136/bjsports-2018-k1662rep · PubMed
