Treatment Modalities

Mobilization and Manipulation

Often times joints in our body such as the joints in our back, neck, arms or legs become stiff. This may be due to an injury that we’ve had, our posture or arthritis. It isn’t unusual for stiffness in one joint to lead to pain in another. A physiotherapist can assess and treat for stiffness with what is called mobilization or manipulation. Mobilizations consists of small passive movements, usually applied as a series of gentle stretches in a smooth, rhythmic fashion to the individual vertebrae or joints in the body. A manipulation however, is when the joint is taken to end range and a thrust is applied to cause a crack or pop. Both are effective means of increasing range of motion in joints, providing pain relief and joint nutrition.

Mobilization is safer because it is done slowly and the joint is only taken to end range and then the therapist backs off. There are fewer contraindications to mobilization than to manipulation. Recently there has been a lot of media attention regarding manipulation on the neck and the risk of stroke following manipulation. Mobilization is completely safe especially in the neck and a wonderful alternative to manipulation.

Most physiotherapy programs will consist of mobilization and sometimes manipulation. The physiotherapist will always achieve your consent prior to using these treatments. The physiotherapist will then provide you with exercises to maintain your new range of motion and strengthen weak muscles.

Trigger Point Dry Needling

Dry needling is a treatment for muscular tightness and spasm which commonly follows injuries and the normal degenerative process of the spine. These areas of tightness or spasm are called trigger points i.e. “knots in your muscles”. Trigger points may cause compression and irritation of the nerves exiting the spine. When nerves are irritated, they cause protective spasm to all of the muscles to which they are connected and subsequently trigger points develop in these muscles. As a result, you may develop problems in your arms or legs such as carpal tunnel, tendonitis, osteoarthritis, stiffness and chronic pain. Scientific studies have shown that in areas of trigger points in the body, there are increased levels of biochemicals associated with pain and inflammation. Dry needling involves placing acupuncture needles in the area of a trigger point and moving the needle in and out of the muscle. This causes the muscle to twitch. This twitching allows the muscle to lengthen and the trigger point to resolve. The needle also causes the biochemicals of pain and inflammation to dissipate. The muscle will feel as if it had an intense workout immediately after; however, you should feel relief of your symptoms. Dry needling is effective for the treatment of muscle and nerve disorders including but not limited to lower back pain, degenerative disk disease, neck pain, headaches, osteoarthritis, tendonitis, carpal tunnel, sporting injuries, repetitive strain injuries, fibromyalgia, multiple sclerosis, whiplash and more!! Balance Physiotherapy is one of the few clinics in Halifax to offer this treatment.


Physiotherapist’s are excellent at diagnosing muscle imbalances. A muscle imbalance develops when some of the muscles surrounding a joint are weak and others are tight. As a result, certain muscles will need to be strengthened and others will need to be stretched. Every good physiotherapy program will consist of some type of exercise. Some exercises will be done in clinic and some will be prescribed to you as part of a home exercise program. A unique difference between physiotherapists and other practitioners who treat pain is that your physiotherapist will teach you how to become independent with your treatment. Usually this consists of an exercise plan that will enable you to control your pain level and strengthen your particular body part so that pain is less likely to recur.

The therapists at Balance Physiotherapy recognize the importance of core stability, therefore most exercises given originate at the core. By strengthening the core, it gives a stable foundation for the arms and legs to move. Core exercises are not always exercises that cause muscle burn like traditional abdominal crunches. They are designed to get the brain activating these muscles which are your internal back brace. Scientific research shows that these core muscles are activated in individuals without pain prior to arm or leg movements. With injury, especially to the back, sometimes these muscles are no longer activated. Thus, these exercise are effective for treating back pain but also pain in other joints of the body.


Acupuncture is the insertion of fine needles into specific points of the body. Acupuncture is used as a physiotherapy modality to reduce pain and inflammation. Acupuncture causes a release of endorphins resulting in relief of pain even after the needles are removed.The needles are usually inserted in the area of where the pain is experienced. Usually the skin will become red around the needle as it stimulates circulation to the area. The needles are much finer than a needle that is used for an injection and generally are not painful.

Laser Therapy

Lasers and LED lights are used for the treatment of various musculoskeletal conditions and injuries. This technology uses both red and infrared light to penetrate diseased or traumatize tissues. As these particles of energy (called photons) are absorbed into the skin and tissue, it results in a complex series of reactions that stimulate your cells to produce more energy, called ATP. This leads to decreasing pain, speeding up the inflammatory process, breaking down scar tissue, enhancing the immune system and encouraging the natural healing process. These effects are achieved by using a low level intensity laser and does not heat or cut tissue, unlike high intensity lasers used for surgery. Laser is appropriate treatment for soft tissue and sport injuries, whiplash, back problems like DDD, disk injuries, osteoarthritis, sciatica and spinal stenosis, repetitive strain injuries like tennis elbow and rotator cuff tendonitis, and inflammatory conditions like plantar fasciitis, rheumatoid arthritis, bursitis and temporomandibular dysfunction.

This treatment is non-toxic, non-invasive, non-allergenic and there have been no adverse reactions reported. It is completely safe and can be used if a person has a pacemaker, metal implant/plate/screw, prosthetic or transplant. The only time it would unsafe is over the womb in the 1st trimester of pregnancy or over a known malignancy. Treatment times vary depending on the area of treatment but last from 30 minutes to one hour. For more information refer to


A whirlpool bath is sometimes used to treat injuries. The body part is immersed in water that agitates to provide a massaging feeling. Often you will also perform exercises while your body part is immersed in water.

A warm whirlpool heats the body part providing relief from pain and muscle spasm and is often preparatory to stretching or mobilization by the physiotherapist. A cold whirlpool is used to decrease inflammation and swelling. Often a contrast bath is used where hot and cold baths are alternated to alleviate pain and swelling.


The word TENS stands for Transcutaneous Electrical Nerve Stimulation. The word IFC stands for interferential current. TENS and IFC are electrical devices that deliver relatively low voltage electricity into the body through small electrodes. The electrical stimulation gives a buzzy feeling that distracts the brain from feeling pain. Physiotherapists use these modalities to provide relief from pain and often use these modalities in conjunction with heat or ice depending on the stage of your injury.


Neuromuscular electrical stimulation (NMES) is an electrical device that delivers electrical impulses into the body to cause muscle contraction. Often muscles become inhibited and do not contract as they should. This may be due to injury, muscle imbalances or post surgery. This can lead to pain. As a result, the brain has difficulty contracting the muscle properly.NMES can cause a muscle to contract involuntarily thus assisting in strengthening weak muscles and correcting muscle imbalances.


Ultrasound is a device that delivers sound waves into the body to provide a deep heat. This heat brings blood flow to the area to stimulate healing. In the acute stages of injury it can be used to decreased inflammation in a joint, muscle or ligament. In later stages it can be used to heat an area for mobilization or to relax muscles. As a result, it decreases pain.


Taping is often used to support a joint or to provide reminders about our posture or to wake up muscles that are lazy or to inhibit muscles that are overactive. Taping also serves as a means of pain control by reminding us to straighten our posture. Taping can also be used to support a joint that has been sprained to hold the joint in proper position for healing.

Work Conditioning

Work conditioning programs are designed to rehabilitate individuals for return to work. Individuals may be off work due to a work injury that is compensable by Workers Compensation or may have been involved in a motor vehicle accident. Physiotherapists can assess your injury and design programs to help you return to work. This often includes work simulation exercise and physiotherapy treatment. Sometimes it is necessary to use a multidisiplinary team of physiotherapist, occupational therapist, psychologist, family doctor, WCB case worker, and employer to get you back to work. At Balance Physiotherapy, we are equipped to handle Workers Compensation Claims and Motor Vehicle Accident Claims. We enjoy great success with recovering injured workers to pre-accident status.