Common questions about physiotherapy techniques

It is usually tolerable. Most people feel a small prick as the fine needle goes in, then the muscle may twitch quickly or ache like a stretch for a few seconds, which is expected. Afterwards, mild soreness like after exercise, or a small bruise, is common for a day or two and settles on its own. You can ask to stop or adjust at any moment.

Read more: Dry needling · Source: Brady S, McEvoy J, Dommerholt J, Doody C (2014). Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. J Man Manip Ther 22(3):134–140

Not quite, although the needles are similar. Dry needling is based on examining the muscles and movement using modern anatomy, and targets tight, tender points inside a muscle within a physiotherapy plan that includes exercise. Traditional Chinese acupuncture is based on Chinese medicine concepts such as energy channels (meridians). Some researchers see dry needling as closer to what is called Western medical acupuncture.

Read more: Dry needling · Source: Zhou K, Ma Y, Brogan MS (2015). Dry needling versus acupuncture: the ongoing debate. Acupunct Med 33(6):485–490

When a trained physiotherapist uses sterile, single-use needles, serious complications are rare. Common effects are mild and short-lived: soreness where the needle went in, during or after the session, a small bruise or slight bleeding. A rare complication is injury to the lung when needling near the chest, so if you get sudden shortness of breath or chest pain that worsens with breathing, go to the emergency department straight away or call an ambulance: 911 in Jordan or 122 in Iraq and Kurdistan. Tell your physiotherapist if you take blood thinners or are pregnant.

Read more: Dry needling · Source: Brady S, McEvoy J, Dommerholt J, Doody C (2014). Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. J Man Manip Ther 22(3):134–140 · Halle JS, Halle RJ (2016). Pertinent dry needling considerations for minimizing adverse effects – part one. Int J Sports Phys Ther 11(4):651–662

It may help some people. Reviews suggest it may ease muscle pain and muscle knots in the short term, but the evidence ranges from very low to moderate quality and long-term benefit has not been shown, so it is used alongside exercise and manual therapy rather than on its own. NICE guidelines advise against it for osteoarthritis. At Revibe we use it when the assessment shows it suits your condition, as part of a plan built on movement and exercise.

Read more: Dry needling, Muscle knots and tension · Source: Gattie E, Cleland JA, Snodgrass S (2017). The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis. J Orthop Sports Phys Ther 47(3):133–149 · NICE NG226 — Osteoarthritis in over 16s: diagnosis and management (2022)

The evidence for it is limited and mostly of low quality. It may ease pain and muscle tightness for a short time in some people, but this is not firmly established, and the evidence is not enough to say it treats a disc problem or any particular disease. What has stronger support for muscle and joint pain is movement and exercise, with manual therapy. At Revibe we use cupping only when it fits your plan, as one part of treatment alongside exercise, never instead of it.

Read more: Cupping · Source: NCCIH — Cupping

Usually it is not very painful. In dry cupping, cups are held on the skin by suction without cutting it, so you feel a pulling or mild discomfort while they are on, and they may leave redness or round marks that usually fade within days, with mild tenderness afterwards. Tell the therapist at any moment so they can reduce the suction or remove the cups. Without care and hygiene, cupping can sometimes cause burns or skin infection.

Read more: Cupping · Source: NCCIH — Cupping

Yes. It can be done for women as for men when it suits the condition, with a few points to keep in mind: it is usually avoided in pregnancy, and it needs care with bleeding disorders, blood thinners or skin infection. There is no good evidence that it treats period or hormone problems. At Revibe you can ask for a female physiotherapist when you book, and the session takes place in a private room.

Read more: Cupping, Female physiotherapist · Source: NCCIH — Cupping · Cleveland Clinic (2023). Cupping Therapy: Definition, Types & Benefits

There is no good scientific evidence for that. Research on cupping is limited and mostly weak, and not enough to say it lowers long-term blood sugar, treats any particular disease, causes weight loss or removes toxins, and repeated wet cupping can cause anaemia. Do not stop or change diabetes or other medicines because of cupping; treatment of these conditions is your doctor's decision. In physiotherapy, if cupping is used, it is only for muscle tightness within a plan that includes exercise.

Read more: Cupping · Source: NCCIH — Cupping

It can help as a supporting treatment: it eases muscle tension, helps you relax, may ease neck and shoulder pain for a short time, and helps reduce muscle soreness and fatigue after exercise. But its effect is often temporary, and it does not replace exercise for ongoing pain. It is safe for most people, but it is postponed on a recent swollen injury, and care is needed with blood clots, blood thinners or osteoporosis.

Read more: Sports massage · Source: NCCIH — Massage Therapy: What You Need To Know · Dupuy O, Douzi W, Theurot D, Bosquet L, Dugué B (2018). An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue, and inflammation: a systematic review with meta-analysis. Front Physiol 9:403

It is a gentle, light massage technique that helps move lymph fluid. Specialist therapists use it to reduce lymphoedema, swelling that can happen for example after cancer treatment, together with compression, skin care and exercise. Being gentle, it is not usually painful. It does not directly cause weight loss, and there is no good evidence that it removes toxins from a healthy body; it may only give a slimmer look for a while. Avoid it with blood clots or a skin infection, and check with your doctor first if you have heart disease or kidney failure.

Source: NHS — Lymphoedema: treatment · UCLA Health (2026). Lymphatic drainage massage — separating fact from fiction

No. Massage is one hands-on technique that may be used within physiotherapy, while physiotherapy is broader: it starts with an assessment of what is causing the problem, then relies on exercise and education, with manual therapy such as joint mobilisation and soft-tissue techniques. For low back pain, NICE guidelines say these hands-on techniques, including massage, should only be considered as part of a plan that includes exercise. Massage also does not count as exercise.

Read more: Manual therapy, Sports massage · Source: NICE NG59 — Low back pain and sciatica in over 16s · World Physiotherapy — What is physiotherapy?

They differ in style, pressure and aim. Swedish is the best known, using long, calm strokes to relax; Thai combines pressure with stretches in which the therapist moves your body; sports massage focuses on muscles tired from training or work; and there are other Eastern styles such as Chinese massage. The evidence is not enough to say that one type is better than another for low back pain, for example. At Revibe we offer sports and deep-tissue massage inside a physiotherapy clinic, after asking about your health and where you feel tight.

Read more: Sports massage · Source: NCCIH — Massage Therapy: What You Need To Know · Cleveland Clinic (2023). Thai Massage: What It Is and 5 Benefits

Mild muscle soreness the next day is common, especially after deep-tissue massage, and usually goes within a day or two; gentle movement helps. A small bruise can sometimes appear: you can put a cold pack wrapped in a cloth on it for short periods, and tell your therapist so they use lighter pressure next time. See a doctor if bruises appear for no reason or there are signs of infection such as spreading redness, discharge or fever, and straight away if the area becomes very swollen, tense and painful.

Read more: Sports massage · Source: MedlinePlus — Bruise (Medical Encyclopedia) · NCCIH — Massage Therapy: What You Need To Know

Usually helpful, not harmful. A systematic review found massage to be one of the most effective recovery methods for easing delayed muscle soreness and the feeling of fatigue after exercise. But it is not given firmly on a recent injury with swelling or bruising in its first days, and it does not replace building up your training gradually. If you felt a sudden, sharp pain during exercise, it may be an injury that needs an assessment.

Read more: Sports massage, Sports injuries · Source: Dupuy O, Douzi W, Theurot D, Bosquet L, Dugué B (2018). An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue, and inflammation: a systematic review with meta-analysis. Front Physiol 9:403 · NHS — Sprains and strains

It uses strong sound waves that a device sends through the skin to a painful tendon or tissue; exactly how it works is not fully understood. It is mostly used for long-standing tendon pain and heel pain that have not improved with exercise, such as plantar fasciitis, Achilles tendon pain and some hip and knee tendons. NICE says it raises no major safety concerns but the evidence on how well it works is inconsistent, so it is used alongside an exercise programme, not instead of it. It differs from using shockwaves to break kidney stones.

Read more: Heel pain, Achilles tendon pain · Source: NICE IPG311 (2009) — Extracorporeal shockwave therapy for refractory plantar fasciitis · Northern Care Alliance NHS — Podiatry: Extracorporeal Shockwave Therapy (ESWT), patient information

It can feel uncomfortable or a little painful during the session, which is common; the therapist sets the intensity to what you can tolerate, and you can ask for it to be lowered at any moment. Afterwards the pain may flare for up to about three days, with redness, bruising or mild swelling in the area, and these effects usually settle on their own. Tell the therapist if the pain lasts or is severe.

Source: Northern Care Alliance NHS — Podiatry: Extracorporeal Shockwave Therapy (ESWT), patient information

Side effects are usually mild and short-lived, such as pain, redness, bruising, swelling or temporary numbness; damage to a tendon or other tissue is very rare, and NICE says it raises no major safety concerns. According to a UK NHS patient leaflet, it is not given to people under eighteen, in pregnancy, with a pacemaker or implanted defibrillator, with an infection or tumour at the treatment site, or within six to eight weeks of a steroid injection in the same area. Blood thinners, reduced feeling, fragile bones, poorly controlled blood pressure or a metal implant in the area need an individual assessment.

Source: NICE IPG571 (2016) — Extracorporeal shockwave therapy for Achilles tendinopathy · Northern Care Alliance NHS — Podiatry: Extracorporeal Shockwave Therapy (ESWT), patient information

It is usually safe when used correctly. It can irritate or redden the skin under the pads, and you should feel a mild tingling, not pain. But devices such as TENS are not used if you have a pacemaker or epilepsy, not in pregnancy unless a doctor or midwife advises it, and not on irritated, broken or numb skin, or on the neck or eyes. Their pain relief is temporary, and for many conditions their benefit is uncertain.

Source: NHS — TENS (transcutaneous electrical nerve stimulation) · NICE NG59 — Low back pain and sciatica in over 16s

A small device that sends a mild electrical current through sticky pads on the skin, giving a tingling feeling that may ease pain for a while; it is thought to work by blocking pain signals and encouraging the body's natural painkillers. It does not work for everyone and does not treat the cause of the problem. NICE guidelines advise against it for low back pain and osteoarthritis, so if it is used, it remains a temporary aid alongside movement and exercise.

Source: NHS — TENS (transcutaneous electrical nerve stimulation) · NICE NG226 — Osteoarthritis in over 16s: diagnosis and management (2022)

Common machines include electrical stimulation, interferential current, therapeutic ultrasound, laser and spinal traction. Their evidence is often weak: NICE guidelines advise against electrical stimulation, ultrasound or laser for osteoarthritis, and against traction, ultrasound or TENS for low back pain. So they are not enough on their own and are at most a temporary add-on; the core is a good assessment, exercise and manual therapy, which is what we build the plan on at Revibe.

Read more: Manual therapy · Source: NICE NG226 — Osteoarthritis in over 16s: diagnosis and management (2022) · NICE NG59 — Low back pain and sciatica in over 16s