When applied as part of a physical therapy program for neck pain, passive treatments are used to help reduce pain and/or stiffness. In theory, when pain and stiffness are reduced, exercises for the neck can be more effective.

Treatment for a Stiff Neck

Types of Passive Physical Therapy

Some passive therapy treatment types, also called modalities, include:

  • Ice and/or heat therapy. Ice or cold packs may be applied to help reduce pain and swelling. Heat packs may be applied to increase blood flow and loosen stiff muscles. In some cases, heat and cold therapy may be alternated, depending on the patient’s injury or preferences.
  • Heat and Cold Therapy

  • Massage therapy. A massage can help loosen and relax muscles, which may reduce pain and stiffness. When treating neck pain, it is common for the back of the neck and surrounding areas to be massaged, including the back of the head, shoulders, and back.
  • Massage Therapy

  • Electrotherapy. This therapy uses a device to send a mild electrical current via wires to the area that is injured or painful. There are various types of electrotherapy for different purposes, such as altering pain signals, stimulating muscle contractions, promoting tissue healing, and sending pain relief medicine through the skin (iontophoresis). The most common type of electrotherapy for neck pain is transcutaneous electrical nerve stimulation (TENS), which sends electrical pulses to the sensory nerves beneath the skin with the goal of altering pain sensations into a more tolerable feeling.
  • How Electrotherapy Works to Ease Pain

  • Ultrasound. A cold gel is typically applied to the painful or swollen area, then a handheld device is gently rubbed against the skin while sending high-energy soundwaves beneath the surface and into the tissues. Some people find that ultrasound gives a mildly warm sensation that relaxes muscles and reduces pain.

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Many other types of passive physical therapy modalities also exist. The modalities that work best for a patient can depend on a variety of factors, such as injury type, pain levels, and personal preference.

Physical Therapy: Passive PT (Modalities) for Back Pain

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Potential Risks or Complications of Passive Physical Therapy

Passive physical therapy tends to be safe when performed under the guidance of a trained medical professional. Some potentials risks and complications to know about include:

  • Skin damage. If ice or heat is applied directly to the skin for too long or at an extreme temperature, it is possible to injure the skin. Having a layer of protection between the skin and a hot/cold pack is advised, as well as regularly checking the skin during an application. Heat or cold should not be applied to areas of skin with decreased sensation due to nerve damage or medical conditions that decrease nerve function, such as diabetes and others.
  • How to Apply Heat Therapy

  • Pain remains or worsens. Passive physical therapy does not always reduce pain. In some cases, a patient may report more pain, such as after a massage. The pain from a massage usually abates after 24 hours. If not, the type of massage therapy may need to be changed, or the pressure applied during the treatment may need to be temporarily decreased.
  • Too much passive physical therapy. While passive physical therapy may feel soothing or bring temporary relief, the focus of physical therapy for neck pain in most cases must eventually focus on strengthening and stretching the neck. Performing more passive physical therapy in place of active physical therapy might delay recovery.
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A well-designed physical therapy program for neck pain has clearly defined goals for progress regarding range of motion and pain relief. If the goals are not being met, the program needs to be reassessed.

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