Is Physical Therapy Painful?
Any injury or painful condition will have you trying to figure out how to get rid of the pain and get back to your normal life. In this process, you may consider if physical therapy will be a major part of your road to recovery or wonder what this process will be like.
A common worry for new physical therapy patients is if it will be painful. We get asked this question all the time… We always start by explaining what physical therapy (PT) is and what a PT will do.
What is physical therapy?
Physical therapy is care that aims to ease pain and help you function, move, and live better. Receiving this care and being evaluated and treated by a licensed physical therapist is very important.
Physical therapists are the experts in the human movement system. We are trained in orthopedic evaluation using the same methods as an Orthopedist, as well as movement assessments to determine the underlying causes of a diagnosis. Physical therapists use the information provided by the patient to tailor each treatment to specific goals, making every case different even when the diagnosis is identical. Personal goals can be something as simple as being able to get out of a chair without help or as advanced as returning to hitting a baseball. Some people just want to recover from surgery, and most people would like to return to, or improve their current level of function. Physical therapy can help these improvements happen.
“Will my physical therapy be painful?” is a common question that can be difficult to answer considering all of the factors in each case. In short, the answer is that PT can be painful, but in most cases it should not be.
Here are a few common factors that can explain the role of pain in physical therapy. Some of these factors are:
Time from onset of injury
Specific diagnosis
Goal of treatment
Injury history, beliefs, and tolerances
Time from onset of injury
Time changes everything. Physical Therapists see patients in all levels of injury and stages of pain, from hours to years after the initial onset. An acute injury is considered anything less than 3 weeks old, while a chronic injury may have been around from 3 months to many years.
New injuries are often painful. In most cases the initial goal of PT will be to reduce the pain and inflammation associated with this new injury. There may be some pain involved in the process since even simple movements may be uncomfortable, but many treatments offered by Physical Therapists can optimize and shorten recovery.
Chronic injuries and pain are more variable in presentation, but as a whole are less irritable than acute injuries. Acute injuries involve a new inflammatory process which may cause high pain levels and swelling which will need to be addressed before any other factor. In chronic conditions, inflammation may be present, but it is usually no longer the main cause of pain. This scenario will require different treatments that may focus on improving tolerance to activity or strength training so pain is not brought on as easily. The goal is not to provoke the pain associated with your diagnosis, but there can be some soreness or discomfort during a particular intervention such as passive range of motion or exercise which is not a sign of further injury.
Diagnosis
Every diagnosis can behave differently and each patient’s situation is unique. Injuries associated with trauma such a hamstring tear while running or a fractured hip from a fall will usually be immediately painful. There may be a period of immobilization after certain surgeries and specific timelines on when goals can be met. The first stages of physical therapy after a surgery or traumatic injury will be to protect the area in order to prevent further injury and encourage the first stages of healing. This is usually not very painful and the goal of PT is to maintain function of the surrounding area. When it is time to get things moving after being in a cast or sling, treatment can be uncomfortable while improving range of motion, but should not be unbearable.
In the case of a more chronic injury such as osteoarthritis or tendinitis, pain may be less severe but still limiting. In these cases, the pain may be triggered more frequently or by less specific activities. A patient with a chronic injury with low pain levels may be able to jump right into treatments such as therapeutic exercise while a person with high pain levels may need the first visit or two to help control pain with hands on treatments and gradually ease into exercise.
Some diagnoses such as tendinitis may need to be pushed into some amount of pain in order to load the tendon and strengthen it. On the other hand, degenerative diagnoses such as arthritis will focus more on working within pain-free motions and modifying certain activities that are performed. There are many cases where an individual will find relief of their symptoms in 1-2 visits while others may take weeks of care and attention. During each visit, your physical therapist will assess not only your current status but also how the previous session impacted your condition, this way treatment methods can be adjusted if needed to provide the most effective care.
Goal of treatment
Some examples of interventions provided during physical therapy can be soft tissue mobilization (massage, myofascial release, trigger point release, etc.), therapeutic exercise, and modalities such as electrical stimulation/TENS. Some people really enjoy certain interventions, such as massage or electrical stimulation because it can help relieve their pain while others find those interventions uncomfortable. The same goes with exercises, some exercises are meant to offload or provide relief to a painful sensation while other exercises are prescribed in order to strengthen a specific structure. As I mentioned previously, some conditions may require working through discomfort in order to achieve certain goals. Sometimes after an intense workout you will “feel the burn” in your muscles which can cause some discomfort or pain. Restoring knee extension post ACL repair is another example that is commonly known to be uncomfortable and create some pain but it is essential to progress through the rehab process. Regardless of your diagnosis, your physical therapist is there to guide you through your rehab process and ready to answer any questions you may have about what to expect at any stage of your condition.
History, beliefs, and tolerances
An individual’s pain experience can have a lot to do with “pain tolerance”. Let’s think about spicy food as an example. There are some people who enjoy putting hot sauce on everything because they love the spiciness, while others can’t stand it. Similarly, people can have “high” or “low” tolerance when it comes to pain. An experienced physical therapist is able to take each patient’s tolerances into consideration and adjust the treatment to achieve the best outcome for each patient. This doesn’t mean the process will always be pain free, but it should always be within each patient’s acceptable standards.
Previous experience with pain may impact perception of pain during physical therapy. Those who have had previous injuries or painful experiences may rank their level of pain as low during a pain provoking intervention based on the severity of those previous experiences. Some people may be more willing to deal with the pain or discomfort because they know it is needed to recover. Your physical therapist should know when pain is a sign to stop or when it is expected and necessary.
Similarly, previous beliefs about pain may influence tolerance to specific interventions. Sometimes a painful sensation is a warning, but sometimes that signal can stick around even though there is no threat. This can be the case with chronic pain conditions. The belief that pain means something is wrong or something bad is going to happen may cause fear in a patient before or during an uncomfortable intervention. A good physical therapist will be able to educate you on why an intervention is necessary and what to expect as well as if pain is a sign of damage with your condition. They should also be able to provide you with alternatives if you are uncomfortable with a specific intervention.
In my experience, the most common concern when someone experiences pain is to avoid further injury. During a physical therapy session, the goal is to help get you better. It is important to communicate with your physical therapist to understand what interventions will be most effective for your rehabilitation. If you are worried about pain affecting your daily life and are looking for a way to manage and get back to your normal ways, book an appointment with us today or call our office at 908-598-9009.