Has it been 17 months since Part 2? Jeez…sorry for the big delay. I think I’ll get part 4 in faster than that 😉
I groan internally whenever I hear a patient say that PT stands for “pain and torture” or “physical terrorist.” It is usually said with humor and I chuckle along to satisfy my patient, but I quickly correct them, too. Physical therapy is not a “no pain, no gain” business. If that has been your experience or what you heard from others, allow me to explain.
In the course of trying to get you better we probably have to add some stress. That’s just how our bodies adapt. Sometimes the necessary stress is painful. Most of the time it’s not. That will depend on your particular condition.
Most conditions can be safely exercised, even if some pain is present. These include neck and back pain, joint pains, rotator cuff issues, strains, and sprains. Things like Achilles tendinitis, patellar tendinitis (jumper’s knee), and plantar fasciitis may even require a certain reasonable level of pain to ensure we are stressing the tissue enough to heal. Physical therapy for post-surgery is most likely going to be a little painful as a certain amount of movement is usually necessary to maintain mobility and prevent complications.
If you suffer from persistent pain and have signs of central sensitization—a hypersensitive and hypervigilant nervous system—pain during exercise may be a bad idea. For these people, painful exercise may only serve to reinforce the nervous system’s interpretation of exercise as bad, and it could perpetuate or worsen the condition. Some education and other strategies may need to be employed before attempting exercise or intense manual therapy.
Painful hands-on therapy may be what most people think of when they’re thinking of PT “pain and torture”. Many people assume that in order to correct their underlying tissue “problem” and loosen things up their muscles and fascia need to be squeezed, poked, kneaded and tenderized. You can read about the questionable effectiveness of many forms of manual therapy in lots of places (perhaps in a future blog here), but suffice it to say if it works it’s because it affects the brain and nervous system, and not because it physically softens muscle, stretches fascia, or puts joints back in place. Because of that, it doesn’t have to require a lot of painful force. So if your therapist is doing some technique that’s painful and you don’t like it, ask them to go lighter. A less painful technique will probably work just as well.
The number one thing to keep in mind is that you should always be in control and have the final say. If you don’t want to do something you should make it known, and your physical therapist should respect that. For their part, your physical therapist should explain what they’re going to do, why they’re doing it, and what you can expect to feel. If you still don’t want to do it, they should have an alternative in mind.
Additionally, your PT needs to put pain in context. They should explain what pain means and represents. They should explain when pain may be a normal, safe response and when pain represents a bad or unwanted response.
Just like going to the gym isn’t always a pleasure, physical therapy may sometimes be a little uncomfortable. But it doesn’t have to hurt a lot and you shouldn’t be feeling a lot worse than when you came in. Make sure you’re comfortable with your PT’s treatment plan. Ask questions and raise concerns if you have them. We PTs are here to help. And, please, no more “physical terrorists”.
If you think you could use some physical therapy help, but you’re afraid that it might hurt worse why don’t you speak directly to a PT about your concerns? Arrange a free 15-minute phone call with one of our PTs and ask questions to understand how we might help you.