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Should Physical Therapy Be Painful?

Information provided on the blog is for educational purposes only and is not intended to diagnose or offer treatment plans.

No Pain, No Gain? Should Therapy be Painful?

We’ve all heard the motto “no pain, no gain” and recently seen the rise in popularity of extreme fitness activities where participants push their bodies to the limits of fitness and pain to get results.

[pullquote_left]”My goal, as a therapist, is not to cause you pain.” [/pullquote_left]

Do these principles apply to therapy? Often, “Will this hurt?” is the first question many patients ask me.

That is a simple question with a complex answer. As an Occupational Therapist for the past 13 years, and a Certified Hand Therapist for the past 6, I specialize in the treatment and rehabilitation of patients with conservative (non-surgical), traumatic, and post-surgical conditions of the shoulder, elbow, wrist, hand, and fingers, so I’ve answered that question many, many times!

With the vast array of conditions, comes a wide variety of pain associated with these conditions. As you can imagine, the pain following a joint replacement surgery might be greater than the pain experienced with tendinitis of the wrist or elbow. Pain is also variable depending on the person. Each patient is different and has a different set of variables to consider. That’s why therapists are trained to pay special attention to you, the patient, during each therapy session in order to diminish pain.

Despite some misconceptions out there, my goal, as a therapist, is not to cause you pain. Your goals are my goals. Do you want to be able to lift a coffee pot, pick up your child or grandchild, or grip and hammer so that you can return to working construction? Great! We’ll work together to do that.

In order to achieve those goals, I use techniques to increase your range of motion and strength. Are some of the techniques I use occasionally uncomfortable? YES. Stretching a stiff joint can be uncomfortable. Some patients also experience delayed onset muscle soreness (DOMS), a condition characterized by pain and stiffness felt in muscles several hours to days after unaccustomed or strenuous exercise.

[pullquote_left]We do everything we can to prevent inflammation and swelling from happening, which also means we’re trying to prevent pain.[/pullquote_left]

But too much pain can stimulate the body’s inflammatory response, which often leads to swelling of the area. If you have ever sprained, jammed, or injured your finger, you know a little swelling can significantly limit the range of motion in that finger. These reactions can cause a delay in your recovery or even occasional setbacks. We do everything we can to prevent inflammation and swelling from happening, which also means we’re trying to prevent pain.

Unfortunately, even the most experienced therapist and most attentive and disciplined patients can run into inflammation and swelling, but we’ll work together to try and prevent or minimize this as much as possible.

In addition to stretching or strengthening techniques, a therapist is also trained in pain control techniques including, but not limited to, heat, ice, and electrical methods to help minimize lasting pain or increased swelling after a therapy session.

But therapy isn’t all about what your therapist does. A major part of recovery from any injury is YOUR active participation and commitment to your home exercise program. Most patients attend therapy 2-3 times a week for 45 minutes, which isn’t that much time. The more you do for yourself by working through your personally designed home exercise program, the greater gains–with decreased pain–you can make during your therapy sessions.

Another important aspect of pain prevention is communication with your therapist. Often my first question to a patient on their follow-up visits is “How did you feel after your last session?” Please take this opportunity to tell me how you really felt. Honesty is definitely the best policy here.

Was there a point at which you noticed more discomfort? Is your home exercise program too difficult to perform as expected? Therapy can be modified to your individual needs. Since your therapist cannot be with you all the time, we rely on our relationships with our patients to identify problems that could potentially cause pain.

If pain continues to be a significant issue during your treatment following necessary modifications and use of modalities, the Rockford Orthopedic team of physicians, physician assistants, therapists and nurses communicate and work together to find other options if necessary,

So should physical therapy be a painful experience? No. Is it uncomfortable at times? Definitely. But through proper communication, individually crafted home therapy programs, and pain prevention methods during therapy sessions, therapists can dramatically decrease the chance of causing you pain during your recovery process.

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Stephanie Krueger, OTR/L, CHT

Stephanie specializes in the conservative and post-operative treatment of injuries to the hand, wrist, elbow, and shoulder. She works for OrthoIllinois at the Roxbury rehabilitation center.


© OrthoIllinois, formerly known as Rockford Orthopedic Associates 2017