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Should Physical Therapy Hurt?

This is an excellent question. No pain, no gain philosophy. My colleague was stretching a woman’s Frozen Shoulder. As the arm was getting stretched, she was biting down on her T-shirt, and you could see how much pain she was in. It was my turn to see her 3 days later. When I called her in, I could see the anxiety that a bigger and stronger-looking person was about to hurt her more just to get the arm better. She walked in carefully and then told me to be easy on her because her shoulder had hurt so much that she could not sleep the night after her last session. With her head down, a concerned look on her face, she sighed, behaved like an obedient child, laid on the treatment table slowly even when she did not feel like it. Since she wanted to get her arm back, and the doctor sent her to PT, she may have thought that the treatment should hurt to make it better, right?. The answer is that it does not have to be.

In my opinion, it is like removing a stripped head of a screw. We put more pressure on the drill to try and get it out, but it only gets worse. Fortunately, a specific tool called a “Screw Extractor” can work effectively remove it. It is the same in physical therapy. We don’t want to add more to your suffering. You have to ask yourself if it is a “good” pain or a “bad” pain. If it feels like it is getting worse, you have to let your therapist know so that they can use a different or more appropriate “tool” or “strategy” to make your treatment as comfortable as possible. Some people indeed have a higher pain threshold and some lower. But, ultimately, you should be comfortable with it.

Make sure your therapist has enough time with you to address your questions and, more importantly, your concerns. One red flag is if your therapist sees too many patients in an hour. Too busy for you to ask if you are doing the exercise correctly or if it can be modified when difficult for you. If it is not rectified right away, then this may not help at all or make you worse. Ideally, you should see some improvement every week.

If you are experiencing some pain with an exercise, make sure your therapist knows. If it continues to hurt, it usually is an indication that something has to be corrected first or changed to make that exercise more manageable. I typically use precise manual techniques to accomplish this. Remember that corrective exercises should gradually reduce pain in contrast to strengthening exercises that usually hurt as you reach muscle fatigue. Repeating the painful exercise is like the “stripped screw head” analogy we mentioned before. A good rule of thumb would be a pain scale of 1-3/10.

We also want the pain to gradually reduce as you repeat the exercise, but there are some conditions where the pain will rise up first and then reduce within 5-10 repetitions. So again, your therapist should know and monitor these signs to guide you in your success. ©