Should You Have Pain During A Physical Therapy Session?
Pain is a universal experience. It is something we all have at some point in our lives and if we have pain it means we have a working nervous system. Sometimes we want to know what to do to limit our pain. For instance it is important to know what to do if you have pain during a physical therapy session. If you search what to do about pain in a PT session something like this may come up: “If you experience pain during therapy sessions, take your pain medicine about 30 minutes prior to your session.”
The problem is this blanket advice is just wrong
Supporting Addiction
Pain medication prescribed for pain is highly addictive. 1 in 4 people, or 25%, become addicted. The goal of recovery in PT is to reduce, manage, or eliminate your pain. Long term pain management is important for chronic pain but often physical dependence or addiction occurs with long term opioid use.
Pain Is Not A Bad Thing
Our pain experience is a 3 stage process. The first is that a danger signal is felt by your nerves and the signal travels up your nerves, to your spinal cord. Second your spinal cord transmits the signal to your brain and responds to the danger. Third the brain processes the signal and responds by an output. This output is how we experience pain. When we hurt monitoring pain and responding to it in a positive way assists in your recovery.
Stage 1 The Nerves
Nerves respond to stimulus. In regards to pain we are concerned about our nerves that sense nociception. These nerves are the reason we are able to feel things from a light touch, to a cut, to swelling. They sense tension, pressure, heat, and chemical types of pain. When a nerve senses a stimulus it just knows that it felt something. You can think about nociception as a dimmer switch that sends a signal of a specific intensity toward the spinal cord. The more intense the sensation the stronger the signal sent will be.
Stage 2 The Spinal Cord
The spinal cord is the second step in the sensation of pain. The spinal cord has the job to detect immense danger and cause a reflex to recoil away. This is why when we touch something hot we do not have to think about pulling away. The response also happens before the signal from the nerve reaches the brain. This is to help protect us from major harm. The spinal cord also has the job to send the signal to the brain.
Stage 3 The Brain
The brain is where all the signals end up. We do not experience pain without the brain. The job of the brain is to receive, process, and output (or respond) to the original signal. The brain takes all information in to account. It turns up or down the pain in regards to your mood, emotions, and memory of similar pain. This is one reason why long standing pain is difficult because the brain will turn up the pain response even if the original signal is not any worse or no longer exists. Our brain then directs us on how to respond. This response can be avoid, do not change, or attack. Each response can be appropriate at different times. Part of the job of a PT is to help people understand what pain is appropriate and masking the pain with medications is not the way to go.
Avoid The Pain
When we avoid pain we will rest. This is good when we have an acute pain less than 2 weeks in duration. This response occurs when we sprain our ankle and then the pain causes us to not walk on it. This is a healthy response to the nociception from the swelling that occurs. Avoiding pain is not the answer after months of pain. This is because the tissue that had original damage will heal and there is not a biological reason for the pain. When our brain has this response when it should not we end up with worse pain.
Do Not Change
Sometimes our brain will not give us a strong enough signal to stop us from doing things. This occurs when we stub our toe. It may hurt but we continue on through our day and the pain tends to go away in time. The problem with this response comes when we do not feel better in what we feel is a reasonable amount of time. Our body then will tell us that we need to change our strategy. When this happens our brain will increase the signal and force us to try a new strategy.
Attack
Physical therapy has the job to help people attack their pain. Specifically PT will help you understand how you should attack your pain to feel better. This comes in many forms but generally includes a gradual increase in activity while you receive focused care on your specific issues. Most people who seek help for their pain have not felt better with their current strategy. Whether your recovery requires an increase or decrease in your activity level PT can help.
Conclusion
The response to pain with physical therapy is not to take pain medicine so you can “tolerate it.” This is an oversimplification of pain and how we should respond to it. Pain is complex and a big part of therapy is to understand pain and why we feel it. This helps us know what strategy we need to use. With the right strategy people are able to increase their activity level and become more active and mobile. The solution is not medication. The solution is to understand, respect, and move/exercise with how your pain response needs you to. For more information on how we experience pain Lorimer Mosely has a wonderful talk on the pain experience.