Can Physical Therapy Make Pain Worse Before It Gets Better?

Physical therapy aims to improve symptoms and pain but sometimes patients experience worsening symptoms after performing physical therapy exercises. Learn why this happens & how long post-treatment discomfort should last.

Can Physical Therapy Make Pain Worse Before It Gets Better?

Physical therapy is a common and legitimate treatment option for many different conditions and injuries, as well as for surgical recovery.

Physical therapy

aims to improve symptoms and pain, but sometimes patients experience a worsening of symptoms after performing physical therapy exercises. The expression “without pain there is no gain” may be familiar to you, and while catchy, it can contribute to a harmful mindset. It also causes people to hesitate or stop physical health changes because they are afraid of the discomfort they may feel.

Interestingly, while it means that physical therapy can lead to a traumatic experience, the opposite is true. It's much more likely to worsen injuries and prolong the discomfort and pain you're already feeling if you avoid care at a physical therapy center. One of the main reasons patients give for postponing physical therapy is the fear that the process will cause or exacerbate pain. Other times, patients don't mention the onset or increase of pain after therapy because they think it's a natural part of the healing process.

Should I feel pain after physical therapy? Yes. If you have just had a physical therapy session and feel that you now feel more pain or discomfort than before the session began, know that you are not the only one to whom it happens; post-treatment discomfort happens to many people and for a variety of different reasons. Understanding why you may feel pain or discomfort after a physical therapy session can help ease anxiety and help you take appropriate steps to feel better later on. If your discomfort is excessive, you should call your physical therapist and talk to him directly for more information.There's no doubt that pain and discomfort can be unsettling or even frightening, and they can often be discouraging if you feel that a treatment session with a physical therapist has made them more prominent.

However, for certain conditions, it's actually an appropriate response (but not always, though). Being aware of this is a fundamental component to your treatment and recovery. Not all aches and pains are inherently bad; in many circumstances, such as when it comes to low back pain, they can mean that positive changes are taking place in the body.1—4 The scientific literature shows that patients who understand the nature of their pain and condition tend to have better recovery results than those who don't,5—8 In short, they improve the health of body tissues (such as muscles and tendons, among others) for better mobility, strength, etc. When these tissues and structures are affected beyond what they are used to, they may become sore, mildly irritated, or tender, so to speak, for a short period of time afterwards.

We sometimes refer to this as “removing the pot” or “getting the bear in”. As a physical therapist, I often refer to this relatively short period of post-treatment discomfort as a “physical therapy hangover”, since its unpleasant nature is similar to the short-lived but annoying phenomenon of having a hangover the day after a “drinking session”. Often, it is a “necessary evil” that must take place to stimulate and increase the tissue recovery process. But, without a doubt, it should never be excessive, just mild at most.

In a very simplistic sense, when a tissue (such as a muscle or tendon) becomes irritated after a treatment session, it is a signal to the body that this structure was not strong or healthy enough to tolerate the treatment that has just been performed in the area. The body then generates a response to initiate a healing or strengthening process in that particular area, but it may not develop that response if it is not challenged enough to realize that it needs to improve in some way. This is the same phenomenon that occurs when you exercise and improve your overall fitness; lifting weights with adequate resistance lets muscles, tendons and bones know that they need to adapt and strengthen a little more. The muscle pain you may experience after a workout is actually a sign that your body is improving its overall strength and physical capacity.

That said, it's vital to know what types and amounts of discomfort are appropriate (and which aren't), so let's look at the next section for more information. As a general rule, when it comes to discomfort resulting from orthopaedic-based treatment (a treatment aimed at joints, muscles, tendons or ligaments), you should expect to feel a sensation of pain or a dull feeling of discomfort in the generalized area being treated. This type of discomfort is often referred to as myalgic pain (pain that comes from a muscle) or somatic pain (pain that arises from pain receptors in the skin, muscles, joints, tendons, and bones). However, in general terms, if the physical therapy treatment aimed to improve the general health and movement of muscles, tendons, or joints, it is not an expected response to have high levels of throbbing, throbbing, or burning discomfort.

These types of discomfort tend to indicate that the pain comes from irritated tissues such as nerves or joints. If you feel a fairly noticeable increase in this type of discomfort after a treatment session, it should only be for a very short period of time - perhaps no more than a few hours at most. If you experience very high and prolonged levels of this discomfort after treatment it may be worth contacting your physical therapist for further instructions. Like many other circumstances affecting the human body - the principle that “more is not always better” is certainly at play in this scenario - when it comes to pain after physical therapy sessions too! Feeling mild (and sometimes moderate) pain the day after the session is probably beneficial and in general is an indication that your body can respond appropriately.

Many doctors including myself usually inform our patients (depending on their condition and treatment given) that if the discomfort does not increase more than 2 points (on a 10-point scale) then it is acceptable.