Taking the Fear Out of Physical Therapy

While some may believe that the “no pain, no gain” mantra applies to physical therapy, they’re wrong, said physical therapist Lori Monson.

“We’re supposed to be reducing, not inducing pain,” said Monson, a partner in New York City-based Bradley & Monson Physical Therapy. “The old-school approach of no pain, no gain has been scientifically disproven. If you stretch the muscle until it hurts, you’re not going to get good results.”

Physical therapy is used to treat disorders of the muscles, bones and joints using heat, light, water, manual and electric massage, exercise and stretching, according to a definition found on Yahoo's online encyclopedia. In some cases, whirlpool baths, ultrasound and short-wave diathermy are used to treat some disorders.

Physical therapists use the therapy to treat patients of all ages, including babies. Treatment is used for conditions resulting from a stroke, arthritis, nerve damage, fractures, muscle tears and chronic inflammation.

Monson said physical therapists are taught to use techniques that strengthen the joints in non-painful ways.

“We’re taught to go gently, asking where it hurts, and holding the position right before the painful place,” she said. “This can be effective for hips that are stiff from arthritis. The stretches are much more effective if they’re done without pain.”

Existing Pain

Often patients are sent to physical therapists when they have pre-existing pain from injuries or painful conditions such as cerebral palsy, multiple sclerosis, and spina bifida. Surgical pain, especially from joint replacements, is also common. In these cases, physical therapy can be challenging, but won’t necessarily increase the existing pain, said Monson.

“Some people come to us because they’re pain is so bad, they’re not sleeping at night,” she said. “In this case, we’ll try to lesson the pain before physical therapy using ice or electricity and nerve stimulation. And, as a last choice, we’ll tell them to take some Tylenol 30 minutes before treatment.”

Pain may be unavoidable in the case of a frozen shoulder, a condition that often results in pain and loss of motion or stiffness in the shoulder. Because a frozen shoulder often results in the thickening and contracture of the capsule surrounding the shoulder joint, making it difficult and painful to move, said Monson.

“In some cases, if we can’t get a frozen shoulder to improve, we’ll send a patient back to a physician and have the patient get shoulder manipulation under anesthesia,” she said.

Talk to Your Doctor

In the majority of cases, however, patients should not experience pain during physical therapy, said Monson. And, if they do, they should talk to their therapists.

“The goal of physical therapy is to motivate someone to do the work they need to do to improve their conditions,” Monson added. “And there has been more evidence that has been discovered by science that pain is counterproductive. So, if you are experiencing pain, you should really talk to your physical therapist and see what they can do to lessen your pain.”