A Guide to Physical Therapy for Chronic Pain
If you’ve ever been on the lookout for drug-free pain relief treatments, you may have come across physical therapy. And, it’s no surprise, given that 41 percent of patients find physical therapy to be the best alternative option for treatment.
Physical therapy, also called “PT,” is evidence-based medical treatment that uses exercises and activities to manage injuries and pain. This kind of treatment can be used to treat a wide range of conditions, from recovering from a surgery to dealing with arthritis.
The goal of any physical therapy is to restore your body’s physical capabilities and reduce or eliminate symptoms of pain. But will physical therapy work for you? How can you know if it will be worth it?
Let’s take a look at the methods and strategies of physical therapy, what it actually does and who it works best for.
In our guide to physical therapy for chronic pain, we will be answering essential questions about what you can expect from physical therapy. In particular, you will learn about:
- What is physical therapy?
- What happens in a physical therapy session?
- What can physical therapy do for chronic pain?
- Is physical therapy supposed to hurt?
- Can you do physical therapy at home?
What is physical therapy?
Professional physical therapy dates back to the early nineteenth century. Massage and special exercises were developed for people recovering from injury in a practice referred to as “physiotherapie,” which means “gymnastics for the ill” in Swedish.
During the polio epidemic in the early 1900s, physical therapists created tools to help treat muscles that had been weakened by the disease. These treatment tools were critical in preventing permanent paralysis for patients. After World War 2, these tools were even more important for helping soldiers injured in battle. And by the 1950s, physical therapists were no longer considered technicians — they had become medical professionals.
Modern physical therapy as we now know it is a well-regarded science. It’s a profession that requires hundreds of clinical hours and a series of tests before a physical therapist can obtain a license. Many physical therapists take their education even further, achieving specialist status or even a PhD.
Physical therapy itself is now performed in a variety of settings worldwide. Hospitals, private practices, pain clinics, sports facilities and elder care facilities are just some of the places you’ll find physical therapists doing their work and helping people get stronger.
What happens in a physical therapy session?
But what does physical therapy actually entail? What is it, really?
The type of physical therapy prescribed can vary widely, depending on your medical history and the reasons why you’re going to a PT session in the first place. “A big misconception about physical therapy is that it’s a passive science. Although some aspects of physical therapy may feel passive, the majority of physical therapy is active and requires lots of personal effort,” says Dr. Jacob Hascalovici, MD, PhD, Chief Medical Officer at Clearing, and a neurologist and pain specialist at Montefiore Medical Center in New York.
Some of the most popular physical therapy treatments include:
- Balance exercises, such as a balance beam
- Low-impact cardio, such as a recumbent bike or rowing machine
- Muscle and deep tissue massage
- Heat therapy or cold therapy
- Guided movement and mobility exercises
- Muscle stretching and strengthening exercise
- Electrical stimulation
- Low-level laser therapy
- Gentle ultrasound therapy
In an initial physical therapy session, you’ll probably be asked some questions about your health insurance status. These answers will help your provider determine what PT is going to cost you. If you have questions about billing or out-of-pocket costs, don’t be afraid to ask. Remember, it’s not at all unusual to want to know how much a service is going to cost you.
You’ll also need to answer several questions about your medical history. These questions will inform your treatment plan, as well as help your therapist keep you safe during your session.
Once the intake paperwork and consultation are completed, your provider will start (gently) trying different treatments and exercises to see how your body responds. Physical therapy often requires a dynamic treatment plan, so you’ll likely do different treatments each time.
During physical therapy, your provider may ask you questions unrelated to your injury or pain level. Many physical therapists do their best to develop a rapport with their patients. But, if small talk makes you uncomfortable, you can tell your provider you’d prefer to stick with the treatments only.
What can physical therapy do for chronic pain?
Musculoskeletal injuries make up the majority of reasons why physical therapy is prescribed in outpatient settings. These are injuries that impact your muscles, ligaments, tendons, bones or joints.
Pain from these types of injuries may be acute, meaning that it begins suddenly and stems from a known trigger like an accident or a surgery. But the pain may also be chronic, meaning that it’s persistent and lasts for months or even years. The causes of chronic pain are also sometimes less clear, which can make treatment more difficult to plan.
Further complicating things, sometimes chronic pain is generalized, meaning that your pain affects many different parts of your body at the same time. Chronic pain doesn’t always have an obvious, primary source. Osteoarthritis, rheumatoid arthritis and fibromyalgia are just some conditions that can cause chronic pain.
With that being said, even if your pain is chronic, physical therapy can still help with pain management.
“With very few exceptions, I encourage almost every single chronic pain sufferer in my practice to participate in some form of physical therapy in whatever capacity they can tolerate,” says Dr. Hascalovici. “For chronic pain sufferers, physical therapy focuses on relieving pain by encouraging and improving movement and by strengthening and stretching affected body parts.”
Research suggests that there are several chronic pain conditions for which physical therapy should be used as a primary treatment strategy. To cite just a few examples:
- A 2017 review of clinical trials showed that stretching, muscle strengthening and aerobic exercise were some of the most effective methods for treating fibromyalgia symptoms.
- Similarly, a 2016 review of clinical trials showed that physical therapy was an effective pain management strategy for people with rheumatoid arthritis.
- In one randomized, controlled trial, researchers found that physical therapy treatment decreased chronic lower back pain for a full year after treatment was completed.
“Physical therapy that focuses on low-impact, high-intensity aerobics, such as swimming and elliptical, has been shown to be very effective in helping manage generalized pain conditions,” Dr. Hascalovici notes. Such pain conditions include fibromyalgia and some forms of arthritis.
Is physical therapy supposed to hurt?
Physical therapy is effective, but it isn’t always comfortable, especially at the beginning of your treatment. While you shouldn’t expect intense pain during a session, you should also be prepared for a little bit of soreness.
“Physical therapy can hurt, especially when you first start attending sessions and have not been physically active for a while,” says Dr. Hascalovici. Your physical therapist may perform a range of movements that your body hasn’t done in some time. Your therapist may also put pressure on different points of your body as part of manual or massage therapy.
But there are some strategies that Dr. Hascalovici says can help make physical therapy more comfortable, even for those who are just getting started with it. “I always encourage my patients to first give your therapist an idea of what your typical level of activity is like, so that they can design a therapy program that meets you at your level,” he says. Basically, if there are exercises in the program that are causing you severe pain, your physical therapist needs to know about that sooner rather than later.
There are swaps and substitutions that a good therapist can try in order to challenge your body and preserve your mobility without putting you into serious pain. “It's important to push yourself to participate in physical therapy as much as possible, but you are the expert in your own pain. Stop yourself from doing anything you think feels dangerous,” Dr. Hascalovici advises.
While physical therapy might feel uncomfortable during your actual session, it’s not uncommon to experience something called delayed onset muscle soreness (DOMS). This term is used for soreness that happens after your muscles have performed an activity that your body isn’t used to. It can take 24 to 48 hours for DOMS to fully set in, and an additional day or two for the soreness to fully subside.
You can ask your therapist for ways to manage post-therapy soreness. They could mention:
- An over-the-counter-NSAID to bring down inflammation, such as ibuprofen or acetaminophen
- Icing your muscles when you feel pain after a session
- Using a heating pad to increase circulation to the sore muscle or joint
- A foam roller to flush out lactic acid from muscles that have become inflamed
If you’re in a lot of pain, it’s also possible that your body isn’t quite ready for a full physical therapy treatment regimen. Communication with your primary care provider is important so that your treatment team is all on the same page in terms of what you’re ready for. “If you are recovering from an acute injury, physical therapy might not be indicated right away, so it's important to talk to your doctor to find out what is right for you,” recommends Dr. Hascalovici.
Can you do physical therapy at home?
Physical therapy has a lot of benefits for pain management, but no one wants to continue office visits forever. And that’s a good thing: physical therapy is usually only short-term. With the right tools, it is possible to do some physical therapy at home to continue with your treatment. And, thanks to telehealth, you can continue to communicate with your therapist and update them on how you’re doing.
“Many of the stretches and strengthening exercises can be done at home on your own. In fact, any good physical therapy program should always include a structured home exercise program,” says Dr. Hascalovici. “I often have to remind patients that guided physical therapy isn't something that should be prescribed indefinitely.”
And yes, you can go back to work during physical therapy if your healthcare provider and physical therapist agree. If your exercises are prescribed to address a work-related injury, such as carpal tunnel syndrome, you may be able to return to work while you’re still getting PT. If this is the case, it’s always a good idea to first discuss your treatment options with your primary care doctor.
How long will I have to have physical therapy?
Both short and long-term benefits of physical therapy are dependent on lots of different factors. It's hard to predict how long you might benefit from treatment. The success of your physical therapy also depends on what your particular goals are.
If you’re going to PT for fibromyalgia, for example, you may never reach the point where you are completely pain-free. But physical therapy can decrease your pain level so that you don’t have to rely on pain-relief medication. Continuing with PT can also help with other symptoms of fibromyalgia, such as improving your mental health and reducing your risk of depression and anxiety.
“It's easy to prescribe physical therapy,” says Dr. Hascalovici. “But it's a lot harder to help a patient participate in therapy and a home exercise program and continue with the program long-term.”
In other words, the success of your physical therapy depends on a lot of variables, but it’s important to remember that you’re the one who controls most of them.
The bottom line
We’re still learning more and more about alternative treatments for chronic pain. But when it comes to nonmedical treatment options for pain, physical therapy is one of the most well-studied options currently available. Many insurance plans will cover a certain number of physical therapy sessions per year, especially if you have a referral. If you’re curious about how physical therapy can work for you, speak with your primary care physician, neurologist, or pain specialist about your options.
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This article is for informational purposes only and does not constitute professional medical advice. Always seek the advice of your healthcare professional with any questions or concerns you may have regarding your individual needs and medical conditions.