The “No Pain, No Gain” Philosophy Is Flawed
- Published on Wednesday, 15 April 2015 08:47
- Written by Kateri
As a physical therapist, I’ve heard patients come up with some pretty entertaining alternatives for the abbreviation PT, including pain and torture and even physical terrorists. Now, these patients were, of course, speaking in jest; but, in truth, there can be elements of pain associated with rehab.
Let me elaborate. Pain is never something that a therapist strives to create, but it may be an unfortunate side effect of certain treatments. We make sure that we are up front with our patients about what to expect in terms of discomfort or pain during various therapeutic techniques. For example, when we are helping a patient gain full range of motion at his/her knee following a total knee replacement, there will likely be discomfort at the end of the range. The same can be said for shoulder surgery. The majority of shoulder surgeries can cause significant discomfort when attempting to gain full motion because of how small the region is and the amount of muscles and nerves that must pass in the often swollen area. Another example of a treatment which may cause discomfort is electrical stimulation. Certain forms of electrical stimulation are intended to create an electrical pulse that causes a muscle to contract and the intensity of the pulse may not be comfortable for all people. As PTs, our goal is to help our patients regain function with as little discomfort as possible, but discomfort cannot always be avoided.
Two important things to understand are that not all pain is the same and no two people react to pain in exactly the same way. Pain may be described as achy, sharp, dull, throbbing, pinching, burning, etc. depending on the cause of the pain. Additionally, even if two people have the same surgery, one may have extreme pain and the other may have very little or no pain. Depending on a person’s condition, a PT may choose to minimize focus on that patient’s pain, because focusing on it can actually increase awareness of pain and therefore the intensity of pain. Other patients may need focus to be placed on pain because they could damage their tissues if they ignore their symptoms.
I have some patients that halt all activity at the slightest inclination of discomfort, while others are constantly trying to push themselves past their bodies’ limits. Neither of these philosophies are necessarily good ones. Pain is very subjective and often needs to be explained in terms of what is expected and what is abnormal. Muscle soreness is a natural result of increased muscle activation. When you perform new exercises, your muscles produce lactic acid. This lactic acid is the root of the soreness or discomfort felt following new exercises. If the soreness lasts for an extended period of time (ex. 3+ days), however, then your level of activity/exercise may have been too high and needs to be reduced. Stretching is another activity that may cause discomfort that is misconceived as harmful pain. When you are stretching you should feel pulling or even a slight burn in the muscle belly. If this burn becomes excessively intense or turns into a sharper pain, then the stretch is likely being performed too far into the range and needs to be reduced.
Exercise should not be painful while you are performing it. There are some exception with regard to various surgeries and chronic pain conditions where pain cannot be avoided during activity; but as a rule, exercise should not be painful. The “no pain, no gain” philosophy is flawed. Pain is your body’s natural defense mechanism. If you ignore it, then you are likely causing damage to your muscles, ligament, nerve, or other structures in the body. I cannot count the number of patients I have seen due to overuse injuries or who continued to exercise improperly despite pain. Pain can be complicated and very subjective, so if you are not sure if your fitness routine is causing potential damage, then call your physical therapist for a consultation.
Should You Have Pre-Surgery PT?
- Published on Wednesday, 01 April 2015 09:56
- Written by Kateri
I often find myself discussing the effects of a person’s prior level of activity related to his/her current predicament. Say, for example, you have been suffering from debilitating knee pain for years and you have stopped doing your normal activities and limit the amount that you move your knee. 1 month later you have a knee replacement. How will you do in physical therapy?
Regardless of your prior level of disability, physical therapy will work wonders for your knee function; however, there will likely be a hard road ahead of you. Your level of strength and range of motion in that knee prior to your surgery can make a big difference on how quickly you will regain your strength and range. If you were a relatively active and strong individual prior to your surgery, you will likely regain your strength quicker than someone who is deconditioned and does not know the first thing about exercise.
How about range of motion? If you had years of limited movement in your knee, then your muscles have progressively shortened to the range at which they have grown accustomed. In other words, your muscles are still going to be tight after you have had your surgery, so they will take longer to stretch in order to regain full motion.
Now, we know that when you are in pain, you will naturally limit your activity level and degree of motion. This is NOT a shock to us. We just want to clarify that years of limited activity or inactivity can make recovery take longer than for someone who has remained mobile. So this advice goes out to ALL individuals, young and old, who want to avoid extra hassle with recovery from future injury or surgery: the stronger you are prior to injury and surgery, the more likely you will have a successful and speedy recovery. In other words, BE ACTIVE! Exercise, go for walks, play a sport, dance, do yoga, etc. I am not saying that you won’t get better if you did not do these things before an injury, but your recovery will go much smoother if you were active prior.
In addition to simply staying fit and active prior to injury, having PT prior to surgery can also make a difference in recovery outcomes. Research has shown that individuals who have PT prior to ACL reconstruction surgery have better overall outcomes up to 2 years following their surgery. These individuals also had PT following their surgery. This is an example of conditioning muscles prior to surgery having a positive effect on outcomes. Similar positive results were found with individuals who had PT prior to hip and knee replacements. The difference is that these individuals were seen prior to surgery only 1 or 2 visits. With these individuals, their outcomes were improved most likely due to training with walking devices, understanding a preliminary exercise program, and being given an understanding of what to expect following surgery. Either way, PT prior to and following surgery can have a very positive effect on a person’s recovery.
PTinMotion Magazine February 2015 p. 62, 63
Getting Rid of That Pesky Sciatic Pain
- Published on Wednesday, 18 March 2015 10:43
- Written by KateriK
Our last blog detailed what sciatica is and the various causes for this condition. Now, let’s venture into the treatment approach for sciatic symptoms.
So, what treatments are the most effective for this condition? Physical therapists are specifically trained to examine this type of ailment and determine the cause of the problem as well as an appropriate treatment plan. Sciatica is more of a side effect of other underlying conditions; therefore, treatment is often geared at the underlying cause while also addressing symptoms.
At the initial onset of symptoms, using ice on and off along the painful area for 2-3 days can help decrease inflammation. Keep in mind that ice should only be applied for 10 to 15 minute increments in order to be the most effective. Ibuprofen (pain reliever and anti-inflammatory) and acetaminophen (pain reliever) may also assist with decreasing pain.
Bed rest is NOT recommended. I repeat, bed rest is NOT recommended. You may need to reduce your level of activity due to pain, but eliminating activity altogether is not good for your body. Due to the fact that the back is the most common cause of sciatic symptoms, certain activities like heavy lifting or twisting should be avoided, especially within the first month following symptoms. Certain exercises and treatments can be particularly helpful depending on the cause of the problem. Disc herniations, for example, respond well to lumbar extension-based exercises while spinal stenosis responses better to forward bending-based exercises. Piriformis syndrome responds well to stretching, manual treatment, and may requires other techniques to decrease acute symptoms. One particular area that tends to be beneficial universally for sciatica is abdominal strengthening and most treatment programs will include some amount of abdominal/core exercises. A physical therapist can determine which exercises fit the condition best based on the cause of the symptoms and develop an exercise program consisting of those exercises. A PT can also determine if certain manual treatments are necessary for the condition including soft tissue techniques or joint mobilizations.
With the appropriate treatment, sciatic nerve pain can be resolved non-invasively within a relatively short period of time. Occasionally, when pain does not reduce, your doctor may choose to perform an injection to reduce nerve root inflammation. Less commonly, symptoms may stay severe enough to require surgery, but this is typically only when progressive neurologic symptoms or bowel and bladder dysfunction are present.