We accept the fact that realigning a fractured bone creates a brief increase in pain for the greater good, correct? Nobody wants pain, but sometimes pain is a necessary part of getting better. It’s my job to educate patients regarding the multifaceted and subjective experience of pain. If I provide patients with intelligent explanations, any fear or anxiety is usually diminished.
When does getting better with physical therapy permit or even necessitate pain? One example is centralization in a deranged (stuck) joint. If mild pain in the arm moves to the neck as a result of neck exercises, this is a positive outcome, even if the neck pain is temporarily more burdensome. Secondly, pain with specific exercises addressing a dysfunctional knee tendon is necessary, but it should not last long after the exercise is finished. Finally, stretching a frozen shoulder as far as it can go should also hurt, but, again, that pain should not last.
With surgical care for orthopedic problems, anesthesia is used to mitigate pain. With conservative care like physical therapy, patients can use rest, ice, heat, etc. to address any temporary increase in pain.
“Deranged” is not a scary word. It’s simply the term I use when a joint isn’t working perfectly. Moving any deranged joint (like the neck joint example above) can hurt to perform. There are specific rules, however. If we have the correct exercise for that joint, pain should improve with repetitions of the prescribed exercise. It should become less frequent, less intense, or less widespread. Pain after the exercise should not last.
Again, it’s my job to know this stuff and to teach it to patients. There are MANY variables when it comes to pain with rehab which vary according to diagnosis, prognosis, individual, and so on. More pain as a result of physical therapy that actually disrupts a patient’s life is very rare. Through education and following the rules, we can accomplish the long-term goal of eliminating pain with little to no increase in short-term pain. --Laura
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