Progress Physiotherapy in Kingston Ontario, Canada
For a long time, I have said to patients:
Patient + Physiotherapist = Team
(so don’t let down the team)
Most patients are attending physiotherapy to reduce or eliminate the painful conditions. Without knowing it their expectations may be in this order:
In my opinion, moving better first is usually mandatory in pain relief. Why? Pain relief is based on both healing and efficient biomechanics. The truth is quality healing is facilitated by appropriate tissue and joint movement and loading strategies. This is particularly true in chronic conditions – that is, injuries ongoing for more than six weeks.
A path to feeling better may look more like this:
Some patients will be afraid to move when movements produce pain. This can lead to pain avoidance behaviors. These behaviors often prevent progress and lead to more pain.
Range Of Motion (ROM), strength, or loading strategies interact with pain relief. Why does this relationship exist? Well to get closer to understanding this we first need to categorize pain into two types: chemical and mechanical pain.
Chemical pain is caused by inflammation, the first or acute stage of healing. During this stage, your body has recognized tissue injury or damage and is beginning the work of cleanup and preparation for the repair to come.
You have sensors in your body called chemoreceptors that send inflammatory messaging to your brain. Your brain receives the messages and assigns pain as a warning to you to protect the injured tissue. Yes – the pain is happening in your brain. Protecting generally means moving less or avoiding normal activities.
Additionally, you may experience swelling, limiting movement, forcing your body to slow down. In a dramatic sense, this is key to your survival – without these warnings, you may continue to damage yourself further.
Mechanical pain happens when you over stretch tissues. For example overstretching and trauma can happen in a slip or fall or over-extending yourself during a sporting endeavor. However mechanical pain can also occur in tissues that have become shortened over time – from prolonged postures or repetitive tasks or after an acute injury without receiving appropriate rehabilitation.
You have sensors in your body called mechanoreceptors that send messages to your brain about pressure or tightness in your tissues. If your brain receives enough messages from these mechanoreceptors, it will assign pain to warn you. Again, the pain occurs in your brain, not the tissue itself.
Back to the original question: How to get the most out of your physiotherapy?
(Remember – it’s a team)
Your physiotherapist will work with you in the clinic with hands on, manual therapy or soft tissue techniques to help start improving tissue and joint mobility. Your therapist will also educate you on graded movements and loading strategies appropriate for your current level of ability. Both your treatments and your exercises impact chemical and mechanical pain. Your part of the teamwork is to follow through on the exercises. Be consistent.
COMMUNICATION WITH YOUR PHYSIOTHERAPIST IN THE KEY
Feedback regarding tolerance to your exercise program is vital to your therapist progressing you appropriately. Your therapist may tell you that it is acceptable to feel discomfort during your exercises. I often tell patients to evaluate their pain levels during and after their exercise program. Discomfort above 5/10 (pain scale) during the exercise means you are likely overdoing it. Increased discomfort or pain after the exercises lasting more than 5-10 minutes means your dose was too high. Some discomfort to improve your movement is expected and often necessary to achieve progress.
Coaching you toward your mobility and pain relief goals is part of your physiotherapist’s teamwork. You earn those goals by completing the work as part of the teamwork.
Without your consistency with your exercise program and your feedback regarding your response, your physiotherapist will not be able to do their part for the team.
Scott Vowles, PT
Scott is a physiotherapist with over 20 years of experience in helping patients achieve their goals.