If you’re early in your physical rehabilitation journey, you may have been told by a physical therapist or friend that physical therapy will get worse before it gets better. Is this actually true?
Patients sometimes feel worse before getting better in physical therapy because the treatment involves mobilizing injured areas, breaking down scar tissue, and strengthening weak muscles, which can cause initial discomfort. This effect generally subsides after the first 2-3 weeks of treatment.
In this article, we’ll discuss what’s actually happening when we subjectively feel that we’re getting “worse” during the initial few weeks of physical therapy treatment, and provide some suggestions to follow if you feel that your condition is actually regressing.
First, you’re not actually getting worse.
The first, and hopefully the most memorable point we’d like to make is that you’re not actually getting worse. During the initial weeks of physical therapy sessions, our patients are often utilizing ranges of motion that they haven’t accessed for quite some time, and they may be mobilizing joints that they have “babied” for weeks or months. Additionally, we may be challenging you to strengthen certain muscle groups that may be very weak and therefore sensitive.
Pain is a strange topic – as we’ve discussed many times, pain is an emotional experience. What this means is that the perception of “pain relief” or “increased pain” may or may not be related to actual tissue damage in the affected joints.
For many patients, the fear of movement seems to cause an increased pain response. As patients progress through their physical therapy program, this fear response goes away and the perception of increased pain often goes with it.
The initial discomfort: why it happens
When you first start physical therapy, it’s not uncommon to experience an increase in discomfort or pain. This can be disheartening, it helps to know that this initial discomfort is generally a natural part of the healing process, and it does get better.
Understanding why it’s happening also goes a long way towards improving your outlook:
Mobilizing injured areas
We’ve all experienced the phenomenon at some point in our lives where an injury causes us to completely immobilize an area. This presents a few issues. First, it can be painful and uncomfortable to reintroduce movement into these joints when we begin recovery.
Additionally, in many cases, the body compensates for an injury by overusing other muscles and joints. Physical therapy can target these compensatory patterns, often causing temporary discomfort as the injured area is mobilized and retrained.
Strengthening weak muscles
Weak or underused muscles need to be strengthened to support healing. This can be uncomfortable for the exact same reasons that the mobilization process is uncomfortable. If you’ve been injured for an extended period of time, the effect can be more pronounced.
Physical therapy exercises typically begin with very light resistance using bands or light weights. Regardless of the entry point, the process of building muscle can cause soreness, similar to the feeling after a strenuous workout. This soreness is a normal part of muscle development and recovery.
Breaking down scar tissue
Though this doesn’t necessarily apply to every case, it certainly applies to those recovering from surgery or severe injuries. Scar tissue can limit mobility and cause pain. Physical therapists work to break down this scar tissue, which can be uncomfortable but is necessary for improved movement and function.
The healing process is gradual
Despite the initial discomfort, physical therapy is designed to promote long-term healing and pain relief. Here’s what to expect as you progress through your therapy:
Early stages of therapy
As mentioned above, you might experience an increase in pain or discomfort during the initial stages of treatment. During this phase, we encourage you to communicate well with your therapist so they can adjust your treatment as needed.
Gradual improvement
As you continue with therapy, you’ll start to notice gradual improvements in your strength, flexibility, and overall function. The initial discomfort will begin to subside as your body adapts to the treatment and starts to heal.
For further reading on time frames, see our full articles on how long it takes to recover from tissue damage, and how physical therapy works.
Ongoing support and adjustments
Physical therapy is an ongoing process. Your therapist will continually assess your progress and make necessary adjustments to your treatment plan. This ensures that you are always working towards optimal recovery.
Final note: please don’t blow off increased pain
We realize it would be easy to read the contents above and conclude that increases in pain or stiffness are “all in your head.” This message is NOT what we intend to get across.
If you’re experiencing increased levels of pain, discomfort, or stiffness as side effects of physical therapy, please communicate with your therapist during or before your next treatment session.
We noted above that the definition of pain is an emotional experience which may or may not be related to tissue damage. That means that there is a chance that something deeper is going on within your tissues that your therapist needs to know about.
In other words, it might be nothing, or it might not. The only way to know for sure is to defer to the actual experts!
Pain relief and functionality is a long term pursuit
The last thought we’ll leave our readers with is this: from the physical therapy process to the home exercise program to the discharge plan, our intention is that our patients would recover over the long term and be armed with the tools to maintain their newfound functionality for years to come.
Whether you experience some initial discomfort or not, it’s generally worth it to see the process through. Nothing replaces the sense of freedom and empowerment our patients feel as they go on to resume their daily activities pain free.
