No Pain, No Gain?
What does PT stand for? Pain and Torture OR Physical Torture. Wrong!
I recently have had this conversation with several patients that "no pain, no gain" is not the appropriate model for physical therapy practice. Patients often come into my doors with scared emotions. They have heard stories about physical therapy being painful. They know physical therapy will make them better, but believe this healing comes at the cost of torture.
As physical therapy practitioners, we need to change this belief system. We know the pain-for-gain model should not be promoted anymore. In instances of acute pain, the brain is telling the body something is painful for a reason. Pushing beyond the point of pain can trigger an inflammatory response resulting in increased tissue injury or prolonged soreness. From a psychosocial perspective, the perception of pain has a negative connotation. Pain can lead to a fear of movement, protective guarding, and a lack of trust in the therapist. If individuals associate therapy with fear and negativity, they are likely to have a slower response to treatment.
So how can we change this belief? The information I give to many patients is that they should feel 'better, looser, or less pain' by the time they leave each session. If not, I am not doing my job. While stretching, strengthening or performing mobility exercises, I tell patients to go to the point of pain and then back off. Soreness or discomfort may arise as you are gaining back your strength and ROM, but these symptoms should be temporary. Therapy is not intended to be painful. We are doing our patients and profession a disservice if we do not properly educate people about therapy and pain.
3/13/2015 11:05:01 pm
Excellent post, Jim. I couldn't agree more. I take a very similar approach with educating patients on this concept, not only patients new to physical therapy, but especially with those who have had it before and had a negative experience. The concept of pain = no gain was something that was highly emphasized by the Ola Grimsby Institute as I went through my residency and fellowship training and I'm glad to see it is being carried on. It is high time to change the public perception of PT and this is one way to do it.
3/14/2015 11:13:42 am
3/14/2015 11:16:52 am
Side note.. @Andrew ... I'm considering some of the programs through Ola Grimsby... if you see this and you're willing to answer a few questions could you shoot me an email... firstname.lastname@example.org
3/15/2015 09:35:37 pm
Too generalized a statement. Some people, when they are healing and collagen being stressed, have high pain, others no pain. The real measure should be are they improving: ROM, strength, function. Pain may or may not occur. Why that is...not sure anyone knows yet.
3/16/2015 10:07:54 am
It's a good point, to be sure, Steve. We can get into a whole other much larger conversation about pain neuroscience, but I think that Jim's point is speaking to a concept as a whole and the misconception that has run rampant in our profession for far too long. Obviously I don't want to speak for the author but that's just my perception.
3/16/2015 12:22:52 pm
3/18/2015 01:56:31 am
Yes, agree. Maybe even some direct to consumer adverts. (like 'big pharm')
4/3/2015 02:06:03 pm
What if the treatment si not painful but it leaves some kind of soreness in the 24-36 following hours?
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