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Picture

No Pain, No Gain?

3/13/2015

8 Comments

 
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. 


-Jim       
8 Comments
Andrew Rothschild link
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.

Reply
Robbie Horstman
3/14/2015 11:13:42 am

Jim -

Good post. I agree completely... Seems like a lot of PTs seem to relish or at least tolerate the whole pain and torture crap.

Reply
Robbie Horstman
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... [email protected]

Thanks

-Robbie

Reply
Steve
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.

Reply
Andrew S. Rothschild link
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.

Reply
Jim
3/16/2015 12:22:52 pm

Steve,

You are correct. This is too generalized a statement. It was intended to be that way. I was simply getting at the larger problem that society believes pain, function, and ROM can only be gained with at the expense of pain. This post was trying to bring light to the fact that good physical therapy (in many situations-- not all of course) does not have to be painful. As a profession, we need to educate the public that physical therapy does not equate to pain.

Andrew and Robbie, thank you for contributing to this discussion as well.

Jim

Reply
Steve
3/18/2015 01:56:31 am

Yes, agree. Maybe even some direct to consumer adverts. (like 'big pharm')

Reply
Tommaso Ottaviani
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?
Could it be accepted as a "normal reset" by the body looking for a new balance?

Reply



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  • Home
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  • Special Tests
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      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
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      • Sharp-Purser Test
      • Spurling's Maneuver
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      • Vertebral Artery Test
    • Thoracic Spine >
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      • Passive Neck Flexion Test
      • Thoracic Compression Test
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      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
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        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
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      • Dial Test
      • FABER Test
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      • Fitzgerald's Test
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      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
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      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
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      • Test for Interdigital Neuroma
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