"No Pain, No Gain"

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This is one of the most common phrases I hear from patients on a daily basis in my physically therapy practice. What they are thinking, and saying, is that physical therapy must be physically painful in order to reach their goals.  Many physical therapists abide by this cliché as well, earning us nicknames such as, “ PT, Physical Terrorist,” or, “ Princess of Pain,” or, “ PT = Pain and Torture.”  While sometimes a patient must experience some physical discomfort, most of the time the “pain” comes from the patient needing to change their mind-set, goals, and habits in order to achieve their desired outcome.

First, let’s dispel this myth. There are really very few instances when a patient should experience physical pain during PT treatments. PT does require the therapist to touch the injured person and for the patient to perform exercise. But, they should be doing so in such a way that pain is less following the treatment. And, they should be listening to the client, watching their face and body language to determine the level of discomfort the patient is experiencing, and modify their technique as to limit the pain response.

Physical pain is perceived in the brain. Our nerves send information to the brain about what is going on inside and outside of the body, utilizing our 5 senses. This is how we know when there is danger, or when the danger has passed, when something is gratifying, or disappointing. It is also how we make judgments about how to proceed.  Here is an example:

You’re walking down the street and trip over a crack in the sidewalk, falling into the street.You have sprained your ankle, and it hurts. You can’t stand up and walk due to the pain.
Now imagine this scenario:
You’re walking down the street and trip over a crack in the sidewalk, falling into the street. You have sprained your ankle, but a car is coming right toward you! You pick yourself up and get out of the street! Now that you are safe, your ankle is killing you and all of a sudden it is hard to even walk or put pressure on it.


The same injury occurred. Why was it only so painful that you couldn’t walk after the danger of getting out of the way of the oncoming car was gone? Your brain made a judgment of which signal for you to perceive and act on.  “DANGER! THERE IS A CAR COMING AND IF YOU DON’T GET OUT OF THE STREET YOU’RE GOING TO DIE!” Once the threat of death is gone, now your brain sends the signal, “ OH, BY THE WAY, YOU SPRAINED YOUR ANKLE.”

Now, all of this is to show that pain is really just a signal. Just like after eating you may feel full, so you stop eating.  Our brains can choose which signals to perceive and which to ignore depending on the situation. Pain is perceived because there is problem. Just like a fever exists to signal your body is fighting off an infection, the fever also serves a purpose. Your body temperature rises because the virus or bacteria causing the infection can’t thrive in a body whose temperature is not ideal.  The purpose of pain is to let us know there is a problem. When the pain is masked by medication, or reduced because the problem is beginning to resolve, the patient will return to their previous habits/activities without fully correcting the underlying cause of the pain.  The patient must change what they are doing to fully resolve the issue.  For example:

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You have pain in your neck and frequent headaches.  You attend 4 visits of physical therapy and now your neck doesn’t hurt, you can turn your head again, and you are even having fewer headaches! Life gets busy, and while you were really diligent about stretching and watching your posture when you were attending your therapy sessions, you forget to do your exercises, you return to your habit of slouching at the computer, In 2 weeks, your neck is killing you again! You call your physical therapist for a quick fix of the pain, and you go 2 more weeks and the pain starts again! You are frustrated!

 The challenge for the therapist is convincing the patient that even though their pain is less, the problem that caused the pain may still exist. The challenge for the patient is to change their mindset, habits, and goals in the absence of the motivating factor of PAIN!  

When most people seek out physical therapy services, their number one goal is to not have pain. The goal needs to be, “ I do not want to have to take pain medication or be in pain, and so I need to change the way I do things to take control of my life.” If the patient’s goal is just to reduce the pain to be able to do what he normally does without it hurting, he may achieve this rather quickly through a pain pill or even in a short course of PT. The patient needs a long-term goal! And, the goal must provide enough motivation to the patient so they stick with it.   This is where the “ No Pain, No Gain” rule applies! The patient must decide how important is to them to be healthy and to stay pain free. Is the deadline at work more important than the fact they have headaches 3 nights of the week that limits them from enjoying their family? Is the constant popping of pain pills to get through the day more acceptable than the ulcer that is developing from use of the medication to reduce the pain? The pain comes in prioritizing our health and goals. If a person truly wants to change, they must make difficult decisions.

I have used the example of pain, but the same holds true for weight-loss, running that marathon, traveling around the world. Whatever goal you want to reach, there must be mental “PAIN” and discipline to really change our actions and habits to achieve the goals we set for ourselves.  So, “ No Pain, No Gain” holds true for individuals when trying to achieve their goals. The pain is in disciplining ourselves to delay the immediate reward, for the long-term goal. And, if you are seeing a physical therapist that thinks physical pain is necessary to achieve your goals, get a new therapist!