Physical Therapy for Chronic Pain: What to Expect

If you have chronic pain, what should you expect from physical therapy? Read about the treatment for chronic pain.

Medically Reviewed by Keith Chan, PT, DPT

Keith Chan is a licensed Doctor of Physical Therapy who has experience treating chronic pain, musculoskeletal injuries, movement dysfunction and post-surgical rehab. He uses evidence-based physical therapy, pain neuroscience education, therapeutic exercise and hands-on treatment techniques to help patients achieve better function and quality of life.

How Physical Therapy Helps With Chronic Pain

When a person feels pain for three months or more, the pain is no longer a symptom, it is a condition. Can impact on movement, sleep, the workplace, exercise and everyday activities.

Chronic pain is one of the most common chronic health conditions in the United States, with an estimated 50 million adult residents of the United States experiencing chronic pain.

Physical therapy is different from many treatments for chronic pain. It emphasizes addressing factors that lead to persistent pain, instead of just treating symptoms, and helping patients build confidence in how they move.

Can Physical Therapy Actually Relieve Chronic Pain?

Yes. Physical therapy can yield superior outcomes in the long term, when compared with the use of medication alone, in many patients.

This is for a very simple reason. Physical therapy aims to restore movement, enhance strength, increase flexibility and to train the nervous system to appropriately react to exercise. Treatment is directed toward the underlying causes that could be causing pain rather than at the symptoms.

A common issue in clinical practice is that physical therapist, Keith Chan has patients coming with the assumption that the painful area is the cause of the issue. But often conditions outside the body, too, are found in the course of a movement assessment. For instance, a weak hip can lead to knee pain and a loss of mobility in the spine can have an impact on the shoulder.

Chronic pain physical therapy treatment incorporates movement, education, and hands-on methods, tackling both the physical and neurological components of pain. The aim is to reduce pain and enhance function, mobility and independence.

What Is Chronic Pain and Why Does It Persist?

A lot of people think that any time they feel pain, there is damage. That can be the case for acute injuries, but chronic pain can be different.

If the pain persists for many months, the nervous system may become more sensitive.

Nerve cells become more reactive, and the brain may start to react to normal sensations as threats. This may occur even after the initial injury to the tissue has healed.

This process is known as central sensitization.

Studies in pain science have demonstrated that the nervous system stays on high alert and

may cause chronic pain. That is, the brain has become accustomed to the pain state.

Knowing this can alter the way treatment is approached. New injury treatments like rest and inactivity are often prescribed for chronic injuries, and can actually make them worse by adding stiffness, weakness and fear of movement.

This is the reason why the treatment method of chronic pain with physiotherapy is different from the treatment method used for injuries.

What We Commonly See in Patients With Chronic Pain

Many patients have used medications, injections, or simply prolonged rest without improvement, and then seek out physical therapy.

A common way is to avoid activity due to discomfort or fear. This avoidance can lead to muscle weakness, decreased mobility and heightened sensitivity to pain over time.

Many patients start to trust their body through education, slow movement exposure and personalized treatment. Moving becomes easier and less painful with improvement, and daily living becomes easier.

Keith Chan's Clinical Insight

A major misconception I see is pain is equal to damage, and many chronic pain patients avoid movement because they fear aggravating their condition, but in fact, it's just one of the best tools I have to retrain their nervous system and get them moving again.

How a Physical Therapist Evaluates Your Pain

Prior to treatment, a full assessment enables the most effective plan of care to be developed.

A chronic pain physio will evaluate:

• Your previous medical and pain experience

• The onset of symptoms and changes in symptoms

• Activities that make the pain better or worse.

• Any other treatment or medicines used.

• Explain the postures and movement patterns.

• Balance and coordination

• Joint mobility and flexibility

• The strength and endurance of the muscles.

• walking, sitting, lifting and reaching

Sometimes imaging (MRIs or X-rays) can give useful information, but not always an explanation of chronic pain. Many individuals have structural findings on imaging but don't have symptoms; this has been demonstrated in research.

Therefore, a thorough physical examination and patient history will continue to be one of the best ways to determine treatment goals.

Treatment Methods Used in Chronic Pain PT

While each treatment plan is tailored to the patient, most chronic pain rehabilitation programs incorporate some active and passive treatments.

Active Treatments

Active treatments depend on collaboration with the patient, and are the backbone of long-term improvement.

Examples include:

• Graded exercise programs

• Strength training

• Functional movement retraining

• Balancing and coordination activities

• Posture correction

• Pain Neuroscience Education

• Home exercise programs

Pain Neuroscience Education help patients understand the effect of the nervous system on pain. Knowledge of pain mechanisms has been shown in research to decrease fear and

treatment outcomes.

Passive Treatments

Passive treatments are done by the therapist, and can calm pain and increase the range of motion.

Examples include:

• Manual therapy

• Joint mobilization

• Soft tissue massage

• Myofascial release

• Dry needling

• Stretching techniques

These treatments can aid in reducing muscle tension, enhancing circulation and promoting movement recovery.

As far as electrical stimulation, there are mixed results in managing chronic pain. The honest physical therapist should tell you the possible pros and cons of any treatment that is suggested for you.

What a Graded Exercise Program Looks Like

Exercise can cause symptoms to worsen and this is a fear of many people with chronic pain.

In fact, controlled and progressive movement is one of the best tools at the disposal of a man.

A graded exercise program begins at a comfortable level and then is advanced when tolerance is reached.

Common courses may consist of:

• Low-impact aerobic exercise

• Walking programs

• Stationary cycling

• Core stabilization exercises

• Strength training

• Mobility exercises

• Flexibility work

• Functional movement training

It's not just about building up the muscles. It is also to provide the nervous system with a sense of safety with movement.

This process over time, helps to decrease fear, increase confidence and decrease the sensitivity of pain.

What Research Says About Physical Therapy for Chronic Pain

Physical therapy has been proven effective in many chronic pain conditions and is the first line of treatment.

Exercise Therapy, education and movement-based interventions are all recommended by the American Physical Therapy Association (APTA) to be essential elements of chronic pain management.

Exercise, patient education and manual therapy have been demonstrated to be effective treatments when combined together for improving function, decreasing disability and improving quality of life in people suffering from chronic pain.

Although the treatment's experience with each patient is different, the evidence is strong in favor of an active rehabilitation process rather than extended rest or just passive treatments.

What Results Should You Realistically Expect?

Unfortunately, chronic pain does not go away instantly.

It is important to establish realistic expectations with the physical therapist from the outset.

Treatment involves a process of improvement over time, not a quick fix.

The majority of patients are visibly improved within 6-8 weeks of regular treatment.

Improvements may include:

• Reduced pain intensity

• Better mobility

• Improved strength

• Greater balance on feet and legs

• Better sleep quality

• Better pain control, reduced reliance on pain medication.

• An increase in the number of children who take part in daily activities

The ultimate goal is not just symptom management. It is assisting patients to restore their independence in life and to engage in meaningful activities.

How to Get the Most Out of Your Sessions

A key to achieving optimum results is to actively involve the patient in their treatment.

For optimum effect:

• Attend appointments consistently

• Do the home exercise program:

• Honestly discuss symptoms

• Ask questions about your treatment plan.

• Concentrate on incremental improvements instead of perfection

• When things don't seem to be going your way, stick with it,

It will be useful to know the reasons for using each exercise or technique, to make it easier to be an active member in your recovery.

Frequently Asked Questions About Physical Therapy for Chronic Pain

Is there a chance that physical therapy will aggravate long term pain?

A little soreness is to be expected when starting an exercise program. Treatment is to be

advanced slowly however, depending on your symptoms and objectives.

How long does physical therapy take for chronic pain?

Patients' symptoms improve in most within 6-8 weeks, but responses to treatment differ depending on the type of condition and the patient.

Is PTA more effective than pain medicines?

Physical therapy and drugs are different. Treatment will involve medication to manage symptoms, and physical therapy to enhance movement, function, and long-term recovery.

What types of chronic pain can physical therapy treat?

Physical therapy can be used to treat chronic back pain, neck pain, arthritis, fibromyalgia, nerve pain, joint pain, post surgery pain and so much more.

Should imaging be performed prior to the beginning of physical therapy?

Not necessarily. A comprehensive physical examination and medical history can often be used to effectively assess many chronic pain conditions.

References

1. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. Chronic Pain Among Adults in the United States. Data Brief No. 518.

2. Arthritis Foundation. Understanding Pain: The Brain-Body Connection in Chronic Pain. Health & Wellness Education Resources.

3. Physiopedia. Pain Neuroscience Education (PNE): Clinical Overview and Applications in Rehabilitation.

4. American Physical Therapy Association (APTA). Physical Therapy Interventions and Evidence-Based Patient Care Guidelines.

   
   

Medical Disclaimer

The information is for educational purposes only and should not be viewed as medical advice. When any pain persists, diagnosis or treatment options, always consult a qualified healthcare professional. Results may differ for each person.