When it comes to pain management, there are two things I commonly hear from patients. The first: “No pain, no gain”. The second: “I was having pain, so I didn’t do anything for 2 weeks”.

These two statements sit on complete opposite ends of the spectrum when it comes to pain management. And in my experience, neither of these patients end up feeling better from these philosophies. We tend to let the pendulum swing very far one way or another (both as patients and as providers). We like things to be black and white, right or wrong, so that way we “know” we are doing the right thing.

As medical providers, if one study says a treatment doesn’t work, or we have a patient that a certain treatment doesn't help, we decide it’s bad and shouldn’t use it any more (despite the fact that this study may have been limited for a number of reasons). On the other hand, if one study says a treatment is great, or we have success with it a time or two, we decide it’s the right thing for every one.

In the world of movement and Physical Therapy, I like to believe we should all be living somewhere right in the middle. There are certain treatment techniques that I prefer over others. For example, I often use dry needling in my practice. I find that dry needling is helpful for 80-90% of the patients I use it on. However, it isn’t effective for every one, and some times it is effective but the patient prefers to try a different technique. This doesn’t mean that I can’t help them as a Physical Therapist, it just means I need to go into my tool box and find another treatment technique and approach that might be more appropriate for that individual. (As a side note: in my opinion, dry needling alone is never the answer. I also utilize other treatment techniques, and ALWAYS promote a focus on movement, to help patients reach their goals).

With all this being said, what should you do if you experience an injury or new onset of pain?

Do you train through it, or do you rest? How do you know when you need to see someone vs giving it a little time to see if it calms down on it’s own?

These questions are hard, and most of the time my answer is - it depends. But, I can at least provide some general guidelines to help you decide what to do in case of an injury. Here are some things to consider:

1) How severe is your injury? - If you felt a pop followed by a sharp pain, and the pain continues to persist as sharp or achy, that is probably a good indicator that you should have a medical professional take a look sooner rather than later. Of course if you feel something may have fractured or there is immediate bruising and significant swelling, I would suggest a trip to the emergency room or urgent care. If the injury was not as severe and caused more moderate pain/swelling, you may seek the guidance of a movement professional (such as a physical therapist) first. If imaging (x-ray or MRI) is indicated, your PT will screen you for that and refer you to the appropriate provider.

2) How long have you had pain? - If you have been experiencing pain for a day or two, without any known incident that caused the pain, you may try some simple things at home prior to seeking treatment. There is some controversy over ice and heat. My general guideline is if you want to try heat and ice go ahead, and if one feels good to you, it is fine to help manage your pain for a few days. You may see some providers recommend staying away from ice unless there is severe swelling, as there is some evidence showing that ice can slow the healing process. In my opinion, if you feel like you need to keep icing to manage your pain after a few days, it is time to get it checked out.

In terms of movement and exercise, my recommendation is to keep doing what you can tolerate. I would not load very painful tissues (for example, if your knee really hurts, it’s not the time to test your squat PR). However, if you can walk and you feel no pain or just slight discomfort (maybe a 1-2/10) and you don’t have increased pain after, then keep walking. Our bodies are made to move, so resting tissues and doing nothing is not helpful in most cases. However, sleep is very important. Sleep is necessary for our bodies to heal and recover, so if you are suffering an injury, make sure you are getting plenty of quality sleep.

3) So it’s been a few days and the pain has not changed, what should you do? If you aren’t improving after a few days, it is time to have someone take a look. An individualized assessment is so important, as there are many factors that can contribute to pain and the proper treatment plan to help you get back to the activities you love. Skip Dr. Google and have someone take a look at you.

4) How do I find the right provider? - There are a few things that I think are important to ask a Physical Therapist or any other movement professional to make sure you are at the right place. First, make sure your goals are clear and that the treatment plan will get you to your end goal (not just decrease your pain, but actually be able to physically do what you want to be able to do). Second, make sure the movement professional is willing to take your preferences into consideration. If a certain treatment doesn’t seem to help, what would the next step be? How many visits should it take to notice an improvement before it is time to switch gears or refer to someone else? If you work with a trainer, is the therapist willing to collaborate with that trainer to make sure you are getting a well-rounded plan?

It is also important that the provider gives you guidelines on how to keep moving when you have an injury. If they simply tell you to stop doing the things you enjoy, I would recommend finding another provider. Some of the other important questions to ask include how long are your sessions, and how many patients will the provider be working with when you are there? In my experience, one-on-one care is far more beneficial than splitting time, and being able to spend a full hour once a week is more beneficial than 2-3 thirty minute sessions a week (plus this is typically much easier to work into your own personal schedule).

In conclusion, if you are experiencing an injury, it is OK if you want to give it a few days. Keep moving, don’t just stop all activities. Find things you can do that do not increase your pain, and modify painful activities as you are able in order to keep moving. Make sure you get plenty of sleep. Use heat and/or ice if they help. And if you don’t notice an improvement, seek out help from a movement professional who can assess and treat your symptoms and is willing to work with you to develop an individualized plan to meet your needs.

If you have been experiencing pain for weeks, months, or even years, it is time to address it. To get started, contact us here.

Blog post by Dr. Alexis Hutchison, PT, DPT, OCS