Physical Therapy for each phase of the pain cycle
More and more, physicians are referring patients to physical therapy for pain management whether it is acute pain or persistent pain. Physical therapists are the experts in the field of movement, and are trained to assess movement dysfunction in order to help patients restore function and mobility. Physical therapists (PTs) are currently trained at a Doctorate level in the United States which allows us to evalute, diagnosis, and provide treatment that is based in both science and the experience of the clinician. This also means, PTs can identify when symptoms are outside of the scope of practice (ie they cannot be treated by at PT) and then how to refer out to the appropriate specialists (ie. orthopedist, neurologist, GYN, etc.). Physical therapy treatment is tailored to each individual and can look vastly different based on your symptoms and what your goals for movement are. The type of pain you are experiencing, whether it’s acute, subacute, or chronic/persistent, is also an important consideration in determining your plan of care in physical therapy.
Photo of Dr. Isha talking with a patient to understand their injury so she can develop a plan of care to optimize healing.
Physical therapy in the acute phase of pain:
Many of us are familiar with the acronym ‘RICE’: rest, ice compression, and elevation. I remember being a young gymnast being told to ‘RICE’ my ankle after a fall. It’s often a method of managing an acute injury or acute pain. But research is finding that RICE is not a complete treatment. The most recent recommendation for the management of acute pain is ‘PEACE and LOVE’. PEACE is important during the first few days of injury and LOVE is the focus for the remainder of recovery.
P: Protection
E: Elevation
A: Avoid anti-inflammatories
C: Compression
E: Education
and
L: Load
O: optimize
V: vascularization
E: exercise
While all components are important, physical therapy specializes in helping guide patients through education, load, vascularization, and exercise. Physical therapist specialize in helping you optimize healing.
Photo of a vertical abdominal scar that has healed during the acute phase after surgery.
Physical therapy in the subacute phase of injury and pain:
Physical therapy in the subacute phase looks a bit different. At this point, the markers of inflammation have decreased, and your body is learning to adapt to stress. If you are prescribed physical therapy in this stage of pain, your course of treatment will likely consist of learning to tolerate load to the tissues, and learning movement habits early on that will reinforce optimal movement and function and prevent future injury. This can look like exercises to improve mobility and strengthen tissues, exercises to improve coordination, manual therapy to decrease tissue restrictions, and education on movement patterns and postures.
Photo of Dr. Isha helping a patient move through a squat focusing on form and education.
Physical Therapy with Persistent Pain:
There are countless studies that support the benefits of physical therapy for chronic pain. By the time you have chronic pain, your movement habits and patterns become shaped and informed by your experience of pain. Physical therapy for the chronic pain patient is complex and multifactorial and therefore requires a multifaceted approach to treatment. To tackle the experience of chronic pain, it’s crucial to understand how the pain has become entangled with psychologic, physical, neurologic, and socioeconomic factors. A PT plan of care for chronic pain must address movement patterns contributing to dysfunction, and help to build new movement patterns that serve your body best. Your physical therapist will want to gain a deep understanding of your relationship to pain and how it impacts your daily activities. Your individualized plan of care will still likely consist of exercise and manual therapy, but education surrounding what pain is and how it impacts your brain should be a large component of your PT interventions.
Written by Dr. Isha Kelkar PT, DPT and edited by Dr. Monica Vandervoort PT, DPT
References:
Rikard SM, Strahan AE, Schmit KM, Guy GP Jr.. Chronic Pain Among Adults — United States,
2019–2021. MMWR Morb Mortal Wkly Rep 2023;72:379–385. DOI:
http://dx.doi.org/10.15585/mmwr.mm7215a1.
Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982. doi:10.1097/j.pain.0000000000001939