Believe it or not, the physical rehabilitation of painful conditions is a space full of controversial and dissenting opinions. You would be forgiven for thinking that from one physiotherapist, chiropractor or exercise physiologist to another there would be fairly consistent schools of thought, even if between these three different professions there are different views. The reality is though, that many professionals within these professions have vastly different approaches to pain. A considerable divide can be drawn along their approach to how much pain a person should be willing to suffer before their pain is expected to improve. This usually leads to generally two different camps; those who believe all pain should be avoided and those who uphold that therapy should persist even, or especially, when painful. As a result of failing to grasp the middle ground, many people give up on therapy and continue to suffer from their complaint, never to resume therapy again with a ‘been there, done that’ sentiment.
Pain certainly feels, at least initially anyway, like it’s something that should be avoided and that certainly can be the case in at least the initial stages. If you’ve suffered the onset of an acute injury then ensuring that your body has the time and space to settle down and/or heal can be important. Yet bed rest has become something we know, in principle, doesn’t lead to better results. That’s why it’s vitally important to get expert oversight when you become injured or suffer the onset of pain, and that the result of this should include at least some idea of what a map of recovery should look like. Yet, health professionals who simply provide the advice to wait until all pain resolves are providing advice that has been found to often lead to impaired recovery and even poorer rates of healing. Our body thrives on stimulus and when we withdraw physical stimulus that keeps our systems regulated appropriately towards tolerating stress we do it a disservice.
Equally, pain often occurs in response to our body’s threat detection systems, and this means that if you’re experiencing pain with therapy there ought to be some consideration of whether or not that therapy is achieving an advantageous outcome. For example, those with persistent tendon concerns like an achilles or rotator cuff tear or tendinopathy (previously known as ‘tendinitis’) are frequently put through treatments which might be painful with the aim of providing a stimulus that will promote the healing of the tissues. However, the art of providing these treatments is in delivering in them with such finesse that pain is not endured unnecessarily – with simple modifications or techniques – and that is actually demonstrating that it is achieving it’s end. Exercise therapy that doesn’t stimulate an appropriate response can leave the injured person frustrated and hopeless, and without a resolution of their symptoms.