The decision to begin physical therapy (PT) aims to regain function and reduce pain, but patients often fear the process might cause a setback. PT is a controlled, progressive treatment designed to restore movement and strength through targeted exercise and manual techniques. While the goal is long-term improvement, temporary discomfort is a common part of the body’s adaptation process. Understanding the difference between expected physical stress and true injury is the first step toward navigating rehabilitation successfully.
Differentiating Expected Post-Therapy Soreness
The most common feeling after an intense therapy session is generalized discomfort known as Delayed Onset Muscle Soreness (DOMS). This sensation is a physiological signal that the muscle tissue has been appropriately challenged to stimulate adaptation and growth. It is not an injury but a normal response to unaccustomed physical stress, which is exactly what therapeutic exercise provides.
DOMS is characterized by a dull, aching sensation spread across a muscle group, and it usually begins 12 to 24 hours after the session. This delayed onset is a signature trait that distinguishes it from immediate injury pain. The underlying cause involves microtrauma—minute, controlled tears in the muscle fibers—particularly those caused by eccentric contractions where the muscle lengthens under tension.
The body’s natural repair process for these micro-tears involves localized inflammation, which is responsible for the tenderness and stiffness experienced. This soreness typically peaks between 24 and 72 hours post-activity and should gradually subside completely within three to five days. If the discomfort feels manageable, is symmetrical across the muscle belly, and does not involve sharp, localized pain, it is considered a positive sign of muscle rebuilding. This temporary feeling indicates that the muscles are adapting to the new demands necessary for increasing strength and endurance.
Factors That Lead to Genuine Worsening
While soreness signals progress, a patient’s condition can genuinely worsen due to a breakdown in execution or communication.
Improper Exercise Execution
One frequent cause is the improper execution of exercises, either during the session or in the home program. Incorrect form places strain on vulnerable structures like joints, ligaments, or tendons rather than the intended muscle group. This leads to new or aggravated mechanical injury.
Overly Aggressive Progression
Another factor involves an overly aggressive progression of the treatment plan, where the physical therapist advances the load, intensity, or range of motion too quickly. Tissues recovering from surgery or chronic damage require a carefully managed timeline for healing and adaptation. Pushing the limits too far can overwhelm the repair process and cause a legitimate setback, such as a muscle strain or joint irritation.
Undiagnosed Conditions and Poor Communication
The possibility of an underlying, undiagnosed condition that mimics a musculoskeletal issue also exists. Physical therapists screen for “red flags” that suggest a problem beyond their scope, such as a vascular issue or an undiagnosed fracture. If such a condition is missed, the mechanical stress of therapy could exacerbate the underlying pathology. Poor communication is also a significant contributor; a patient failing to report pain accurately or a therapist neglecting to adjust the plan can lead to counterproductive treatment.
Clear Signs to Immediately Consult Your Therapist
Recognizing the difference between expected discomfort and a true injury requires the patient to monitor specific symptoms closely. These signs indicate that tissue is being damaged, not strengthened, and require immediate consultation with the therapist:
- Sharp, shooting, or stabbing pain during or immediately after an activity. Unlike the dull ache of DOMS, this pain is often localized and intense.
- New onset or significant increase in neurological symptoms, including numbness, tingling (paresthesia), or a burning sensation that travels along the path of a nerve.
- Pain that is constant and unremitting, meaning it does not change based on movement, position, or rest.
- Localized physical signs like swelling, redness, or heat around a joint or injury site that lasts longer than a few hours, indicating an excessive inflammatory response.
- A persistent increase in pain that lasts longer than 48 to 72 hours, showing no signs of reduction.
Patients must act as advocates by clearly and promptly communicating these specific symptoms to their physical therapist so the treatment plan can be safely and effectively modified.