The decision to pursue physical therapy (PT) while experiencing pain is a common dilemma, as many people question if movement will cause harm. Pain is a protective output from the brain, designed to warn the body of potential danger, but it does not always correlate directly with the severity of tissue damage. The instinct to stop moving when something hurts can be counterproductive, as gentle, controlled activity is frequently required for the body to heal and adapt. Understanding that some discomfort is an expected part of the recovery process is the first step toward successfully engaging with rehabilitation. The goal of physical therapy is to safely increase your tolerance and function through controlled movement, not necessarily to eliminate pain instantly.
Differentiating Types of Pain
To navigate physical therapy effectively, it is helpful to distinguish between different categories of pain. The first is expected therapeutic discomfort, which often presents as a dull ache, muscle fatigue, or generalized soreness a few hours after a session. This sensation, similar to delayed onset muscle soreness (DOMS), is a normal sign that tissues have been appropriately challenged to promote strength and growth. It should generally subside within 24 to 48 hours and should not be sharp or intensely localized.
The second category is mechanical or warning pain, which is sharp, highly localized, and immediately worsens when performing a specific movement or loading a joint. This type of pain signals that the tissue is being stressed beyond its current capacity and requires modification. It is a protective mechanism that should prompt you to stop the exercise or adjust your form immediately. Ignoring this sharp, immediate increase in pain risks further aggravating the underlying issue, hindering long-term progress.
A third type is generalized inflammatory pain, which is often systemic, constant, and fails to ease with rest or changes in position. This pain may be present even at night or when the body is completely still, indicating a broader inflammatory condition, infection, or a deeper underlying issue. This unrelenting, non-mechanical pain should be reported to your therapist and physician. It suggests the pain is not solely related to the mechanical stress of the therapeutic exercise.
The Physiological Role of Movement
The scientific rationale for why movement is necessary for healing, even in the presence of pain, centers on biological and neurological mechanisms. Movement is essential for enhancing circulation, which delivers oxygen and nutrients to damaged tissues while clearing metabolic waste products that contribute to inflammation. For tissues like cartilage, which have limited direct blood supply, joint movement acts like a pump. This ensures they receive the nourishment needed for repair and maintenance.
Controlled movement also plays a significant role in reducing stiffness and preventing the formation of excessive scar tissue or adhesions that limit the range of motion. Gradual loading of tissues helps to align collagen fibers in an organized pattern, creating stronger, more flexible repaired tissue. The neurological benefits are equally important, as physical activity stimulates the release of natural pain-relieving chemicals in the brain, such as endorphins.
Consistent, gentle activity works to “turn down the volume” of a hypersensitive nervous system, a state known as central sensitization. In this state, the brain amplifies pain signals even without significant ongoing tissue damage. By safely reintroducing movement, physical therapy teaches the brain that movement is not a threat, helping to reduce the exaggerated pain response over time. This process shifts the focus from avoiding pain to safely increasing function, which is fundamental to long-term recovery.
Strategies for Modifying Therapy Sessions
Effective pain management during physical therapy relies heavily on open and specific communication with your therapist. You should use a consistent method, such as the 0-to-10 pain rating scale, to quantify your discomfort during and immediately after an exercise. A tolerable pain level, perhaps a 3 or 4 out of 10, may be acceptable for a brief period. The goal is to work near the edge of discomfort without crossing into sharp, high-intensity pain, as pushing into high levels of pain consistently is counterproductive.
If an exercise causes a significant spike in pain, the session can be modified using several practical techniques to keep the movement beneficial. Modifications include reducing the range of motion, such as only squatting halfway down, or lowering the amount of external resistance or weight being used. Increasing the rest period between sets can also allow the tissue to recover slightly, preventing an excessive build-up of pain or fatigue.
Pacing is a strategy where you avoid the temptation to push through intense pain in the moment, which often leads to a significant flare-up afterward. You and your therapist should aim for a “just right” challenge that stimulates the tissue without causing a major post-session setback. The overall treatment plan should be flexible, allowing for real-time adjustments based on your symptoms on any given day.
Absolute Red Flags: When to Pause PT
While managing discomfort is part of physical therapy, certain absolute warning signs necessitate immediately pausing treatment and seeking consultation with a medical doctor. Sudden onset of neurological symptoms, such as new or rapidly progressing weakness, significant numbness, or a pins-and-needles sensation, suggest potential nerve compression. These symptoms require urgent medical evaluation to rule out conditions like severe disc herniation or other neurological disorders.
Uncontrolled systemic signs also demand immediate medical attention, including severe pain that is unrelenting, fails to change with position, or is accompanied by systemic symptoms like unexplained fever or chills. Pain that suddenly spreads to a new area or is associated with changes in bowel or bladder function is a medical emergency. If pain significantly worsens and fails to return to your established baseline level within 24 hours of a session, the exercise load was likely too high and needs a physician’s review.