Written By: Riley Stewart, PTA, Teton Therapy Cheyenne
“No Pain, No Gain”
I have patients repeat “no pain no gain” on a regular basis and frequently have to tell them that this is outdated and not true in the field of Physical Therapy.
Frankly, this saying is dangerous.
This mentality can lead to further injury and can lead patients to think that exercise is supposed to hurt. This can go one of two ways: the patient will overdo their exercise routine (causing further injury), or the patient will avoid exercise in general because they think exercise is going to make their pain worse. Neither of these outcomes is good for the patient or the therapist.
A common misconception is that exercise has to hurt or be very strenuous in order to be making gains. This is simply not true and isn’t a safe way to exercise or improve. A Physical Therapist Assistant’s job is to progressively overload the body in a safe manner in order to get patients where they want to be or an activity they want to return to.
Progressive Overload
Progressive overload means starting at the baseline of what the body can do without pain and progressing from there. Progressions of activity have many forms.
Some examples include
- resistance,
- volume,
- frequency,
- and / or new exercises that are a more challenging version of something a patient may have been doing in PT.
If an exercise causes severe discomfort that means we should not be doing the exercise or the exercise needs to be modified so the patient can complete without pain. I frequently tell patients to listen to their body when an activity or exercise hurts and to communicate that pain with the therapist. That communication lets us know if the exercise needs to be modified or if we need to hold off on the exercise entirely until they progress further in their treatment plan.
If patients can safely progress without pain they are more likely to make exercising a part of their daily routine which is arguably the most important aspect of therapy. Consistency is key with reducing pain, progressing with strength, progressing with mobility, and maximizing the body’s overall function. A patient could have the perfect exercise routine that does not cause pain, but if they are only exercising once a month, no gains will be made and their pain will likely not improve.
Can Pain Be A Good Thing?
Pain is not a bad response when exercising; it tells us professionals what the patient’s limitations are and what we need to progressively work towards while not provoking symptoms.
It also reduces the risk of injury because pain can prevent overuse and damage to other structures, such as muscle within the body.
You may assume pain is a bad thing, but it shows what the body’s limitations are and areas that need to be focused on during treatment. The goal in physical therapy is to exercise safely and not to provoke pain. Having the patient do as much as they can with as little discomfort as possible is the ultimate goal.
Don’t Confuse DOMS and Pain
Another topic that I believe isn’t talked about enough is DOMS. DOMS stands for “delayed onset muscle soreness.” DOMS can be confused with pain, especially early on in physical therapy, usually due to the body adapting to a new exercise routine or just starting to exercise in general.
DOMS’ primary symptoms are:
- soreness,
- tenderness to touch,
- and ache within the muscle.
DOMS can last between one to three days and soreness can peak on the third day. This can be interpreted as pain for many patients, which can cause hesitation in doing exercises at physical therapy or at home. DOMS is a normal response following exercise and rebuilds the broken down muscle tissue into a stronger version of itself.
After the first month of exercise, DOMS typically occurs less often and is less intense due to the body getting stronger and the muscles adapting to an exercise routine.
Summary
It is crucial for patients to understand the difference between pain and soreness following exercise because it can be easy to confuse the two if they are new to being active, or haven’t been active in a long time due to limitations/pain.
Is it pain or is it DOMS? The expert therapists at Teton Therapy can help you identify the source of your pain, and get you back to living pain-free. Consultations are free, so call, text or click to schedule yours today!
In Cheyenne, 307-514-9999,
In Lander, 307-332-2230,
In Riverton, 307-857-7074
or find us on the web at TetonTherapypc.com
