I am still hurting. PT is not helping. What should I do?

Atlas: "I don't know why my back has been hurting. I haven't done anything to aggravate it." Physical Therapist: "What???"

With the advent of summertime I have recently had several patients who are having an increase in pain. That is to say, they have had a few weeks of PT, which helped relieve their pain, and then ‘for no reason at all‘ their problem started to hurt again. This caused the patient to wonder if physical therapy was helping or not.

Whenever I have a patient who initially responds well to treatment, and then, ‘for no reason at all‘ starts to hurt again, my first thought is, “I think there is a reason your pain has increased and I have to get you to tell me what it is.” My thoughts are often related to their PT exercise program. Are they doing their exercises? Are they doing the exercises correctly? Are they doing the exercises too much (rarely) or too little (more common).

When I can check off improper exercise as the culprit, my next review is of the patient’s recent activity level. My standard question is, “So what have you been doing for fun lately?” To this I might hear that the patient has been playing more golf, running more, hiking more, or maybe they just took a very long car ride to Chicago. Any of these things are very good reasons that the patient has increased pain.

A more common response to my query of “What have you been doing for fun?” is, “Fun! I haven’t been having any fun. I’ve been landscaping.” “I’ve been painting the house.” “I’ve been washing windows.” Or my recent favorite, “I’ve been lifting 100# logs onto a splitter.” 

Heavy activity is a great reason why pain gets worse. Oddly enough, I am often supportive of the patient working extra hard to take care of their house. (I get it. I own a house that needs a lot of maintenance). They just need to be smart about it. I point out that increased pain is a natural response to increased activity. Even people who don’t have anything wrong will hurt after a hard day of manual labor.

Physical Therapy is equal parts Modalities (hot packs, ultrasound, electrical stimulation), Manual Therapy (by the physical therapist), Exercise and Education.  It’s the Education part that is often overlooked. Patients can get things wrong in so many ways. The PT always has to have their ‘A game’ on when listening to the complaint of “My pain started again for no reason at all.”   When the real reason is ‘I’ve been having way too much fun’.