Ask a PT: Am I hurt enough for PT?

“I didn’t think it was bad enough to get help.”

“I figured it would go away eventually, but it’s been six months now.”

“If I don’t sit/run/walk/drive/sleep on my side, I don’t have pain, so I’m just avoiding that.”

I have heard these words, in many variations, more times than I can count throughout my career. Many people feel that to get care, they need to be completely debilitated.

The truth is, musculoskeletal conditions, like most things in life, are best treated early. The longer we experience pain, dysfunction, and range of motion limitations, the more our nervous system, movement patterns, and behaviors will change in response, and the worse the condition can get. The worse the condition gets, the longer it takes, and the more physical therapy (PT) you’ll need to reverse the condition.

Let’s take a look at what to do and how PT can help at every stage of pain.

The first four weeks: acute pain from injury

The acute phase of pain can last up to four weeks.

Generally, acute pain is more sharp or severe and you can usually trace it back to what caused it. Threw your back out lifting groceries? Rolled your ankle on the sidewalk? Tweaked your neck from staring down at your phone? All of these things can cause acute injuries. As the injury heals, the pain should go away.

The key to getting through this phase is to keep as active as you can, and gradually increase your activity as your pain permits. If you get physical therapy at this stage, your chances of recovery are optimal.

Your PT will develop a program designed to help you heal from your specific injury, including exercises that help you push past your limits safely. With SWORD, your digital therapist will tell you if you’re performing exercises incorrectly, and your physical therapist gets precise feedback on how you’re doing, so they can update your program as your healing progresses.

Surgery is another example of an acute trauma. You can’t wake up from a knee replacement and run a marathon. Your body needs to recover from the trauma of going under the knife, and learn how to function with this new foreign object in your knee. Great PT after surgery is key for making a full recovery - especially if you have big goals in your sights!

When to get help for an acute injury:

• Seek medical attention immediately if you experience a trauma, are unable to bear weight on an arm or leg, have severe pain or are experiencing numbness or tingling.
• Call your doctor or tell your PT if it’s been a few days and things aren’t improving, or if you have swelling that’s worsening or not resolving.
• If you’re not sure what to do, err on the side of caution and seek treatment.

4 - 12 weeks: subacute pain

After 4 weeks, pain is now considered subacute.

If you’ve been treating your injury with a good PT program, the inflammation will have subsided and things should be getting back to normal. If you haven’t sought care, this is the point where you should really ask yourself: are things still off? Am I still feeling pain? I am moving differently than usual? Am I avoiding certain movements or activities I used to enjoy? If so, it’s time to get help. If you start a physical therapy program in the subacute phase, the chances of it becoming a chronic issue are much lower. Great PT in the subacute phase can help get you back on track and back to doing the things you love.

12+ weeks: chronic pain

If you’ve been in pain for more than three months, it’s now considered chronic.

You may not know how your pain started, or you may remember a specific incident that caused it. There are many things that can cause chronic pain, including acute injuries, overuse and underuse of muscles, other chronic conditions, and even emotional trauma.

This pain is less related to damaged tissue and more related to changes in your nervous system. Something has tripped the wires in your brain, and your receptors get stuck on a pain loop. Chronic pain can range from mild and intermittent to severely debilitating, and if left untreated, it can last years or a lifetime, and can get worse as time goes on.

If you’re struggling with chronic pain of any degree of severity, please know that you’re not alone, it’s not your fault, and you can manage it. A good PT program will help you tackle all the factors that are contributing to your chronic pain: therapeutic exercise for physical strength and recovery, education to help you understand what’s causing the pain, and behavioral coaching to give you the mental and emotional tools to get back in control.

No matter how severe or sustained your pain is, a good PT program is worth it. And you are worth it.

Why pain and injury damage our overall health

Pain changes us. We move differently. We avoid things we think may cause it to worsen. We don’t sleep as well. Our physiology also changes as our nervous system responds to the perceived threat, whether there is tissue damage or not.

Sometimes we bounce back. But other times our bodies don’t know how to go back to how things were before the injury on their own. The result is a life lived in pain - and none of us deserve to live that way.

The good news is, it is possible to manage pain at any stage. But just like it’s easier to remove a stain from your clothing if you treat it right away, it’s easier to change symptoms before they set in.

Does that mean you should call your doctor or PT for every little ache and pain? Maybe not, but here are some general guidelines.

Pain level guidelines to help you triage and respond

If you have mild pain that is improving, your pain doesn’t cause you to limp or move unnaturally, you’re sleeping well and you’re still active, it’s ok to take a ‘wait and see’ approach. It’s helpful at this stage to note your symptoms: when they come up, how long they last, what they feel like. Kind of like having a cold, you should expect your symptoms to improve over 7-10 days.

But if your pain lingers or symptoms worsen, the intensity of the pain is moderate to severe, or it limits your ability to do your normal activities, ask for help - even if you think your issue is not that big of a deal.

You deserve to get help, and the earlier you seek treatment, the better off you’ll be. One of the great things about the SWORD program is that you can get high-quality treatment without a big time commitment. In just 20-30 minutes a day, you can start working on your pain at its source with your physical therapist at your side - no commuting or scheduling required. Our members do their sessions whenever and wherever they like: early in the morning, late at night, while their child is sleeping, and between meetings.

If you’re on the fence about physical therapy, give it a try - you deserve to help your body heal!

About the author: Megan Hill, PT, DPT

Megan Hill, Doctor of Physical Therapy, is a licensed physical therapist focused on musculoskeletal rehab and chronic pain management. She dropped her plans to go to law school for physical therapy after a knee injury from the Chicago Marathon left her in need of rehab, and she hasn’t looked back since. She’s on a mission to empower people to manage their health through exercise, education and coaching, rather than relying on passive approaches.

Megan earned a Doctor of Physical Therapy degree from the University of Illinois at Chicago (UIC). She also holds a Bachelor of Arts degree in psychology from Duke University and is a certified running coach.

Megan lives in Denver, Colorado, where she spends every spare second running, biking, hiking, sailing and stand up paddleboarding with her husband, Layton, and dog, Ollie.