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A New View on Pain in Physical Therapy

By: Jared Sonnier, PT, DPT, MTC

“No pain, no gain” is one of the most common phrases said in physical and occupational therapy clinics daily. It is used to motivate and help individuals tolerate discomfort during a treatment session. Although the phrase is taken from the bodybuilding world, in rehab, it is largely flawed when you look at emerging pain science research. Here I’ll briefly discuss a few surprising findings from top pain researchers.

Pain is as complex as it is mysterious. It can be caused by trauma, emotional distress or no injury at all. Pain is primarily thought to be the result of tissue damage, but the truth is it’s actually poorly correlated to tissue damage. Everything from stress levels, to our beliefs, and even the perception of a threat play a role in an individual’s pain experience. Here's an example: A man rolls his ankle while crossing a busy street and moments later sees a bus heading toward him. Without thinking, he quickly crosses the street to safety. In that moment, his brain decided the bus was a greater threat than his rolled ankle and was able to avoid experiencing pain to reach safety.

Pain is an output from our brains, not an input from our bodies. That said, it’s important to note that all pain is real and individualized. An example of this is when two witnesses of the same car accident see things differently because of their unique perspectives. This helps us understand that treatment should be individualized for each person and not just focused on the painful tissues. The best approach is multi-disciplinary.

Finally, exercise and education can positively affect an individual’s pain experience.

Physical/occupational therapists are movement experts who can provide exercise prescriptions and education regarding pain. The more active someone is and the more one understands how pain works, the less likely they are to experience it. “Know pain, now gain”.

Information sources from research by Adrian Lowe and Lorimer Moseley.

Jared Sonnier PT, DPT, MTC

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