Physical therapy and pain
What is pain?
Pain is a signal from the body that damage or injury is occurring, such as from a fall. It is an unpleasant sensation that can be stabbing, throbbing, nagging or cramping in nature. Besides an actual ''trauma,'' pain can also be caused by overuse, inflammation (pressure/strain) or damage to the nervous system. Pain is thus actually a mechanism that protects us from severe(er) damage.
In the body we distinguish two types of pain, acute pain and chronic pain. Acute pain is easy to recognize. This pain occurs after damage (a cut in your hand, for example). This type of pain is generally stabbing in nature and the location of the pain is clearly identifiable. Acute pain generally goes away fairly quickly. Chronic pain is pain that is present for at least three months. Thus, we can no longer speak of tissue damage here.
Pain is measurable, we do this using an NRS (Numeric Rating Scale) or VAS (Visual Analog Scale). Here we ask the patient to give a score of 0-10 (NRS) or 0-100 (VAS) to provide insight into the amount of pain experienced. This data can be used evaluatively and play a role in choosing the appropriate treatment method.
Cushioning pain
Despite that pain feeling is very important, we also sometimes want to dampen pain. Fortunately, the body has several ways to dampen pain. For this we can use medication such as paracetamol or NSAIDs, as well as interventions such as dry-needling, TENS/shockwave, relaxation therapy, heat/cold, massage, manipulations, exercise and rest. All of these ways to dampen pain ensure that less pain is experienced by making the body less sensitive to pain stimuli.
What is muscle pain?
Muscle pain, as the name implies, is pain in the muscles. We distinguish two forms of muscle pain, early or late muscle pain. Early muscle pain occurs just after an exertion and is caused by exhaustion and acidification of the muscles. Late muscle soreness occurs 24/48 hours after an exertion and is caused by hairline tears in the muscle that have occurred due to the requested strain. With muscle pain, you often experience a nagging stiff feeling in a particular muscle (group). Muscle pain is generally felt after sport or another intensive activity and is a normal reaction of the body to the load placed on it. Muscle pain is therefore clearly different from "real" pain in this respect.
Rehabilitation and pain
When you visit a physical therapist the cause often lies in experiencing pain. Something is bothering you and you may be restricted in your daily activities. Whether this is after a operation, after trauma (fall, sprain o.i.d.) or from symptoms that arose for no apparent reason, one thing is certain, you are suffering. During treatment from a physical therapist, you may experience pain because a certain exercise or technique used by the therapist complaints provokes. Sometimes this is necessary to achieve the intended result. There is just a caveat to this. Experiencing mild pain/complaints during treatment is generally considered acceptable up to a patient indicated NRS score of 2-3. Of course, there are exceptions to this.
Physical therapists often recommend that even during the rehabilitation keep moving, as this promotes recovery. Thus, pain may also be experienced during daily activities, sometimes exceeding an NRS score 3. Do not be alarmed by this. It is not bad to experience more pain feel, this generally has no effect on recovery. However, it is important to make sure that this does not happen too often. So try to modify or temporarily avoid movements and activities that cause a lot of symptoms. Your physical therapist can advise you well on this.
Besides pain during a treatment, it is also possible that a treatment results in an after-reaction. By an after-reaction, we mean the temporary increase in the experienced burden/pain/restriction due to the stimuli given to the body during physical therapy. For example, a patient with neck pain feel less discomfort after a treatment, but experience more pain a few hours later. Sometimes this even results in a feeling of numbness. This is a normal reaction of the body to the given stimuli. However, we like to see the after-reaction decrease within 24 hours.
