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Can Physiotherapy Make Pain Worse

Physiotherapy is intended to cure painful conditions and provide various other benefits. So it comes as a shock to many people if the treatment actually causes their pain to increase or even to result in pain that wasn’t there previously. They’re generally caught in something of a dilemma because they don’t know if this is the expected outcome of the treatment and the pain will gradually decrease or if the condition is actually being made worse.

The aim of physiotherapy is, of course, not to put you in more pain but, ultimately, to create an overall improvement in your condition. It’s important to know, however, what to expect and what you should do if things don’t appear to be going according to plan.

How Physiotherapy Can Cause You Pain

Physiotherapy often involves the exercising of muscles to make them stronger. Sometimes this is because the muscle has been injured and has become tight and weak as a result. Since the body tries to protect an injured muscle, adjoining muscles have to compensate and can become overworked and strained.

A Sydney physiotherapist may exercise the injured muscle and this can cause irritation and pain due to a build up of lactic acid in the muscle and those near to it. However, the exercise will eventually cause the muscle to get stronger and to stretch, with a consequent decrease in pain and a resumption of normal functionality.

Whilst physiotherapy often aims to improve your posture, this can cause irritation to surrounding nerves. It can usually be eased by adopting a rest position, such as lying on your back until the pain subsides. A similar situation applies to a joint, which can become inflamed when using exercise to improve or restore mobility.

Muscle, joint and nerve pain can also be alleviated by the application of ice to the affected area immediately after treatment. To avoid irritation, the ice should not be applied directly to the skin but should be put in a plastic bag with a cloth covering. A bag of frozen peas is a useful alternative but application must be limited to a maximum of 25 minutes.
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Avoidable Pain from Physiotherapy

Although some degree of pain can be expected from certain physiotherapy exercises, it should be relatively mild and will eventually disappear. However, there are cases when pain should not occur and can be avoided with proper treatment. Some examples are as follows.

  1. Failing to Assess the Whole Area
    Pain can often result from treating a particular symptom without taking account of the surrounding area. For example, a lack of mobility in the neck may be addressed by stretching it to attain freer movement. However, the neck comprises seven separate vertebrae and it’s important to ensure each of these is moving freely before starting such treatment. Failure to do so puts pressure on surrounding vertebrae and disks, causing pain and also running the risk of triggering degenerative arthritis.

    A similar situation can arise if the patient’s overall posture is not addressed. For example, incorrect spinal alignment may prevent certain types of treatment and make the situation worse if used.

  2. Treatment in the Wrong Sequence
    If a patient has separate ailments, treating them together or in the wrong sequence can cause unnecessary pain. Treating a shoulder pain by manipulation can, for example, aggravate nerves and cause pain unrelated to the initial treatment. It’s necessary to assess the overall situation and treat one condition before moving on to another that’s affected by it.
  3. Not Dealing with Scar Tissue
    Manipulation and exercise are often used to stretch muscles and ligaments in order to restore full mobility. However, scar tissue will not stretch and, if not dealt with first, can cause severe pain when such treatment is used.

How to Prevent or Alleviate Unexpected Pain from Physiotherapy

If you’re experiencing pain or discomfort, or you think the treatment isn’t working as it should do, tell your physiotherapist. The process of treatment is a partnership between the physiotherapist and the patient so you need to keep each other fully informed of what is going on.

Physiotherapy is supposed to be beneficial for the patient but it will only be so if the practitioner is aware of any failings. Once informed of any pain or discomfort, changes can be made to the procedure so it’s more effective and achieves the desired results.

If any irritation is caused by an exercise being too vigorous, this can be decreased so it doesn’t cause pain and then can be gradually increased again as a muscle becomes stronger. The sequence of treatment can be changed or the whole approach can be altered so that the rehabilitation process is more comfortable and, ultimately, more successful.

Everyone has a different pain threshold and different pain triggers, so it’s important that the physiotherapist is aware of these and can adjust accordingly. An unsuccessful treatment is not in anyone’s interest so keeping the dialogue going is vital. The aim should always be to monitor progress and be flexible enough to change the treatment if it isn’t working as it should do.

If a change to the treatment plan doesn’t have the desired effect, you can justifiably ask for a change of physiotherapist and this shouldn’t cause any upset. People have different skills, specialities and areas of interest, so a fresh mind can make all the difference.

Whatever you do, stick with the treatment because physiotherapy is a proven means of alleviating pain and fixing problems. Just ensure you choose a practice, such as Anzac Parade, that has the necessary range of knowledge, skills and experience to return you to full health with no pain. We are dedicated to providing the treatment that’s just right for you and will work with you until we achieve the desired results.

We always start with a full assessment of your needs and current condition and so are able to create a treatment plan that’s suitable for you. And we constantly assess progress and outcomes so we can adjust when necessary to achieve what’s needed.
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Exercise Physiology

Our exercise physiologists specialise in the prevention and management of chronic illness through movement and health modification counselling.


We take a holistic approach to the prevention, treatment and management of a wide range of musculoskeletal conditions.


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