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Physical Therapy for

Chronic Pain

What Is Chronic Pain?


The simple definition of chronic pain is pain that has been present for greater than 3 months.


However, it can be more complex than that, and the best way to understand chronic pain is to learn about its cousin: acute pain. Acute pain is pain that comes on suddenly and lasts for a few weeks. Typically, acute pain is caused by some traumatic event that injures your body's tissues.


If you smash your hand in the door jam, for instance, this causes acute pain. The pain is sudden and severe, and you can easily discern the cause of it. Your hand becomes red, swollen, and painful. Over the course of a few weeks, however, the pain goes away as your hand heals.


Now imagine that you smash your hand in the door again. Your hand becomes red, swollen, and painful. This time, imagine your hand pain continues long after the signs of injury have gone away. The tissues are clearly healed, but your hand still hurts. When you try to move your hand, the pain increases. This is chronic pain.


Chronic pain can be confusing, and it can prevent you from moving normally and concentrating on your daily activities. Plus, dealing with chronic pain can leave you and your doctor perplexed.


Chronic pain serves no biologic purpose as it is not related to the threat of tissue damage. Chronic pain can be considered a disease state and can persist for months or years.


Often times, pain occurs when there is little or no tissue damage. Why is the pain lasting long after the tissues are healed? Why are medicines not effective in treating your pain? Is there something really wrong? These questions may be difficult to answer, and finding the best treatment for your chronic pain may be equally difficult.


Treatments Types


There are many different treatments available for chronic pain. Finding the best one for you can take a little trial and error.


  • Physical therapy (PT)

  • Medication (oral or injected)

  • Supplements and natural remedies

  • Manual Therapy (Physical Therapy Specialty)

  • Massage

  • Acupuncture

  • Exercise

  • Meditation

  • Cognitive behavioral therapy (CBT)


There are likely more items to add to this list, and you may find one remedy helpful while another may not be effective for your pain at all. Physical therapy may be an option to treat your chronic pain, and working with a physical therapist who is a Certified Neuromuscular Manaul Therapist (CNMT) has been shown to help chronic pain sufferers improve their function while decreasing or eliminating their pain.

What to Expect

When attending physical therapy for chronic pain, your first session will be an initial evaluation. During this session, you will meet your physical therapist and discuss your condition.


Your therapist should ask questions about your pain and how it behaves. Is your pain present constantly or intermittently, and how does it affect your life? What makes it better or worse? Your physical therapist should also ask about any previous treatments you have received and the effect those treatments have had.


We might do a review of your overall medical history and will perform various tests and measures to get a sense of any impairments that may be contributing to your pain, including:


  • Range of motion

  • Posture

  • Strength

  • Balance

  • Endurance


Some of these tests may increase your pain, while others may cause your pain to decrease. Be sure to communicate with your physical therapist how you are feeling and how sensations are changing during your evaluation.


Once your PT evaluation is complete, your physical therapist should work with you to develop realistic and attainable goals for therapy. Goals may include: pain relief, extended range of motion, increased strength and improved functional mobility. Your goals should be personal and should give you a road map to follow during your rehabilitation program. Finally, your treatment can begin.


Finding What Works


Some Treatments Not Proven Effective

Some PT treatments for chronic pain are based on theoretical models and have not been proven to be effective for pain. Does this mean that they will not be effective for you? No. It simply means that in studies of large groups of people with similar characteristics, some treatments have not been proven to work. Understanding the research can help you make informed decisions about your care.

Some treatments that may not be as effective for chronic pain include ultrasound, TENS, or heat and ice.

A meta-analysis (study examining conclusions of many different studies) concluded that ultrasound was not effective for chronic low back pain (LBP) when compared to exercise alone or a placebo (fake treatment). The authors concluded: "No high-quality evidence was found to support the use of ultrasound for improving pain or quality of life in patients with non-specific chronic LBP." Another meta-analysis of the use of massage for chronic pain concluded that patients may report a 20 to 80 percent reduction in pain after a massage, but that these reductions are temporary. Massage, however, may help improve the mobility of tissues and feelings of well-being. Dry needling studies show similar results, and both heat and ice are shown to give slight short-term relief of pain.

Treatments Proven to Be Effective

Exercise has been proven to be effective for chronic pain. Pain neuroscience education (PNE), or learning about pain and how it affects your body, has also been shown to offer long-term benefits with pain reduction and improved mobility.

The most important thing to remember is that your pain is personal. Your physical therapist can work with you to find specific things that can help you move better and feel better.

A Word From Rehab Oasis

If you have chronic pain, you may find that it is difficult to function well. Managing your pain can be challenging, as there are many different options for you, all with varying degrees of effectiveness. Rehab Oasis team of registered Physical Therapists, will focus on exercise and pain neuroscience education, as an effective way to decrease your pain and improve your mobility.

Research published in the Archives of Physical Medicine and Rehabilitation showed that a graded walking program can have a positive effect on patients with chronic pain. However, one important caveat of the study was that adherence to an exercise and a walking program can be difficult. Still, finding ways to maintain walking and exercising is important. (Your PT can help with this.)

In addition, neuroscience pain expert Adriaan Louw has found that learning about pain through pain neuroscience education (PNE) can improve symptoms, mobility, and feelings of psychological well-being in people with chronic pain.


Overall, passive treatments like heat, ice, or massage may feel good. However, if you want to take control of your pain, more active treatments like exercise and learning about your pain are recommended.

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