A common question I always get is “when should I go to physical therapy or seek help for my joint/muscle pain?” “Should I just train or do my activity anyway despite the pain?”
Here are some questions I like to present for you to consider about your current issue:
How long has the pain/discomfort been going on? When did the pain start? Is it an Acute or Chronic issue? Is it linked to a specific event or change in activity? Or did the discomfort start out of no where?
Is there a certain time of day when the pain is worse or better? Is there a pattern to the issue in terms of when you feel the pain?
What is the quality of the discomfort? Is it sharp, dull/achy? Is there numbness or tingling? Is there a muscle weakness in the associated limb?
What is the intensity of the discomfort? Is the pain consistent or Intermittent?
How has your quality of life been impacted by this issue? Are you able to partake in the activities you want or is your mobility limited?
Some of these questions can be easily tracked with a Pain journal. It can be as simple as making a note on your phone or in your calendar of the time of day, activity you were doing, quality of discomfort, length of time it lasted, and perhaps the intensity of the pain on a 0-10 scale. The Visual Analogue Scale (VAS) is a commonly used scale in the medical field to gage the intensity of the discomfort. A lot of the time, clients do not like answering these questions. There are two things I always tell people. 1. This scale just allows us to track how your discomfort may change over time. 2. It is also rated on your own pain experience and is not comparatively to anyone else’s. Let me repeat this, It is based on YOUR OWN PAIN EXPERIENCE! Not anyone else’s. Pain is just a complex sensation we continue to learn more about each day as further research is done. But, the bottom line is that pain is not black and white and is truly an experience given to you by the brain. There are many factors that go into this sensation including emotions. For further information on this topic, please reference the Neuro Orthopedic Institute. A great easy reference for understanding pain is Explain Pain Handbook if this is a topic you would like to learn more about.
Once you have some data to reference from your notes or thoughts on your pain, let’s dive into these questions more. There are some types of discomfort and issues that you just don’t mess around with and should seek help immediately. These are considered “red flags”. These red flags are additional signs that the pain is something more serious. Red flags may include but are not limited to the following: “severe trauma, history of cancer” (Bescia, 2017), unexplained weight loss or weight gain, area is red and swollen, area is hot to touch, “dizziness, loss of consciousness, clumsiness walking or handling objects, unexplained weakness, nausea, night sweats, fever, chills, change in bowel or bladder function, change in symptoms after eating or drinking, difficulty speaking, difficulty swallowing, paresthesia or anesthesia, and change in vision” (Bescia, 2017). The above issues listed are outside of the scope of practice for a Physical Therapist to deal with. If your discomfort is accompanied by any of the above listed symptoms, please seek the help of a Medical Doctor immediately.
Timeline: How long has this discomfort been truly going on for? Have you ignored or put it on the back burner to be addressed? Have you been exercising or training through it to reach a goal? This is typically the case with a lot of people. A specific event causing the pain is typically more explainable and appears more rationale. What I notice clinically, is that when a discomfort does not have a specific origin, it is more bothersome to the client. There is a tendency to need an “explanation” for every pain or discomfort. Sometimes, the truth is that we just don’t know. I find in these cases that there has been a potential issue or compensation brewing over time, but you don’t notice there is a problem or change until there is discomfort. Our bodies are amazing at figuring out ways to do what we are asking them to do even if we don’t technically have the range of motion or strength to do it. We will compensate to accomplish the task. Compensation can lead to other issues in the body. (It has accumulated over time and more than one thing may have contributed to the issue)
Pattern Recognition: Is the discomfort reproducible with a certain movement or activity? Does the pain change if you minimize or avoid the activity? Some patterns are easily recognized and others can be more complicated. If you are able to recognize specific activities or exercises that provoke the discomfort, try changing the activity or exercise. For example, say you feel the discomfort with a barbell bench press in your shoulder, does the pain change if you were to use two dumbbells in a neutral grip? Another example is, if you have increased pelvic pressure when performing jumping jacks, does it feel the same if you “walk” your feet apart and spread your arms apart. What if you slowed the jumping down, does the feeling change? Thinking about these responses now can assist you with the issue and help problem solve. This will also provide detailed information when you seek out PT services.
Quality/Intensity: The type of discomfort you are having can allude to different issues. When there is muscle weakness involved, please seek medical treatment. This can be as simple as decreased grip strength or you noticed a decreased ability to stand on the toes of one foot and maintain the position. It is usually the sign of a more emergent issue. Does the discomfort dissipate with intervention or change? Or is it consistent. If nothing seems to make it better or worse, please seek out treatment sooner rather than later! Tracking the intensity of the discomfort can be helpful to notice if the pain is worsening or lessening over time, even though you may not notice day to day. Pain can be like a roller coaster. Most of the time it is normal for pain to be up and down. You may have more “good” days than “bad” days which can show a positive improvement over time. There can be a lot of frustration when you have pain for 3 days straight then it completely disappears and you think you are “cured” to just return after two days of no discomfort.
Here is my Best Recommendations:
Our bodies are complex and each one is unique. Pain is our body’s alarm system trying to get our attention that something is going on. Perhaps it's time we listened! If you have been dealing with an issue for more than two weeks and it has been worsening or getting more consistent, it is time to seek help! I highly encourage you to try to do something about the pain when you first notice it. Change or remove the activity to see if the discomfort lessens. Try doing some self massage with a foam roller or massage ball against the wall. Try some gentle stretching and range of motion exercises in the area of discomfort or perhaps above and below. Being more mobile and having the connective tissue of the body slide and glide across each other can be helpful in most cases. Light strengthening can also be helpful as long as there is no pain. If things do not improve after two weeks of being consistent, please seek the advice of a medical professional. The longer you let things linger, the longer the recovery typically is.
Depending upon your issue, there are many different avenues to try. For a musculoskeletal complaint, physical therapy can be a great line of defense first if able. We are able to screen for a wide variety of issues. If the issue seems more severe, perhaps an Orthopedic Medical Doctor would be more suited especially if your day to day function is being severely impacted. If your issue appears to be more muscularly based, seeking the help of other practitioners can be helpful such as massage therapy, acupuncture, or cranial sacral therapy. If it appears to be more of a joint restriction, perhaps chiropractic care is a good option.
Musculoskeletal complaints are sometimes straightforward, but sometimes they are not. Your body could be producing a protective pattern that needs further assessment to rule out a central nervous system tension pattern, visceral protective patterning or joint/muscle dysfunction. No matter what the origin of your issue is basic health and wellness practices tend to come in to play as well. Prioritizing sleep, hydration, and nutrition are non-negotiables. If you are not able to rest, hydrate, and nourish your body well. It will not function well. This includes your ability to void and defecate regularly and efficiently. If you are having problems with these, then seek help for these issues first!
Exercising with Pain: I firmly believe that you can exercise around injury. If you are struggling to find activities or exercises that do not cause more pain, then seek the help of a physical therapist or knowledgeable trainer. Many exercises can be modified to an individual. Not every exercise is made for everyBODY. That is correct! If there is an activity or exercise that irritates the pain for more than 2 days, then it should be changed. This is a sign that it is potentially inflaming or irritating the current issue. I usually recommend not letting discomfort get above a 3/10 with exercise and it should never be sharp or shooting. Muscle soreness is an okay discomfort to experience with exercise! That is the difference between good pain vs. bad pain.
My hope is that this information empowers you to listen to your body a little bit better than you have in the past and know that it is the smartest thing in the room!
References
DPT, Dr. D. B. (2023, October 10). Screening for red flags by an orthopedic manual physical therapist. NMPT. https://www.napervillemanualphysicaltherapy.com/single-post/2017/03/15/medical-screening-for-red-flags-by-a-physical-therapist
Moseley, G. L., & Butler, D. S. (2018). The explain pain handbook: Protectometer. Noigroup Publications.
