Most of us sport enthusiasts have heard or come across a physio in our sporting career, particularly in GAA circles I find, where the ethos of treatment is ‘no pain, no gain’ and who is known for causing substantial pain in their bid to remedy injury. (I use the term physio loosely, as to denote the varying types of professionals that exist in this country for sport injury i.e. chartered physiotherapists, sport therapists etc). In some cases the physio can often be referred to in sadistic or in heavenly terms. Which term is utilised, is usually dictated by the ultimate success of treatment, in other words, if the injury got better or not. This leads to the lingering question, should receiving physio treatment be painful or not?
Well, first of all it is important to realise that when one goes for physiotherapy they are usually in considerable pain in the first place. Often they have waited a considerable length of time before contacting their physiotherapist until the pain has become almost unbearable in some cases. This is often coupled with their reluctance to move the affected injured part in order to protect it from causing even more pain. The irony of this is that such dramatic action usually adds up to more stiffness as a secondary problem to their original injury, causing even more pain. It is important that one avoids the painful movement in the first few days but complete rest is usually contraindicated in most injuries as it leads to reduced mobility, with reduced strength and function in the injured area.
The Irish Society of Physiotherapy describes Chartered Physiotherapists as mainly using ‘physical means such as exercise, manipulation, mobilisation, massage and electrical modalities to help patients’ overcome their injury. Electrical modalities may be felt by the patient in application but they should not cause the patient any pain if applied appropriately. Other forms of intervention such as mobilisation and massage, particularly transverse fractioning may induce pain in the patient. The aim of transverse frictioning is to realign injured fibres appropriately to the stress they will be placed under in normal joint movement. This may induce pain as the clinician aims to break down abnormal adhesions by strongly moving across the injured ligament or tendon. Frictions may initially be uncomfortable, but if applied appropriately tissues will become “numb” and pain relief should be achieved alongside other benefits including improved blood supply to the area. In relation to manipulation, where the bones are been realigned, there can often be a short, deep pain on full expiration lasting less than a few seconds. In trained hands it is a safe, effective and comfortable treatment, however, and should leave the patients original pain much better if not absent after the procedure.
As a general rule of thumb, if there is an imprint of your finger nails on the physio table while receiving any treatment intervention, than your clinician is going beyond the beneficial zone of treatment and may actually be causing more damage to your injury. So, physio treatment should cause you no more pain than what you were originally experiencing with your injury.