Common Questions About Physical Therapy and Pain

You have questions, we have answers! I’m Lauren Masi, Doctor of Physical Therapy and Board-certified Orthopedic Clinical Specialist. I’m also the owner and Clinical Services Director of Bay Area Physical Therapy and Lafayette Physical Therapy. Today we’re going to talk about some common questions about physical therapy and pain.

How Long Will Physical Therapy Take?

The short answer that you don’t want to hear is, it can depend. But to delve into that a little bit deeper, tissue healing is where everything starts, and we know that on a cellular level, tissue healing can take about six to eight weeks. So depending on the ailment or issue you’re coming in for, if there is actually an injured tissue that needs to heal, we’re probably looking at about six to eight weeks.

How Long Will Physical Therapy Take with Chronic Pain?

Some other things that bring people to physical therapy could be more chronic issues. Postural dysfunction, so bad habits in how you sit at your desk, can lead to pain. And oftentimes, although you have created some inflammation or damage to local tissues, the issue there is really breaking a bad habit. And we all know breaking bad habits can take a long time.

For those patients, what I will tell them is, once we get to the root cause of what led you to the pain that you’re reporting, then we have to start breaking that habit. As quick as you can get that done, that’s when the clock will start ticking on allowing the tissue healing piece to kick in. After you break the habit, from then it could be six to eight weeks.

How Long Will Physical Therapy Take with Underlying Health Issues?

Other health issues can also slow down healing. If you have diabetes, or if you are obese or are a smoker, those are known other medical conditions that can slow tissue healing times. We certainly encourage that if you are a smoker, stop smoking as soon as possible because we do know that the minute you stop smoking, your body does start to heal and you get improved circulation, which can help heal those tissues.

How Soon Should I See a Physical Therapist?

In general, the sooner you handle an issue, the better. I have people who walk in my door and they’re like, “Yes, I’ve had this back pain for 10 years and I’m going on this nice European vacation and I’m going to do a lot of walking in two weeks. Can you fix my pain?” And honestly, I’m going to tell them no. If you had something going on for 10 years, you’re probably falling into that category of needing to break some bad habits and you’ve had some adaptive tissue changes that could lead to significant weakness in some areas and tightness in others, and that can take some time to improve.

One of my rules I tell my patients and family and friends is, if you do have pain and it’s not improving within a week, I want you to seek care and help soon so that we can get it handled and get you back on track to recovery faster. The faster we can start to address something, the faster we can get you better.

When Should You Use Ice for Injuries?

Another common question that I’m often asked is, should you use ice or heat? Again, it depends a little bit on the situation. Generally speaking, for acute injuries (meaning they just happened), we are going to recommend ice for at least the first 48 to 72 hours. And the reason for that is if there’s an inflammatory process, we don’t want more blood and more fluid pumping to an area.

Heat is a vasodilator. What that means is that the blood vessels are actually getting larger, which allows for more blood flow and fluid to go to the area. And in those acute cases, your body can take some of that fluid and create more inflammation. That’s why we don’t want heat in the acute phases. We would prefer ice, which is a vasoconstrictor. The blood vessels are going to get smaller.

As soon as you thaw out from using that ice, your blood vessels are going to go back to normal. It’s not like we’re causing any long-term changes, but it’s just going to allow your body to not absorb more fluid and hopefully be able to eliminate some of it.

What Types of Ice Should You Use for Injuries?

You can use direct ice cubes in those old school ice bags. What I do warn is, if you are using actual ice cubes, please make sure there’s at least a layer of something thin between the ice and your skin like a thin kitchen towel or at least a paper towel so you don’t freeze or burn yourself. But if it’s too thick, like a beach towel, the cold won’t get through. When you are trying to ice a tissue, it needs to get pretty darn chilly to have the effect that we are looking for.

When you are icing, we say a minimum of 10 minutes and no more than 20 at any given time. And once your skin thaws out to the touch, you could ice again and end up being about once an hour if necessary.

When Should You Use Heat for Injuries?

If you have something that’s more chronic, meaning it’s going on at least 72 hours, heat can be a good option. Generally, if you’re feeling tightness or stiffness, sometimes heat is good because it does bring more blood flow to the area, which can act as a lubricant to your muscles and to your joints.

I’ll often talk to patients who have arthritis, and they might say (especially in winter), “Oh gosh, I wake up so stiff in the morning.” And I joke around and say, “Yeah, you wake up like the Tinman, and to help oil your joints, you can use heat.”

What Types of Heat Should You Use for Injuries?

And there’s different forms of heat. Yes, it could be a hot water bottle, it could be an electric heating blanket or heating pad. Could just be a warm shower or a bath. All of those heating modalities have that same vasodilating effect.

With heat, usually we say use it for up to 20 minutes, make sure it’s not too hot that you’re going to burn, and please don’t fall asleep with electric blankets or heating modalities on you because I do have people who burn themselves.

How Does Posture Relate to Pain?

Posture can have a lot to do with pain, and it can have an effect on all sorts of disorders. It can cause:

Headaches
Temporomandibular joint dysfunction (jaw pain)
Neck pain
Shoulder pain
Back pain

Posture has a lot to do with how a person might be reporting pain and where that pain might be. And oftentimes, posture is just a habit. So poor habits like slouching, rounding that upper back, or a forward head position can lead to tightness in some of the neck muscles. And for people who report pain in the upper back, if you’re super slouchy, it’s your back muscles screaming at you and trying to fire to pull you back up tall. It’s almost like they’re overworked, they’re tired of trying to lift you back up.

Most People Don’t Realize They Have Poor Posture

The other big problem with posture is that most people don’t know that they have poor posture, and knowledge is half the battle. If you don’t know that you’re in poor posture, then how are we going to go about fixing it? Oftentimes I will tell patients to have a family member or a friend take a picture of them on the couch or at their desk (if they have a home desk workstation) when they’re not paying attention. And sometimes they’re mortified at what they see.

You can then take that picture back to your physical therapist, and we can start to talk to you about strategies to improve your posture that hopefully don’t mean buy a whole new workstation. We have some good tricks of the trade that we can pass along.

What Does Good Posture Look Like?

In general though, when it comes to posture, think alignment: we don’t want that head jutting out in front of us. If you think of the hole in your ear, we want the hole of your ear lined up right over the tip of your shoulder. And if you’re standing, we want the little hip bumps on the side of your hips aligned down through the side of your knee and into your ankle bone.