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Ask A PT! Why Does My Pain Come Back?

Hi, this is Dr. Brad Conder. Just want to give a quick update regarding what I experienced last week, as far as nighttime low back pain. One thing I wanted to kinda talk about real quick is just the fact that I actually had some back pain myself last week. And I was looking through my actual suggestions and recommendations, and I actually took my own advice and felt much better. By night time my back pain was better.

But on to today. Mainly what I wanna talk about today is I had a…one of my clients this week, one of her first questions was, “I came back to therapy two months ago and I got better real fast. Why did my pain come back?” Well it’s a very common issue that I might need to address with a lot of my clients, is that, you know, the fact that you’re gonna get pain to come back at times. You know, in general, when you’re having musculoskeletal conditions, say, neck pain, back pain, knee pain, there is no “fix.” I do feel like physical therapy is the most appropriate option for these conditions. But the reason that is is because our approach is more of learning how to properly make sure your body is taking care of this condition for long term.

So what does that mean? Well, so I’ve had patients come to physical therapy and they get better real quick, and after two visits, their pain’s better and they think they’re done. Well that’s usually not the case. So the way physical therapy kinda works is that we have to diagnose first of all what the issue might be. And in her case it was the fact that she just works a lot. She’s a stay-at-home mom, does a lot of computer work, get a lot of postural stress, lot of neck pain. So we were able to get her pain better within a couple weeks with manual therapy and some self-exercise and some suggestions going for pain, say like ice, heat, stuff like that.

But the pain came back. So why did it come back? Well the primary reason is because we didn’t really complete physical therapy. Because part of what our plan of care is supposed to be is that you come in, we learn what caused it, we do all the great manual therapy and exercises and some other suggestions to help manage your pain. But also too, we need to address all the other factors that kind of make this an ongoing issue, such as learning how to get stronger, learning to actually strengthen on a daily basis, maybe change some healthy habits, say like exercising two to three times a week, diet sometimes comes into play in some certain conditions or drinking a lot of water. But primarily what I wanted to get across to her is that we need to finish the plan of care to where I can help train her to get more endurance through strengthening and hopefully get better habits to have exercises that she does every single week. And usually that takes about at least a month or month and a half. Now I tell my patients all the time that, you know, some of these changes that we’re looking to happen just don’t miraculously get better over night. I wish they would but they usually don’t. And the reason that is is because one of our conditions might be heavily dependent on a certain amount of strength that we’re trying to gain out of your neck or your back or whatever we’re working on, and that can only happen so fast.

So for example, so say if you go and you do some exercises, you do some bicep curls, right? Well once you break that muscle down and go for the heel, it can only heal so quickly. So meaning that it takes at least four weeks for that muscle to break down, build back up, and actually be stronger again. So that’s why, you know, when we give people a plan a care as far as a month, month and a half, or six to eight visits, it’s not necessarily an arbitrary number. We’re prescribing that based on what we know, what your condition is, how quickly we can get the pain down, but also retrain the body to improve its endurance and ability to handle your everyday life. And that’s where the long-term benefit’s gonna come, from physical therapy.

So to sum it up, basically what I want you to make sure to kinda get across is that if you go and you have a severe condition like neck pain, back pain, gets better real quick with physical therapy but then it comes back, kind of look at what we did as far as treating that. Most likely we didn’t complete what we needed to make sure that you really stay healthy for long term. As usual, if you have any questions, email me at drconder@physicaltherapylouisville.com, or text me, call me at 502-509-3136.