There are a variety of reasons why physical therapy fails to help alleviate pain.
First. The number one reason physical therapy treatment doesn’t work is when there’s pain that is sharp, electrical, or burning that never goes away, according to ProHealth Physical Therapy and Pilates Studio Founder, Dr. Karyn Staples, PT Ph.D. She indicates that this is likely nerve pain, but not just nerve pain—because some nerve pain can be improved with PT. This is the sort of pain that no matter what a person does or how they move, they have a high intensity of pain that never goes away.
For that kind of pain, rather than PT, the patient needs to go the medical route and see if pharmacological (medications), injections, or even surgery would be beneficial. This is especially true if the pain is occurring at a high level even at night. A visit back to the family doctor (if insurance requires) or to a specialist (like an orthopedist) or even a pain management physician may be in order.
For most patients who are in pain, there are PT movements that help to alleviate the pain in the long run. But when PT movement makes the pain worse or just doesn’t help at all, then it’s time to find other pain relief options.
Second. Physical therapy may not work when a patient lacks ownership in their role in getting better. This is the patient who is given exercises to do at home and doesn’t do them. Or maybe doesn’t even fully participate to the best of their ability during their PT session.
PT may also fail for that reason when a patient is told how to get in and out of bed, or how to stand, and they choose not to follow that advice. They continue to do things the way they have been doing them because it feels more comfortable. Some repetitive motions are harmful and habits have to change for effective PT.
Dr. Staples asserts that they need to change the input into their body. The positioning and right muscle activation patterns aren’t happening because they’re not doing their home exercise program.
If a patient’s shoulder continues to feel stiff, but they’re not actually moving it in the ways that it should be then it’s a lack of following the advice and the guidance of the physical therapist. It’s not working because the person’s not doing their part. Good PT is a partnership between the physical therapist and the patient.
Third. The third reason that PT fails is a red flag physical therapists are trained to look for. These are a patient’s symptoms that are actually alerting something else.
Some conditions mimic musculoskeletal dysfunction like bone cancers, for instance. Bone cancer can be quite painful and depending on where it starts, it can mimic a repetitive use injury.
If there’s no change to the area of pain or discomfort within two weeks of physical therapy, this might need to be a referral back to a physician. This assumes that the patient has fully participated in their treatment, and the PT is also doing their role.
This isn’t just for cancer, it may be someone with knee pain who has no cartilage left in their knee, and actually needs a knee replacement. Or it may be someone who has a tumor on their thyroid, or their thyroid is nonfunctioning, so they have body aches that mimic musculoskeletal issues. If all parties are doing the right things, but there’s no change in a couple of weeks, something else might be going on.
Fourth. If the injury was a trauma, which could be a major fall or a motor vehicle accident, or even a strenuous lift at the gym, diagnostic testing should rule out fracture before physical therapy begins. There’s a possibility that someone who had physical therapy before might come directly to a physical therapist. It’s important for the PT to make sure that that’s been checked.
Fifth. When patients come in feeling very weak and they indicate that they’ve lost a lot of weight recently with no effort, this is a red flag for potential cancer or some other condition like diabetes or hypoglycemia. PT can be highly effective in treating weakness in muscles, even after dieting. The lack of effort part of such weight loss is the red flag.
In most cases when physical therapy fails, it’s because the patient didn’t know they needed to knock on the door of a different kind of healthcare provider. No treatment is 100% effective. Even if the patient is headed for surgical intervention, research tells us that good PT prepares them for a better long-term outcome on the other side of it. Establishing better movement patterns that prevent wear and tear, becoming stronger, that’s valuable.
The goal at ProHealth Physical Therapy and Pilates Studio is to work on musculoskeletal issues that can actually be assisted by our competent physical therapists. 80% of the time, physical therapy is the right first choice in care for a musculoskeletal injury. It’s a good starting point to figure out how to prevent future injury and pain.
In some cases, patients say that they have “already tried physical therapy and it didn’t work.” ProHealth’s physical therapists work one-on-one with patients on individualized plans to improve their quality of life. It’s a better standard of care than some physical therapy clinics commit to.
So if you’ve found failure elsewhere, you might be surprised by your better results at ProHealth. If you’re in the South Atlanta Area, call for an appointment at 770-487-1931.