When you think of physical therapy, you think of exercising, right? I occasionally meet patients who are afraid of physical therapy because they worry it will cause more pain.

Physical therapists (PTs) understand that exercises like squats and planks are not appropriate for all patients and it is important that your treatment plan is unique to you. PTs have a wide range of skills and treatment techniques, in addition to exercise, that can help to reduce your pain, even without medication.

Interestingly, recent research has suggested that providing the patient with educational information about pain, including why pain occurs and what factors affect the pain experience, can actually reduce pain. In the past, patient education has often focused  on detailed information about medical imaging results and potential problems with muscles, bones, and nerves. Research has shown that these common problems can actually be a normal part of the aging process and do not necessarily cause pain. For example, in people around age 50 without back pain, 80 percent will have evidence of “disc degeneration” in a CT scan or MRI, while 60 percent will have “disc bulging.”

When medical professionals are talking with patients, words matter too. One research study showed that when specific medical terms are used to describe a condition, patients were more likely to agree to more invasive treatment options that were not always necessary. On the contrary, education simply explaining pain decreases fear and tends to lead to improved results.

Pain Science

Adriaan Louw, PT, PhD, CSMT, is a prominent physical therapist and an educator who is spreading the word of pain science around the world. He performed a study to determine if education before total hip or total knee joint replacement surgery could help with pain after surgery. His research showed that pain education had a positive effect on pain! In 2018, Louw performed another study indicating that patients who received pain education had “positive shifts in their beliefs about their future knee surgery.” Other research by Louw showed that a single session of pain education can decrease pain in patients who have chronic lower back pain.

Although pain education can be helpful, patients often respond even better when education is combined with appropriate, individualized hands-on techniques. In a research article by Enrique Lluch, PT, MsC, PhD, patients had four sessions of either pain education combined with hands-on techniques or biomedical education with hands-on techniques before surgery. Patients who received education with hands-on techniques had less pain exaggeration and were less fearful of movement both before and after surgery. This research highlights the importance of the combination of education on pain in addition to some of the skilled, hands on techniques that physical therapists can perform.

Not all therapists have training in pain neuroscience education. Lifespan Rehabilitation Services has two physical therapists who are therapeutic pain specialists, a certification through the International Spine and Pain Institute that requires specialized training. In addition, other therapists within Lifespan are knowledgeable about these specific treatment techniques.

If you need physical therapy and are interested in this treatment technique, ask for a therapist who knows about pain education. It is likely you will have better results. For more information on Lifespan Rehabilitation Services, please visit our website.

Courtney Klenk, PT

Courtney Klenk, PT, DPT, OCS

Courtney Klenk is an orthopedic board-certified physical therapy specialist in outpatient rehabilitation services at The Miriam Hospital.