In the end, movement is essential to live a life with less pain.
But the problem is most people want to jump straight to movement therapy when their body isn’t ready for it. There’s a sequence that has to happen before you can move with good biomechanics. Stacking physical therapy on top of a painful or dysfunctional joint will only cause more pain. There’s an even bigger problem with how physical therapy is delivered in America. I call it the medicare shuffle. It’s where you go to a physical therapy clinic owned by a large corporation and see a physical therapist who prescreibes the same set of exercise for everyone with shoulder pain. Then you’re left to your own devices or stuck with a physical therapy assistant who has 4 other patients in the same hour and told you need to come 3 times a week for 8-12 weeks. You end up doing a bunch of stupid exercises that don’t apply to your specific situation and never feel any better and potentially are worse off.
If you could out exercise your problem, then you likely would have already.
This most recent study was a high quality randomized controlled trial that compared PT to fake treatment for hip arthritis. About a hundred patients with 4/10 or worse hip pain due to arthritis were randomized to receive either 10 treatments over 12 weeks of real physical therapy or an ultrasound treatment of the hip with the machine turned off. The fake therapy group actually had slightly more pain relief than the PT group, but the differences weren’t statistically significant. The rest of the function scores were also not different between the groups.
It all comes down to sequencing.
Movement can be key to your healing as it is the highest expression of neurofunction (your body’s ability to send nervous system signals to muscles and do some task). But it is also incredibly complex and if it’s done with poor biomechanics or compensation due to pain then it can cause more problems. So step 1 is to restore function to your nervous system so it can send a clear electrical signal to your muscles. Step 2 is to send a non-painful signal from the surrounding sensory nerves to your spinal cord and then your brain to override nociceptive (painful / irritating) nerve signals. Step 3 is your muscles work better and we’ve block the pain signals so now you can start to move better with less pain. This is where physical therapy or movement therapy can come into play.
The good news
You don’t have to live with your pain. The majority of pain conditions respond really well to dry needling and electro-acupuncture. Once we get your body to function better adding in movement therapy can be amazing!
