Maybe, you wake up and realize it is a bad pain day.

Maybe, your pain gets a little flared at physical therapy one day and remains higher.

Maybe, you feel your home exercises are making your pain worse.

What do you do? It seems like physical therapy is not working and is not going to work for you, so you cancel your treatment session and keep suffering.

NO! GO BACK TO SEE YOUR PHYSICAL THERAPIST!

I know this seems like the right choice, but let me explain how physical therapy really works and why I (and every other physical therapist I know) want you to come in even when you have pain or are having worse symptoms… especially if you are having worse symptoms!

In the beginning, I do a full body evaluation. This includes listening to your history so I know what symptoms you are experiencing and how your symptoms are affected by movement. I then watch you move, test your strength, touch a variety of places on your body. I develop a working theory of what is happening within your body to cause you pain or incontinence as you move throughout your day. I may perform some manual treatment to address your symptoms, I may give you specific exercises to perform, I may educate you on changes to make in your movements or behavior to improve your symptoms, and then I send you on your way until your next treatment session.

Your response to my treatment, exercises, and education will help to either support or refute my working hypothesis.

I admit, it is very frustrating for your symptoms to get worse after a physical therapy session. It does not matter whether the symptoms get worse because of manual treatments, exercise, or behavior and movement modifications. It is frustrating to spend time doing something that you hope will help only to have it make you worse initially. When that does happen, I do not like it as much as you do not like it, but I want a second chance. The fact that your pain got worse gives me more information to have a clearer picture of your symptoms.

If your pain is worse, I am not going to do the same thing! I am going to make changes to my treatment plan. I will use different techniques and exercises, and hopefully I get it completely right on the second try. Hopefully I choose the right tools, but I want 4-6 chances to get it completely right. I have never had a patient get worse for 4 visits before figuring it out, but sometimes it takes a couple of tries to figure out every piece of the puzzle. I want 4-6 chances to make adjustments to your program and treatment in order to address all of your concerns. I do occasionally need a few visits to find the right combination of treatments. Maybe one of your symptoms improves right away, but you see no change in another symptom. It may mean we need to work in stages (one symptom first then the next) or it may mean that I have solved part of the puzzle but not the other.