What happens if I don't feel any improvement with physiotherapy?

If you don't notice any improvement, your physical therapist can review your progress and adjust the treatment plan with you. The following points will help you prepare for this discussion:

• The Different Forms of Improvement
• Activities that make your symptoms worse between appointments
• Your sleep quality
• How to Do Your Exercises and Adapt Them to Your Needs
• Reassessment of the Diagnosis and Care Plan

In what ways can improvements from physical therapy be felt?

Improvement through physical therapy may take the form of less severe or less frequent pain, a greater range of motion, or activities that are easier to perform. Pain may also return less quickly or subside more rapidly after the same level of exertion.

In cases of persistent pain, the British guidelines on assessment and follow-up recommend taking quality of life into account, even when pain persists.

You can make a note of the following changes to discuss them during the meeting:

• Pain reduction
• Decreased frequency of pain
• Increased range of motion before the same pain occurs
• Increased time to do an activity before the same pain appears
• The pain subsides more quickly after the same movement or activity

Improvement can also translate into greater confidence in moving. A study gathered the perspectives of 11 people with shoulder pain related to the rotator cuff—the muscles and tendons that help stabilize the shoulder. Some participants reported increased confidence in their shoulder and less fear of movement after doing the exercises.¹ These testimonials reflect the participants’ personal experiences. They do not prove that the same changes occur for all types of pain. Moving with greater ease and confidence is still a beneficial improvement worth discussing with your physical therapist.¹

Comparing several benchmarks can reveal progress that pain alone does not show. Work with your physical therapist to choose one or two activities that are important to you, and then note what is becoming easier.

The intensity of pain does not directly reflect the extent of tissue damage. In an article on pain education, Moseley emphasizes that these two phenomena are distinct.² Tissue can contribute to pain, but its condition does not always explain the pain’s intensity or effects. Persistent pain is therefore not enough to conclude that your body is deteriorating further.² If your symptoms change, your healthcare provider should reassess the situation.

Is your body under too much strain between matches?

Certain activities between appointments may worsen your symptoms if their duration, intensity, or frequency exceeds what you can currently tolerate. Your physical therapist can help you adjust these activities while maintaining movements that are appropriate for your situation.

The number of activities or movements that aggravate your symptoms may be something to reconsider. Describe the actions that worsen your symptoms and how long it takes for you to return to your usual level of function. Your physical therapist can specify which movements, activities, or postures you should temporarily modify. Increased pain alone does not necessarily mean that you have been moving too much.

Adjusting activities is part of the treatment. For patellar tendinopathy—a condition affecting the tendon located beneath the kneecap—clinical guidelines recommend adjusting the level of exertion that worsens symptoms and then gradually building up the ability to tolerate these activities.³ Progress may take time. It relies on appropriate exercises, rather than relying solely on treatments received without active participation. These guidelines pertain to this specific tendon issue; your program should be tailored to your own condition.³

Can Your Sleep Affect Your Pain?

Lack of sleep can increase sensitivity to pain, and pain can also disrupt sleep. A review of studies on sleep and pain describes these links in several conditions involving persistent pain.

If you often wake up feeling unrested, talk to your physical therapist. He or she can discuss with you the role of sleep in your recovery and refer you to a healthcare professional if necessary.

Sleep disturbances can accompany nociplast pain. This term refers to pain associated with a change in how the nervous system processes signals, without any tissue or nerve damage sufficient to explain it. One review specifically describes sleep problems and fatigue in fibromyalgia, a condition that causes widespread pain.⁴ This type of pain can also coexist with pain related to tissues or nerves.⁴ A meta-analysis combining several experimental studies in healthy individuals observed an increase in pain sensitivity following sleep deprivation. The effect was moderate in comparisons between groups and more pronounced in before-and-after comparisons within the same individuals.⁵ These results do not directly measure the effect of sleep on wound healing or on persistent pain in a clinical setting.

Are you doing your exercises the right way?

Your physical therapist can check whether the way you’re doing your exercises, how often you do them, and the level of effort required are appropriate for your needs. Demonstrating your exercises during an appointment allows the therapist to clarify the instructions and adjust the program.

Progress depends, in particular, on the choice of prescribed exercises, the time devoted to the program, and your ability to do them regularly. Pain, the demands of daily life, or unclear instructions can make the exercises more difficult. If you’re having trouble, please let us know. We can work with you to find exercises suited to your condition and ways to incorporate them into your routine.

How can you verify the diagnosis if there is no improvement?

Your physical therapist will confirm the diagnosis by reassessing your symptoms, their progression, and the results of the examination. He or she may then adjust the treatment plan or seek a second opinion if the situation warrants it.

Several health conditions can cause similar symptoms. The physical therapist compares possible explanations with your examination findings and your response to treatment. If the expected progress does not occur, the therapist reviews this analysis with you. The decision depends on the new information gathered. Also, report any changes in your symptoms. For persistent pain, British guidelines recommend a reassessment when the presentation changes and a discussion of the care plan based on your goals.

References

Links open in a new tab.

1. Powell JK, Costa N, Schram B, Hing W, Lewis J. “Restoring That Faith in My Shoulder”: A Qualitative Investigation of How and Why Exercise Therapy Influenced the Clinical Outcomes of Individuals With Rotator Cuff-Related Shoulder Pain. Phys Ther. 2023;103(12). (Back to sections: 1, 2)
2. Moseley GL. Teaching people about pain: why do we keep beating around the bush? Pain Manag. 2012;2(1):1-3. (Back to sections: 1, 2)
3. Malliaras P, Cook J, Purdam C, Rio E. Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. J Orthop Sports Phys Ther. 2015;45(11):887-98. (Back to sections: 1, 2)
4. Fitzcharles MA, Cohen SP, Clauw DJ, Littlejohn G, Usui C, Häuser W. Nociplast pain: toward an understanding of prevalent pain conditions. Lancet. 2021;397(10289):2098-2110. (Back to sections: 1, 2)
5. Schrimpf M, Liegl G, Boeckle M, Leitner A, Geisler P, Pieh C. The effect of sleep deprivation on pain perception in healthy subjects: a meta-analysis. Sleep Med. 2015;16(11):1313-1320. (Back to section: 1)