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.

Dans la douleur persistante, on recommande¹ de considérer la qualité de vie, même lorsque la douleur reste présente.

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. One 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. ² These testimonials reflect the participants’ personal experiences. They do not prove that the same change occurs for all types of pain. Moving with greater ease and confidence is still a beneficial improvement worth discussing with your physical therapist. ²

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. ³ Tissue can contribute to pain, but its condition does not always explain the pain’s intensity or its effects. Persistent pain, therefore, is not sufficient grounds to conclude that your body is suffering further damage. ³ 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 beneath the kneecap—clinical guidelines recommend modifying activities that worsen symptoms and then gradually building up the ability to tolerate those activities. ⁴ Progress may take time. It relies on appropriate exercises, rather than relying solely on treatment received without active participation. These guidelines pertain to this specific tendon condition; your program should be tailored to your own condition. ⁴

Can Your Sleep Affect Your Pain?

Le manque de sommeil peut augmenter la sensibilité à la douleur, et la douleur peut aussi perturber le sommeil. On retrouve ces liens⁵ dans plusieurs problèmes de douleur persistante.

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.

Les troubles du sommeil peuvent accompagner la douleur nociplastique. Ce terme désigne une douleur associée à un changement dans le traitement des signaux par le système nerveux, sans qu’une lésion des tissus ou des nerfs suffise à l’expliquer. Une revue décrit notamment des problèmes de sommeil et de fatigue dans la fibromyalgie, une condition qui cause des douleurs diffuses.⁶ Ce type de douleur peut aussi coexister avec une douleur liée aux tissus ou aux nerfs.⁶ Une analyse regroupant plusieurs études expérimentales chez des personnes en bonne santé a observé une augmentation de la sensibilité à la douleur après un manque de sommeil. L’effet était moyen dans les comparaisons entre groupes et plus important dans les comparaisons avant et après chez les mêmes personnes.⁷ Ces résultats ne mesurent pas directement l’effet du sommeil sur la guérison d’une blessure ni sur la douleur persistante en clinique.

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.

Plusieurs problèmes de santé peuvent produire des symptômes semblables. Le physiothérapeute compare les explications possibles avec votre examen et votre réponse aux soins. Si les progrès attendus ne se produisent pas, il revoit cette analyse avec vous. Le choix dépend des nouvelles informations recueillies. Signalez aussi tout changement de symptômes. Pour la douleur persistante, on recommande¹ une réévaluation lorsque la présentation change et une discussion du plan de soins selon vos objectifs.

References

1. National Institute for Health and Care Excellence (NICE). Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. NICE guideline NG193.↩ Back to text: 1st, 2nd mentions
2. 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 text: 1st, 2nd mentions
3. Moseley GL. Teaching people about pain: why do we keep beating around the bush? Pain Manag. 2012;2(1):1-3.↩ Back to text: 1st, 2nd mentions
4. 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 text: 1st, 2nd mentions
5. Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539-52.↩ Back to text
6. Fitzcharles MA, Cohen SP, Clauw DJ, Littlejohn G, Usui C, Häuser W. Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet. 2021;397(10289):2098-2110.↩ Back to text: 1st, 2nd mentions
7. 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 text

Nos physiothérapeutes ont défini la stratégie de recherche, le plan et le contenu clinique de cet article. Un outil d’IA a soutenu la recherche documentaire et la révision du texte pour assurer une cohérence du contenu et du style d’écriture.