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Physical Therapy for an Injured Athlete: Pain To Pressure, Not Pain and Torture

Evaluating source of pain important part of PT process

Patients often think of PT as standing for "pain and torture."  Part of this idea comes from the fact that physical therapists do apply pressure around an injured body part to locate the source of the pain and increase pressure to see how the athlete reacts.

But when a physical therapist is poking and prodding around your child’s knee or shoulder (what is called "palpation"), he or she isn't doing it to cause pain, but as a way of helping them figure out the extent of injury, how it should be treated, and how healing is progressing. 

Locating the pain 

All pain is not created equal, so location is very important.

Pain to pressure over joints, tendons, and ligaments is generally more of a concern than pain directly over a muscle.  Bruises are very common in sports and often will heal on their own. Touch pain over more sensitive areas, such as the rotator cuff tendons or ligaments around the ankle, require more attention. This is because these areas are common for overuse or will cause weakening to a joint, potentially causing more damage.

Eventually, if one pushes hard enough, it will cause pain, but it may be normal. Abnormal pain, such as sleeping on a shoulder or tenderness to light knee pressure is not normal and needs to be more closely examined. Sprained ankle

Side by side

At the first visit, and then during the rehabiliation process, one of the things a physical therapist does is to compare the injured part, say, a sprained ankle, to the uninjured part. Because body parts are generally symmetrical from side to side, feeling how the athlete's "good" ankle feels tells the physical therapist what the injured ankle should feel like when it has healed.  Swelling, stretched ligaments, bruises, or muscle spasms are easier to determine after examining both sides. Sometimes an injured ankle may have an akward feel to a physical therapist but if the other one is the same, then there likely is no major problem.

Hands-on process

Physical therapists develop a great sense of "feel" following thousands and thousands of hours of patient contact. It this hands-on component of rehabilitation that really sets physical therapists apart from other healthcare providers. While a young athlete may view it as "pain and torture", it is an objective tool for a physical therapist to figure out how healing is progressing.  

Posted February 26, 2012