Why Does Physical Therapy Hurt if it is Supposed to Help?

Typically, patients will come to physical therapy because something about their bodies just does not feel right. They might feel increased pain over a joint, in a general body region or within the muscles. Ultimately, patients want physical therapy to help them feel better, however, some patients are surprised when muscle soreness may be present the day after a therapy session.

Patients will often ask, “why did you hurt me?” or “I thought I came here to feel better?”

Truth is when a muscle, body region or joint hurts the physical therapist’s job is to determine what is the cause of the pain? Is it overcompensation? Is the pain due to muscle guarding? Or joint dysfunction? Perhaps there is there is a combination of the above options contributing to a patients discomfort. After determining a course of care, typically physical therapy will include a variety of manual therapy approaches and exercises.

And that is what gets ya! The exercises.

The therapists hands most likely did not lead to the soreness that the patients experience the next day. Rather the exercises most likely did. No, physical therapists do not follow the “No pain, No gain” mentality of your former high school sports team coach. However, they do attempt to strengthen areas of weakness for which opposing muscles were previously compensating or areas of weakness that lead to joint or tendon inflammation and pain.


Soreness after exercise is commonly known as delayed onset muscle soreness or DOMS. DOMS typically affects muscles after they have completed unaccustomed tasks or strenuous activity. So if you think about trying to retrain muscles that are not correctly operating than DOMS will likely occur. Typically, DOMS will be present anywhere from a few hours to 24-48 hrs after a treatment session.

So, how do you limit the duration or severity of DOMS symptoms? Easy!

1) Stay hydrated: drinking plenty of water or electrolytes will help with muscle recovery after activity.
2) Continue to lightly stretch: by continuing to stretch after exercise you will aide the body in recovery by assisting in waste removal and promote muscle recovery.
3) Stay active!!: Yes, by continuing with light or moderate activity or completing your home exercise plan as provided by your physical therapist will help make the activity a customary activity versus unaccustomed activity and, thus, reduce muscle soreness.

Basically, when a patient tells me they are in “more pain,” I first try to determine whether or not there is more pain or a natural response to new activity.

Joel DeMaris, PT, DPT, CMTPT
**Physical therapy exercises should not produce sharp or shooting symptoms if they do, contact your physical therapist as this is not a typical DOMS related response. 

October 14th, 2015

Posted In: General

One Comment

  • Thanks for the interesting read about physical therapy. It’s good to know that the pain you experience is areas of weakness are being strengthened that were previously compensating. It sounds like a great way to make sure that your body is functioning properly and effectively.

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