Physio exercises and pain

[TPMB12]

A wrist injury and physio gave me exercises. One involves doing the very sort of movement that causes pain. Do I do it but only a bit to minimise discomfort or just leave it and hope that the other exercises fix the issue?

[hellymedic]

My usual mantra is 'Do not provoke pain' for instances where there has been no acute injury.
Mobilising a stiff joint etc. after a fracture, dislocation or surgery is another matter; it might be necessary to push through pain to regain lost movement.

Can you discuss this with your physio?

[TPMB12]

TBH I think the physio was stumped by it. I think the way the pain manifests with a turning the key type of movement without any swelling or signs of damage.  That little bony bit on the outside of the wrist on little finger side hurts up m the forearm a little from there when I turn my hands.  But the exercise is to do that.

Anyway,  I have another 3 or 4 exercises to do so think I'll leave this one that hurts ba but when doing it. For me pain means stop, but when no broke my hand the physio made me push through the pain a bit to get my mount moving more.  Took several years before I really got it moving too.

[L CC]

This year in January I had my knee replaced and Mr Smith had multiple fractures of his shoulder.

I have much better range of motion in my new knee than he has so far recovered in his shoulder and this is entirely because I was positively encouraged to push through the pain and he was not.

Range of movement can be permanently restricted if you stay within your pain threshold.

[T42]

IME, "pushing through the pain" works with contractures and such. Dunno about residual pain from healed injuries - I wouldn't do it without the GP's or the phizzy's go-ahead, and I'd hope that both would be working from X-rays.

[barakta]

This year in January I had my knee replaced and Mr Smith had multiple fractures of his shoulder.

I have much better range of motion in my new knee than he has so far recovered in his shoulder and this is entirely because I was positively encouraged to push through the pain and he was not.

Range of movement can be permanently restricted if you stay within your pain threshold.

I'm not sure that's a fair comparison. Shoulders are a very much more tricky joint than knees.

After my hip surgery, my physio was started too fast without consideration of my level of capacity and generated severe knee pain which took months to clear and only after I flat out refused to do any physio for weeks. I "pushed through pain" that I should not have pushed through. 3 months later another physio started from ABC again and realised I didn't have the baseline stability in my hip to have started walking/exercises so soon so started me on much more basic exercises. I still get knee issues and pain which I'd not had before.

[mrcharly-YHT]

One of the most helpful pieces of input I've ever had from a physio was this:
"the healing on your <bodypart> is like half-done darning; if you do too much or push it too far, the darning unravels".

IME, quite a lot of physio involves using very tiny loads (hair elastics for my injured fingers), and limited ranges of motion.

It is really, really, really important to stick to the limits that the physio gave you.

Many of us are cyclists who are used to pushing through discomfort.

When doing physio, do the exercises as described.

If the physio says "Sit on a chair with feet on the floor, then alternately straighten one leg until that foot is 6" off the ground", then do that. Don't straighten the leg completely and add some leg lifts.

[chrisbainbridge]

these days knee replacements are a standardised operation where everything is geared towards movement.  Essentially no bone healing has to take place and the soft tissues are cut in such a way that they will not be stressed by physio.  The net effect is that pushing activity is very much a good thing.  In addition patients are almost always given large doses of steroids and a drug called tranexamic acid to reduce swelling and bleeding.

A fracture on the other hand takes place in a less than ideal environment, causes major soft tissue injury and then the metalwork is put in to "stabilise" the bone so they can heal but this take many weeks.  The soft tissue injury also encompasses a variable amount of disruption of the muscles moving the shoulder joint which need time to heal.

Not infrequently in hip fractures a full replacement will be performed rather than fixation of the fracture to allow faster, better recovery.

[Rod Marton]

Just had a hip operation yesterday and was started on the physio today. Admittedly this only involved getting out of bed, but... Anyway, pushed through the pain (I'm a cyclist, after all) as I was encouraged to do, to such an extent that I blacked out and ended up on the floor. Not a good result. Though it was quite fun riding back onto the bed on top of a balloon.

There should be a moral to this story. Probably that cyclists capacity for pain is rather higher than that of the general population.

[hellymedic]

Medical Twitter is full of horror stories about farmers and their low pain threshold.
Medics themselves do silly things when truly sick.
Then there are cycling medics.
And cyclists...

[rafletcher]

Just had a hip operation yesterday and was started on the physio today. Admittedly this only involved getting out of bed, but... Anyway, pushed through the pain (I'm a cyclist, after all) as I was encouraged to do, to such an extent that I blacked out and ended up on the floor. Not a good result. Though it was quite fun riding back onto the bed on top of a balloon.

There should be a moral to this story. Probably that cyclists capacity for pain is rather higher than that of the general population.

Cyclists perhaps, most women for another.  My wife has had 2 hip replacements. I was with her the day after her second (that was privately done and local). I don't think I've seen anyone go from pink to grey in such short order as she was helped to the loo by the nurse.  (Equally, she went from grey to pink almost as quickly when she had a blood transfusion a couple of days later.)

One of the reasons she was so diligent in the exercises despite the pain (and she doen't like to take any painkillers) was that a friend of hers, who is a GP, was adamant (and correct) that if she didn't do them, she WOULD limp.

She doesn't (at least as far as most are concerned), but another of our fellow villagers, seeing her walking one day, said "Have you had your hip done? Disappointed, my wife admitted she had, and asked how it showed. "Oh, it doesn't really, but I'm used to judging horses walks" came the rejoinder.