Can physical therapy help chronic pain?

It can, as part of a broader plan. ChoosePT, the American Physical Therapy Association's consumer site, describes physical therapy for chronic pain as education about how pain works, a graded exercise program matched to your abilities and gentle hands-on techniques, with your physical therapist working alongside your physician. The usual goals are doing more and handling flare-ups with more confidence; we can't promise the pain will disappear.

Should I keep exercising if it hurts?

Often, yes, within limits you agree on with your therapist. ChoosePT notes that chronic pain often occurs independently of tissue damage, and that a carefully graded exercise program can help train your brain to sense the painful area without increasing its danger messages. New numbness or weakness, or a sharp change from your usual pain, is different: stop and get checked.

Can physical therapy help joint hypermobility?

It may. A 2023 review notes that physical therapy helps strengthen the muscles around joints and that stretching should target tight muscles rather than loose joints. The same review says rigorous studies are lacking and a multidisciplinary approach is likely optimal, so we treat the joint and muscle side and coordinate with your physician.

How long does physical therapy for chronic pain take?

There's no standard number of visits. We give you an estimate after the first evaluation and revise it as you respond. Much of the progress happens through your home program, and remote therapeutic monitoring lets us adjust that program between appointments.

Chronic Pain Physical Therapy in Buffalo | Lake Erie Physical Therapy

Q: What is RSD called now?

Reflex sympathetic dystrophy (RSD) is now called complex regional pain syndrome (CRPS). It usually follows an injury to an arm or leg, such as a fracture, sprain or surgery. A doctor familiar with the syndrome, such as a neurologist or pain management doctor, generally makes the diagnosis, and ChoosePT recommends a team approach that includes doctors, psychologists and physical therapists.

Pain is generally called chronic once it has lasted more than three months. By then, the original injury may have healed while the pain carries on, which is why chronic pain physical therapy looks different from rehab for a fresh sprain. At Lake Erie Physical Therapy in Buffalo, the aim is practical: understand what keeps your pain going, then rebuild the activity you’ve been avoiding at a pace your body can handle. We can’t promise the pain will disappear, and we’ll tell you honestly when another kind of care should take the lead.

Why pain can outlast an injury

ChoosePT, the American Physical Therapy Association’s consumer site, explains that chronic pain can and often does occur independently of any tissue damage. When pain is constant, the brain and nervous system go on “high alert” and become more sensitive. That doesn’t mean the pain is imagined. It means hurt and harm aren’t always the same thing, and a sensitized system can be trained to settle.

How chronic pain physical therapy works here

It starts with a one-on-one evaluation of your whole history: what you’ve tried, what helped, what flares you and what you want to get back to.

Understanding comes first

ChoosePT lists education about chronic pain first among physical therapy treatments. Using pictures and joint models, we explain what’s happening and why a flare-up doesn’t necessarily mean new damage.

A starting point you can repeat on a bad day

ChoosePT describes a graded exercise program that starts at your current level and increases gradually, which can help train your brain to sense the painful area without increasing its danger messages. We set a baseline for walking, lifting, sitting or exercise that you can manage even on a rough day, then build in small, planned steps rather than pushing hard on good days and paying for it afterward. ChoosePT also recommends keeping up your normal activities as much as possible and avoiding bed rest.

Checking for a mechanical problem

Long-standing back or neck pain sometimes still responds to specific repeated movements, so we test for that with the McKenzie Method (MDT) before assuming otherwise. A movement that reliably eases your symptoms is a tool you can use on your own. See our McKenzie Method page and back pain and spine care for more.

Hands-on care and support between visits

ChoosePT includes gentle hands-on techniques in chronic pain care, and we use manual therapy when it helps you move or exercise better, not as a substitute for the active work. Most progress happens at home. With remote therapeutic monitoring, you log your exercises and symptoms in an app, and we adjust your program between appointments. We’ll estimate how many visits make sense after the first evaluation and revise that as you respond.

When a physician or pain specialist should lead

Physical therapy does not replace a medical diagnosis. ChoosePT notes that your physical therapist works with your physician and refers you for evaluation if something suggests a more serious underlying condition. See your physician before starting, or get emergency care where noted, if:

Your pain has changed character, spreading, intensifying or behaving differently from your usual pattern without an explanation
It comes with fever, unexplained weight loss or a history of cancer, or it’s worse at night and no position eases it
You have new numbness or weakness, or changes in bladder or bowel control (go to an emergency department)
Your medications need adjusting. Those decisions belong to your physician or pain specialist.

Long-lasting pain affects mood, too. ChoosePT notes that some people with chronic pain have thoughts of suicide; if you do, tell your doctor. If you’re in crisis, call or text 988 to reach the Suicide & Crisis Lifeline.

Complex regional pain syndrome (CRPS), formerly called RSD

If you’re looking for physical therapy treatment for RSD, the condition once called reflex sympathetic dystrophy is now known as complex regional pain syndrome, or CRPS. According to ChoosePT, it generally arises after an injury to an arm or leg, such as a fracture, sprain, strain or surgery. Signs include:

Pain often described as burning, stabbing or throbbing, more extreme than the original injury would explain
Sensitivity to touch, swelling, and changes in skin color or temperature
Changes in hair and nails, guarded use of the limb, or a feeling that it’s larger than normal or doesn’t belong to you

CRPS needs a physician. ChoosePT notes the diagnosis is generally made by a doctor familiar with the syndrome, such as a neurologist or pain management doctor, and recommends a team approach that includes doctors, psychologists and physical therapists. Within that team, ChoosePT describes physical therapy that keeps the affected limb moving, teaches how pain works and gradually reintroduces feared movements. It also describes graded motor imagery, a staged program designed for CRPS that progresses from left/right recognition to imagined movement to mirror therapy.

Lake Erie Physical Therapy is an orthopedic practice and doesn’t run a specialized CRPS program. If your physician or pain specialist is directing your care and wants an orthopedic physical therapist for the movement and strengthening work, call us to talk through whether we’re a good fit. If an arm or leg develops pain, swelling or color changes out of proportion to an injury, see a physician promptly; ChoosePT notes that early detection helps you and your providers begin early management.

Joint hypermobility

Some joints move well beyond the usual range with little effort. A common screen is the Beighton score, nine quick checks scored from 0 to 9; in adults, 4 or more suggests generalized joint hypermobility, according to a 2023 review in Rheumatology and Immunology Research. Hypermobility on its own is a description, not a diagnosis, and it doesn’t cause problems for everyone. With ongoing joint pain, repeated sprains or partial dislocations, or fatigue, a physician may consider a hypermobility spectrum disorder (HSD) or hypermobile Ehlers-Danlos syndrome (hEDS), and sorting that out can take several visits and specialist input.

If you’ve been searching for a hypermobility physical therapist, here’s what an orthopedic approach can offer, based on that review:

Strength around the joints to make them more stable
Stretching only where it’s needed, focused on tight muscles rather than loose joints
Controlled loading, which can include isometric exercises (muscles working without moving the joint), an option the review describes as reasonable
Balance and control drills, since people with hypermobility may have a weaker sense of where their joints are
Bracing or taping, which may help prevent injury in some cases

The review is candid that rigorous studies of any single treatment are lacking and that a multidisciplinary approach is likely optimal. We treat the joint and muscle side and coordinate with your physician; we don’t run a specialty hypermobility program. Dizziness or a racing heart when you stand up, digestive problems or bladder problems can accompany hypermobility disorders and belong with your physician; the review suggests a cardiologist manage postural orthostatic tachycardia syndrome (POTS).

Referrals and coverage

With most plans, New York’s direct access law lets you start physical therapy without a referral for up to 10 visits or 30 days, whichever comes first, though some insurers still require one to pay. Pain that began with a car accident or a work injury is different: No-Fault covers physical therapy only with a referral, and Workers’ Compensation requires a referral from your treating physician, physician assistant, podiatrist or nurse practitioner. Medicare doesn’t require a referral to start; your physician (or nurse practitioner or physician assistant) certifies the plan of care we write.

If pain has been setting the limits on your days for months, call (716) 332-4838 or request an appointment. Bring your medication list and any imaging or specialist notes so we start with the full picture.

Sources

Written by the Lake Erie Physical Therapy clinical team. This page is general information, not a diagnosis; your physical therapist will assess your situation in person.

Physical Therapy for Chronic Pain