Chronic Pain

Physical Therapy to Help Chronic Pain

Jennifer King Lindley
By Medically Reviewed by 
Reviewed:
Medically Reviewed
woman receiving physical therapy for chronic knee pain
You may be surprised by how much physical therapy can improve knee pain.Getty Images; Canva; Everyday Health
Physical therapy, often called PT, identifies, diagnoses, and treats movement problems. Physical therapists examine patients, then work with them to develop individualized plans using a range of treatment techniques designed to restore function and mobility, reduce pain, and improve quality of life. Physical therapy is an active, not passive, form of therapy: Many treatment plans include strengthening and stretching exercises for patients to practice at home.

How It Works

The goal of physical therapy is not simply to treat symptoms but to address the root cause of pain or movement limitations to bring about long-term relief. For example, a patient’s back pain may be caused by poor posture or weak core muscles, which can be improved through exercise. Knee pain from arthritis may be relieved by strengthening the muscles around the joint to better protect it.

RELATED: 8 Great Pain Relievers You Aren't Using

Physical therapists may also deliver hands-on treatments to help a problem area heal, including physical manipulation of the area, ultrasound therapy, and dry needling. In this last technique, a needle that doesn't contain medication is inserted through the skin into areas of the muscle to release or inactivate trigger points to relieve pain and improve range of motion.

Therapists may prescribe assistive devices, such as splints for carpal tunnel syndrome or a brace after a knee injury.

Chronic pain is complex, notes Colleen Louw, a physical therapist, a spokesperson for the American Physical Therapy Association (APTA), and the program director for the Therapeutic Pain Specialist Certification for Evidence in Motion. “Physical therapists are increasingly taking a biopsychosocial approach. We strive to empower patients through education to help them understand why they hurt and to decrease their fear of movement so they can get back to life.”

Chronic Pain Symptom Relief

Among the chronic pain conditions that physical therapists often see are lower back pain, fibromyalgia, and knee arthritis, says Louw.  Recently, physical therapy has been in the spotlight as a treatment that could reduce the overuse of opioids. Physical therapy is one of the first approaches recommended in the Centers for Disease Control and Prevention’s new draft guidelines for treating pain. The draft guidelines note, “There is high-quality evidence that exercise therapy (a prominent modality in physical therapy) for back pain, fibromyalgia, and hip or knee osteoarthritis reduces pain and improves function immediately after treatment and that the improvements are sustained for at least two to six months.”

Meanwhile, a scoping review found a relationship between early PT interventions for pain conditions including lower back pain, joint pain, and orthopedic surgery recovery and a lower probability that a patient would go on to be prescribed opioids.

Various studies have found physical therapy to be effective in treating specific chronic pain conditions:

  • Knee Pain A study found that patients with osteoarthritis of the knee who underwent physical therapy had less pain and functional disability at one year compared with patients who received steroid injections.

  • Sciatica A study found that patients with back pain from sciatica who were assigned to physical therapy after their initial diagnoses showed less disability and back pain intensity compared with those who were not.

  • Pelvic Pain Physical therapy is also being used to treat chronic pelvic pain. A study looked at patients who had experienced gynecological cancers and found that those who were treated with pelvic floor physical therapy reported a reduction in pain, improvement in sexual functioning, and reduction in urinary symptoms.

General Health and Wellness Benefits

Physical therapy has a wide range of applications, from fall prevention in the elderly to post-surgical recovery. Among the many health issues that physical therapists treat are stroke recovery, pelvic pain, chronic fatigue syndrome, and rotator cuff injury.

A major goal of PT is to help people overcome issues that prevent them from being more active. That’s key because a body of research has shown that increasing exercise and activity can benefit a host of physical and mental health conditions and reduce overall mortality. “Movement is medicine,” says Louw.

How to Use It

Physical therapy is provided by licensed physical therapists and widely available in settings including hospitals, private practices, pain clinics, and outpatient programs. Physical therapists are increasingly offering virtual appointments as well.

Your primary care provider can make a referral, or you can contact a physical therapist directly without a referral, according to the APTA.  Some physical therapists specialize in treating chronic pain.

Fees: Is PT Expensive? Will Health Insurance Cover It?

Many insurance plans, including Medicare, workers' compensation, and private insurers, pay for physical therapy services that are deemed medically necessary and are provided by a licensed physical therapist or a licensed physical therapist assistant under the supervision of a physical therapist.

What to Expect

Prepare for your visit by wearing comfortable clothing that allows you to stretch and move freely. During your first appointment, the physical therapist will take a detailed health history, including questions about your condition and current symptoms. They will perform a physical exam — typically evaluating your strength, flexibility, and balance — and screen for other signs and symptoms such as unexpected warmth in an area that could signal infection or loss of sensation that could signal a spinal nerve issue and need for referral for physician evaluation.

They may use their hands to feel on or around the areas of concern. You may be asked to perform such everyday activities as walking or getting up from a chair so the physical therapist can observe how you move. After the exam, your physical therapist will discuss your goals for treatment and work with you to create a treatment plan.

In addition to your in-office therapy sessions, you will typically get homework: Your physical therapist may show you exercises to practice and coach you on healthier ways to perform your everyday activities.

Considerations

You may be worried that physical therapy will hurt. “People who have chronic pain are often afraid to move. They have anxiety that any exercise will cause them pain or make things worse,” says Louw. A first step is to establish a sense of trust with the patient, she says. That can mean increasing exercises in a gradual step-by-step way so the patient can feel safe moving again. If you do feel pain or discomfort, communicate with your physical therapist, who may modify your treatment or suggest strategies such as icing to reduce soreness after a session. “I might suggest a patient with knee arthritis exercise in a pool to start to reduce the load on the joint, for example,” Louw says.

PT can require self-discipline to keep up with your prescribed exercises. “You will get out of your physical therapy sessions what you put into them,” notes APTA.

Editorial Sources and Fact-Checking

  • Benefits of Physical Therapy. American Physical Therapy Association.
  • Dry Needling. Cleveland Clinic. January 1, 2018.
  • About Physical Therapists and Physical Therapist Assistants. ChoosePT.com.
  • Proposed 2022 CDC Clinical Practice Guideline for Prescribing Opioids. Federal Register. February 10, 2022.
  • Brown-Taylor L, Beckner A, Scaff KE, et al. Relationships Between Physical Therapy Intervention and Opioid Use: A Scoping Review. PM&R. June 2021.
  • Deyle G, Allen D, Allison S, et al. Physical Therapy Versus Glucocorticoid Injection for Osteoarthritis of the Knee. The New England Journal of Medicine. April 2020.
  • Fritz JM, Lane E, McFadden M, et al. Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica: A Randomized Controlled Trial. Annals of Internal Medicine. January 2021.
  • Cyr MP, Dostie R, Camden C, et al. Improvements Following Multimodal Pelvic Floor Physical Therapy in Gynecological Cancer Survivors Suffering From Pain During Sexual Intercourse: Results From a One-Year Follow-Up Mixed-Method Study. PLOS One. January 2022.
  • Symptoms and Conditions. ChoosePT.com.
  • Posadzki P, Pieper D, Bajpai R. et al. Exercise/Physical Activity and Health Outcomes: An Overview of Cochrane Systematic Reviews. BMC Public Health. November 2020.
  • Health Insurance and Physical Therapy. ChoosePT.com.
  • Leerar PJ, Boissonnault W, Domholdt E, Roddey T. Documentation of Red Flags by Physical Therapists for Patients with Low Back Pain. Journal of Manual and Manipulative Therapy. 2007.
  • Preparing for Your Visit with a Physical Therapist. ChoosePT.com.
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