"No Pain, No Gain" Fallacy

I've had new patients (and potential patients) ask me if physical therapy treatment will hurt. I explain to my patients that our first goal is to reduce their pain levels before we restore any lost functionality. Many times I will start with hands-on techniques to reduce pain, restore tissue pliability, and generally prepare the patient, so they can advance without hindrance through exercise and activity training toward their ultimate goal.

Depending on the patient’s needs, we may spend considerable time in our gym or workout area. When I show a patient how to use a certain weight machine, I emphasize that while the exercise may feel uncomfortable, the patient should never experience pain, particularly in the tendon and joint areas. With the first hint of pain, my patient stops lifting that particular weight, and we adjust the joint angle of the movement to a pain-free range. In some cases, the patient may need to stop and work on joint and tendon lubricating exercises before the strength training is resumed for that session.

If you injure yourself, especially as a beginner, you may give up on strength training, fearing that you will hurt yourself again. So, it is important that you know the proper form to avoid injury and that you listen to your body's pain signals. If something hurts, stop and review that your form is correct. If it is, you may need to lower the weight or adjust the movement you're making to put less stress on your tendons and joints in particular. You may want to hire a professional weight trainer so that you can be sure that you are lifting properly and avoiding potential injury. They may also help you adjust certain lifts to put less stress on your joints and tendons.

Palms Up to Protect Shoulders

When my kids were little, my wife started having intense shoulder pain. She had been painting walls in our new home, and she kept lifting the heavy paint cans with her palms facing down. That night when she explained the pain to me, we got her some ice to help reduce the pain. (See our blog Heat vs Ice for when and how to use ice properly.) I then showed her a tip to avoid injuring herself in the future by lifting the paint cans with her palms up.

It's second nature for many of us to lift things up with our palms down, like if there's something you need in the back seat. If you find yourself needing to grab your purse or a diaper bag from the back seat, turn in your seat and lift the bag with your palms up. You'll help avoid injury of further injury to your rotator cuff. As I show in the video below, always lift with your palms up to avoid injuring your shoulder, specifically your rotator cuff.

Travel Pains

Vacations are wonderful ways to create memories with loved ones. Traveling, on the other hand, can sometimes put stress on the body. For example, as we grow older, our joints are less forgiving when we sit in a car for too long. Whenever I am traveling, here are some of the things I do to avoid pain after a long day on the road or in the air.

If I am on a flight, I try to get up and walk up and down the aisle every hour to help stimulate blood flow. If I cannot get up because of turbulence, then I pump my ankles and “draw” circles with my feet. If I am driving, it can be hard to stop every hour, but I still try to stop as often as I can to get out and stretch my legs.

If your car or airline seats don’t have good lumbar support, bring a small pillow to put behind the arch of your back. I recommend back support for long and short trips.

Even if you're tempted to avoid drinking water while you’re traveling to cut down on bathroom breaks, make yourself sip water to stay hydrated. Whether I’m flying or driving, I pack a water bottle, so I can refill as often as possible. Staying hydrated prevents many stressful and painful conditions.

These three tips make traveling less uncomfortable for me, and I hope they help spur some good ideas for you to make traveling less stressful and painful.

Gardening Counts As Exercise

This time of year, more people are going outside to do yard work or to start their gardens. Whether you're mowing the grass, weeding, or planting new flowers; you can get some great exercise. However, because injury is possible with any physical activity, we must take the proper precautions to avoid injury while working in the yard or garden. Here are some tips that I try to keep in mind whenever I am out in my backyard.

Stay Hydrated

Whether you keep a water bottle outside with you or if you take frequent breaks to go inside to get a drink of water, you need to make sure you stay cool and hydrated, even if it doesn't feel that hot outside. If you struggle with muscle cramps, you may want to drink something with electrolytes.

Use Knee Pads

If you're going to be down on your knees in your flowerbeds, you may want to invest in high quality knee pads or a knee mat. However, if you still experience knee pain afterward, be sure to ice your knees. For tips on safe ways to ice, check out a previous blog, "Ice vs Heat."

Avoid Twisting

If you are planning to be weeding or hoeing,  it can feel natural to twist in order to reach more area. However, twisting can cause injury to your back. Instead, move your whole body so you can reach the area easier without twisting. Again, if you find you twisted without realizing and have injured your back muscles while working outside, be sure to stop to ice your back.


Yard work and gardening can bring great satisfaction as well as great exercise. Just be sure you stay hydrated and avoid injury.

Exercise through Volunteering

When you volunteer to walk or run for a 5K, you know that you will also personally benefit from the physical activity. Yet, there are more ways that just walking or running to get a little exercise while volunteering. You may be able volunteer at a local kitchen to wash dishes, serve meals, and organize the pantry, all of which fight our sedentary habits. Other organizations may need help with landscaping or janitorial cleaning. Even something as simple as sweeping can give you a decent workout.

A few things to be aware of while doing manual labor to reduce the risk of injury:

1. Lifting heavy objects. Squat down to lift heavy objects. Read Kelly's blog for more information about Lifting Properly to avoid injury.
   
2. Refrain from twisting. It's easy to injure your back by twisting quickly while doing manual labor. Instead of twisting, try to turn your whole body, whether you're moving a box or sweeping.
3. Take breaks. Even though you're volunteering, you still need to be able to take breaks. Be sure to use that time to stay hydrated.

If you ever experience pain, stop whatever you're doing to prevent further injury. I suggest using ice on the injured area as soon as possible. For more tips on how to properly use ice on an injury (and when to use heat instead), check out our blog Heat vs Ice.

To add variety to your exercise routine, look for volunteer opportunities and get exercise at the same time.

Massage Your Own Neck & Shoulders

After a long day at work, my shoulders and neck can be sore. So, I invented a way I can massage my own shoulder and neck.

In the video below, I talk about how I got a dowel or rod and set one end up on a surface that is approximately level to my shoulder height. I can then place the rod on my shoulder and rotate it up and down my shoulder, as seen in the video. It helps loosen that muscle tissue and really give some relief. Note that I keep the dowel against my skin and not against clothing.

As I rub my shoulders with the dowel, I hunt for sore spots in my shoulder. When I find a particularly tender area, I can just pause and hold pressure there until I feel a nice release.

I can also use the dowel as a anchor to stretch my neck. If I hold the dowel down on my neck, I can then gently let my head fall toward the other shoulder. It can really help decrease the tension or pain in shoulders.

As shown a little later in the video, you can also use this same technique on up your neck. I call it a "reverse roll." As I push the dowel up the side of my neck, I rotate the dowel downward.

While I used a dowel in this video, I have also bought PVC pipes from a local hardware store. I like to use a thicker walled PVC pipe, called Schedule 40. It's a three-quarter inch thick walled PVC pip.

Heat Vs Ice

I have patients frequently asking me when they should use heat and when they should use ice. It really is a great question!

In general, if you have pain, use ice. If you have stiffness or soreness, use heat.

If you use heat at an improper time, it may feel good at first, but in the long run, you can actually worsen your symptoms. However, if you use heat at the proper time, I need to warn against lying on a heat pad or pack. It can actually capture heat underneath you and end up burning you.

Similarly, if you overuse ice, you can actually develop frostbite. Stop using ice if you start noticing the following symptoms:
1. You start experiencing numbness where you have iced
2. The skin underneath the ice begins to thicken
3. The skin you've iced starts to turn white

In the video below, I show you how I use ice packs and ice cups. I also explain when I prefer using an ice massage on the painful location, and I show how I do it.

Pain After Treatment

A physical therapist is always reaching for a balance between doing too much and too little during a treatment. Sometimes, patients may experience an increase in discomfort or pain after a physical therapy treatment. In the video below, I advise to:

1. Call the physical therapist.
2. Use ice packs on the treated area immediately after a treatment. Warning: Do not put ice directly on the skin.

The next question is, "What if I have pain by my next appointment?" Again, I advise to call the physical therapist involved to see if they still want you to come to the appointment. But at Aptitude Physical Therapy, I always tells our patients to come, because there are things we can do that will actually lessen their current pain. Most patients leave with their pain levels under control and glad that they came.