Healing Versus Getting Better

Question: “I had knee surgery in June. My doctor says everything looks good, but I still feel a lot of pain. I’m afraid to do anything because I don’t want to injure my knee again. Can you give me some advice?” -Jen (Saratoga Springs) I had one of those moments a while back, a moment when the old light bulb goes off, and I realized what some of my patients were really asking me. It started when a patient who was clearly in a lot of pain asked a similar question. Your question can be translated like this: “How is it possible that everything looks good when I feel so bad?” The answer: healing is not always the same as feeling better. Just because you are healing does not mean you are feeling better, or should feel better. Certainly there are times when healing and pain go hand and hand but it is important to make sure we don’t interpret healing and pain as the same thing. We can have pain without healing and we can have pain with healing as well as healing with pain and healing without pain. Let me give you two examples. I fractured my wrist when I was 12. It hurt for a couple of weeks and then I didn’t have much pain. However, my bone was not “healed” for six to eight weeks. So in my case, the pain stopped before the healing stopped. Later, when I was in my early 20s, I tore ligaments and broke a bone in my ankle. This really hurt. In fact, this hurt for months after the original injury. I couldn’t walk without limping for at least two months and it was hard to run and play basketball for over a year. Despite the lingering pain, the healing was complete 6-8 weeks after my injury. I use the six- to eight-week marker because when we study the body’s healing, most conditions are healed in that amount of time. Some conditions take longer, but for argument’s sake, let’s just say that most heal in six to eight weeks. This is important to remember. When I injured my ankle, I hurt for close to a year, but I was healed after six to eight weeks. So had I gone to a doctor, I would probably have heard, “Things look good,” meaning, “Your healing looks good.” There are a lot of reasons for still having pain after the tissue is healed. If you avoid activities because they hurt then you may be actually perpetuating the pain, not actually helping to heal. It is not that you are intentionally contributing to why you hurt, it is that you are trying to protect something that simply does not need protecting. Pain does not equal injury. When I pull my finger back far enough it hurts. But when I release it, it no longer hurts, and I have not injured it. Remember, my ankle was better and healed, but it still hurt. For my patients with healed injuries, I reassure them and teach them safety rules like “Go to the pain, not through the pain,” meaning when you do something that hurts, it is important to stop (i.e. go to the pain) and if the pain persists after stopping then it is wise to stop all together (i.e. not through the pain). I also tell patients they have a “48-hour rule” meaning that the increase in pain must return to the baseline within 48 hours. So, if you have a three out of 10 on the pain scale when you start an activity and the pain goes to nine out of 10, but when you stop it returns to three out of 10, then to me it is safe to continue the activity. As long as within 48 hours your pain returns to baseline—in this example 3 out of 10—it is safe and you have not done any harm to yourself. Another way I describe this is by saying, “Pay attention to the duration of pain, not the intensity of pain.” Pain that is on a roller coaster, up and down, is not what concerns me, even it the pain is 10 out of 10. What concerns me more is pain that increases and stays increased for days. When pain lasts, it means we did too much and we risk delaying our recovery. As a general rule, most of the healing from an injury takes place in six to eight weeks. However, if you suffered a major injury or are ill, it can take longer. If you have other medical conditions like diabetes, for example, it can take longer. But the bottom line is there is a point where things are healed, but you may or may not still have pain. My best advice is, “Don’t be afraid of pain,” and remember that when it goes up and down you are safe. Proceed cautiously and if you need specific instructions seek out a physical therapist to help guide you. If you have tried therapy once, maybe it is time to try again with a different therapist. We have different perspectives and generally speaking, there is a solution. With the right PT, you’ll be on your way to full recovery. Matthew Goodemote PT, Dip MDT is the owner of Goodemote Physical Therapy PLLC in Saratoga and Community Physical Therapy and Wellness PC (aka The Wellness Center) in Gloversville, NY.