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hourlgass with red sand

“Shake it off!”

“Rub some dirt on it!”

“Are you hurt, or are you INJURED?”

I don’t know about you, but I’ve heard all of those phrases from coaches, parents, and friends over the years. After all, there’s a difference between being “hurt” and being “injured”, right? Some “injuries” only hurt for a few minutes or a few days, while others can persist for weeks or months on end. What is the difference between a sprain, strain, bump, or bruise, and an injury that requires skilled medical evaluation and treatment? And how can you know that on the front end? How long should you wait before deciding you need to see someone for assessment of a new source of pain or injury? What are the consequences of waiting too long and allowing an acute problem to become a chronic one? I’ll strive to answer those questions and more below.

The first question we need to answer is simple – what constitutes an injury? After all, aches and pains are a normal part of life. You don’t call an allergist every time you sneeze, do you? Similarly, you don’t need medical attention every time your knee is sore or your back feels tight. However, there are clearly situations that warrant medical attention. Beyond the obvious situations involving extreme deformities such as dislocated joints or fractured bones breaking through skin, here are several other factors to consider when deciding whether or not to seek immediate medical attention:

  • Are you unable to put weight on your injured leg (assuming a lower body injury)?
  • Is your pain so severe that you are unable to fall asleep or stay asleep?
  • Are you unable to use the affected body part (make a fist, raise your arm, bend your elbow, etc.)?
  • Do you have a history of significant injury or surgery on your injured body part?
  • Is there a significant amount of swelling or discoloration around the injured area?
  • Are you unable to perform basic body functions (eat, cough, sneeze, laugh, urinate, etc.)?

If you answer “yes” to any or all of these questions, seeking medical attention is the appropriate next step. So who should you see? Ideally, you should see an orthopedic physician who could perform and interpret diagnostic imaging, apply any necessary splinting or bracing, prescribe anti-inflammatory medications, and potentially refer you to physical therapy or a surgeon. The availability of these providers can often be limited, however, so I encourage my members to reach out to me first, and I can help facilitate an immediate referral if necessary.

What if you don’t have a significant injury? Maybe you just “pulled a muscle” or “tweaked your back”. So how long should you wait before seeking further medical attention? Although it is never too soon to consult with a medical provider in these situations, imaging and diagnostic testing is often expensive and unnecessary. A good general rule of thumb is to wait for 7-10 days. Why? Let’s refer back to my previous post on healing times. Generally, the first 7-10 of a new injury is characterized by inflammation. As inflammation subsides, most minor injuries begin to feel much better and motion and strength begin to return. However, if there is no improvement within the first 1-2 weeks, then the injury is likely more significant than just “inflammation.” Who should you see in this case? The evidence is clear-cut – you should see a physical therapist. Here are several reasons why:

  • You’re unlikely to have an injury that requires immediate surgical intervention.
  • Imaging such as x-ray and MRI are expensive and often unnecessary.
  • Physical therapists are trained in differential diagnosis to determine the presence of things like fractures, dislocations, joint instability, and systemic conditions such as cancer, infection, blood clots, etc.
  • You will likely receive a referral to physical therapy anyway if you see a physician first (or at least you should!)

This is why a relationship like I have with my members is so valuable. They have a person who they can reach out to and ask these types of questions to help determine their appropriate next steps, whether that means treating their injury through physical therapy or referring them to another provider who can more adequately manage their injury.

What’s the big deal about waiting? After all, I wrote in my last post that most tissues heal in 12 weeks. So why not wait until 12 weeks? To answer that question, we’re going to need to discuss types of pain and why classifying pain is important.

Pain can be classified based on a number of variables: location, severity, duration, source, etc. For the sake of this post, the most relevant classification of pain is based on time. Any pain lasting up to 12 weeks is considered “acute pain.” Pain lasting 12 weeks – 6 months is considered “subacute pain.” Finally, pain that lasts longer than 6 months is considered “chronic pain.” The CDC reports that more than 20% of Americans suffer from chronic pain of some kind. Why is this a big deal? Chronic pain doesn’t respond to traditional medical management nearly as well as acute or subacute pain. When an individual has been in pain for more than 6 months, there are chemical and structural changes that happen within that individual’s nervous system which change the way his or her body receives and interprets sensory information. These changes cause your body to become more sensitive to painful and non-painful stimuli. In other words, activities that used to not be painful become painful, and activities that used to only cause mild pain begin causing severe pain. This worsening pain with activity leads to a vicious cycle of disuse and neglect, which only causes increased pain. As a physical therapist, one of my primary responsibilities in treating injuries is to prevent them from becoming chronic situations. However, just because a person is dealing with chronic pain does not mean all hope is lost – it just means that traditional medicine is unlikely to be effective. Anti-inflammatories are unlikely to be helpful because we’re no longer dealing with an inflammatory problem. Reconstructive surgery is unlikely to resolve chronic pain because we’re no longer dealing with a structural problem. Once pain becomes chronic, the only way to successfully manage and overcome it is to treat the nervous system with techniques and exercises that recalibrate and desensitize the body’s pain receptors.

Chronic pain is an incredibly complex topic which I continue to learn about on a daily basis. It affects a large number of people in the US and it likely affects many of you reading this post. My goal in writing this post was two-fold. My first goal was to educate people on why it is important to address and treat problems early so that they don’t become chronic. My second reason was to give hope to those who find themselves suffering from chronic pain. There is hope for relief and recovery, but it is unlikely to be found through a pill, injection, or a surgical procedure. This is where many have been led astray, and I look forward to continuing to point people in the right direction when it comes to how to manage both acute and chronic pain. Until next time…