Health + Wellness

Treating Chronic Pain with Physical Therapy

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World Physical Therapy Day is just around the corner. Come 8 September, physiotherapists around the world will be raising awareness around chronic pain – the theme for this year.

Chronic pain has been a significant burden on global health, with low back pain causing more disability than any other condition. In Singapore, this condition is also not uncommon.

A recent survey by Core Concepts found that almost half (49%) of Singaporeans experiencing pain have lived with it for over six months. More alarmingly, 92% of respondents agree that the pain interferes with various aspects of their daily lives, causing a negative impact on quality of life.

Alas, back pain

Although the sensation of pain is often more subdued in chronic pain as compared to acute pain, it is actually more dangerous. Instead of functioning as a warning signal to prevent tissue damage, chronic pain occurs as a result of malfunctioning of the nervous system.

One of the most common types of chronic pain is back pain. Sufferers can be categorised into two groups. The first group (15%) has an organic cause for back pain (such as slipped discs, multiple sclerosis and spinal tumours) and can be identified with x-rays, MRI scans, blood examinations, or other medical tests.

The remaining 85% of the population suffering from chronic back pain are unable to attribute this to a specific cause. Sources of pain can stem from a wide range of factors such as a previously unresolved tissue injury, avoidance due to fear, poor posture or a sedentary lifestyle. Any one or a combination of these factors could lead to acute pain, developing into severe chronic pain.

Whatever the reason may be, the source of the pain can be difficult to identify, often misunderstood, and therefore misdiagnosed and mistreated.

Chronic pain – how long is too long

Despite challenges in diagnosis, chronic pain should not be ignored. If you are suffering from pain, one red flag to look out for is if the pain does not go away after more than two weeks with appropriate rest. In such instances, it is high time to seek the help of professionals to identify the root cause inflicting the pain.

The danger of not treating chronic pain promptly is that our bodies will find ways to compensate for pain, at a great cost. For example, when a person has knees that hurt, other muscles in the body may need to compensate by working harder to absorb shock and facilitate body movements. We may also shift our body weight or change the way we move, positioning our body parts to protect the body from further harm.

With persistent pain issues, the body remains locked in these movement patterns until it becomes the new normal. This new movement pattern may not be helpful or efficient, and can even lead to complications or dysfunctions in other parts of the body.

Typically, three months is the expected time frame for an injured structure to heal fully. If pain persists beyond this period, there may be physiological changes in how pain is processed – and as a result, the magnitude of pain becomes far more severe than what is expected.

Physical therapy – an effective relief

Singaporeans are fortunate to have access to a wide variety of treatment methods for pain. According to the recent Core Concepts survey, respondents cite exercising and stretching, topical pain applications and medication as the most popular forms of treatment. However, 93% of respondents stated that the most relief was derived from physical therapy treatments such as manual therapy. This ranks higher than massage therapy (89%), Tuina/TCM (85%), chiropractic treatment (85%), medication (84%) and meditation/relaxation (84%).

Also, although overall awareness of physical therapy is high at 97%, its use is limited to sports injuries and muscle-related pain. 74% of respondents would also only seek physical therapy if it were mandated by a doctor.

Contrary to popular belief, patients do not necessarily need a GP referral and can consult a physiotherapist directly. As an evidence-based treatment method, physical therapy focuses on having proper diagnosis of underlying pain. Consultations always begin with an assessment to identify the root cause of pain, in order for physiotherapists to educate the patient and get their buy-in to begin the healing process.

Physiotherapists then treat pain through therapeutic activities such as stretches and mobility exercises. Exercise programmes are prescribed to expose patients to previously painful movements or activities. This allows the body to adapt positively to physical stresses, strengthen muscles and increase range of motion.

By tackling the root cause of the pain, physical therapy respects the body’s healing timeframe and provides long-term relief. As pain is an unpleasant but subjective emotional experience, it should not be used as a tool to measure the amount of tissue damage. If you are suffering from persistent pain, seek professional medical help as soon as possible. With less fear and anxiety, a person living with pain becomes more willing to return to functional activity and exercise, allowing for a speedier recovery.


This article is attributed to Victor Khoo, Managing Director, Core Concepts Group.

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