Aches and pains come and go. You may notice some heel pain just as you get out of bed or back pain creeping up on you as you sit down for dinner. Then, there’s the consistent hamstring pain at mile 4 of every run. Every human, including physical therapists, experiences aches and pains.

The pain may resolve on its own- could be in a day, or it may stay for months. You want to get rid of it because it’s distracting you from your day, but how do you know if it’s a good idea to come to a physical therapist?

Seeing a physical therapist

There are two rules I follow for when I think someone should come in and see me. First, come in if you can’t get your pain to go away on your own, and second, your pain is getting worse and stopping you from what you enjoy doing.

Rule #1

If you can’t get your pain to go away on your own, see a physical therapist. Examples of this include, a severe ankle roll playing basketball (and taping doesn’t work), inability to finish a squat cycle due to knee pain (but you roll out on a foam-roller before every workout), or struggle to get back to normal running speed with pain in the buttocks (no matter how much cream you put on).

Home remedies not helping?

There’s not necessarily a timeframe for this rule. A bad ankle roll needs immediate attention. Pain in the buttock while running may not stop you right away, but after two months, it may be a hurdle down the road.

Rule #2

If the pain is getting worse with movement and stopping you from fully functioning, you should see a physical therapist. Now, in no way am I trying to scare you; I just don’t like seeing patients limping into my office because they kept pushing through an injury that has gotten progressively worse. That can sometimes prolong healing and possibly make other parts of your body hurt.

When to get an X-Ray

What about times you should get an X-Ray? I know what you’re thinking- “But you guys always say we shouldn’t get imaging! Now you’re saying we should?”

Sometimes, you absolutely should get imaging for musculoskeletal injuries. There are 3 main rules (called the Ottawa Rules) for pain at the knee, ankle, and foot and apply if the injury occurred within 7 days.

Ottawa Rules for the Knee-

You should get imaging on the injured knee IF:

-Isolated Tenderness at the patella

OR

-Tenderness of the head of the fibula

OR

-Cannot flex to 90 degrees

OR

-Unable to bear weight both immediately and in the emergency room department for 4 steps

Ottawa Rules for the Ankle-

You should get imaging on the injured ankle IF:

Bone tenderness at the posterior edge or tip of the lateral malleolus (A)

OR

Bone tenderness at the posterior edge or tip of the medial malleolus (B)

OR

An inability to bear weight both immediately and in the emergency department for four steps

Ottawa Rules for the Foot-

You should get imaging of the injured foot IF:

Bone tenderness at the base of the fifth metatarsal (C)

OR

Bone tenderness at the navicular (D)

OR

And an inability to bear weight both immediately and in the emergency department for four steps

All of the rules can be found here.

Summary

So there you have it. If your pain isn’t going away after trying home remedies, see a physical therapist. If your pain is stopping you from getting after daily activities, see a physical therapist. Also, if your pain follows the Ottawa Rules (within 7 days of the injury), get imaging. I hope you stay pain-free during the winter and crush your personal bests (even though zero competitions are going on right now.)

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