It’s easy to question what’s normal when it comes to pain or soreness. After a physical therapy session, we occasionally hear from individuals wondering why a treatment designed to promote healing might leave them feeling less than their best.
Pain after physical therapy sometimes occurs because the exercises and manipulations stretch or strengthen muscles, joints, and tissues, causing temporary soreness as the body adapts. This discomfort can also stem from inflammation, nerve irritation, or scar tissue breakdown—all normal parts of the healing process.
This is a common concern for us as we help those recovering from injuries, surgeries, or chronic conditions. During the first few weeks, a little bit of discomfort can be a natural part of the process and a side effect of physical therapy.
In this article, we’ll explain why it happens, the difference between normal soreness and “bad” pain, and how we can manage this discomfort effectively.
Why soreness occurs after physical therapy
Many patients report that they feel some soreness after physical therapy. This can happen following exercises that target dormant muscle groups, stretches that address chronic tightness, or manual therapy techniques aimed at improving mobility.
For many of us, this feeling is tied to muscle fatigue after physical activity. When our bodies are asked to perform tasks they haven’t done recently—due to injury, inactivity, or post-surgical recovery—they need time to adjust.
This response is typically temporary and linked to our efforts to adapt. For example, if we’re working to regain strength after a prolonged period of limited movement, we might notice our muscles reacting to the new demands. While this soreness can feel uncomfortable, it’s often an indicator that the therapeutic process is beginning.
The science behind post-therapy discomfort
Most of us have overdone it during an activity and felt sore the next day. However, there may be cases where we’ve pushed the envelope a little too far.
To understand why soreness or pain occurs, we can point to delayed onset muscle soreness (DOMS), which can develop 12 to 48 hours after physical exertion. During therapy or other activities, we create small microtears in muscle fibers. These microtears are a normal part of re-strengthening a muscle group. As our bodies repair them, we build greater resilience.
If we notice soreness immediately after a session or activity, it’s a sign we’ve overdone it. We should consider talking to a physical therapist if DOMS sets in quickly following an exercise, or if it lasts for more than 2 days.
When pain goes beyond soreness
In rare cases, additional pain or discomfort goes beyond what we would call “normal” soreness. In this case, we’re generally referring to joint pain or deep tissue discomfort that’s different from simply over-working a muscle.
Modalities like deep tissue manipulation or therapeutic exercises post-surgery can lead to temporary tenderness as our tissues respond to the work being done. For instance, if we’re recovering from a rotator cuff repair, we might feel increased stiffness after a session focused on restoring range of motion. These reactions should be short-lived and manageable.
This distinction is important for us to understand as we watch for the signals our bodies send when we are experiencing pain. Physical therapy treatment aims to challenge us to rebuild strength and function, but it shouldn’t result in excessive discomfort or harm.
Here are a few indicators of when pain is a concern.
- Increased pain that lasts longer than two days
- Pain accompanied by swelling, redness, or reduced mobility
- Chronic pain with sharper, more localized sensations (e.g., stabbing or burning)
- A deep, throbbing ache that doesn’t go away with rest
- Nerve-related pain, such as an electric or shooting jolt down a limb
- Persistent, nagging pain from overworked tendons or ligaments that gets worse with movement
Managing Soreness: 5 ways to alleviate discomfort
There are practical steps we can take to alleviate discomfort and support successful recovery. Here are 5 simple strategies we recommend:
- Communicate with your therapist: We can’t stress this enough – keep your therapist updated appointment-to-appointment about how it’s going! If discomfort seems unusual or excessive, let them know so that we can make immediate changes to your treatment plan.
- Rest appropriately: We should allow time for recovery but avoid complete inactivity. Light movement, like walking, can prevent stiffness without overtaxing our bodies. (See our guide on physical therapy rest days here)
- Apply ice or heat: We can use heat to ease muscle tightness or ice to reduce swelling or acute soreness, depending on our specific needs. Your therapist can advise you on the best approach.
- Stay hydrated: Water intake supports our muscle recovery by assisting in the removal of metabolic byproducts, like lactic acid, that build up during activity and can prolong soreness.
- Get plenty of sleep: Sleep is truly a superpower for recovery (much of your body’s physical rebuilding processes happen during sleep), and many of us aren’t getting enough. Aim for at least seven hours of sleep per night, but eight is ideal. (Read through our full physical therapy and sleep guide)
Moving forward with confidence
One thing we want to make clear – pain after physical therapy truly isn’t common. It’s generally addressed very easily by communicating well and making simple tweaks to your modalities, your therapeutic exercises, and your home exercise program.
That said, we do have a mantra we repeat to patients: sometimes this process can feel like it gets worse before it gets better. Keep an open mind, stay positive, and stay consistent; healing doesn’t happen overnight, but the benefits of long-term healing are immense.
Our goal is to offer support in achieving rehabilitation objectives without unnecessary setbacks. Soreness or mild pain doesn’t necessarily mean the physical therapy isn’t working; it often reflects our bodies’ active response to treatment sessions.
By understanding what’s normal, applying strategies to manage discomfort, and maintaining open communication with our therapist, we can stay on course toward our goals. If questions arise about a post-therapy experience, our team is here to provide clarity and support.
