Soft tissue pain and physical therapy

Pain is a natural response to soft tissue injury but when it is unresolved, neurophysiological changes can occur to establish chronic pain. Acute pain is usually linked with a specific incident, though in repetitive or overuse injuries this is not obvious. With chronic pain there is a prolonged period of pain, frequent and unsatisfactory healthcare use and, often, negative psychosocial factors. The cause of soft tissue pain is identified by history, palpation and selective stressing of structures. The overriding aim of acute and subacute pain management should be the prevention of chronicity, and careful questioning is indicated to identify psychosocial predictors of chronicity. Confirmation of chronic pain is primarily a case of elimination and history, and failure or reluctance to diagnose chronic pain impedes rehabilitation. Physical therapy for the acute pain of soft tissue injury aims to manage healing and restore function by early rehabilitation. Various physical, electrical and thermal methods are used, though the evidence for these is questionable. The traditional biomedical approach of physical therapy is inappropriate for someone with chronic pain. A wider biopsychosocial approach is advocated to optimize activity and participation while living with pain. The therapist should encourage education, exercise, pacing of activity, and planning for flare up. Where possible, there should be close liaison with other colleagues. Acute pain should resolve in a few weeks with restoration of function. Chronic pain is unlikely to resolve, but with appropriate management and support the person can regain high levels of activity and participation.