Joe: 00:00

Welcome back to another episode of the Freedom Talks podcast, everybody. This is your host, Joe Ogden. And today, what we're gonna be talking about is a topic that we talk about a lot in physical therapy. And quite honestly, not just physical therapy. This can be applied to any sort of medicine or life experience that people have.

Joe: 00:21

And the topic we're going to talk about today is acute versus chronic pain and some of the things that we can do to manage these different types of pain and understand which category really we fit in. So acute pain is in this depends on where you find this information. There's different definitions out there. But I'm just going to kind of give an overview of how I think about it as a physical therapist and some of the windows that I like to look at it with. So acute pain, I look at it as anything within a thirty to sixty day window, anything less than about thirty to sixty days.

Joe: 00:58

And this can be from spraining your knee, rolling your ankle, playing pickleball, basketball, falling while skiing, you know, falling and falling on your shoulder, hurting your back. These acute injuries are the short term. And what's important about these injury windows is we want to make sure that we decrease pain, decrease inflammation, and increase range of motion as fast as we can. So and as fast as we can, we also want to do it as efficiently as we can because I'd rather have a high quality range of motion and do it in ample time than have kind of crummy range of motion and we're doing it as fast as we can. So we wanna also be smart with what we're doing.

Joe: 01:42

But so we'll use an example of so let's say hypothetically, I'm playing pickleball with my wife and I go for a shot and I roll my ankle. Right away, I have a serious amount of pain. Feel like, oh, that that really hurt. First, I'm gonna sit on the ground, kinda do an assessment of what's going on, make sure that nothing's broken, make sure no bones are sticking out. And then I'm gonna kinda move my ankle around, make sure the Achilles tendon is still attached and everything feels okay.

Joe: 02:11

I then wanna get up, walk a little bit, try and put some weight bearing on it as long as I don't have any pain around the malleolus to make sure that it's not broken or anything. We're then gonna get up, move around a little bit. And let's say it's bad enough that we have to stop playing. So in the acute phase, you wanna go home, put some ice on that injured area so that we decrease any inflammation. More than likely, unless you put ice on immediately after the injury happens, there's probably gonna be some inflammation.

Joe: 02:41

That's normal. Your body senses that there's an injury to that area, and it's gonna send blood to that area to try and repair it. Our bodies are really smart that way. So what I like about that is our bodies are good enough to kind of heal itself for the most part, unless there's a serious pathology going on. Any acute injury, that's nothing serious.

Joe: 03:00

Our bodies do a really good job of healing themselves. But what's important is we need to also make sure that we're giving our bodies the tools to help ourselves heal correctly. So I put ice on this area. I then want to do some gentle range of motion to try and get full range of motion back. Typically, as range of motion increases, pain will go down because we're able to move more.

Joe: 03:21

As we start moving more, we're probably gonna be able to feel better. Now, once we start feeling better, we're gonna be able to strengthen that area. We start with isometrics. We then go to concentrics, and then we go to the eccentric, which is the strongest muscle contraction we can do. Typically, once the eccentric ability is obtained, we're able to do higher functioning things and probably get back to playing pickleball or whatever activity you were initially injured in.

Joe: 03:46

This acute injury stage sometimes can take up to eight weeks to get back to doing that activity. That doesn't mean it's anything serious. It just takes the body that long to heal. So in the acute phase, if if an injury has happened less than sixty days, some literature will say thirty days, but I use the thirty to sixty day window. I just combine the two to make it easy.

Joe: 04:10

Injury itself, little faster to recover from as long as you're seeing the proper provider and doing the proper thing. This is where the chronic pain category gets a little muddy because it does overlap with the acute stage and acute pain can turn into chronic pain. So we'll talk about chronic here a little bit. Chronic pain is anything greater than ninety days. And in the health care world, there's a lot of patients that we see that have chronic pain.

Joe: 04:40

And to me as a provider, it's really something that I do enjoy working with because it's such a joy to be able to get through with people and and to work with people who are having chronic chronic pain. And they put in all this work, and at the end, they're out of pain. I think it's one of the most honestly gratifying feelings as a provider to see a patient who's in chronic pain, assess what's going on, listen to their story, listen to their specific goals and be like, alright, this is what I see is going on. This is what we're gonna do, and this is what the end result hopefully is gonna be. The tricky part with chronic pain, because that pain has been lasting a longer time, sometimes it may take a longer time for that pain to disappear.

Joe: 05:24

I think for me personally, when I first started as a physical therapist, I was so gunk ho at getting people to feel confident in working with me. So I I would promise things a little sooner than science would allow for. And I think we all kind of fall into that category sometimes where we just want people to buy into what we're doing because we're really there just to help them. And some people are a little more hesitant. What I've transitioned to now is really just being honest with people.

Joe: 05:50

And I think some people really haven't appreciated that honesty, where if you're having chronic pain and been dealing with something for twenty years, it's probably going to take a little while in being consistent with a routine to really assess, okay, how much better are we getting from this and what do we need to change? And that's the tricky part with our lives now in 2025. I always refer to our society now as kind of a microwave generation. We want results immediately just because we have everything immediately. If I have a question on something, who is the seventeenth president?

Joe: 06:26

And off the top of my head as I'm doing this podcast, I don't know who it is. I could look it up and find it out in ten seconds versus before without the Internet. It would take a little bit to find that information. We're now everything is just at our fingertips. So we assume that everything else should be given to us pretty quick.

Joe: 06:42

I fall into that category myself. I'm not knocking on anybody. I think that's just the reality of the situation here. So the big thing with chronic pain, in in in my opinion, is I think it's important to educate people on on truly what's going on. So we see people who've got, you know, twenty years of having knee pain.

Joe: 07:05

Okay. Let's start from the beginning. When did this kinda start? Okay. What have you tried so far?

Joe: 07:12

And even when people say, you know, I've been to physical therapy, I've been a chiropractic care, you know, I've worked out with a trainer, all that stuff. To me, what I've learned is I really need to dive deeper into, okay, what specifically have you been doing? You know, some people will say they've been a physical therapist and they just saw him a couple times and they didn't really do anything at home. So really, did they try physical therapy? I don't think so.

Joe: 07:35

Same thing with a chiropractor. Yep. I saw a chiropractor and then you start diving deeper into it and they've just seen a chiropractor once. Like, again, is that really going to do anything? No, probably not.

Joe: 07:45

I mean, maybe some short term benefit, but long term benefit, probably not. So diving deep into understanding what people have been through and really what they've truly tried and and done to improve their pain. A big thing too, think, with chronic pain and dealing with things for a longer period of time is really educating people about what pain actually is itself. Pain is just an output. It's not an input.

Joe: 08:10

I actually give a talk on this through our Glendale rec department here and Nicolet rec department here in the Fox Point area in Wisconsin as well as the Mequon rec department. I also do a talk here at Freedom and Fox Point about pain education. And what I think is really important about pain education that really resonates with chronic pain patients is we're so conditioned that every movement hurts. For instance, people with knee pain, let's say going up and down the stairs or getting out of a chair, that always hurts. Eventually, body is smart enough and can really condition itself to just know that anytime that movement happens, there's gonna be a pain reaction.

Joe: 08:50

But that's actually the output. Your body is interpreting that stimulus to be painful. Sometimes we have to rewire that connection and recondition ourselves that, yes, we can do this. We have to just adjust it. And the example I give with that is it's always as a kid, you touch a hot stove.

Joe: 09:09

That first split second that you touch that stove, you actually don't get pain. Your body has to decipher what that is. You then burn yourself, and then you condition yourself that your body knows that, hey. Anytime I touch that fire or touch that stove, that's gonna be hot. Don't do that.

Joe: 09:24

The pain is the output. The stimulus of the hotness goes through your body. If you're touching with your finger, it goes through your finger up to your head. Your brain then deciphers that pretty quick and says, oh, that's painful. Get your hand away.

Joe: 09:38

Now the the cool part about the human body is that's all done in a split second. I mean, fast. With chronic pain, the same thing happens as we get in the same cycle of anytime you see X, Y, or Z, that's gonna be painful. I think oftentimes where we where the education piece lacks at this is it's not that sometimes chronic pain patients come in and they say, well, I've seen other physical therapists in the past and they say it's in my head. Well, no, it's not in your head.

Joe: 10:10

You you are having pain. We just have to decipher what is causing that pain and rewire how your body's interpreting it. For instance, have a patient right now where she is having pain going up and down the stairs. She's very concerned that she'll fall with it. So she has a pain output with it.

Joe: 10:34

I have a conversation with her while we do it and I give her two commands. Get up the step and come down. That's it. That's all I want you to think about. Get up on that step and come down.

Joe: 10:44

And then I showed her yesterday that it was only four inches. You're not gonna fall. You're not gonna go anywhere. You're just going four inches. Get up and get down.

Joe: 10:54

And as we were doing this and as I was talking to her, she kinda stopped in the middle of it. I like, oh my gosh. I'm doing it again. I was like, yeah. There's a method to the madness.

Joe: 11:04

I need to distract a little bit so you can focus just on the simple task of getting up and getting down. It's the same thing with any other chronic type pain presentation is we just need to kind of rewire things to allow for your body to do that movement and essentially live your life. So if we can get that brain to not focus on pain so much and get you focused on other things, that really helps chronic pain patients, I think. Because there's so much life to live truly that chronic pain or excuse me, people with chronic pain miss out on because the pain is just so intense. If we can change how your body interprets that pain to help you live a better life, I think that's a pretty cool role that we play as physical therapists.

Joe: 11:47

So in conclusion, the big thing to kind of focus on the difference between acute and chronic pain, it's still pain. Acute typically is a shorter duration, meaning it hasn't been going on for as long, less than a sixty day window. It typically goes away a little faster just because it just happened. We come in right away. We take care of the deficits and we improve it.

Joe: 12:09

Chronic pain happens for a longer period of time and takes longer to decrease. That doesn't mean it's not gonna decrease. I always tell people, and this is something I talk about more and more because I just I really think it's true. I think with this quote unquote microwave era that we live in where everything is given to us immediately, There's no secret sauce to physical therapy or occupational therapy. The secret sauce is being consistent.

Joe: 12:38

Being consistent with your home exercise program, being consistent with senior physical therapist, being consistent with a routine so that routine can take you to the next level and decrease your pain. If anybody has any questions about acute or chronic pain, please reach out to us here at Freedom Physical Therapy. Thank you everyone for listening to another podcast episode of Freedom Talks. If anybody has a topic that they wanna hear about this year or guess that they'd be interested in hearing more about, please let us know either on social media. You can leave a review for us here on Apple Podcasts or Spotify.

Joe: 13:12

We see all of those and that helps us spread the positivity of the health care world. Or just talk if you're a current patient, just talk to us here at Freedom. We love to hear your opinion and keep the podcast growing. So thanks again everyone for listening to another week's episode, and we'll see everyone in the next couple weeks.