Chronic Pain
Chronic pain physical therapy can help people who have had pain for months or longer. The pain may affect one area, such as the neck or lower back. It may also spread across several parts of the body. Chronic pain is often defined as pain that lasts longer than three months or continues past the usual healing time. It can affect sleep, work, exercise, mood, focus, and daily tasks.
Living with long-term pain can be tiring and frustrating. Some days may feel easier than others. A person may avoid movement because they are worried about causing more harm. Over time, less activity can lead to weakness, stiffness, poor balance, and lower confidence. At Reform Physical Therapy, we provide one-on-one care for chronic pain, fibromyalgia, persistent neck pain, and ongoing lower-back pain. Treatment is based on your symptoms, health history, current ability, and personal goals.
Your physical therapist will not tell you that the pain is “all in your head.” Pain is real, even when an X-ray or MRI does not fully explain why it continues. Treatment focuses on helping you understand your symptoms, move more comfortably, and slowly rebuild strength and trust in your body.
What Is Chronic Pain?
Pain is one of the body’s warning systems. When you are injured, pain can help protect the area while it heals. This type of short-term pain is often called acute pain. Chronic pain works differently. In some cases, pain continues because of an ongoing health condition or tissue problem. In other cases, the injury has healed, but the nervous system remains highly alert and continues to produce a strong pain response.
The brain, spinal cord, nerves, immune system, emotions, sleep, stress, past injuries, and daily activity can all affect how pain is felt. This does not mean the pain is imagined. It means pain is shaped by more than one body part. The National Institute of Neurological Disorders and Stroke explains that pain may come from tissue damage, nerve problems, inflammation, or changes in the way the nervous system processes danger signals. Fibromyalgia and some cases of chronic lower-back pain are examples of pain that may involve changes in pain processing.
Chronic pain may be affected by:
- A past injury
- Arthritis
- Surgery
- Nerve irritation
- Muscle weakness
- Joint stiffness
- Poor sleep
- Stress
- Fear of movement
- Low activity levels
- Repeated flare-ups
- Fibromyalgia
- A long-term health condition
- Changes in how the nervous system reacts
Pain can be complex, so treatment often works best when it looks at the whole person instead of focusing only on one painful joint or muscle.
What Is Persistent Pain?
Persistent pain is another name for pain that continues longer than expected. The terms persistent pain and chronic pain are often used in similar ways. Pain may remain in one area or move around the body. It may feel sharp, dull, burning, aching, tight, heavy, or electric. Symptoms may stay at the same level or change from day to day.
A person with persistent pain may notice:
- Good days and difficult days
- Pain that changes with stress
- Pain after poor sleep
- Increased symptoms after doing too much
- Pain after long periods of rest
- Fear of certain movements
- Trouble returning to exercise
- Fatigue
- Muscle tension
- Trouble focusing
- Lower confidence
- Frustration or worry about the future
Pain does not always match the amount of tissue damage. A small movement may feel very painful even when it is not causing harm. Learning how to tell the difference between discomfort and danger can be an important part of recovery.
How Physical Therapy May Help Chronic Pain
The goal of physical therapy is not to promise that every symptom will disappear. Instead, treatment may help you move better, build strength, take part in more activities, and manage flare-ups with greater confidence. Physical therapists can help people with chronic pain identify movement limits, weakness, fear, sleep habits, stress, and activity patterns that may be adding to the problem. Treatment plans may include gentle movement, exercise, hands-on care, education, and a gradual return to daily activity.
Physical therapy may help you:
- Improve strength
- Increase joint movement
- Build endurance
- Improve balance
- Walk farther
- Return to work
- Sleep more comfortably
- Reduce fear of movement
- Manage flare-ups
- Improve posture
- Return to exercise
- Complete daily tasks
- Build trust in your body
- Find a healthier balance between rest and activity
Regular physical activity can offer important health benefits for people with chronic health conditions. The right type and amount of activity should be based on the person’s health, symptoms, and current ability.
Conditions We Treat
Long-Term Pain
Chronic pain may affect the muscles, joints, nerves, spine, or several body areas at once. It may begin after an injury or surgery. In other cases, there may not be one clear event that caused it. Some people continue to search for one damaged body part that explains every symptom. However, long-term pain often involves several factors working together. Learn more about chronic pain
Signs may include:
- Pain lasting longer than three months
- Pain that limits work or exercise
- Stiffness
- Weakness
- Poor sleep
- Fatigue
- Pain that changes from day to day
- Trouble sitting or standing
- Fear of movement
- Reduced activity
- Pain that returns during stress
- Pain that does not match test results
Your physical therapist will listen to your experience and look at how pain affects your daily life. The evaluation may include strength, movement, balance, walking, posture, and the activities you are avoiding.
Treatment may include:
- Gentle exercise
- Strength training
- Walking or aerobic activity
- Stretching
- Balance work
- Pain education
- Activity planning
- Hands-on care
- Breathing and relaxation
- A home exercise plan
Progress often happens in small steps. A patient may first work on walking for five minutes, preparing a meal, or sitting through a meeting. These gains can become the base for larger goals.
Fibromyalgia
Fibromyalgia is a long-term condition that can cause pain across the body. It may also lead to fatigue, poor sleep, muscle tenderness, trouble focusing, and sensitivity to touch or activity. Symptoms can vary from person to person. Some people have daily pain, while others have periods when symptoms become stronger. Weather, stress, poor sleep, illness, and activity changes may affect how a person feels.
Fibromyalgia is linked to changes in how the nervous system processes pain. The pain is real, even when there is no clear injury in each painful area. NINDS lists fibromyalgia as an example of nociplastic pain, which involves changes in pain processing.
Common concerns may include:
- Widespread pain
- Muscle tenderness
- Fatigue
- Poor sleep
- Headaches
- Trouble focusing
- Sensitivity to touch
- Stiffness
- Reduced strength
- Trouble with exercise
- Symptoms after doing too much
- Fear of causing a flare-up
Physical therapy for fibromyalgia should begin at a level the patient can manage. A hard workout may cause a large flare if the body is not ready for it. Doing too little, however, may lead to more weakness and reduced activity.
Treatment may include:
- Gentle aerobic exercise
- Walking
- Light strength training
- Pool exercise when available
- Stretching
- Balance training
- Pacing
- Sleep and movement education
- Breathing exercises
- A gradual home program
The goal is to slowly increase what the body can handle without creating a repeated cycle of overdoing activity and then needing several days of rest.
Persistent Pain
Persistent pain may continue after an injury has healed or after tests no longer show a clear cause. Some people feel confused or worried when medical tests do not match the amount of pain they feel. A lack of major findings does not mean the symptoms are fake. The nervous system may remain sensitive and react strongly to movement, touch, stress, or pressure.
Persistent pain may lead to a cycle:
- Movement causes pain.
- The person becomes worried about damage.
- Activity is avoided.
- Muscles become weaker.
- Normal tasks feel harder.
- Pain and fear increase.
Physical therapy may help break this cycle through safe movement, education, strength, and gradual exposure to activities that have become difficult.
Treatment may focus on:
- Learning what movements are safe
- Starting with manageable activity
- Building strength
- Improving confidence
- Setting realistic goals
- Managing flare-ups
- Increasing daily movement
- Returning to hobbies
- Reducing long periods of rest
- Finding a steady pace
The goal is not to force someone through severe pain. The plan should challenge the body without causing an overwhelming increase in symptoms.
Pain Neuroscience Education
Pain neuroscience education teaches patients how pain works in the brain, nerves, spinal cord, and body. It explains why pain may continue even after damaged tissue has healed. This type of education does not mean the pain is caused only by thoughts or emotions. It helps patients understand that the nervous system can become more sensitive over time.
A sensitive nervous system may act like a smoke alarm that goes off too easily. The alarm is trying to protect you, but it may react to normal movement as though it is dangerous.
Pain education may cover:
- How the nervous system creates pain
- Why pain can continue after healing
- Why stress may increase symptoms
- How poor sleep affects pain
- Why fear can make movement harder
- The difference between hurt and harm
- How safe movement can calm the system
- Why progress may not follow a straight line
- How to respond to a flare-up
- Why strength and activity still matter
Research reviews suggest that pain neuroscience education may improve a person’s understanding of pain and may help with fear, movement, and disability when combined with active treatment. Education works best when it is paired with movement. Learning about pain without slowly returning to activity may not be enough to improve daily function.
Chronic Neck Pain
Chronic neck pain lasts for several months or keeps returning. It may begin after whiplash, a work injury, arthritis, poor sleep, or long periods of sitting. Pain may stay in the neck or spread into the shoulders, upper back, head, or arms. Some patients also have headaches, stiffness, or fear of turning the head.
Common symptoms may include:
- Neck pain
- Stiffness
- Shoulder tension
- Headaches
- Pain while driving
- Trouble looking up or down
- Pain while using a computer
- Muscle tightness
- Trouble sleeping
- Arm pain
- Fear of quick movement
- Pain that returns during stress
Physical therapy may help improve neck motion, shoulder strength, posture, and tolerance for work or daily activity.
Treatment may include:
- Gentle neck movement
- Upper-back mobility
- Shoulder blade strengthening
- Deep neck muscle exercises
- Posture changes
- Workstation changes
- Hands-on care
- Breathing and relaxation
- Gradual return to exercise
Patients with numbness, weakness, loss of balance, or pain traveling into the arm may also need an evaluation for a spine or nerve condition.
Chronic Low Back Pain
Chronic lower-back pain is pain that lasts for several months or returns often. It may affect sitting, standing, walking, lifting, sleeping, work, and exercise. Some people have arthritis, disc changes, spinal stenosis, or a past injury. Others do not have one clear cause. Imaging may show age-related changes, but those findings do not always explain the amount of pain.
Chronic lower-back pain may also be affected by weakness, poor sleep, fear of movement, stress, long periods of sitting, or sudden changes in activity.
Common symptoms may include:
- Lower-back aching
- Stiffness
- Pain while sitting
- Pain while standing
- Trouble bending
- Pain with lifting
- Pain after walking
- Trouble getting out of bed
- Fear of exercise
- Pain that changes from day to day
- Hip or buttock discomfort
- Reduced strength
Physical therapy may help patients build strength, improve movement, and return to daily activity. Chronic low-back pain is also listed by NINDS as a condition that may sometimes involve changes in pain processing.
Treatment may include:
- Walking
- Core and hip strengthening
- Back mobility
- Lifting practice
- Posture changes
- Balance exercises
- Gentle aerobic activity
- Activity planning
- Pain education
- A home exercise plan
There is no single best exercise for every person with lower-back pain. The plan should match the patient’s symptoms, goals, and current ability.
Understanding Pain Flare-Ups
A flare-up is a short-term increase in pain or other symptoms. It may happen after too much activity, poor sleep, illness, stress, travel, or a sudden change in routine. A flare-up does not always mean that new damage has occurred. However, new or severe symptoms should still be checked when needed.
During a flare-up, it may help to:
- Reduce activity for a short time
- Keep some gentle movement
- Use calm breathing
- Change positions often
- Follow the home plan
- Avoid staying in bed all day
- Return to activity in small steps
- Track possible triggers
- Contact your therapist if symptoms do not settle
Stopping all activity for a long time may lead to more stiffness and weakness. Your therapist can help you find a level of movement that feels safe and manageable.
Pacing Daily Activity
Pacing means spreading activity throughout the day instead of doing everything at once. Many people with chronic pain follow a “boom-and-bust” cycle. They do a large amount on a good day, then need several days to recover. This can make it hard to build steady strength and endurance.
Pacing may include:
- Taking planned breaks
- Splitting large tasks into smaller parts
- Changing positions
- Slowly adding time or distance
- Avoiding big jumps in exercise
- Choosing a steady starting point
- Tracking activity
- Planning harder tasks around rest
- Increasing one thing at a time
Pacing is not the same as avoiding activity. It is a way to build activity in a more steady and predictable way.
Treatment Methods for Chronic Pain
Gentle Movement
Early movement may include short walks, easy joint motion, or simple daily tasks. The starting level should feel manageable.
Strength Training
Strength work helps the muscles support the body during walking, lifting, standing, and exercise.
The therapist may begin with light resistance and increase it slowly.
Aerobic Exercise
Aerobic activity may include walking, cycling, swimming, or another activity that raises the heart rate.
The length and effort level should match the patient’s health and current ability.
Balance Training
Balance may decrease when pain causes a person to move less. Training may include stepping, reaching, standing on different surfaces, or single-leg work when safe.
Hands-On Care
Hands-on treatment may help with stiff joints or tight muscles. It may provide short-term relief and make movement feel easier.
Hands-on care is usually paired with active exercise rather than used as the only treatment.
Pain Education
Education helps patients understand why pain may continue and how sleep, stress, movement, and fear may affect symptoms.
Breathing and Relaxation
Slow breathing may help reduce muscle tension and calm the nervous system. These skills can be useful during pain flare-ups or before a difficult activity.
Functional Training
Functional training focuses on real tasks, such as:
- Walking
- Stairs
- Lifting
- Cooking
- Cleaning
- Yard work
- Sitting at a desk
- Caring for family
- Returning to work
- Returning to exercise
Home Exercise Program
Your home plan may include strength, walking, mobility, balance, breathing, or activity goals. The plan should be realistic and easy to follow. A small program completed often may be more helpful than a hard routine that causes a large flare.
What to Expect at Your First Appointment
Your first visit will begin with a full conversation about your pain, health history, sleep, work, stress, daily activity, and goals.
Your therapist may ask:
- When did the pain begin?
- Where do you feel it?
- What makes it better or worse?
- How does it affect sleep?
- Which activities have you stopped?
- Have you had surgery or an injury?
- What tests or treatments have you tried?
- Do you have numbness or weakness?
- How often do flare-ups happen?
- What would you like to return to?
The physical exam may include:
- Joint movement
- Strength
- Balance
- Walking
- Posture
- Functional tasks
- Light touch or pressure
- Nerve checks when needed
- Activities that cause fear or pain
- Current activity tolerance
Your therapist will explain the findings and create a plan based on what matters most to you. At Reform Physical Therapy, appointments are one-on-one without aides or double-booked visits. This gives your therapist time to listen, answer questions, and adjust treatment based on your response.
When to Seek Medical Care
Most chronic pain can be discussed during a planned visit. Some new symptoms need faster medical care.
Seek urgent help for:
- Sudden loss of bowel or bladder control
- Numbness around the groin
- New or quickly worsening weakness
- Chest pain
- Trouble breathing
- Facial drooping
- Trouble speaking
- A sudden severe headache
- Fever with severe pain
- Unexplained weight loss
- Severe pain after a fall
- A cold, pale, or blue arm or leg
- Loss of feeling
- Thoughts of harming yourself
New pain that feels different from your normal symptoms should not automatically be treated as a chronic pain flare-up.
One-on-One Chronic Pain Physical Therapy in Maine
Reform Physical Therapy provides care for chronic pain, fibromyalgia, persistent neck pain, and long-term lower-back pain at our Maine clinics in Topsham, Brunswick, Freeport, Yarmouth, South Portland, Kennebunk, and Eliot.
We help patients who want to:
- Walk farther
- Sleep more comfortably
- Return to work
- Sit or stand longer
- Exercise again
- Care for family
- Complete household tasks
- Build strength
- Reduce fear of movement
- Manage flare-ups
- Return to hobbies
- Feel more confident
- Improve daily function
Patients with ongoing back or neck symptoms may also benefit from our spine and nerve physical therapy services. People who want to return to running, sports, or a more active lifestyle may benefit from our sports physical therapy services.
Schedule a Chronic Pain Physical Therapy Evaluation
Chronic pain can make life feel smaller. Activities that once felt simple may become difficult or stressful. You may feel unsure about what movement is safe or where to begin. A physical therapy evaluation can help you better understand your pain, identify areas of weakness or stiffness, and create a steady plan for returning to meaningful activity.