"DO NOT HURT." Looking back on it almost 13 years later, I heard that saying a lot in school. When I was completing my Masters of Physiotherapy, that was one of the biggest messages drilled into our brains.
I'm not too sure about other schools, but there are a SIGNIFICANT amount of therapists that as soon as somebody says "ouch" they avoid the area or back away. Myself on the other hand - I say to myself, "that's it, that's where I need to be."
Let's break it down on how I perceive these two words:
Harm - To physically cause harm - break bones, sever tendons, tore muscles, cartilage damage, ligament damage, dysfunction, etc. This is what we are to "rehab."
Hurt - To palpate an area that is tender, sore, swollen, or to create change that is not damaging but beneficial. This is our treatment, how we will improve healing.
Let's bring in an example:
Shoulder pain - mechanical, built up over time.
99% of the time the shoulder blade is not moving, the referral pattern typically travels down the arm and in front of the shoulder. Sometimes you get pain in the back of the shoulder, sometimes you don't. However, I ALWAYS CHECK THE SHOULDER BLADE FIRST. Don't worry, the shoulder will be for another time my friends.
I want to get that shoulder blade moving as that is usually a primary source of pain, then ill deal with the secondary stuff that the individual is actually explaining where there pain is.
Usually on the first visit, I try to be nicer on the "hurt" or how much pain I may infleict by getting tissues to move how I want them to move. Note: Regardless of my treatments, I always treat based on what the individual can handle. Otherwise, I want to build a rapport, get in to that shoulder releasing and calming the pain as much as I can (occasionally people give me the green light to be mean the first visit - that is where I have the most fun in my treatments - but for those that don't want significant amounts of pain, I understand, I want them to come back as I know I can make a positive impact).
Fascial releases usually HURT. Sometimes an individual has compared this hurt to feeling like burning sensation, or you know, the feeling like I'm peeling there skin with a butter knife.... I have used a butter knife before. We can talk about that later too. A quite efficient tool if I say so myself. Between muscle and fascial releases, some pain is inflicted but movement is typically restored and some great changes in pain levels - although, not everyone is this easy.
If I were to be much more aggressive - I'm going to fascially cup an individual. I try to hurt as minimal as possible (some clients would not agree), the more inefficient my treatments are the more aggressive I typically get - to a point. One of the most aggressive and efficient ways to treat a fascially stuck individual however is through dynamic cupping. I start with some ultrasound gel, put a silicone cup on the skin and drag that thing until I am satisfied (or if they tap out - as it can hurt - no shame though, I get it). Typically if someone is quite inflamed we will get some bruising. If I see this may occur I let them know quite quickly, most do not care, they are here to get fixed.
Now, I have clearly hurt someone during my treatment to achieve pain relief, I do it all the time! If I were to "harm" an individual, they would have an immediate increase in pain, no relief, worsening symptoms. That's likely an "uh oh" on our end. Soreness later or in the following days is normal, but I have not HARMED them. If I treated something and it popped, or the individual gets sharp pain, or a significant increase in swelling - that is when I likely did something real dumb and caused harm. Does this happen sometimes? Sure does. But it should be quite rare in itself. Afterall, that is what we are trained to avoid.
In conclusion my dear intrigued followers - hurt is alright, but do not harm. That would be shamed upon.
-KR