Doctors, therapists and nutritionists can do a lot to ease your pain, but there’s only one person who can take your treatment all the way.

That’s right, it’s you.

As a licensed physical therapist for Integrative Pain Specialists, I work every day with patients who are experiencing chronic pain. I can work with you in the office and I can track your progress and make adjustments as needed. What I can’t do is force you to do the exercises at home. That part is up to you, and what you put into it makes the difference in your success.

How it works

When a patient comes in to my office at Integrative Pain Specialists, the first thing I do is assess their needs, their condition, their lifestyle and their physical limitations. Most of my clients are dealing with chronic degenerative pain, such as arthritis, as opposed to post-surgery pain that lessen over time. With a chronic condition, the goal is to lessen their pain and increase their functionality. In most of these cases, the pain won’t ever go away completely, but it can be lessened and it can be managed.

I start by designing and creating an individual plan for each client, based on what they can and can’t do currently, and what their needs are. The plan also takes into account the client’s household structure and daily routine — a client who has to walk up and down a flight of stairs several times a day is likely to have different priorities than one who lives in a one-story house.

And each person is different – two people with the same condition may have different physical factors that exacerbate the problem. Are you out of alignment? Is there too much stress on one of your joints? Are your muscles too tight? Is inflammation making it worse? Figuring out what’s exacerbating the problem is the first step in decreasing pain. After that, part of your individual plan involves integrating your daily household activities so it gets better, not worse, with movement.

Clients come into the office once or twice a week, so most of their work is done on their own at home. Doing the exercises that are prescribed for you is the most important thing you can do in physical therapy. Yes, it’s hard work and yes, it often hurts. And when we hurt, it’s always hard to keep pushing ourselves to keep going. And yet that’s what will bring your pain level down and your functionality up in the long run.

Taking it home

And physical therapy is more about what you do than what you don’t do. Sometimes when a client first comes in, I advise them to take a break from an activity that is exacerbating their pain. If they’re trying to ignore pain to do a certain task and that’s leading to inflammation or muscle tightness, I may have them stop doing that activity for a while until we can get things under control. But for the most part, physical therapy means exercising more, not less.

If a client is elderly and has a caretaker, I’ll usually talk to the caretaker as well about what exercises the client should be doing and what their physical limitations are. Similarly, if the client is a child, I’ll tell their parent what exercises the child needs to do.

But in both cases, it’s still up to the client to get the exercises done themselves; no one but you can make your muscles flex and stretch. And since most of my clients are independent and don’t have caretakers, they’re especially responsible for remembering and motivating to do their physical homework. I tell my clients every day: “You have to be your own advocate in your therapy. It’s up to you to get motivated to get better.”

Back in the office

Clients sometimes ask me if I’d be able to tell if they weren’t doing their exercises at home. The answer is always yes. The exercises are designed to decrease your pain, so doing the exercises will make you feel better. If a client comes in and their pain hasn’t gotten much better in the last week, it’s a pretty sure sign that they weren’t doing the exercises. And if they aren’t familiar with the exercises or can’t remember what they were or demonstrate how they’ve been doing them, that’s a definite indication that they weren’t working on it at home.

When that happens, I just remind the client that they really will feel better if they do the exercises. Remember, I can only help you for an hour or two once or twice a week. Beyond that, it’s up to you to help yourself.

Other factors

Of course there are sometimes other factors at play and integrative pain management takes into account all of a client’s conditions.

People with chronic pain often suffer from depression and not being able to move well can make that worse. Treating the depression is part of the overall pain management strategy, but even just working at the physical therapy aspect can help to an extent — knowing you can move and being able to go about your daily routine can alleviate some of the mental stress.

For many clients, inflammation is a major contributor to pain and since some types of foods are inflammatory, diet and nutrition are an important part of their pain management. Other clients ask for help losing weight in order to move better and in those cases too, diet plays a key role. I work closely with registered dietician Cayla Jablonski to pair physical therapy with a nutrition plan, in order to maximize the client’s success.

And sometimes, a client’s muscles are just so stressed that we talk with doctors about prescribing a muscle relaxer temporarily to ease the tension so we can get down to work.

No matter what the factors, however, we still have to get down to work. Motivation is key and showing up for your own treatment when you’re alone at home is just as important as showing up for it in the clinic.

Stephanie Musselman heads up the physical therapy department at Integrative Pain Specialists. Licensed in the Commonwealth of Virginia, Stephanie earned her BS degree in Kinesiology from Shenandoah University in 2000. She then attended Virginia Commonwealth University Medical College of VA, and in 2003, received her Doctorate of Physical Therapy. 

To find out more about our physical therapy division or schedule an appointment at Integrative Pain Specialists, visit