Advice

Common Reasons for Increased Back Pain After Physical Therapy

Muscle Activation & Inflammation
Physical therapy often introduces new movements and exercises that activate weak or tight muscles. This can lead to delayed onset muscle soreness (DOMS), which is common 24 – 72 hours after a session.

You might feel…

• Stiffness
• Soreness
• Increased sensitivity in muscles or joints

This discomfort usually decreases as your body adapts to the new demands.

Stretching Tight Structures
When therapists stretch tight muscles, tendons, or ligaments, it can cause temporary discomfort. Your body is adjusting to improved posture, mobility, and alignment, which might initially feel painful, especially if your spine or pelvis is out of balance.

Triggering Inactive or Compensating Muscles
If certain muscles have been underused due to injury or chronic pain, therapy may begin to reawaken them. This can result in temporary pain as your body re-learns how to move and distribute force correctly.

Poor Technique or Overexertion

Sometimes pain increases when…

• You’re pushing beyond your current limits
• You’re performing exercises with poor form
• Your program is too aggressive too soon

This is why communication with your therapist is critical, they can adjust your routine to match your condition and tolerance.

When Is Pain After Physical Therapy Normal?

It’s common to feel…

• Mild to moderate soreness
• Slight increase in symptoms after a new exercise or technique
• Temporary stiffness after sessions

This kind of pain should be short-term and gradually decrease as you continue therapy.

When Should You Be Concerned?

You should speak with your physical therapist or doctor if…

• Pain is sharp, shooting, or radiating (especially into the legs)
• Discomfort is severe or lasts more than 2 to 3 days
• Your symptoms are getting worse with each session
• You experience numbness, tingling, or loss of strength

These signs could indicate that the treatment plan needs to be modified or that another condition is present, such as a herniated disc or nerve compression.

What You Can Do to Minimize Post-Therapy Pain

• Apply ice to reduce inflammation after sessions
• Use heat before exercises to loosen stiff muscles
• Stay hydrated to help muscle recovery
• Communicate openly with your therapist about pain levels
• Follow your home exercise program consistently but gently
• Track your symptoms to notice patterns and share them during sessions

Mild soreness after physical therapy for back pain is usually a normal part of the healing process, especially as your body adapts to new movements. But, sharp, worsening, or long-lasting pain should not be ignored.

Always keep your therapist informed and ask questions about what you’re feeling. With the right adjustments, most people begin to see steady improvement and long-term relief.