Advice guide
Do I Actually Need Physio, or Will This Settle on Its Own?
This is the question we are asked more than any other, usually with a slightly apologetic tone, as though it is cheeky to ask a physiotherapy clinic whether you need physiotherapy. It is a fair question and it deserves a straight answer. A great many aches settle on their own within one to two weeks with sensible movement and a bit of patience. Others do not, and the ones that do not tend to give you clues fairly early. Here is how to read those clues, and what we would tell a friend or family member who rang us about it.
Signs it is reasonable to wait and see
If the picture below matches yours, giving it a fortnight of gentle activity, sleep and common sense is a perfectly reasonable plan. Keep moving within comfort, avoid complete rest, and keep an eye on the direction of travel rather than the day to day noise.
- The pain is clearly easing week on week, even if slowly
- You can identify an obvious cause, such as an unusually heavy day of gardening or a first gym session in a while
- You can still do most of your normal daily activities, even if a bit gingerly
- There is no pins and needles, numbness or weakness
- Sleep is broadly intact, or disturbed only when you roll onto it
Signs it is worth having assessed
None of these mean anything sinister. They simply mean the problem is unlikely to sort itself out quickly, and that a proper assessment will probably save you time.
- It has been the same for three weeks or more with no clear improvement
- It has come back for the third or fourth time in the same place
- You are avoiding activities you would normally do, such as running, lifting or driving distances
- There is pins and needles, numbness, giving way or a feeling that the limb is not trustworthy
- You have a deadline that matters, such as an event, a season or a return to work
- You have started rationing your life around it without really noticing
The two week rule of thumb
A useful test is direction rather than level. Ask yourself how it compares with a fortnight ago, not with yesterday, because day to day pain is naturally noisy and can mislead. If a fortnight ago you could walk fifteen minutes and now you can manage thirty, the trend is right and time is on your side. If a fortnight ago you could walk fifteen minutes and today it is still fifteen, that is a plateau, and plateaus rarely break on their own. Plateaus are the single most common reason people come to see us, and they are usually straightforward to shift once someone works out what is holding the recovery still.
What waiting actually costs
Waiting is not neutral, though the cost is often overstated. For most simple strains, waiting a fortnight costs nothing at all. For longstanding tendon problems, stiff shoulders and recurring back pain, the picture is different: the longer a joint is guarded and the longer you avoid a movement, the more strength and confidence quietly drain away, and rebuilding that takes time. This is a general pattern rather than a promise about your particular case, and it is not a reason to panic about a sore back on day three.
| Problem | Often settles alone? | Usual reason people end up booking |
|---|---|---|
| Simple back strain after lifting | Frequently within two weeks | It keeps recurring every few months |
| Ankle sprain | Pain often settles quickly | Balance and confidence do not return, so it turns over again |
| Tendon pain such as tennis elbow or Achilles | Slowly and often incompletely | Grip or running has not come back after months |
| Frozen shoulder | Very slowly, over a long period | Sleep and dressing become difficult |
| Nerve related leg or arm symptoms | Variable | Symptoms spread, or numbness persists |
What you can sensibly do in the meantime
Whether you book or not, these are the things we would suggest to anyone in the first couple of weeks. They are general advice rather than a prescription for a specific diagnosis.
- Keep moving within a tolerable level of discomfort rather than resting completely
- Reduce the aggravating load temporarily instead of stopping everything you enjoy
- Protect sleep, because poor sleep reliably makes pain feel worse
- Use heat or ice based purely on which feels better to you, since neither is harmful for short periods
- Note what makes it better and worse, which is genuinely useful information if you do end up booking
When not to wait at all
Some symptoms need medical attention today rather than an appointment next week. Go to A and E if you lose bladder or bowel control or develop numbness around the saddle area. Call 999 for sudden weakness on one side, face drooping, difficulty speaking, or chest pain with breathlessness or sweating. Seek urgent review after significant trauma such as a fall from height or a road traffic collision, and see your GP promptly if pain comes with fever, night sweats or unexplained weight loss.
Common questions
How long is too long to wait?
As a general guide, three weeks without clear improvement suggests the problem is unlikely to resolve quickly on its own. That is a rule of thumb rather than a deadline, and plenty of things take longer and still settle.
Will resting fix it?
Complete rest is rarely the answer beyond the first few days. Tissues need graded load to recover their tolerance, and prolonged rest tends to leave you weaker and more sensitive when you go back to activity.
Is one session enough to know?
Usually a first assessment tells you what the problem appears to be, what is driving it and what a realistic plan looks like. Some people take that away and manage it themselves, others prefer ongoing support.
Does pain level tell me how serious it is?
Not reliably. Very painful problems are often simple, and relatively painless ones can matter more. Function, weakness and nerve symptoms are more informative than the number out of ten.
I have had this for years. Is it too late?
No. Longstanding problems are often more about capacity and confidence than damage, and those can change at any age. We cannot promise an outcome, but a long history is not in itself a reason to give up on it.
What if it settles before my appointment?
Then say so and we will use the time differently, looking at why it happened and how to reduce the chance of the next episode. Give us notice if you would rather cancel.