If a pain has not clearly improved within 7 to 10 days, or you have started moving differently to avoid it, get it assessed. Waiting for pain to change is not a neutral choice. It has a cost, and the cost usually grows the longer you leave it.
Most people wait. They rest it, stretch it, search for it online and tell themselves it will settle. Sometimes it does. At my clinic in Richmond I see the other outcome every week: a pain that changed rather than went away, and a second problem that grew out of the first. Here is why that happens, and a simple rule for when to see a physio or sports therapist.
Pain changing is not the same as pain getting better
A change in your pain often means your body is adapting around the problem, not fixing it. That distinction matters, because the change is exactly what persuades people to keep waiting.
Three changes I hear about all the time:
- Sharp pain that turns into a dull ache. The early inflammation has settled, so the pain feels less urgent. The reason it started is usually still there.
- Pain that moves. It started in the knee, now the hip aches. You have not healed the knee, you have changed how you load it, and the hip is paying for that.
- Pain that only shows up after a run. The tissue copes with daily life but not with training load. That is a threshold, not a recovery.
Ignoring pain works for a while because your body is good at finding a way round it. The niggle you train around for three months is the classic sports injury story. It does not stop you, so you never deal with it, and then one day it does.
A club runner came to see me in the spring with a hamstring that had been "niggling" since January. It had started sharp during a sprint session, faded to a dull pull within a fortnight, and he took the fade as a green light. By the time I assessed it, four months on, the hamstring was fine at an easy pace and gave way at anything close to full effort. He had missed the first two races of the season he had spent the winter training for.
How compensating for one pain creates another
When something hurts, you offload it, and something else takes the load it was not built for. That is compensation, and it is automatic. You do not decide to do it.
A sore left ankle shortens your stride on that side. Your right leg does more of the work, your pelvis tilts to make it easier, and a few weeks later your right calf is tight and your lower back is stiff. You book in for the back, and the back is not the problem.
That example is not hypothetical. A client came in with a lower back that had been aching for six weeks with no obvious cause. Her back was fine. She had rolled an ankle on a kerb two months earlier, never had it looked at, and had been walking with a shortened step on that side ever since. We treated the ankle and worked on her walking pattern, and the back settled within a fortnight. Another client, a cyclist, arrived with right knee pain that had started two weeks after a left hip flexor strain he had "pushed through". The right leg had been doing most of the pedalling.
Compensation does not always cause a second injury. A short period of favouring one side is normal. The trouble starts when it goes on for weeks: the new pattern becomes the default and the overloaded tissue never gets time to adapt. In injury rehabilitation much of the work is unpicking that pattern, and it is quicker to unpick at week two than at month four.
The longer pain goes on, the more sensitive your nervous system becomes
Pain that carries on for months can change how your nervous system processes it, so it hurts more, and for longer, than the tissue alone explains. Clinicians call this central sensitisation: the nervous system turns the volume up on signals from the painful area, and sometimes from areas around it.
Two things tend to happen. Movements that should be fine start to hurt, and the area that hurts gets bigger and vaguer. People describe it as "everything on that side" rather than one spot. Pain that has lasted more than about three months is usually treated differently for this reason, because at that point the sensitivity itself needs addressing, not just the original injury.
This does not happen to everyone, and when it does it does not mean anything is damaged. The alarm system has become over-protective. The best way to avoid it is not to give it months to develop: an early assessment and a plan to keep moving in a controlled way.
If you want more on persistent pain, the NHS guide to ways to manage chronic pain is a clear place to start.
Limping, guarding and moving differently
Avoiding a pain changes how you walk, run, lift and sit, and those habits tend to outlast the injury. A limp that protects a sore heel is what clinicians call an antalgic gait. Bracing the muscles around a sore back so it feels safer is guarding. Both are sensible in the first few days. Both cause problems if they become how you move.
Runners are the clearest example. A shortened stride to protect one knee changes cadence, foot strike and hip position on both sides. The knee settles, the stride never goes back, and six weeks later there is a new running injury somewhere else. The client is sure it is unrelated. It is rarely unrelated.
Retraining a movement pattern is routine work, and exercise therapy is built for it. It is much easier when the pattern is two weeks old rather than two years old.
When to see a physio or sports therapist: a simple rule
If you're not sure what you've done, go and see someone. If you are sure what you've done, go and see someone.
That is the whole rule. Being sure is not the same as being right, and even when you are right, an assessment tells you how bad it is and what to do about it, which is the part you cannot work out on your own.
If you want something more specific, book an assessment when any of these apply:
- the pain has not clearly improved after 7 to 10 days
- you cannot put full weight through it or use the joint normally
- swelling has not settled
- the same injury has come back more than once
- you have changed how you walk, run or sit to avoid it
- it wakes you at night or stops you sleeping
- there is numbness, tingling or weakness alongside the pain
- you have a race, match or event coming up and need to know where you stand
Red flags: see a GP, call 111 or go to A&E instead
Some symptoms need medical assessment rather than a clinic appointment. Do not book with me or any therapist first if you have:
- loss of bladder or bowel control, or numbness around the groin or backside
- a visible deformity, or an injury from a fall or impact where you cannot bear weight at all
- back pain with fever, unexplained weight loss or feeling generally unwell
- chest pain, or pain with shortness of breath
- sudden severe pain with no obvious cause
Who should you see?
A physiotherapist, a sports rehabilitation therapist and a GP all assess muscle and joint pain, and for most injuries any of the three is a good first call. GPs are the right route for the red flags above and for anything that might not be a muscle or joint problem. Physiotherapists and sports rehabilitation therapists both assess and treat injuries using hands-on treatment and exercise-based rehabilitation. I am a sport and exercise rehabilitation therapist with an MSc in the subject, and most of my work is with people who are active and want to stay that way. You do not need a GP referral to book.
What happens at an initial consultation
An initial consultation at MG Rehab is an hour. We start with your history: what happened, what has changed since, what you have tried. Then a movement and strength assessment, and specific tests for the area to work out what is involved and what is not. Most people get hands-on treatment in the same session. You leave knowing what the problem is, what the plan is and roughly how long it should take.
Nothing about it needs preparing for. Wear something you can move in and bring your questions.
Frequently asked questions
How long should I wait before seeing a physio after an injury?
A few days of rest and gentle movement is sensible first. If it has not clearly improved after 7 to 10 days, or it is getting worse at any point, book. If you cannot bear weight, cannot use the joint or have any of the red flags above, do not wait at all.
Should I see a physio for a sprained ankle?
Yes if it is still swollen or painful to walk on after a week, or if you have sprained the same ankle before. A sprain that is not rehabilitated properly is the most common cause of the next sprain, because balance and strength around the joint do not come back on their own.
Does treatment hurt before it gets better?
Some hands-on treatment is uncomfortable, but it should never be more than you can tolerate and should not leave you in more pain than you arrived with. Rehabilitation exercises will often feel like work. If anything hurts sharply, we stop and change it.
Do I need a GP referral to see someone?
No. You can book directly with MG Rehab. If something in the assessment suggests you need a GP, imaging or a specialist, I will say so and point you in the right direction.
Should I keep training through pain?
It depends on the pain. Mild discomfort that settles within a day and is not getting worse week on week is often fine to train around, with some adjustment. Pain that is sharp, that changes how you move, or that is worse the next day is a signal to get it looked at before you load it again.
The cost of an assessment is an hour of your time. The cost of waiting is usually a lot longer than that.
This article is general information, not medical advice. If you are in pain or unsure about an injury, book an assessment.
