Gauging and Judging Pain in Physical Therapy

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From year of experience doing physical therapy (shoulders 2, back and legs 2); a common reoccurring theme is pain: the recovery process for any injury involves this subjective, "you'll know it" pain scale rating. I feel like this disconnect between me (and multiple other trainers in the past) where I don't know if he's assuming I'm being overly-cautious, and saying "I think you're fine", or I'm just projecting uncertainty about how severe my pain is, so he takes that self-doubt as "Well I guess it isn't that bad". I have spent so long trying to get this right with the stretching, pushing it to the limit with exercises without exceeding that mysterious "threshold" that enters into "muscle tearing" territory. Am I pushing too hard, aren't I...I seriously don't know, and I get this feeling of "Jesus kid, you should know what I'm talking about." No, actually I don't, and I'm frustrated that these physical trainers expect me to know the relationship between the pain that I'm feeling and the microscopic effects that's going on with my muscles.

My issue is my uncertainty about pain, my fear of pissing off the physical therapist, my possible overcompensation of that fear by way of blowing a little pain out of proportion, my hypersensitivity to that pain, and my tendency to act tough (even to an extent where I downplay my pain even in my own self-talk). At the core of it all, persistent problems have me asking, have I totally over or under estimated what pain the physical therapist is referring to?

I think you have to know yourself. If you tend to hurt yourself by being unaware what you're doing, then ignoring pain is probably a bad habit you shouldn't continue. If you don't have a pattern of winding up in pain or injured because you didn't notice you were doing something that wound up hurting you, then if the PT seems useful, that's fine.

But if your facial expressions confuse a trainer or physical therapist and you express that you're uncomfortable/in pain in a way that surprises them, they may have trouble processing the discrepancy between your words and how they think you look.

In my stroke rehabilitation this issue of trying to figure out what is too little and what is too much is a constant issue. I don't want to delay recovery or prevent some it from occurring by doing too little, but I don't want to do too much and injure something and have to start all over again. Adding to the issues is Autistics often are hyper or hypo sensitive. To me my amount of pain tolerance may seem normal but may not be.

Unlike Autism, Psychical rehab is common and everyone has a need to share an opinion even though every situation is different.