Can Physiotherapy Help With Chronic Pain?

More common than most people realise. Almost 1 in 5 Australians aged 45 and over (around 1.6 million people) were living with chronic pain in 2016 ². It isn't a fringe problem, and it isn't something you've been unlucky enough to be singled out for.

The same data gives a sense of what it costs people. Australians over 45 with chronic pain were five times as likely as those without it to be "limited a lot" in their daily activities, and 2.7 times as likely to have been dispensed pain medication ². That first figure matters for everything below, because it points at the thing worth treating: what the pain has taken off you, as well as the pain score.

The definition is simple. Pain that persists or keeps coming back for more than three months is chronic pain ^1,4. That's it: it's about duration, not severity, and not about whether anyone has found a cause.

Clinicians generally sort it into two broad groups ⁴. Chronic secondary pain is pain where an underlying condition adequately accounts for it: osteoarthritis, rheumatoid arthritis, a spinal cord injury. Chronic primary pain is pain with no clear underlying condition, or where the pain and its impact are out of proportion to any injury or disease you can observe. The two can sit together in the same person, which is part of why this gets confusing.

Pain is also individual. Every person experiences it differently, and it can range from mild to severe ¹. Two people with the same scan result and the same diagnosis can be living completely different lives, and neither of them is doing it wrong.

Yes, with a caveat attached, and you deserve both halves of that answer.

The yes: Healthdirect lists physiotherapy as one of the recognised options for managing chronic pain, alongside medicines, psychological therapies, relaxation techniques and physical activity ¹. It isn't an alternative therapy or a long shot. And Healthdirect is firm on the broader point underneath it: people who actively manage their pain in these ways see more improvement in their mood, their health and their ability to function than people who only use medicines ¹.

The caveat: the research behind exercise-based approaches specifically is weaker than the confident marketing around it suggests. The biggest available synthesis pulled together 21 Cochrane reviews, covering 381 studies and 37,143 participants, and its authors' own conclusion was that the quality of the evidence is low, largely because the individual studies were small and underpowered ³. There were favourable effects on pain severity, but they were mostly small-to-moderate and they weren't consistent from one review to the next ³.

Here's the part we think is most useful to know. Physical function held up much better than pain intensity did. Function improved significantly in 14 of the reviews, though again with only small-to-moderate effect sizes ³. The UK's NICE guideline reaches the same place from a different angle, advising clinicians to discuss with patients that there can be improvements in quality of life even if the pain remains unchanged ⁴.

That distinction runs through this whole topic. Physiotherapy for long-term pain is much better understood as a way to make your life bigger than as a way to make your pain number smaller. Sometimes both happen. The first is the one you can more reasonably expect.

One more thing that review found: it's safe. Only a quarter of the studies actively reported on adverse events at all, but where they did, the problems were mostly increased soreness or muscle pain that settled after a few weeks ³.

Supervised, graded exercise. NICE recommends offering a supervised group exercise programme to people aged 16 and over for chronic primary pain, taking individual needs, preferences and abilities into account ⁴. Note both words: supervised, and individual. The supervision isn't supervision for its own sake; it's what stops the most common pattern in long-term pain, where a good day gets overdone and costs you the next three. Building that progression is what our exercise prescription and conditioning work is for.

Understanding your pain, but paired with movement, not instead of it. Pain education on its own is weak. When researchers pooled the trials, the effect on pain was of low clinical relevance and the confidence interval crossed zero, meaning no reliable benefit; the only clinically relevant short-term result was on fear of movement ⁶. Combined with exercise, it does better: an Australian-authored review of five high-quality trials (460 people) found pain education plus exercise beat exercise alone over the first 12 weeks for pain, disability, fear of movement and catastrophising ⁵.

We'd rather you knew the limits of that second finding too. The authors graded their own certainty as low for the pain and disability results, moderate only for fear of movement, and very low for catastrophising, and long-term data existed for just two of the five studies and couldn't be pooled at all ⁵. So: understanding what's happening in your body helps, especially in the first few months, and especially when you're also moving. Nobody has shown it still helps at two years, because nobody has properly looked.

Psychological therapy, where it fits. NICE suggests considering acceptance and commitment therapy (ACT) or cognitive behavioural therapy for chronic pain ⁴. That sits with a psychologist, not with us, but it's part of the same mix of approaches Healthdirect describes ¹. It isn't a suggestion that your pain is imaginary.

There isn't one, and that's a real finding, not a dodge.

The Cochrane overview covered aerobic exercise, strength work, flexibility, range-of-motion training, core and balance work, yoga, Pilates and tai chi, and no single mode came out on top ³. NICE's recommendation doesn't name an exercise either; it names a format (supervised, group-based) and a principle (built around your needs, preferences and abilities) ⁴.

So the most useful answer to "what's the best exercise" is the one people find least satisfying: the one you'll keep doing, started below the level that flares you up, and progressed in steps small enough that you don't get knocked back. The dose and the progression matter far more than the choice of activity.

You won't find this part on many clinic websites, and it's the reason we wrote this page.

For chronic primary pain, NICE says do not offer TENS, ultrasound or interferential therapy, "because there is no evidence of benefit" ⁴. Those are still advertised by some physiotherapy and allied health providers in Australia. If you're offered one as the centrepiece of a long-term pain plan, it's fair to ask why.

The guideline is equally blunt about medicines for chronic primary pain: don't initiate opioids, paracetamol, NSAIDs, gabapentinoids, benzodiazepines or corticosteroid trigger-point injections ⁴. Healthdirect makes the same point for an Australian audience: opioids are not usually recommended for chronic non-cancer pain ¹.

Two qualifications on that. First, these recommendations only cover chronic primary pain. If your pain has a clear underlying condition driving it, the picture is different, and that's a conversation for your treating doctor. Second, medication decisions aren't ours to make. Physiotherapists don't prescribe or administer medicines. We're telling you what the guidelines say so you can have a better conversation with your GP, not so you can change anything on your own.

Everything above is why our approach to long-term pain looks different from our approach to a fresh ankle sprain. Our chronic pain management page goes through what an appointment involves, but the short version is that the first session is longer on questions than you'll expect, and what you leave with is a structured program with a defined reassessment point, not an open-ended run of bookings.

Hands-on work (manual therapy, dry needling where your assessment points to it) has a place. We use it to make movement more comfortable so the active work is possible. It opens a window; it isn't the plan.

Funding is a barrier for a lot of people with long-term pain, so it's worth saying: Well Motion is a registered NDIS provider and works with WorkCover claims, and long-term pain is a common reason for both. Those have their own pages: NDIS physiotherapy and WorkCover physiotherapy, or just ask when you book. You don't need a GP referral to book with us privately.

Some days it isn't manageable, and pretending otherwise doesn't help anyone.

Flare-ups are an expected part of chronic pain, not a sign you've failed at managing it. NICE includes fluctuating symptoms and flare-ups in what clinicians should discuss when setting up a care plan, along with the possibility that a cause may never be identified ⁴. If you're flaring and it isn't settling, the right move is a reassessment and a look at whether the plan still fits, not gritting your teeth harder.

See your doctor rather than working through it alone if the pain is getting worse, if it's stopping you doing things you need to do, if it's affecting your sleep or your mood, or if what you're currently doing has stopped helping ¹.

And if it has got to the point where you're struggling to cope, or you're having thoughts of harming yourself, please talk to someone today: your GP, or a crisis support line. That's not a physiotherapy problem and we won't pretend to manage it, but it's common enough alongside long-term pain that it belongs on this page.