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19 June 2022

What to do after physiotherapy session

Posted By
- Amir Majidi is a sought after doctor who graduated from the prestigious New York Chiropractic College. He is pursuing to be an expert doctor in the fields of sports medicine, anti-aging medicine and other specialized areas of health. He has been involved with researching numerous topics relating to Biomechanics and Inflammation for lectures performed worldwide by Dr James Stoxen at Team Doctors for the American Academy In Anti-Aging And Regenerative Medicine And Congress On Anti-aging Medicine. Specialties: Sports Medicine - Anti-aging Medicine - Diet, Nutrition, Headache/Migraine, Training, Complex Pain etc

If you have never had a physiotherapy session before, it would be good to know what to expect. Although unlikely, sometimes a physiotherapy session may leave a patient feeling more sore, bruised, sensitive, and occasionally in more pain. This highly depends on the types of treatments performed by the Toronto physiotherapist. These are just a few of some normal reactions after having done a physiotherapy session. These post-session symptoms should be temporary and should not linger for more than 24-48 hours post-session. Keep in mind, one person’s reactions greatly vary from the next person e.g. one patient may feel sore and bruised, and the other may feel immediately better after a session. If you are wondering what the average cost of a physiotherapy session in Canada is, read this article

Here are some tips and advice to follow after finishing your physiotherapy appointment:

  1. Drink plenty of water: Replenishing fluids after physiotherapy will improve recovery times and possibly reduce post-session soreness and sensitivity. Water flushes toxins out of the body, transports nutrients into the cells and helps regulate body temperature and pH balance. Water also helps with muscle soreness and tension.
  2. Use ice or heat packs: Follow the advice of your physiotherapist regarding which to use. These can help decrease any soreness and sensitivity, while improving recovery. Generally speaking, do not use heat on acute injury (<1 week) because extra heat can increase inflammation and delay proper healing. For acute injuries less than 1 week old, it is usually best to choose ice. The cold constricts blood vessels which numbs pain, relieves inflammation and limits bruising.
  3. Exercises: If during your physiotherapy session you were required to perform a large number of exercises, it may not be a good idea to immediately perform another set of exercises when you get home. Allowing muscles and joints to recover will provide the best chance of the injury to heal. Ask your physiotherapist for specific advice regarding this topic. Generally wait a minimum of 4 hours before starting another set of exercises. Normally the patient will be required to perform a set of home exercises daily to provide pain relief, reduce symptoms, and increase overall healing outcomes.

Is This Normal After A Physio Treatment?

Yes. Although it can be intimidating to expect slightly increased soreness after your physiotherapy session, rest assured it is normal for up to 24-48 hours post-session. Please contact your physiotherapist if your soreness/pain does not settle after 24-48 hours.

Common Side Effects From Physiotherapy


In the course of treating your injury or condition, there may be techniques that involve moving your body part(s). Sometimes these movement-related techniques can cause increased pain/discomfort during or after the session. You will be guided by your physiotherapists on how much pain is normal during these techniques, as there should not be a dramatic increase in your pain or soreness.


Some treatments may include using the hands and pressure from the physiotherapist. Sometimes hands-on treatment may lead to mild bruising on the areas that were treated. Bruising in the treated areas after physiotherapy is normal and should subside within 24-48 hours. Bruising usually shows in a form of discoloration, usually yellow, purple, or a mix of both.


Headaches are a common symptom after physiotherapy due to the nature of the muscle areas being treated. Headaches are generally more common if the muscle areas treated were closer to the neck and head regions. Around the neck and head regions, there are nerve connections that can lead to headaches. The headache triggering after a session should not last too long, less than 24 hours. Your physiotherapist should give specific advice on how to manage headaches if they appear as a form of post-session symptom.


Similar to bruising, some of the hands-on treatment by the physiotherapist can lead to some form of redness appearing on the skin. This may be due to the pressure applied by the hands or the tools that the physiotherapists used in the session. Redness is a normal response after mechanical pressure is applied to the skin, and should subside within 24-48 hours at the latest. Your physiotherapist should be able to provide specific advice regarding redness if this is a post-session symptom for you.


Occasionally physiotherapists may be lotion or cream that have a possibility of irritating the skin, depending on the patient’s sensitivity. Although the lotion/cream used is usually neutral and hypo-allergenic, there is a small chance it can still irritate some patients’ skins. When skin irritation happens, it is best to protect the irritated area until it heals. For example, do not scratch or apply any other types of lotion/cream to soothe the irritation. The skin irritation should naturally subside on its own, within 24-48 hours. If the irritation does not subside within the suggested time, it is best to consult with a family doctor to take further actions. Also it will be a good idea to inform your physiotherapist so that he/she can avoid using the same irritant in the next physiotherapy session.


The best case scenario for most patients after a session is feeling better immediately. Due to the natural endorphin release of exercise and movement, most patients leaving a physiotherapy session feel immediately better, whether mentally and/or physically. This is the reason why physiotherapy treatments work and will continue to. The hormone release of endorphins has been known to be one of the main reasons people choose to exercise and stay physically active throughout life. It is proven that daily movement and exercise will provide a natural release of the endorphin hormones immediately post-exercise. Another reason why some patients feel better after a physiotherapy session is due to the effect of the pain gate theory, which states that exercise/movement is a stimulus that can act as a “distraction” or “alternative” signal that can help inhibit the pain-related signals going to the brain. This theory doesn’t tell us everything about pain perception, but it does explain some things. For example, after banging your finger on the wall, rubbing/shaking your hand might stimulate normal somatosensory input to the projector neurons. This may reduce the perception of pain.

Have you already made an appointment for physical therapy? Not yet? Then read our article about whether you need a doctor’s note to see a physical therapist.

What is the difference between physiotherapy and massage therapy

Massage Therapy vs Physiotherapy – What’s the Difference?

Both physiotherapy and massage therapy can provide relief from pain and discomfort while helping you return to optimal physical function. Physiotherapy is used for rehabilitating muscle and joint function, whereas massage therapy is commonly used for immediate relaxation of pain and muscle spasms. In the next paragraphs, you will learn the difference between physiotherapy and massage therapy, what they treat, the accreditation required for each profession, and the methods used by each of them. With this information, you will be equipped to make an informed decision about which health professional to see for your current situation.

Understanding the Physiotherapy vs Massage Therapy Difference


A person may seek physiotherapy treatment due to new, worsening pain; an ongoing condition that requires long-term management; post-surgery rehabilitation; or for preventative education and exercise. Physiotherapy may be the right choice if any of the following apply to you:

  • If you experienced pain or reduced motion in your body as a result of a specific event. For example, you hurt yourself while playing a sport, experienced a strain, were involved in a motor vehicle accident, etc.
  • If you underwent surgery that impacted your mobility or function. For example, hip surgery, knee surgery, ACL reconstruction, etc.
  • if you have or believe you may have developed an existing condition that impacts your mobility and would like to manage or improve your function. For example, lower back pain, arthritis, carpal tunnel syndrome, etc.
  • If you are looking to become more active, improve your range of motion, mobility, and incorporate more physical activity into your life.
  • If you want to reduce your risk of injury in sports or physical activity.

Massage Therapy

Massage therapy is a therapeutic treatment that focuses on manipulating the soft tissue of the body to reduce pain and discomfort. Massage therapy may be the right choice if any of the following apply to you:

  • If you have minor aches and pains caused by occupational stresses or intense workouts.
  • If you need relaxation from everyday pain and discomfort.
  • If you have chronic pain conditions that may benefit from soft tissue massage.
  • If you are looking to improve sleep.
  • If you suffer from headaches and are looking for relief.

Massage Therapy vs Physiotherapy – What They Treat

Physiotherapists have in-depth knowledge of how the body works and specialized hands-on clinical skills to assess, diagnose, and treat symptoms of illness, injury, and disability. Physiotherapy includes rehabilitation, as well as prevention of injury, and promotion of health, fitness, and optimization of athletic performance.

Physiotherapists can assess, diagnoses, and treat injuries such as repetitive strain injuries, rotator cuff injury, running injuries, sciatica, among many others. They also provide rehabilitation to post-surgery cases, for example, those who have undergone ACL surgery, hip replacement surgery, knee surgery, among others.

On the other hand, registered massage therapists’ hands-on skills are focused on their ability to alleviate pain and discomfort, release muscle tension, promote recovery, and prevent injury. Registered massage therapists are not certified to diagnose specific ailments, however, they can play an important role in rehabilitation once a diagnosis has been made.

Massage vs Physiotherapy – Accreditation

Becoming a licensed physiotherapist requires an undergraduate degree in a related health field, followed by a 2-year Master’s program. To use the title Physiotherapist, Physical Therapist, or PT, they must be registered with a regulatory college such as the College of Physiotherapists of Ontario.

Registered massage therapists are required to complete a 2-3 year Massage Therapy diploma program, and in order to use the designations Registered Massage Therapist (RMT) or Massage Therapist (MT) they must obtain a Certificate of Registration from the College of Massage Therapists of Ontario. Both physiotherapists and registered massage therapists are regulated by their respective Colleges in Ontario.

Physiotherapy vs Massage Therapy – Methods

As part of treatment, physiotherapists use a variety of modalities, including joint manipulations and mobilizations, laser, myofascial release, dry needling, shockwave, ultrasound, among many others. A key component of physiotherapy treatment is client participation in an exercise and strengthening program that complements and supports their return to optimal function. A physiotherapist may prescribe several exercises to do at home to relieve pain and discomfort.
Massage therapy techniques involve manipulating muscles and ligaments, kneading, gliding, vibration, compression, and stretching. These are all techniques which move the soft tissue of the body to relieve trigger points, improve circulation, and reduce muscle pain or stiffness, and improve overall function of the body. Massage therapy also offers added mental health benefits to help patients manage stress and anxiety.

Does physiotherapy cure sciatica?

1. Sciatic Nerve

You may have heard of something called sciatica. Sciatica is the medical term for pain traveling down the line of the long sciatic nerve that originates in your low back and runs down the back of the leg down to the foot. Sciatic pain can be extremely intense and is described as shooting, sharp, tingling, numbness, pins and needles, and may lead to weakness, loss of sensation or any combination of these symptoms. If you have any sciatica-related symptoms, you should immediately consult with a family doctor or a physiotherapist to ensure that you do not have any cauda equina symptoms, which is a form of an emergency situation. These symptoms include loss of sensation in the saddle region, sciatic pain in both legs, loss of bowel or bladder control, observable clumsiness, etc.

The treatment strategies for sciatic depends on the original cause of the nerve irritation. Generally, nerves get compressed and irritated secondary to disc herniations/protrusions/bulges, joint degeneration, inflammation, or muscle tension. Treatment for these pathologies differ, and will be further altered with associated nerve irritation. If you have nerve irritation of any kind, it is best to consult with a physiotherapist who is knowledgeable and competent in low back specific injuries. Usually a combination of manual therapy and exercises can resolve most sciatica-related issues.

Here is one common exercise for nerve irritation called nerve flossing:

  • Lay on your back and bring the knee of your affected side to 90 degrees.
  • Hold your foot flexed while you bend and straighten your knee as much as possible without eliciting pain or other symptoms.
  • Do 15 reps slowly and smoothly with no holds. Repeat 2-5 times per day. Note: This exercise is meant to be done pain free. If it causes the pain or numbness in your leg to be or exaggerated, stop the exercise and discuss it with your physiotherapist.

2. Facet Joints

Facet joints are small joints where the two vertebrae meet. In your lower back, these are called lumbar facet joints. Often facet joint injuries come from forced compression or extreme load, which can jam and compress the joint surfaces together. When the lumbar facet joints get irritated, there can be referral pain down into the glutes, hips, and sometimes the legs.

Facet joint injuries usually have a directional preference to help relieve symptoms, and allow for exercises without pain. In this case, it is flexion-based or bending forward. These can be referred to as “joint-opening” exercises. You can find relief by using flexion-based positions or movements to take the pressure off the irritated joint surfaces.

Here is one example of a gentle flexion based exercise:

  • Lay on your back and bring both knees to your chest.
  • Hold 30 to 60 seconds. Repeat 2 -5 times per day. Note: This exercise should always relieve symptoms, never exacerbate them. If you find this exercise is making your pain or symptoms worse you may have a wrong or incomplete diagnosis. Stop the exercise and consult your physiotherapist.

3. Sacroiliac Joints (SIJ)

The SI joints are a pair of joints that are part of your pelvic girdle. Usually pain and symptoms related to the SIJ are associated with pain in the low back and pelvis, but can refer all the way down your leg and into your foot. Treatment for this joint commonly involves mobilizing the joint to get it moving, and core exercises to stabilize it.

One exercise to mobilize the SIJ goes like this:

  • Place the foot of your affected side on a chair.
  • Rock your hips forward and back into a lunge while keeping your body upright.
  • Repeat this 15-20 times as a slow, rhythmical movement. Note: This exercise should be done every hour or two to keep the joint moving. Do not perform this exercise through pain. It should be relieving or neutral, but not irritate your symptoms.
    If the SIJ is inflamed it can be very tricky to find the right combination of treatments to settle it down. In this case, rest with ice can be helpful. It is best to consult a physiotherapist to fully assess and diagnose the situation.

4. Muscles

Muscle-related pain may be one of the most common pain. When we talk about muscle pain, we are usually talking about pain caused by trigger points. Trigger points are hyper-irritable muscle fibers that have a problem with their neuromuscular system, essentially the connections between your brain, nerves, and muscles to create movement.

Trigger points commonly have referral patterns associated with them. Most commonly, low back and hip muscles often refer pain into the glutes, down the back/side of the legs and potentially all the way down to the foot.

Here is how to roll your glute muscles:

  • Sit on the floor with your knees bent and your affected side on a small sports ball (tennis ball or lacrosse ball).
  • Find a sore spot and stay stationary on it for 15-20 seconds. Move only slightly and repeat.
  • Do this for 1-5 minutes every day or every second day. Note: Always consult with your physiotherapist to ensure the technique of the rolling is appropriate for what you are experiencing.

5. Discs

Intervertebral discs injuries are quite commonly found within sciatic-related injuries. Intervertebral discs are structures that look like “squishy donuts” placed between vertebrae to make up your spinal column. Injuries to these structures involve tearing, bulging or ruptures to the outer fibers of the disc.

Most disc injuries have a preferential direction of extension, which can be used to treat the disc and alleviate symptoms. In some cases there may be a flexion-preference. Your physiotherapist should be able to assess and decide which direction is preferable to you.

  • Lay on your stomach, keeping your back relaxed and do a mini push-up with just your arms.
  • Hold for 1-2 seconds, and repeat 10 times every few hours. Note: Do not push through pain. This exercise should always be relieving. If you are experiencing pain while doing this exercise, stop and consult your physiotherapist before continuing.
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