The most common physical therapy mistakes are relying too much on scans, fearing all pain, pushing through every flare-up, expecting a quick fix, and ignoring daily habits like sleep and walking. Each one can slow your recovery. Avoiding them often matters as much as the exercises you’re given.

I’m Chris Keith, and I’ve had over 30 years of personal training in San Diego. Many of my clients start with me after physical therapy, so I see these patterns often, and I see how much faster people progress once they move past them.

Physical therapy mistakes guide: Chris Keith rowing on a Concept2 RowErg in his private Bay Park studio in San Diego

Mistake 1: Is relying on an MRI one of the biggest physical therapy mistakes?

It can be. When a knee, shoulder or back starts hurting, it feels logical to get an X-ray or MRI and “find the problem.” However, scans often show changes that have nothing to do with your pain.

For example, a 2015 systematic review by Brinjikji and colleagues in the American Journal of Neuroradiology looked at spine scans of 3,110 people with no back pain. Disc bulges showed up in 30% of 20-year-olds and 84% of 80-year-olds. Similarly, a 2014 review in the Journal of Shoulder and Elbow Surgery by Teunis and colleagues found that rotator cuff changes become more common with every decade, whether or not people have symptoms.

In other words, many “abnormal” findings are a normal part of aging. Also, a scary-sounding report can make people afraid to move, and fear tends to slow recovery. Of course, imaging matters in some cases, such as after a fall or accident, or with serious nerve symptoms. Your doctor decides when you need one.

Mistake 2: Why is fearing pain a problem?

Pain is real, but during rehab it usually isn’t a sign that you’re damaging tissue. Still, many people stop an exercise the moment they feel anything. Then they do a little less each week.

As a result, the amount you can do before pain starts keeps shrinking. Eventually, everyday things like stairs, golf or carrying groceries feel out of reach. That’s why understanding your pain is so useful: the better you understand it, the less it controls you.

Keep in mind there are clear exceptions. For instance, sharp pain after a fall, a joint that gives way, or pain with swelling, fever or numbness needs a doctor, not a workout.

Mistake 3: What happens when you ignore pain completely?

The opposite mistake is “no pain, no gain.” Pushing through a big flare-up can knock you back for days. Then you rest, try again at the same level, and flare up even sooner. This boom-and-bust pattern is one of the most common physical therapy mistakes I see.

Instead, use two simple checks:

  • During exercise: is the pain tolerable? For many people that’s somewhere around 3 to 5 out of 10.
  • The next day: is your pain better, worse or the same? If it’s clearly worse the next morning, do a little less next time.

So the goal is the middle ground: not complete rest, and not all-out effort. I explain this next-day check in more detail in my guide to tendonitis strength training.

Mistake 4: Why doesn’t a quick fix work?

Online, there’s always a “one exercise” that promises to fix your back or shoulder overnight. Usually, one of two things happens. Either it doesn’t help, and you wonder what’s wrong with you. Or it helps for a day, then the relief fades.

The same goes for massage guns or hands-on treatment you’ve relied on for months without lasting change. These can feel good, and that’s fine. However, real progress usually comes from the basics:

  • Changing the activities that keep flaring things up
  • Gradually increasing the load your body can handle
  • Slowly returning to movements you’ve been avoiding
  • Tracking how you respond, and adjusting

Even surgery has limits. In a 2014 BMJ review by Wartolowska and colleagues of 53 trials comparing surgery with placebo surgery, the placebo group improved in 74% of trials. Also, in about half of the trials, real surgery did no better than placebo. Surgery is sometimes the right call, of course, but it doesn’t replace the work that comes after.

Mistake 5: How do daily habits affect physical therapy?

Your physical therapist focuses on the painful area, because that’s why you’re there. However, your overall health affects your joints, tendons and muscles too. Short sleep, lots of sitting and very little movement can make recovery slower.

For example, the CDC recommends that adults get 150 minutes of moderate activity a week plus muscle-strengthening activity on 2 days. A daily walk is an easy place to start. In fact, for many people, a 30-minute walk and a good night’s sleep help more than any single exercise. Changing habits isn’t easy, so start small.

How do you avoid these physical therapy mistakes after PT ends?

Avoiding physical therapy mistakes gets harder once your visits end. Insurance often covers a set number of sessions, but full strength can take months longer. That gap is where many people stall or slide back into old patterns.

That’s what my strength training after physical therapy program is built for. In private 1-on-1 sessions, we keep building on what your physical therapist started. We progress the load gradually, use the next-day check, and fold in walking, sleep and everyday strength. Many of my clients are in their 40s, 50s and 60s, so my training for adults 40+, 50+ and 60+ often goes hand in hand with this work.

If your home exercises have started to feel too easy, see my guide to upgrading 5 common rehab exercises.

The studio is at 5260 Riley St in Bay Park, an easy drive from Clairemont, Point Loma, Pacific Beach, Mission Valley and Old Town. Sessions are 1 hour, by appointment only. See packages on the rates page, or text Chris at (619) 840-9099 for a free consultation.

Frequently Asked Questions

Do I need an MRI before starting physical therapy?

Often not. Many back, knee and shoulder problems are treated well without a scan, and scans often show age-related changes that aren’t causing pain. However, imaging can be important after a fall or accident, or with serious nerve symptoms like weakness or numbness. Your doctor or physical therapist can tell you whether you need one.

Is it normal to feel some pain during physical therapy exercises?

Yes, mild pain during rehab exercises is common and usually doesn’t mean you’re causing damage. Many people work at around 3 to 5 out of 10. The key check is the next day. If your pain is clearly worse the morning after, reduce the amount you did. Always follow your physical therapist’s guidance.

Why does my pain keep coming back after physical therapy?

Often it’s the boom-and-bust pattern: doing too much on a good day, flaring up, resting, then repeating. Another common reason is stopping strength work when formal physical therapy ends. Steady, gradual progress over several months, plus good daily habits like walking and sleep, usually works better than bursts of effort.

How long does recovery take after physical therapy?

It varies a lot by injury and person. Formal physical therapy often lasts a few weeks to a few months, but rebuilding full strength can take longer. Expect steady progress rather than a quick fix, and track what you can do, such as walking farther or lifting more, not just your pain level.

Can a personal trainer help after physical therapy?

Yes. Once your physical therapist clears you, a trainer can keep progressing your strength in a structured way. Chris Keith trains adults 1-on-1 at his private studio in Bay Park, San Diego, and works alongside your doctor’s or physical therapist’s guidance. Text (619) 840-9099 for a free consultation.

Ready to keep your progress going? Text Chris at (619) 840-9099 for a free consultation, or use the contact page.

This article is general information, not medical advice. If you have pain or an injury, follow your doctor’s or physical therapist’s advice.

Research and Guidelines Cited

Chris Keith has over 30 years of personal training in San Diego (since 1995) and was voted Best Personal Trainer by San Diego Magazine.