Why Your Pain Sometimes Gets Worse Before It Gets Better

Recently, we treated a patient in her mid-30s for tennis elbow. After a few sessions, she told us the pain had actually increased. This happens more often than you'd think. It doesn't mean the treatment isn't working. Here's why it happens.

It's not a sign that something's gone wrong. Usually, it's the opposite. Something has started.

At YAPCHANKOR, we'd rather explain this properly than let patients worry through it quietly. So here's what's actually going on in your body in those first few sessions. And why the timeline is completely different depending on whether the problem is in your muscle, your tendon, or your ligament.

The Paradox, Explained

Recovery isn't a straight line. Tissue that's been tight, guarded, or under-used for months, sometimes years, doesn't just switch from "stuck" to "free." It has to go through a phase where it's actively being worked on. And that phase can be uncomfortable.

Usually, three things are happening at once in those early sessions.

• Reactivation. An area you've been protecting has to start moving properly again. Muscles that haven't fired well in a while start firing. Joints move through range they've been avoiding. All of that creates real, temporary sensation.
• Manual therapy. Your therapist is working directly on tissue that hasn't moved well in a while. Deep tissue work and mobilisation change muscle tone and stimulate the tissue and nerves underneath. That triggers a small, local response: blood vessels open up, immune cells move in, a bit of fluid builds up. It's the same basic process behind muscle soreness after a hard workout.
• The herbal patch. Several of the herbs in our formulation are traditionally used to improve local blood circulation. In the first few applications, that can feel like warmth or a fuller sensation in the area. This is separate from the formulation's anti-inflammatory action. Laboratory research conducted by our research partner, Relivium Sciences (maker of PainFix products), with Monash University has shown this reduces key inflammatory markers such as TNF-α and IL-6.

None of this means treatment is making things worse. It means treatment is doing something.

Worth knowing: this works differently from an oral anti-inflammatory. NSAIDs genuinely reduce inflammation and pain. They mainly work by blocking the enzyme (COX) that produces inflammatory signals, quickly and throughout your whole system, for as long as they're active in your body. Our approach works locally instead. It aims to improve the condition of the tissue itself, through movement, manual therapy, and progressive rehab. That's part of why it can feel more active at the start rather than quiet. The tissue is being worked on directly, not just muted.

Why Muscle, Tendon and Ligament Don't Follow the Same Timeline

These three tissues heal at completely different speeds.

Muscle has a rich blood supply. Oxygen, nutrients, and repair cells reach it quickly. Soreness from reactivation or manual therapy usually peaks within 24 to 48 hours and settles within a few days.

Think about a Thai massage. The next day, you might feel more sore, especially around the spots where the masseuse worked out a knot. That's not damage. Working a knot creates small, local microtrauma in the muscle fibre and triggers a short burst of inflammation as your body starts repairing and lengthening the tissue. It's the same process as muscle soreness after exercise, and it settles on its own within a day or two.

If your issue is mainly muscular, the early flare usually settles fast. Real improvement often shows up within your first few sessions.

Tendon is a different story. Tendons get far less blood flow than muscle, and blood flow is what drives healing. Conditions like tennis elbow also aren't simple inflammation. They're tendinopathy: a structural change in the tendon's collagen, caused by load the tendon couldn't quite keep up with.

That's why a tendon can go through what's called a reactive flare. When new loading or manual pressure gets introduced, a tendon that's been under-used responds with swelling and pain, in proportion to that new load. This is a well-documented pattern in tendon rehab. It also tends to show up a little later than muscle soreness, often across the first several sessions rather than just the first one.

The repair itself is also just slower, by biology, not bad luck. Early repair tissue is a weaker, disorganised type of collagen. The body only starts converting it into stronger, properly aligned collagen after several weeks. The full rebuild takes even longer.

This is exactly why our therapists sometimes tell a patient with tennis elbow to expect more sessions before real improvement shows, compared to a straightforward muscle strain. It isn't a slow response to treatment. It's tendon tissue behaving like tendon tissue.

It's also why every YCK treatment plan follows the same three-phase structure, regardless of tissue type: Settle, calming the area down; Restore, rebuilding movement and mobility; and Strengthen, rebuilding the load capacity that keeps the problem from coming back. What changes between muscle, tendon, and ligament isn't the plan itself. It's how long each phase takes before you're ready to move to the next.

Ligament sits close to tendon here too: poor blood supply, slow to remodel, with the added job of keeping the joint stable. Rehab has to rebuild both tissue strength and the joint's sense of position. That's part of why a sprain that seems "healed" in a few weeks can still feel unstable for a while longer.

In short: if your pain is muscular, expect the early flare to settle quickly, and progress to show early too. If it's a tendon or ligament, expect the early phase to take a bit longer to appear, and the whole timeline to stretch over months rather than weeks. That's not a difference in treatment quality. It's just different biology.

The Old Injury Connection

An area that's been through pain before doesn't just carry old scar tissue. It can carry a nervous system that's learned to stay on high alert. Nerves in a site with a history of pain can become sensitised. A sensitised nerve releases chemical signals, like Substance P, straight into the surrounding muscle, tendon, or ligament. Those signals can contribute to real, physical swelling and extra sensitivity in the tissue itself.

That's why treating an old injury, especially one that's flared up more than once, can produce a stronger early reaction than a fresh problem would. It's not just the tissue reactivating. The nervous system supplying that area has learned to respond faster and louder. So the same treatment can genuinely feel more intense in the first few sessions. Our approach accounts for this. Calming an overreactive nervous system is just as much a part of recovery as treating the tissue itself.

What's Expected, and What Isn't

Most of what you'll feel in the early sessions is predictable, and it settles on its own. A few things are worth flagging to your therapist straight away.

Usually expected:

• Dull, achy, or stiff discomfort
• Spread across a broader area, not one sharp point
• Shows up within 24 to 48 hours of a session
• Eases with light movement
• Fades within a few days

Worth telling your therapist:

• Sharp, stabbing, or localised pain
• Pain that keeps getting worse rather than settling
• Numbness, tingling, or weakness
• A flare that feels worse each session, not gradually lighter

That timeline above is for muscle-type soreness. A reactive tendon flare can run longer, over several sessions rather than a couple of days. So for tendons and ligaments, duration alone isn't the red flag. What matters is direction: is it easing off session by session, or genuinely getting worse?

Mild soreness that settles within a day or two is usually fine to keep training through. Pain that keeps escalating, or badly limits normal movement, needs a reassessment rather than pushing on regardless.

A good recovery plan doesn't ignore this window, it plans around it. Loading gets introduced progressively rather than all at once, and your therapist checks in on how you're responding session by session, adjusting the intensity so the tissue is challenged enough to adapt, without going past what it can currently handle.

Why This Matters Beyond the Early Weeks

Treatment here isn't built to just take the edge off and send you home. The same approach that explains why you might feel more before you feel less is also what stops the problem coming back. Rather than just muting the pain signal, we work through the actual causes: restricted tissue, weak support, an overreactive nervous system. The goal is recovery that holds, not one that fades the moment treatment stops.

If you're a few sessions in and wondering why things feel more active rather than less, that's worth a chat with your therapist, not a reason to stop. Recovery isn't measured by whether each session feels easier than the last. It's measured by the trend over the weeks. One bad day tells you far less than the overall direction.

Ready to start, or want to check in on where you're at in treatment? Message us on WhatsApp to book a clinical assessment or speak to your therapist about what you're experiencing.