Creating pain for gain

On a previous placement, I was working with chronic stroke patients who presented periodically to the outpatient gerontology clinic. The main issues they seemed to have were difficulty walking due to poor weightbearing on their affected side contributing to poor weight translation on to the unaffected leg. Their weight is predominantly on the unaffected side already. This means the patient will abduct and/hip hike with the affected limb to clear it through the decreased swing phase in combination with the increased lower limb tone. These patients were presenting to me at least ten years post stroke, so the habits they had formed to enable ambulating were quite strong. However, if you imagine this gait pattern, you can easily see how balance becomes an issue as they are prone to overbalancing on their unaffected side.
I spoke to my supervisor after assessing such a patient, with the plan to improve the patient's weight transfer, first in sitting then standing, and progress to gait retraining. I was also going to implement some spasticity reducing techniques. My supervisor gave me the go-ahead. I found, though, that the weight transfer strategies were not working well and the patient's really struggling to complete the task. I went back to my supervisor for assistance and she suggested SIMMS. The idea of these is to release the soft tissue by pressure application to trigger points in the muscle belly followed by release in the direction of the muscle fibers (usually towards the origin) and forcing the joint the muscle crosses into further range that stretches the muscle. My stroke patients had complained of pain between the first and second metatarsals but I had placed it low on the priorities, until now. I began focusing the SIMMS on between the metatarsal heads and in the soleus of the affected leg. The patient was immediately in so much pain that I felt I should stop. My supervisor recommended I continue until release was apparant. However,I had to dodge and block the patient's flailing arms and legs trying to kick out at me, and listen to a lot of painful moans. I felt terrible. But when I reassessed his gait, the difference was amazing.
Instead of leaning heavily on the walking stick and being overbalanced on the affected side, the patient could weightbear on both limbs, take nearly equal steps and naturally began to flex at the hip, and more importantly, dorsiflex and plantarflex the ankle to clear the foot. I was amazed, it was such a difference and the patient really appreciated it then.
Therefore, if you know there is a benefit to the technique, sometimes you have to coax a patient through pain in order to get the best result for them. I could do more for my patient through the painful way (and yes, he did come back) then I ever could have doing sitting weight transfer techniques. So if you know you will make the difference, go for it!