Almost everyone knows pain. You bang your knee, sprain your ankle or feel sore after a hard training session. Usually we understand fairly well why it hurts, and the pain goes away on its own.
But what if pain persists? What if an injury should have healed long ago, yet moving still hurts? Or when scans and tests show no clear damage, while you are very much in pain?
To understand persistent pain, it helps to first understand what pain actually is.
We often think of pain as a direct measure of damage in the body.
more damage = more pain
It is not that simple. Pain is a protective experience that arises when your nervous system and brain decide your body needs protecting. Information from your tissues, the nociceptive signals, plays an important part, but other factors weigh in too. Think of previous experiences, fatigue, stress, sleep, expectations, and how safe or threatening a particular movement feels.
That does not mean pain is “all in your head”. Pain is real. It does mean that the amount of pain you feel does not always tell you exactly how much damage there is in your body.
A useful comparison is a smoke alarm. A good smoke alarm goes off when there is a fire, but not when you light a candle during a nice dinner with your partner. An oversensitive smoke alarm goes off too easily, and that ruins a romantic evening for two. You would think something can be done about that. And you guessed it: it can! Our pain system can become oversensitive in a similar way, and fortunately something can be done about that too.
Lorimer Moseley, professor of clinical neuroscience, explains in five minutes how a pain system becomes overprotective and how to calm it down again. The video comes from Tame the Beast, an education project by his research group.
Want to know more about pain? Visit tamethebeast.org.
The signal from the tissue is only one of the inputs to your alarm. Click, line by line, what plays a part for you and watch what the dial does. The left side turns it up, the right side turns it down.
With acute pain there is usually a clear cause. You sprain your ankle, cut your finger or have just had surgery. In that situation pain has an important job. It prompts you to protect the affected body part for a while so that healing can take place. This is nociceptive pain, driven by signals from the tissue itself.
As the tissue heals, the need for protection normally fades. You can do more and more, and the pain usually eases gradually.
Acute pain is therefore a useful alarm signal:
“Pay attention. Let's be careful with this.”
We usually speak of chronic or persistent pain when pain lasts longer than three months or keeps coming back. Persistent pain does not automatically mean there is still tissue damage.
In some conditions there is a physical cause that keeps driving the pain, for instance an inflammatory process or damage to a nerve. But in persistent musculoskeletal pain the nervous system itself can also become more sensitive. This is called sensitisation. The protective system has, in effect, learned to raise the alarm sooner.
Movements or loads that used to be normal can start to feel painful. Sometimes even the expectation of pain, or uncertainty about a movement, can influence the protective system.
The pain at that moment is still completely real. Only the link between pain and damage has become less direct.
This is an important difference. When you have been in pain for longer, it can feel logical to move less and less:
“If this hurts, it can't be good.”
In the short term, avoiding can feel better. But when there is no longer a medical reason to avoid a movement, prolonged protection can make your body less and less used to load.
Your fitness and strength can decline, movements can become more daunting and the confidence in your body can fade. That is how a vicious circle can form:
That is why recovery from persistent pain does not always mean searching for a single damaged structure that we can “repair”. More often it is about rebuilding confidence, capacity and freedom of movement.
No.
The goal is not to ignore pain or to push yourself through every pain. Pain remains information we take into account. But with persistent pain we look at more than just the pain score. For example, we look at:
From there we build up load step by step. An increase in pain during or after movement does not automatically mean new damage. Sometimes it is a sign that the protective system still needs to get used to a load that can safely be built up.
Perhaps the most important thing to know is that a sensitive pain system is not fixed. The nervous system can adapt. By understanding pain better, building new positive experiences with movement and increasing load gradually, the body can learn again that movement is safe. That process is different for everyone. With persistent pain there is rarely one exercise or treatment that works for all.
At Movement Based Therapy we try to work out together why your pain persists and which factors play a part for you. We then use movement and training to rebuild confidence and capacity step by step. Not only to have less pain, but above all to get back to the things that matter to you.
Persistent pain can be frustrating. Especially when earlier treatments did little, or when nobody can properly explain why you still hurt. Looking at pain differently can then be an important part of recovery.
Pain means your body is asking for protection. But protection is not always the same as damage. By understanding what is happening, we can work out which load is safe, give your body back its confidence step by step, and let you experience that moving is safe.
That is where we want to get to at Movement Based Therapy: not just treating where it hurts, but helping you trust what your body can do again.
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Persistent pain? Book an intake at the location that suits you best. Together we look at why your pain persists and build from there. No referral needed.