From a young age, we all learn how pain occurs naturally in response to injury. Most of the time, it makes sense that something would hurt, such as when we roll out onto our ankles or trip down stairs. At other times pain can be more mysterious.
You might notice pain bothers you more when you’re feeling down or stressed than when you’re at a fun event with others, or you might continue to feel pain in an area that was injured months or years ago, even though the tissue injury seems to be well and truly healed. For some of us, pain becomes an inescapable part of everyday life, reminding us of an injury every time we move, affecting our mood, and our ability to enjoy daily life with our loved ones.
There’s so much to consider when it comes to the complex topic of pain, so we’ve taken a closer look at where pain really comes from, why you feel pain when you do, and why working with a physiotherapist who understands the connection between the brain and body is so effective in helping you find relief, giving you the freedom and mobility to achieve your goals and feel more in control of your life.
Is Pain Helpful?
Pain is an incredibly helpful biological response designed to protect us and promote our health and wellbeing. When our body feels pain, it is letting us know about an injury, problem, disease or other warning sign. This helps us to behave in ways that will protect our body and keep ourselves safe, whether that involves immediately stopping what we are doing to prevent an injury from worsening, tending to the injured area to prevent infection, resting to help it heal, or seeing a health professional to uncover what’s going on and seek treatment.
Where Does Pain Come From?
Feeling pain is a combination of both input and output from your brain and body. When we injure ourselves, our body recognises a range of different inputs (we’ve detailed what these are below), and sends these pieces of information up to our brain. When our brain receives these inputs, it analyses these pieces of information and decides whether something is threatening or not. If it decides that you’re in danger or need protection right here and now, it will normally create pain as an output and make your body hurt, so that you hopefully stop whatever it was you were doing that’s causing you harm. If not, it might be a less noticeable and smaller twinge.
Inputs can include pressure (touch), mechanical (movement), thermal (heat), chemical, and nociceptive sensors. Nociceptors are a receptor that tells your brain information about how much danger there is in a certain situation. All of these receptors are like dials, giving a small or large input. For example, when you touch a hot frying pan, your body activates thermal, pressure and nociception receptors and sends this information to your brain, which then creates an output of pain so you can remove your hand to prevent further burn injuries.
Why Can Pain Become So Unhelpful?
We can also use this knowledge about pain to understand why we sometimes experience so much more pain than what is happening in our body. When we’ve been in pain for an extended period of time, whether that’s a few weeks or a few years, it often doesn’t take much to flare up that injury again. This is because when we injure ourselves, whether it’s our knee, ankle or back, our body ignites a large number of nociceptors in that area. It’s our body’s way of saying “I want to look after this area, let’s keep a closer eye on it”, so we end up becoming more sensitive to pain in that area, and more likely to protect it from further injury. This response can become amplified when the body has had input from that area for a long period of time.
In this same situation, the threshold of these receptors before they send off pain messages is also decreased, which means that they send off warning signals to the brain even when only touched very lightly, moved gently, or even when no damage is done to the tissue at all, creating false pain messages. Ultimately, the input from our receptors can become so sensitive that our brain over-protectively exaggerates pain, and we feel much more pain over time than we normally would.
How Our Brain Affects Our Pain
Our learnt experiences, beliefs, and pain memories can strongly affect how our brain perceives the input of pain. When we’ve had an injury, we may find that every time we do a certain activity it can make the injury flare up again and feel worse. This might even be a safe activity that does not cause damage, such as reaching to pick up a water glass, but it may still cause significant pain. In cases like this, the nervous system may have become so sensitive that the small inputs involved in the simple action of stretching your arm trigger your brain to think “I remember that time you did something similar to this and it caused a lot of damage, so I’m going to send you a huge output of pain to prevent you from doing this, just in case it causes more damage.”
You may also find that even though you have damage or injury, the amount of pain you’re perceiving is never consistent – it changes depending on your context. If you’ve had a really stressful day, and are feeling overwhelmed and exhausted, then stubbing your toe on the coffee table may feel excruciating. In another context, you may hit your head while at a birthday party on a joyous summer’s day and hardly notice the pain, because your brain is happy and distracted. Same injury, different context – different pain.
How Can A Physiotherapist Help To Manage Your Pain?
Physiotherapists can work alongside you to manage any type of short or long-pain, including headaches, muscle pain, joint pain, nerve pain, repetitive stress injuries and conditions such as arthritis and fibromyalgia. Our physiotherapists are highly experienced in a range of evidence-based approaches to alleviate pain, and work with you by:
- Listening To Your Story
The most important part of pain management involves listening to what is happening and how your pain feels to you. No one knows your individual experience of pain or the journey that you’ve been on, so our physiotherapists seek to gain a thorough understanding of any past injuries you’ve had, what you’ve tried that works and what doesn’t, any health diagnoses, and how your pain affects you and your life. We can talk to you about your goals, what it is you’d like to be able to do, and how we can work with you as a team to help you to achieve them, through a personalised treatment plan that works for you.
- Performing An Objective Evaluation
Our physiotherapists can use a range of gentle assessment techniques to take a closer look at the areas that are causing you pain, and analyse any potential changes to your muscles, tissues or joints, to gain a comprehensive picture of what areas need support to heal and why certain areas may be triggering pain.
- Providing Education About Pain
We work alongside you to help you understand the mechanisms behind how pain is created, and how your unique memories, emotions, thoughts, beliefs, and expectations can alter how pain is produced and how you perceive pain. This is very effective in pain management, and can shorten your overall treatment time. When you understand why things hurt more on a particular day, it can remove some fear and empower you to try changing the way you’re doing something that may change the input to your body, and reduce your brain’s output of pain.
- Motivating And Prescribing Movement
While there’s no ‘right’ or ‘wrong’ way to move, some techniques may trigger more pain for you than others. Many people reduce their movements when in pain, but without the right knowledge, these can actually continue to produce or exacerbate your pain. Our physios can help you alter some of the movement inputs from your everyday life so that your brain is less concerned about the threat of danger or injury, and sends out less pain signals. We can also prescribe exercises that are safe, new, and enjoyable for you to help rewire the brain’s output of pain and while strengthening your muscles and improving your fitness – which can also help to reduce pain. We can educate you how to pace your activities without increasing your pain, and improve your ability to do the things you love.
- Using Manual Therapy Techniques
Our physiotherapists can also use a number of hands-on manual therapy techniques to help alleviate pain. For those with heightened pain and sensitive nervous systems, we can use gentle, non-painful techniques to improve your tissue health without further sensitising it.