Imagine you injure your ankle. It swells, it hurts — but over a few weeks, it heals. The pain fades. That’s how pain is supposed to work.
But what if it doesn’t?
What if you’re still in pain weeks, months — or even years — after the injury has healed?
Welcome to the world of chronic pain — a condition experienced by 1 in 5 Australians, where pain continues long after normal tissue healing has taken place.
As physiotherapists, we often hear:
- “But nothing showed up on my scan.”
- “I just want someone to fix me.”
- “Is it all in my head?”
The answer is: No, your pain is not imaginary. But it may not be where you think it is either.
Pain Isn’t Always About Damage
Traditionally, we believed pain meant damage. You injure a muscle or joint, and it hurts — simple. But modern pain science paints a more complex picture.
Pain is a protective message from your brain. It’s your brain’s way of saying, “Something could be wrong — let’s be careful.”
Pain is real — but it’s not always a direct sign of physical damage.
So Why Do I Still Hurt?
There are a few key reasons why pain might stick around longer than expected.
- Peripheral Sensitisation – This means your nerves at the injury site become more sensitive. They start reacting to things that wouldn’t normally cause pain, like light touch or gentle movement. This can cause symptoms like heightened pain or pain that spreads beyond the original injury.
- Central Sensitisation – This happens when your brain and spinal cord become more sensitive to pain signals. Even though the injury may have healed, your brain continues to send pain messages. You might feel pain from things like stress, temperature changes, or even watching someone else move.
- Emotional and Psychological Factors – Stress, anxiety, poor sleep, or a history of trauma can make pain worse. When we’re stressed, our muscles tighten, our breathing changes, and our nervous system becomes more alert — all of which can feed into the pain experience.
What Can Physios Do to Help?
Physiotherapists are trained not only to treat pain, but to understand the whole picture — your movement, your nervous system, your habits, and your goals.
Here’s how we help:
- Movement therapy to help you regain confidence and reduce pain through safe, guided exercise
- Education to help you understand how pain works, which can reduce fear and anxiety
- Breathing and relaxation strategies to calm your nervous system
- Manual therapy if appropriate to support movement and function
- Support with pacing and planning activities so you don’t flare up
The Bottom Line
Pain is not just about injury — it’s about how your body and brain are protecting you. But the good news is that pain can be retrained.
Through a tailored approach that involves movement, education, and support, physiotherapy can help you break the pain cycle and get back to doing the things you love.
If you’ve been struggling with long-standing pain, you’re not alone — and there are strategies that work.
Let’s take the first step together.
References:
- Brukner, P., & Khan, K. (2017). Clinical Sports Medicine (5th ed.)
- Hall, J. E. (2021). Guyton and Hall Textbook of Medical Physiology
- Silverthorn, D. U. (2019). Human Physiology: An Integrated Approach
- Garland, E. L. (2012). Mindfulness-Oriented Recovery Enhancement
- Latremoliere, A., & Woolf, C. J. (2009). Pain mechanisms: from nociception to chronic pain
- Ji, R. R. et al. (2003). Central sensitization and long-term potentiation in pain pathways
