As physiotherapists, one of the most important messages we share with patients is this: pain doesn’t always mean something is broken or seriously injured. This can be a tough concept to wrap your head around, especially if you’re in a lot of discomfort and have been told otherwise. But thanks to advances in pain science, we now understand pain far better than ever before – and this has huge implications for how we assess, treat, and support you.
What is Pain, Really?
Pain is your body’s alarm system. It’s designed to protect you from harm and signal when something might be wrong. But like any alarm system, it can be overly sensitive, go off too easily, or continue to ring long after the danger has passed.
Pain is created by the brain, not by the tissues themselves. This doesn’t mean it’s “in your head” – it’s very real – but it does mean that your brain takes in a lot of information (including mood, past experiences, sleep, stress, and actual tissue status) before deciding whether or not to create the sensation of pain (1).
Imagine you stub your toe – the pain is immediate and intense. But if the same thing happens during a football match, you might barely notice it until later. That’s your brain filtering information based on the context.
Pain Without Damage
We often see patients in clinic who are in significant pain, yet scans and tests come back completely normal. This is especially common in:
● Lower back pain
● Tendinopathies
● Persistent neck pain
● Post-surgical pain after full healing
These scenarios highlight that pain is not always a direct reflection of damage. In fact, studies have shown that many people with no pain at all have disc bulges, joint degeneration, or tendon tears visible on imaging (2).
Why Does Pain Persist?
Sometimes pain sticks around long after tissues have healed. This is often due to central sensitisation, where the nervous system becomes more sensitive and responsive to stimuli. This means even light pressure, movement, or temperature changes might cause discomfort.
This can be influenced by:
● Poor sleep
● High stress levels
● Anxiety or fear of movement
● Lack of physical activity
● Negative beliefs about pain or injury
As physios, we address these factors as part of a biopsychosocial approach (3), looking at the whole person, not just the
injury.
What Can You Do About It?
Here’s the good news, you’re not stuck with it. By understanding pain better and addressing the wider contributors, you can absolutely take control and reduce your symptoms. Here’s how we support our patients:
● Education – Understanding how pain works can actually reduce pain (4). We’ll explain things clearly and help replace fear with confidence.
● Graded movement – Gradually reintroducing movement helps calm the nervous system and rebuilds trust in your body.
● Strength & rehab exercises – Building strength in key areas gives you more resilience and reduces pain over time (5).
● Manual therapy (where appropriate) – Can help reduce protective tension and encourage movement (6).
● Lifestyle changes – We support better sleep, stress management and daily movement habits.
Key Takeaway
Pain is complex, and it’s not always a sign that something is damaged. At our clinic, we’re here to guide you through recovery using up-to-date pain science, practical rehab strategies, and a whole-person approach.
You don’t need to be fearful of pain, let’s understand it, work with it, and move forward together.
Our Barnet, Cockfosters & Enfield Physio’s have tons of experience and are specialists in treating pain management. Have confidence that our specialist Physiotherapists will closely assess, diagnose & treat you in the correct & evidence-based way for all injuries. You can book an appointment here.
Blog By: Emre Oz (Musculoskeletal Physiotherapist at Crouch Physio).
References
- Ferrell, Bruce A. “Pain management.” Clinics in geriatric medicine 16.4 (2000): 853-873.
- Brinjikji, Waleed, et al. “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.” American journal of neuroradiology 36.4 (2015): 811-816.
- Darnall, Beth D., Daniel B. Carr, and Michael E. Schatman. “Pain psychology and the biopsychosocial model of pain treatment: ethical imperatives and social responsibility.” Pain Medicine 18.8 (2017): 1413-1415.
- Louw, Adriaan, et al. “The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review of the literature.” Physiotherapy theory and practice 32.5 (2016): 332-355.
- Semmons, Judith. “The role of physiotherapy in the management of chronic pain.” Anaesthesia & Intensive Care Medicine 20.8 (2019): 440-442.
- Ho, Emma Kwan-Yee, et al. “Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis.” Bmj 376 (2022).
