Pain that persists is not a measure of tissue damage – it’s over-protection.
When pain lingers, your body changes how it responds. Pain that persists for longer than 2-3 months leads to changes in your nervous system – a process called sensitisation. This is where your nervous system becomes more responsive, more reactive, to different stimuli.
The longer pain persists, the more sensitive the nervous system gets. You feel pain more readily because the nervous system is disrupted – things that wouldn’t ordinarily cause pain now do. It’s why someone with persistent pain might report that sitting for too long, or lifting a coffee cup at the wrong angle, aggravates their pain. Those movements aren’t damaging any tissue. But a sensitised nervous system registers them as dangerous, and sends a response to protect you – pain. Great, thanks nervous system.
In actual fact, this is part of how we survive as a species – pain protects us against perceived danger. The problem with persistent pain is that this useful protection mechanism becomes over-protective. It becomes the helicopter parent, always warning of what could potentially happen.
And it’s more than just physical movement that can set off the nervous system. People experiencing persistent pain commonly report that stressful work, relationship troubles, poor sleep, certain foods, or troubling thoughts and emotions can all affect their pain experience.
So what’s the answer? How do you restore the nervous system? How do you recalibrate that over-protection?
Here’s what commonly gets missed: we often try to treat the tissues in isolation, rather than treat the whole system.
What I mean by that is rehab programs often involve plenty of exercise, manual therapy, massage, needling and so on – but don’t look at the whole person. To desensitise the nervous system, the person in pain needs to feel safe.
Signalling safety to the nervous system looks different for everyone, but here are some common safety-promoting strategies:
- Movement: Start with an enjoyable activity – like walking. Begin with an amount that doesn’t flare up your symptoms (doesn’t feel threatening to the nervous system), then slowly build it up over time. This is called pacing.
- Exercise: Specific exercise can build strength where there’s weakness, improve a restriction, and create positive feedback loops (“this makes me feel powerful – let’s repeat it”).
- Planning: Structure your day to avoid boom-and-bust cycles – aim for slow, even, predictable increases over time.
- Psychological safety: Challenge beliefs that may be signalling threat to your nervous system (e.g. “this pain is my muscles tearing apart, and it’ll leave me in a wheelchair if I keep going”).
- Breath: Breathing can activate the parasympathetic nervous system – the “rest and digest” counterpart to the sympathetic “fight or flight” stress response. Long exhales or techniques like box breathing can help.
- Joy activities: Listening to music, sitting in the sun, a cup of tea and a chat – whatever it is for you. More joy activities can promote safety and help reduce nervous system sensitivity.
- Journalling or drawing: Writing down your thoughts, or drawing your experience, can help you process it.
These are just a few options, and there’s no one-size-fits-all approach. Notice how different they all are from each other? That’s because the nervous system is more than just your tissues – so managing it typically requires more than massage and exercise. It needs to encompass how you think, feel, process and experience the world.