Introduction:
Pain is something everyone experiences, but what if everything you know about it is wrong? Pain is commonly linked with physical damage, but theres a lot more to it than that. Misconceptions about pain can lead to unnecessary treatments, prolonged recovery, and limit exercise participation. In this article, we’ll break down the most common misunderstandings about pain, helping you retake control and captain your recovery, and prevent these issues from holding you back.
What Is Pain? More Than Just a Physical Sensation
Pain is defined as “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” by the IASP.
At its core, pain is an emotional and sensory experience designed to protect us. However, it’s much more complex than simply detecting injury. Think of pain as your body’s alarm system. Sometimes it warns you about real danger (like touching a hot stove), but sometimes it’s a false alarm, making you feel pain even when there’s no injury present. Sometimes it’ll turn on disproportionately, a red alert for only a minor injury. It can exist or persist in the absence of physical injury or long after an injury has healed.
Pain isn’t “felt” by tissues or even the brain itself—it’s an interpretation of all signals within the brain. This means that how you think and feel, such as negative emotions or anxiety, can influence your pain experience. It means that your pain can range anywhere from non-existent to severe, from the same “Pain” stimulus from e.g. a cut or bruise.
Pain Sensitivity: The Amplifier Effect
Your spine and brain can amplify or dampen pain signals, much like adjusting the volume on a stereo. Imagine you’re in an adrenaline-fueled emergency situation like a severe car crash. As you’re fighting for life to escape the wreckage or save others, you may be unaware you’ve broken several bones until the situation has calmed down and your brains processing returns to baseline.
Now, imagine a different scenario: you’ve heard stories about people never being able to lift again after back injuries. You feel a minor back tweak during a workout. The fear of long-term injury sets in, and suddenly, the pain seems unbearable. In reality, your body might be perfectly fine, but your brain has turned the volume up due to fear and anxiety.
Misconceptions About Pain: What Scans Don’t Tell You
One of the biggest misconceptions is that pain always correlates to physical damage. Imaging scans often show conditions like disc degeneration or joint wear and tear, but these are common even in people without any pain. In fact, studies show that spinal degeneration as shown on MRI is extremely common and a poor predictor of current or future pain. You’ll find disc degeneration in 37% of 20-year olds who don’t have pain, and this increases with age. We generally consider these findings akin to grey hairs or wrinkles, rather than a root cause for pain.
While scans are invaluable in some situations, they don’t always tell the whole story, especially when it comes to musculoskeletal pain. Often, they can even worsen the problem by increasing stress and fear about a condition that might not actually be the cause of your pain.
Common Misconceptions About Pain:
- Pain always indicates tissue damage.
- Scans always reveal the cause of pain.
- Surgery is the best solution for pain relief.
Why This Matters for Your Training and Recovery
If you’ve been told to avoid certain exercises due to back pain or other issues shown on a scan, it’s important to get a second opinion as this is genuinely rare. Few musculoskeletal conditions worsen with exercise, especially when performed sensibly. In fact, exercise is among one of the best ways to manage pain and improve your overall function. But this doesn’t prevent misinformed Doctors, Physios, Trainers etc from commonly prescribing unnecessary limitations.
As a trainee, coach or health practitioner, it’s crucial to stay informed about the latest research so you don’t inadvertently disempower your clients by over-cautioning them against movement.
Do you think you or a client of yours may be in this boat? I offer low-cost, express assessment-based consultations to determine whether you or your client can be cleared for exercise. Book here.
The Power of Mindset in Pain Recovery
Research shows that the way we think about pain can drastically influence our recovery. Positive, proactive thoughts about injury rehabilitation can help reduce the intensity of pain, while negative emotions can slow healing.
Remember how degenerative findings of the spine are actually quite normal? We now know that if you present to the Doctors office with run of the mill back pain, and are referred to imaging, you’ll be 6x more likely to get surgery than those who did not get a scan. These people also have increased anxiety, depression, pain scores, and activity. Physiotherapy is also disempowered as whatever was found in the scans is often treated as the singular root cause for the pain, which Physiotherapy cant change. This is why although prevelant, imaging in these people is seen as harmful and not recommended.
Placebo Effect and Pain: Why Some Surgeries “Work”
Drugs are regularly tested by giving one group the real pill, and the other a “fake” or “placebo” pill. This is because it is well-known that patients will experience positive or negative effects if they think they’re taking a drug. This may surprise you, but in the rare cases that surgery has been studied this way (Yes, fake surgery), improvements in pain are often exactly the same whether people received the real or fake surgery. This reinforces the powerful effect of context on the mind (Surgery is regarded in peoples minds as the ultimate fix), and devalues the importance of physical damage.
A short, incomplete list of these surgeries:
- Knee arthroscopy (“Knee Washout”)
- Subacromial Decompression (For “Shoulder impingement”)
- Meniscal Repairs
- Rotator Cuff Repairs
- Spinal Fusion
This is not to say that we or anyone should NEVER recommend surgery. However, its important to consider conservative approaches like physiotherapy, and source a highly trusted and informed opinion from quality practitioners if surgery is on the cards.
Final Thoughts: Take Control of Your Pain
Pain is complex and influenced by many factors beyond just physical injury. The good news? By understanding how pain works, you can take charge of your recovery and avoid unnecessary treatments. Whether you’re dealing with chronic discomfort or a recent injury, movement and understanding are your best allies.