Pain explained – Tips to speed up injury recovery
- Maryke Louw
- 5 days ago
- 15 min read
Updated: 2 days ago
Yes, (most) injuries cause pain. But the severity of the pain is not linked to the severity of your injury, and sometimes pain can persist long after an injury has healed. Learn how pain is created and how to use this to guide your injury recovery.
Remember, if you need help with an injury, you're welcome to consult one of our physios online via video call.
In this article:
A new understanding of how pain works
We used to think that pain was quite simple: You have pain receptors everywhere in your body, you get injured, it triggers the receptors, and that creates the pain. And the more severe your injury is, the more painful it is.
Thanks to recent advances in the field of scanning and interpreting injuries inside our bodies, we now know that there is not necessarily a link between how bad an injury is and how much pain we experience.
There have been many instances of people whose scans showed severe injuries while they experienced very little or no pain.
Also, people without injuries (or whose injuries have healed completely) who had extreme pain.
And of course, sometimes the pain reacts like we expected it to in the “old days”: You have an injury, and it’s painful. As the injury heals, things get better, and the pain goes away totally.
❓ So, why does that happen in the expected way for some people while for others there seems to be a disconnect between the pain and the injury?
Why and how pain is created
What we now understand about the nervous system is that we don’t have “pain receptors”.
What we do have is sensors that are constantly measuring things that could potentially affect our tissue health. These are things like pressure, stretch, chemicals, and temperature – some of which are present all the time. And these sensors are constantly sending our subconscious brain messages or signals about these.
Obviously, your brain would go haywire if it were to react to all these messages, so there’s a threshold above which it goes “Hey, this seems like it could be dangerous to the body I’m inhabiting!” It then creates pain because it wants you to take action to reduce those signals.
👉 It is important to note that this is your subconscious at work here – you have no direct control over it. That is why “mind over matter” is not a way to deal with pain, and in fact, that approach might even increase your pain. However, this is also not to say that pain is “all in the mind” – your body undergoes actual physical changes in reaction to it.
A typical pain response
When you’re injured, your subconscious brain goes into “protection mode” and lowers the threshold at which it creates pain – this is to ensure you take extra care with the injured part, which, in theory, should allow it to heal more quickly.
For example, you can squeeze your thumb as hard as you like when it’s not injured, and it doesn’t really hurt. But let’s say you’ve just hit it with a hammer – even the most gentle squeeze can cause very strong pain. Such a gentle squeeze is obviously not strong enough to cause damage – it’s just the pain system being on high alert and telling you to “be careful please!”.
👉 So, it’s normal for an injured area to be painful and to experience discomfort during your recovery period. Just because a rehab exercise or movement is causing a bit of discomfort, does not necessarily mean it is making things worse – it is likely just the alarm system firing off an early (and maybe unnecessary) warning.
Every injury is different and will have very specific requirements for what activities you’re allowed to do and how much pain is expected and OK to experience during rehab. We discuss this in detail for each type of injury elsewhere on our website, so I am not going to go into those details now.
And of course, we specialise in creating very individualised rehab programmes for our patients that take their personal pain-and-rehab circumstances into account. If this is what you’re after, consider booking a video call with one of our physios.
In an ideal world, if you stay within the rehab and pain parameters of what your physiotherapist or doctor has prescribed, the injury will heal and the pain system should return to normal in line with this.
But of course, few things work perfectly in real life, so often the pain system can get a bit oversensitive and cause more pain than it should – higher intensity or simply just more persistent low level, annoying discomfort.
Why pain can get dialled up
The signals from the sensors are not the only things that determine whether and to what extent your subconscious creates pain. There are other factors at play that could make your subconscious interpret these signals as more dangerous or less dangerous than what they are conveying and which, in turn, make your subconscious dial the pain up or down accordingly.
Here are some examples. Often, several of these factors combine to sensitise the pain system.
Oh, and this is not an all-or-nothing situation – most of us will have a mix of true injury-related pain and some "extra" pain (sensitivity) – an experienced physiotherapist can help you understand your situation and help pitch your rehab at the right level to allow it all to calm down.
Physical changes to the pain system “hardware”
If you’ve had pain or an injury in a specific area for several weeks, you develop more of those little sensors, and they get triggered more easily and fire off more messages to the brain.
📢 So, your body becomes better at creating the signals that trigger a pain response. It’s as if the body feels you’re ignoring it, so it wants to make more noise to get your attention.
👍 But the good news is that, if you provide your body with the correct level of activity and rehab and work on the other elements mentioned below, it reverts these physical changes back to normal.
Past experiences with pain
If your past experience of, say, a running injury tells your subconscious brain “Nah, that type of pain goes away quite quickly, I just have to have a couple of days of rest, then I can run again” it's not going to pay that much attention to that area, and your pain will just calm down as the tissue calms down.
However, if the last time you had pain in that area meant that you were not be able to run or exercise for six months to a year, it is going to pay heavy attention to it, and it's likely going to create more pain than how severe the actual injury is.
If your father has had bowel cancer and you suddenly get pain in your stomach, your subconscious brain might go “Oh shucks, Dad had bowel cancer! Now my stomach's hurting. It might be bowel cancer!” and it might create more pain than is warranted.
There have been experiments where they've measured people's pain before they see a doctor, then they see the doctor, and they get a diagnosis that the injury is not serious. When they then measured the pain immediately afterwards, and it has decreased by nearly 50% on average. Obviously, no physical healing has taken place during the consultation, but the subconscious brain has been reassured that the injury is not as dangerous as it had thought it was.
Social media can be a problem
These days, it’s very common to google an injury or join online communities (such as Reddit or a Facebook Group) to research and discuss injuries. And yes, this can be very useful. However, the voices in these groups are often extremely polarised, creating a negative expectation about recovery.
People don’t usually look for, or join, online communities when their recovery is going as expected.
Instead, these spaces often gather a high concentration of people who, unfortunately, haven’t recovered as expected and continue to struggle. The message is often: “This injury will never get better – I’ve had it for x number of years.” This message can get stuck in people’s minds, shaping what they believe. That can heighten their subconscious perception of how severe the injury is and keep their symptoms dialled up.
It’s natural to look for support from others who can relate to your situation, and this type of support can be very helpful. I’m not saying you should avoid it. But it’s important to remember that every person is different. We all have unique circumstances – stress, fear, genetics, and many other factors – that can affect recovery. One person’s reality does not have to be yours.
👉 If the people you interact with (online and off) often make you feel that you’ll never recover, it might be time to look for a different community. Those thoughts are very likely to sensitise your pain system and might increase or cause persistent pain.
Words I (and other healthcare professionals) use
There is strong evidence that the belief someone has about their injury (how severe or serious it is, how likely it is to recover, etc.) can influence the intensity of their pain. It can also make them avoid activities unnecessarily because they expect them to hurt or cause problems.
Terms like “wear and tear” or “degeneration” are often used when clinicians talk about arthritis or tendinopathies (e.g. degenerative tendinopathy). But these terms can make you picture that area of your body as being worn out, which can then easily lead to thoughts like, “Well, that must mean that it will only get worse and never recover.”
In a recent study, a group of researchers tested this concept on 50 Achilles tendinopathy patients. They divided the participants into two groups who followed the exact same rehab plan. The only difference was that:
one group was given a very detailed explanation of the injury process, including medical terms like “degenerative tendinopathy,” while
the second group was told their tendons were just irritated and sensitive due to being overworked and therefore not able to tolerate as much training at the moment, but that the rehab plan would allow the sensitivity to settle and restore the tendon’s exercise capacity. (I paraphrased what they said)
At the end of the trial, the second group reported significantly less pain than the other group, despite following the same rehab plan. This is just one example of how well-intended advice can backfire.
Our team always try hard to use words that we think are unlikely to cause unhelpful beliefs, but it is really difficult to anticipate how someone might interpret them.
👉 The best way we’ve found around this is to build a good rapport with our patients and take time to listen to them and discuss their beliefs. This is one of the reasons why we take so much time during our video consultations to really talk the situation through.
Emotions such as stress and fear
Stress (work, family, life) and fear cause the body to release stress hormones. These can cause the pain to be dialled up or down.
In the short term, when you experience a high-stress crisis situation, your subconscious might dial down the pain to allow you to deal with a dangerous situation. This is why some people in car accidents have been able to rescue fellow victims in dire need of help while they themselves had a broken arm or leg, and only hours later do they realise they have broken something.
But if those stress hormones are elevated for days on end, your subconscious brain starts to increase the pain response. For instance, if you fear that your injury is going to prevent you from continuing to earn a living and provide for your family, the pain might get dialled up to way beyond what the physical nature of the injury warrants.
If you're a strong-minded person who is inclined to “get on with it and get things done”, it can be annoying when somebody tells you “But your brain and your thoughts and your feelings can contribute to this pain experience.”
🤔 And their first reaction – mine too – is typically to rebel against that. But the research shows that it's the Type A personalities – perfectionists and high-achievers who tend to be able to get on with things and who like high-stress situations – who tend to suffer more with ongoing pain.
A disconnect between your brain and the injured limb
Using MRI scans, the people in the white lab coats have figured out which part of your brain lights up when you move, say, your leg or even when you just think about your leg – and it’s the same part of the brain – on the opposite side – for either leg.
They have found that for people with persistent injuries that last for several months (say, an injury to the right ankle), the brain doesn’t light up in the same way anymore that it lights up for the left ankle.
The area that lights up for the injured or painful side is smaller, and it looks like the uninjured side becomes more prominent. They’ve also found that, as chronic injuries or pain starts to improve, the brain’s representation of that area becomes closer to normal.
This has led them to speculate that the subconscious brain has started to disregard that limb as a part of the body, which might contribute to the pain being dialled up.
👉 The good news is that they’ve also identified very simple techniques that can help to get things back to normal. I share them in the sections below.
💡 In summary, pain is often being dialled up because your pain system has become “too good” at protecting you. So, how do we reverse this?
How to use pain science to help recovery
Don’t push through pain
If you ignore your pain and continue training or repeatedly doing activities that significantly irritate your symptoms above a certain level, the subconscious feels that you’re not taking it seriously and usually amplifies the pain.
So, the first step should always be to consult your doctor or physiotherapist and have your injury diagnosed so you know what you’re dealing with. They can then also help you understand what the correct level of activity and expected pain levels are that will allow your body to recover while also calming the pain system down.
Movement is important
Some injuries (like fractures) might require that you rest the area completely for a period of time. But it’s really important not to over-protect your injury and limit activity unnecessarily.
There’s evidence to show that over-protecting and injury causes the subconscious brain to think more and more of that area of the body as “not part of your body”.
👍 So, a big part of “reclaiming” your injured body part and connecting it to your brain again is to start moving it. This is why we try and keep our patients as active as possible within their safe limits.
Where people often go wrong at the start of their rehab is to think they should really push it. You don't have to. If it's really painful, you just start with what it can do without too much pain.
Your physio will help you to understand what the best activities and exercises are for the type of injury you've had.
“Mindful” exercise
Now, I'm very aware of how airy-fairy the term “mindful exercises” sounds, but hear me out.
Remember how I said that MRI scans show how your brain starts to light up differently for an injured limb? Researchers have found that you can change how the brain lights up back to normal simply by paying attention to the limb rather than ignoring and overprotecting it.
At some point in your recovery, you will very likely be prescribed rehab exercises. Rather than watching TV while you are doing your exercises, you should switch off the TV and think about what you’re doing – pay attention.
Some things that have been shown to be useful include:
Looking at your injured limb while you move it,
Observing what you feel and how it moves, and
Really trying to control the movements properly – slowing the movement down can be very effective for this.
If it’s an exercise for your arm, this is your way of telling your subconscious brain “This is my arm. We are moving my arm. And see, it is okay to move my arm.”
💡 In some research studies, they ask patients to move their injured limb to the beat of a metronome or to slow the movement down and focus on moving for "x" seconds in one direction before switching. The method isn't important – what matters is that, by having to match a rhythm, the brain is forced to pay attention, and this improves its control over the limb.
Self-talk
Self-talk has to do with all those thoughts and worries that pop into your head throughout the day, but also while you're doing your exercises and doing your activities.
Identify all those negative thoughts – all the fears. They might be legitimate fears, but identify those creeping thoughts and feelings that are making you more worried. That little voice that's sitting here on the shoulder – get it to shut up. And don't just tell it to shut up. Reason with it. Explain to it that “No, it will be okay. It’s going to take time, but it will gradually calm down.” It doesn't like to just be ignored or told to shut up; you have to “convince” it by providing "evidence".
Another way to counter those negative thoughts is by taking time to reflect on how far you’ve come. It’s easy to feel that “you’ll never get better” if you focus on how far you are from where you want to be.
Whenever I’m injured, I force myself once a week to take a few moments to reflect on what I can do this week that I couldn’t do two weeks ago – sometimes it’s just that I can now walk to the shop without as much pain or slightly faster than before – that is progress and a sign that my body is recovering.
This is another reason why it is useful to work with a physiotherapist – they can help you understand what the expected recovery time is for your specific case and whether you’re recovering as expected. They are also great at helping you to acknowledge your progress.
Pain psychologists and sports psychologists can also help – they often have clever techniques to help with the mental side of injury recovery.
Breathing
Why breathing? It's the most effective way they have found so far to get your vagus nerve to calm down.
The vagus nerve is in charge of your fight-or-flight reaction or your stress response. And if you can get the vagus nerve to calm down, it actually helps your stress hormone levels to calm down, and that can desensitise your pain system.
So, we’re talking slow, deep breathing – the kind that makes your belly move in and out. You don't have to get fancy about it. Just every now and again, tell yourself to breathe.
You can approach this in two ways or use both. First, make sure that you breathe deeply while you are doing your rehab exercises and focus on relaxing as you do it.
But you can also have one or two sessions a day where you just do deep breathing for a few minutes. You could stick on a YouTube video about yoga where they teach you about breathing and just follow along.
Massage
There's good evidence to show that touch and massage can decrease pain and desensitise nerve endings.
And research has shown that that touch or massage that comes from a loved one works even better. But when you have an injury that's extremely painful and you can easily reach it, rather start off by doing it yourself, because your subconscious brain trusts you more than anyone else.
What’s important is that the massage (regardless of who is doing it) should be at a comfortable or “comfortably uncomfortable” level. A very painful massage might further sensitise the pain system and cause a flare-up of pain several hours later. And some injuries should not be massaged, so check with your physiotherapist before you do anything.
💡 Massage is not appropriate for all injuries, so please check with your physio before you do it.
Heat and cold
Both heat and cold therapy can be useful for calming the pain system, but they are not appropriate for all injuries. You can read a detailed explanation of when/how to use ice or heat for sports injuries here.
Acupuncture or dry needling
In my experience, acupuncture usually doesn’t work if the person is scared of needles. I think this is because, when you're scared of it, it actually increases your stress hormones and cause your pain to feel worse.
But if you're not bothered by needles, acupuncture or dry needling is something that could be useful to decrease pain.
However, it doesn't work for everybody, and you shouldn't have it just for the sake of having it. If you've gone for three or four needling sessions and you haven't seen improvement, it's likely not going to work for you, and it's not worth spending money on more of the same.
How we can help
Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.
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