Clapham Manual Therapy and Functional Movement

The Nature of Pain

Pained figureMost new patients at Backs Etc arrive with some form of musculoskeletal pain. They are often scared that the pain is resulting from some form of tissue damage and fear that they are ‘broken’ with a fragile body that is giving up. These attitudes and fears are not surprising as they are reinforced by the media and many medical professionals.  Indeed, when you have recently had an accident, eg a car crash or heavy fall, then there will be tissue damage and inflammation (which is the body’s healing process). However, in most patients the onset of their pain was either completely unclear (came on gradually for no specific reason), or is related to an injury more than a couple of months old.  In these cases the tissue damage has healed or is just not there.

Human bodies are resilient, and it’s unlikely that anyone will structurally damage their backs by bending to pick up a sock or sleeping in a soft bed. However these innocuous events often appear to be the proximate cause for an episode of excruciating pain. So if there isn’t any tissue damage, what is going on? Modern neuroscience has identified another function of pain.  Our nervous system’s prime function when we move is to keep us safe and stable, so pain is an indication of threat levels in a person’s nervous system and is a message to try and stop us moving in a way that our brains have determined to be threatening. It is a multidimensional response; an output of the brain that weighs up a whole range of inputs not just relating to pain receptors in your back but also habitual movement patterns, sleep, anxiety, nutrition, beliefs and overall systemic health. Thus, the brain is making a decision based on all sensory inputs into your nervous system as to whether or not it feels ‘safe’ in relation to any movement you want to do with any part of your body.  If the decision is that it doesn’t feel safe, there will be restriction and/or pain in the relevant area to try and stop you. In fact, we should feel grateful for this type of pain as it is a message from our nervous system to try and persuade us to change. Unfortunately we mostly misinterpret the message and either ignore it or just suppress it with painkillers. Then, over time, our pain response can be hyper-sensitised so that it over-responds to things that considered individually are not very threatening.  This is like a fire alarm that makes the same sound whether the house is burning down or when you have burnt some toast.

Here at Backs Etc we discuss and evaluate the stressors to your nervous system with you to decode the message your brain is trying to send you.  In some cases, just reducing fear by explaining the pain science can be beneficial. Also, giving guidance in relation to managing stress and improving sleep and nutrition is part of the treatment.  However a large part of the negative inputs into the nervous system come from the neurological traces of old injuries, a lack of core stability, and poor movement patterns. These are all inputs which can be changed with treatment. NKT is particularly effective to improve motor control patterns.  We also improve movement with functional training, and gain core stability with breathing retraining. Our strategy is to reduce these movement-based threats as much as possible to return the nervous system to a state of equilibrium and so eliminate pain.


If this short post has whet your appetite, here are a few links to some further resources:

Tame the Beast – It’s time to rethink persistent pain

Body in mind – the role of the brain in chronic pain

Your Cranky Nerves: A Primer For Patients To Understand Pain