Home > Blog > Pain And Physiotherapy

Pain And Physiotherapy

The most common reason a person walks into physiotherapy is because of pain. Our job as physiotherapists is to reduce and eliminate the pain and hence it’s important to understand each client’s personal experience with pain and their goals.

Pain starts with interpretation.

It is a process starting from nerves to spinal cord and lastly to brain cortex where the ultimate decision on whether it is pain and how intense the pain is felt is made. Each individual, no matter how big or small the mechanism of injury, processes pain uniquely.

Some example of this can be found in victims who felt little or any pain even though massive tissue damage occurred while others go through debilitating pain with no evidence of bone or tissue damage. Many factors can explain this and one is how the peripheral system can be stimulated by our own body chemistry (neuropeptides) to create more receptors and hence send more signals to the brain to perceive more pain (Butler & Moseley, 2013).

It has been shown that pain can be amplified by one’s emotions and past experiences. Poor attitude, negative emotions, being upset, anxiety, and sadness can influence how much pain is felt. There is acute pain that warns the body of immediate harm or injury. And there is chronic pain, pain that is felt more than 6 months (Louw et al, 2011).

Just pain itself demonstrates why each treatment requires individualized approach in hands-on treatment, proper exercise and education to re-start that connection between the body and brain to interpret the decrease of pain. As part of regaining power over the body, it is the clinician’s job to reduce the anxiety or fear of movement to move toward good clinical outcome (Moseley, 2012).

What is most important in this process is getting back to moving properly. During the process of dealing with pain whether for 1 week or a few months, movement is changed to protect the painful area. Issues arising from adopted poor movement patterns, over-exposure to static positioning, loss of functional range of motion, stability and/or balance all contribute to the breakdown of good movement (Silfies et al, 2017).

To get each client back to proper movement, a plan is set for each specific diagnosis:

Individualized evaluation

There is no one size fits all even with the same diagnosis as each person comes with different specific needs as well as different response to treatments.


Any sticking points whether it is joints or muscles will be addressed with manual skills (a decrease in proper range of motion will set off a kinetic chain of more issues elsewhere in the body.)


Creating proper stable base and proper firing of muscles will protect joints, create more efficiency in muscle contraction and improve movement.


One of the most important factors in creating excellent movement and dynamic stability is the simplicity of balance.

Active and Passive Treatments

Treat the root cause of pain and not just the symptoms: that means incorporating a mix of passive and active treatments customized to the specific condition at the proper stage of rehab. Active treatment is the exercise and movement component of rehab.

Passive treatment includes hands-on treatment with manual skills, use of anti-inflammatory modalities and joint mobilizations and many other techniques. The combination of both treatments in the timing and application is the magic of physio.

References & Citations

Butler, D. S., & Moseley, G. L. (2013). Explain Pain (2nd ed.). Adelaide: Noigroup Publications.
Clarke, C. L., Ryan, C. G., & Martin, D. J. (2011). Pain neurophysiology education for the management of individuals with chronic low back pain: A systematic review and meta-analysis. Manual Therapy, 16(6), 544–549. http://doi.org/10.1016/j.math.2011.05.003

Moseley, G. L. (2012). Teaching people about pain: why do we keep beating around the bush? Pain Management, 2(1), 1–3. http://doi.org/10.2217/pmt.11.73

Louw, A., Diener, I., Butler, D. S., & Puentedura, E. J. (2011). The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Archives of Physical Medicine and Rehabilitation, 92(12), 2041–2056. http://doi.org/10.1016/j.apmr.2011.07.198

Silfies, S. P., Vendemia, J. M., Beattie, P. F., Stewart, J. C., & Jordon, M. (2017). Changes in Brain Structure and Activation May Augment Abnormal Movement Patterns: An Emerging Challenge in Musculoskeletal Rehabilitation. Pain Medicine,18(11), 2051-2054. doi:10.1093/pm/pnx190