Understanding pain and MSK recovery

Pain is something we have all experienced. It might be a sudden sharp sensation after touching something hot, or discomfort following an injury. In these situations, pain makes sense. It alerts us to danger and encourages us to protect the body while healing takes place.

Usually, once tissues recover, pain settles. However, pain does not always follow this pattern.

Around 34% of people in the UK wake up each day with pain, long after the expected healing period has passed. A fracture may have healed and scans may look normal, yet pain continues. Over time, this can dominate thoughts and behaviour, affecting work, activity levels and enjoyment of everyday life. 

Understanding why pain occurs is an important step towards managing it more effectively.

How pain has traditionally been explained

For many years, pain was explained through the idea of a separation between the mind and the body. This concept, introduced over 400 years ago by philosopher René Descartes, suggested that physical injury or tissue damage directly caused pain, while thoughts and emotions were separate.

This way of thinking influenced healthcare for centuries and still shapes some beliefs around the concept of pain, today. However, pain science has shown that this model does not fully explain why pain can persist after tissues have healed.

A whole-body understanding of pain

Modern research shows that pain is shaped by biopsychosocial processes occurring throughout the body. Multiple systems – including the nervous system and brain – influence emotions, beliefs, thoughts and behaviours, all of which play a central role in the experience of pain.

This does not mean pain is “all in the head”. The central nervous system is constantly monitoring for changes and potential threats, and when these fall outside normal limits, pain may be produced.

Essentially, pain can be understood as a call to action in response to perceived danger. Even after tissues have healed, some systems may continue to signal danger, resulting in ongoing pain without clear tissue damage.

Factors that influence pain

Pain is experienced differently by different people, even when tissue damage appears similar. This is because pain is influenced by many factors beyond physical structures, including:

• Beliefs and past experiences
• Emotions and mood
• Stress and anxiety
• Sleep and fatigue
• Activity levels

Understanding these influences can help people take small steps towards improving their quality of life.

Pain, movement and exercise

For many people, exercise is a safe and effective intervention for pain management – particularly when combined with other supportive approaches – which can help people gradually challenge their bodies and rebuild function through movement and exercise.

But what should you do if you feel pain during exercise? Well, contrary to popular belief, experiencing pain is not necessarily harmful. Often, exercise-related pain reflects new or increased demands placed on the body, sometimes referred to as mechanical stress. This helps inform the body how it needs to adapt to new stressors.

Everyone’s tolerance is different, but keeping exercise-related pain at a level that feels manageable can help ensure the body recovers before the next session. And, thankfully, as the body adapts, pain associated with exercise often settles.

Persistent pain and adaptation

When pain lasts a long time, the nervous system can become more sensitive. The brain may continue to produce pain signals even after the original injury has healed.

However, just as the nervous system can learn to feel pain, it can also learn safety. 

Through experiences such as movement, education, relaxation and mindfulness, the system can gradually become less sensitive. Small, gradual changes, including pacing activity, gentle movement and relaxation techniques, can help shift the body into a calmer state over time.

Starting movement safely

Beginning movement at a level that feels tolerable is important. For people experiencing persistent pain, gentle mobility exercises can be a helpful starting point.

Examples of good exercises include: knee rolls, cat-cow movements, thread-the-needle, and squats. These movements can support confidence, mobility and gradual return to activity.

EQL’s approach to pain

EQL’s approach to pain is underpinned by effective exercise and education. By focusing on both the physical and psychological aspects of pain, our approach supports people to move safely, without overloading bodily systems, and regain confidence in movement.

Need additional support?

EQL is a clinically-led MSK tool developed by expert physiotherapists. It helps people understand and manage bone, muscle and joint concerns, including persistent pain, and signposts users to the most appropriate care pathway.