Nov 15 min read

Why am I always in pain?

Maybe we need a different perspective...

In the past, we have given too much credit to poor posture, biomechanics, and asymmetries

causing pain. While they can contribute, they are often a much smaller factor than we think.

If there is 1 thing you take away from this, it’s that Pain is ALWAYS multifactorial. (1)

There are 2 types of pain:

1. Pain from an injury

2. Pain without injury

You can have pain with and without injury and injury with and without pain. For example, a

random bruise you have no idea how it got there = injury without pain. Many overhead

athletes, such as baseball players, have full-thickness rotator cuff tears and yet have full

range of movement and no pain = Injury with no pain. (3)

In fact, over 90% of pain-free people have abnormalities in shoulder, hip, and

knee scans. Over 90%!!! (4) And that 50% of pain-free 40-year-olds have a spinal disk

bulge. So, pain isn’t always due to what was found on a scan. Perhaps these scan findings are just wrinkles on the inside instead.

Is my pain caused by injury or something else?

If you have an injury, you usually need one of two things to occur:

1. Trauma, e.g., falling over, a car crash, etc.

2. Too much too soon, e.g., never having done Pilates before, to Reformer every day, or you want to run a marathon, and the first run you do is a 10k. You need to build up slowly.

So if you have neither of the above and aren’t within injury healing times, you

have pain without injury.

It’s been found that 95% of back pain is not caused by identifiable problems in the tissue. (1) It's important to note that I am not dismissing your pain; your pain is very real, but it is also something we can learn to manage.

If it’s not an injury, then what is causing the pain?

I like to use Greg Lehman's cup of resilience analogy. Take a big cup and stick all of life's stressors in it. When your cup resilience overflows with stressors, your brain becomes highly sensitised to pain. Your nervous system is on high alert and becomes a bit like a faulty smoke alarm—it starts sounding the pain alarm even though there’s nothing there. So, the pain is never one single cause; all these stressors can have an impact and it becomes multifactoral. It’s very easy to overfill our cups with stress in our modern life. Do you recognise any of these in your life?

Lack of sleep (8) – Only 2 nights of poor-quality sleep is the best predictor of spontaneous pain in the body….so maybe you didn’t sleep funny – you just didn’t sleep well!
Rumination – repetitive thinking and dwelling on your pain, its causes, and consequences. Focusing on negative feelings and distress will only make things worse.
Nocebo—being told you’ll be in pain for the rest of your life could lead to precisely that. The opposite is true of placebo. Be mindful of any negative comments from family, friends, and health professionals whose advice could lead to negative expectations and outcomes!
Depression – Depression and inflammation share the same pathophysiology.
Lack of physical activity
Menopause
Psychological trauma
Poor diet
Work/family stress
Lack of community

Ways to decrease pain: (2)

Address any of the above stressors if possible.
Increase physical activity - Exercise raises pain threshold.
Use apps like Curable or seek out therapies such as Acceptance and commitment therapy or CBT, to help decrease rumination, fear avoidance and catastrophising
For trauma, find a psychotherapist that you like, it can take time, but it will be worth it.
Be optimistic - It's associated with less chronic and acute pain. Optimism involves noticing the goodness in self and others, identifying what is controllable, remaining wedded to reality, and challenging counterproductive beliefs.
Positive expectations predict better outcomes.
Ask for help! From family, friends, or a health professional who has a biopsychosocial approach to pain.
Join a HKore class, and you can kill 3 birds with one stone: Exercise, community, plus positive & knowledgeable teachers.
Remember not to get too bogged down in finding that one root cause because pain is always multifactorial. Instead, look at a few of your stressors and see if you can improve anything. If you can’t, find ways to give yourself a bigger cup to put them all in, such as changing your relationship to pain (see resources) or meeting exercise guidelines (see previous blog).

I have chronic pain; should I still exercise?

100! A lack of physical activity is a risk factor for more pain. (5)

Unlike a wine glass, we are antifragile. We must stress the body to build stronger tissues and become more resilient. Without stressing the tissues, we become more fragile. Knowing that pain doesn’t always mean you are doing damage is empowering. Talk to your instructor to find out how far, when and when not to push it. They will work with you to slowly build your resilience in a safe and empowering way. If you have an injury or you really struggle to move confidently with pain, then we recommend a 1-1.

How learning this has helped me:

Since I have changed my mindset around pain, I move with more joy, freedom, and confidence. I have more energy and have saved vast amounts of money on flitting between soft tissue and musculoskeletal therapists, hoping they could ‘fix’ me. It’s not that they don’t have a place; it’s just that I now know my body is perfectly inherently knowledgeable and capable of fixing itself – I am not fragile. It’s tapping into the knowledge that my body has its own inner wisdom. For a while, I was tricked into second-guessing and thinking my body couldn’t possibly be that intelligent all on its own, that I had to control it, and I couldn’t avoid injury without overthinking and overanalysing every ache, pain, and movement I did. But now, I move fearlessly and have become more resilient and optimistic regarding pain and movement.

Some resources I highly recommend if you want to learn more: