Acute Pain
Acute pain is usually pain that has been present for less than three months. It may follow an injury, accident, sporting activity, sudden overload, or sometimes something as simple as an awkward movement that leaves a joint or surrounding tissues irritated and protective.
Treatment initially focuses on settling pain, reducing unnecessary muscle guarding and restoring comfortable movement. This may include hands-on treatment, advice about activity, and gentle movement to prevent the area becoming increasingly stiff or sensitive.
Exercise is introduced progressively as symptoms settle, with the aim of rebuilding movement, strength and confidence without repeatedly aggravating the area.
Chronic & Persistent Pain – Pain, Protection and the Nervous System
Have you ever noticed that when life becomes stressful, your body seems to tighten with it?
Your shoulders creep upwards. Your jaw clenches. Your breathing becomes shallower. Your back stiffens. Perhaps an old injury suddenly starts hurting again.
As a physiotherapist, I find this relationship between our emotional state and our physical body fascinating.
It doesn’t mean pain is psychological or “all in your head”. Quite the opposite. Stress produces real physiological changes in the nervous system, muscles, breathing and the way we process pain.
Your nervous system is designed to protect you
When we perceive danger or significant stress, the nervous system prepares the body to respond.
Heart rate and breathing may change. Muscles become ready for action. Attention becomes more focused on potential threats.
This response is extremely useful when we genuinely need to protect ourselves.
The difficulty comes when the system remains on alert for too long.
Periods of prolonged stress, illness, grief, poor sleep or emotionally difficult experiences can sometimes leave people feeling persistently tense, tired, sensitive or unable to properly “switch off”.
In people with persistent pain, the nervous system can also become increasingly protective, meaning that sensations which would previously have been relatively insignificant may begin to hurt.
There is also a recognised association between traumatic experiences, post-traumatic stress and persistent pain, although the relationship is complex and varies enormously between individuals.
Muscle Tension – The body can develop protective habits
I often see this clinically.
Someone may unconsciously hold their breath when they move. Another person continually braces their abdominal muscles. Someone else holds their shoulders elevated or moves their whole spine as one rigid unit.
Initially these strategies may have been useful.
If something hurts, it is perfectly sensible for the body to protect it.
But the body is very good at learning.
A temporary protective strategy can gradually become the way we habitually sit, stand, breathe and move — sometimes long after the original reason for protecting ourselves has passed.
I prefer to think of this as protective tension, rather than saying that an emotion is literally trapped inside a particular muscle.
Nerve endings and – fascia (connective tissue)
Fascia is the connective-tissue network that surrounds and connects muscles and many other structures throughout the body.
We once thought of it largely as wrapping.
We now know it is highly innervated.
A systematic review examining fascial tissue found abundant free nerve endings as well as specialised sensory receptors. Fascia contains both proprioceptive nerve endings, involved in our sense of movement and position, and nociceptive nerve endings, which can contribute to pain. Some pathological fascial tissues also appear to contain greater nociceptive innervation.
That makes fascia an interesting part of the pain system.
But this is where I think we need to be careful.
You will sometimes hear that “trauma is stored in the fascia.”
At present, science doesn’t demonstrate that fascia literally stores emotional memories.
What we can say is that emotional stress influences the nervous system, muscle activity, breathing, movement and pain perception — and fascia is richly supplied by nerves and mechanically connected with the muscles we use to move and protect ourselves.
So there is a very real body–brain connection without needing to suggest that a particular emotion has physically become trapped inside a piece of connective tissue.
Massage – Why can touch sometimes have such a powerful effect?
This is one of the reasons I continue to value hands-on physiotherapy.
When I put my hands on someone, I am not simply looking for a “tight muscle”.
I am feeling how the tissues move, where movement is restricted, where someone guards, how one region relates to another and how the person responds to touch and movement.
Manual therapy also provides a considerable amount of sensory information to the nervous system.
Research suggests manual therapy can produce short-term changes in pain perception and nervous-system activity. The effects aren’t purely mechanical; there appear to be neurophysiological effects as well, although research is still determining exactly how important the various mechanisms are.
Sometimes during treatment you see an almost immediate change.
Breathing becomes slower.
The jaw softens.
The shoulders drop.
Movement that initially looked effortful becomes easier.
I don’t interpret that as “releasing stored trauma”.
I see it as the nervous system receiving different information and the person beginning to feel that they no longer need quite so much protection.
Breathing is part of the picture too – Yoga Therapy
Breathing and movement are intimately connected.
When we are stressed, frightened or concentrating intensely, breathing patterns often change. Some people use their upper chest and neck muscles excessively; others unconsciously hold their breath.
Conversely, changing breathing can influence movement and sometimes pain.
Recent systematic reviews suggest breathing exercises may help some people with spinal pain, although the quality of the evidence varies and breathing should not be regarded as a cure-all.
It is one reason I pay attention to breathing during physiotherapy and yoga.
Not because everybody needs endless breathing exercises, but because sometimes the way someone breathes tells me a lot about how much effort and protection they are carrying in their body.
Movement can help the body feel safe again
The answer isn’t simply to relax.
And it certainly isn’t telling someone with pain that they are “too stressed”.
Sometimes there is an irritated joint, tendon, nerve or other physical structure that needs appropriate assessment and treatment.
But when protection has become part of the problem, movement can gradually teach the nervous system something new.
A shoulder can move without being guarded.
A spine can bend without being braced.
A hip can take load again.
Breathing can continue while we exercise instead of stopping every time something feels difficult.
This is one of the reasons I combine hands-on physiotherapy, movement retraining, exercise and therapeutic yoga.
Hands-on treatment can sometimes help reduce pain and unnecessary guarding.
Then movement gives the body an opportunity to practise something different.
The body remembers patterns — but it can also learn new ones
I don’t believe we need to separate the physical body from the nervous system or our emotional lives.
They are continuously interacting.
Stress can change the way we breathe and move. Pain can make us anxious and protective. Poor sleep can amplify pain. An injury can change movement long after the tissues themselves have healed.
And equally, touch, movement, exercise, breathing, sleep and positive experiences can gradually change those patterns again.
So if you feel as though your body is constantly tight, guarded or “holding on”, it may be worth looking beyond the painful area alone.
Sometimes the question isn’t simply:
“Which muscle is tight?”
It is:
“Why does my body still feel that it needs to hold on so tightly?”
And importantly — what can we do to help it feel confident enough to move again?
Let us help you treat Acute / Chronic or Persistent Pain – Physio Body and Sole in Milsons Point, North Sydney