Understanding pain: Why a “healed” injury can still hurt

As a physiotherapist, I deal with pain – a lot.

Usually I see clients when pain is interfering with their daily lives. In some cases, the pain is very simple: “I sprained my ankle; it was sore for a few days and now it’s better.” However, with some of the clients I see, the pain is a little more complex. For instance, what began as an ordinary ankle sprain may still hurt months after, even though the doctor said it should be healed. Or maybe there’s pain without any apparent injury and lasts for months.

So how can pain come and go in such a seemingly random fashion?

Pathways of pain can lead many directions

Our understanding of pain has changed over the years. We used to think it was fairly straightforward. If we stubbed our toe or rolled our ankle, the pain fibres from that tissue sent a “pain signal” to a “pain centre” in our brains and – BAM – we felt pain. The more damage to the tissue, the bigger the pain fibre response, the more pain we felt.

We know now that pain is much more complex.

Our body tissues do not send pain signals, they send danger messages that go up into our brain. Also, we don’t have just one pain centre. Many areas of our brains are involved in a pain response, and they form what we call a “pain matrix.” Our brain then decides how to interpret these danger signals. To put it simply, our brain decides whether those signals are threatening or not, if they are threatening then we feel pain.

Let’s return to the ankle sprain. In the beginning, our injured ankle sends signals up to our brain, those signals go into our pain matrix and it considers: Is this a bad thing? Do I need to protect this ankle from more damage? If it decides “YES,” then we feel pain. We limp. We need to sit down and rest it. This is common in acute injuries while tissues are healing.

But what about that same ankle sprain three to six months later? It should be healed, so why does it still hurt?

The road to recovery

Many things can influence our brain as it decides whether these signals are threatening or not, especially if we have been in pain for longer than a few months. Factors that make our brain more sensitive to danger signals include increased stress, lack of sleep, prior traumatic experience, prior injuries, how we feel about pain and fear of not getting better, just to name a few. If we have many of these things occurring in our lives, our pain matrix can become more sensitive and decides that any signal from our ankle is dangerous and threatening; therefore, we can feel lots of pain, even if the injury has healed.

Does this mean my pain is “in my head” and isn’t real?

Pain does come from a complex interaction in our brains, but this does not mean that the pain you experience is not real. One of the most important things to learn from this new understanding of pain is that pain is complex and is not as simple as a signal from damaged tissue. Tissue injury is only a small part in why we experience pain, and this understanding can help people begin to move better and feel they have more control over their experience of pain.

Fortunately, physiotherapists have many treatment options to help deal with pain. We can provide education to help you understand where pain comes from, perform various techniques to help your joints and muscles move better, and provide exercises to reintroduce movement that will reduce pain and get you stronger.

Feeling pain and need to get your groove back? Call on your Copeman physiotherapist today.



Physiopedia. Theories of Pain. Available from http://www.physio-pedia.com/Theories_of_Pain Accessed on Feb 10 2020

Physiotherapy Alberta. Understanding Pain. Available from: https://www.physiotherapyalberta.ca/public_and_patients/the_you_movement_blog/understanding_pain Accessed on Feb 10 2020