Chronic Pain: Why It Doesn't Always Mean Ongoing Damage

Aug 29

By Corey Kim, MPT | Registered Physiotherapist | Published August 28th, 2026

I see this a lot. A client comes in who's had pain for months, sometimes years. They've had imaging. Their scans came back "clean." And instead of relief, they feel dismissed — like if nothing showed up on the picture, maybe it really is "all in their head." That's not true, and it's not fair to how hard this actually is to live with.

What Is Chronic Pain, Really?

Chronic pain is when your pain lasts for more than 3 months.

The brain is plastic — it adapts when your body develops an injury. The representation of your body in the somatosensory cortex (the part of the brain that processes sensation) starts to change, which results in altered sensation. As a result, your brain can start interpreting load differently — the normal stretch and contraction of a muscle may get interpreted as pain because of these changes in the brain, not because of ongoing damage at the original site.

It's tough to live with chronic pain because no one can feel or even see the pain itself. If you've fractured your wrist or ankle, you wear a cast — it's visible. No one can feel the effects of chronic pain but you. It's self-reported, which can make others skeptical of it, and that can perpetuate a lack of awareness and empathy for the person actually experiencing it.

Is Chronic Pain Avoidable?

Sometimes, yes. It depends on multiple factors. But often, when people get injured, what they do is leave the injury alone and never get help. They assume that over time, the injury will heal itself — which is true, injuries do get better with time. But that doesn't mean your body will move as well as it did before. Sometimes when we heal, we develop faulty movement patterns. Our bodies are very good at finding other ways to complete a movement — we call these compensatory patterns. Over time, these patterns become the new norm for your body, which can create problems later down the road.

Many of my clients with chronic issues have a similar story when I take their health history. There was an injury, they didn't seek help, and they continued the same activities, which led them to develop pain that hasn't changed for years. Many times, people acknowledge they wished they'd seen a professional at the time. But the reasons for not seeking help are usually the same: being too busy, a stressful life event, or the old "walk it off" mentality that got ingrained in them as a kid.

Getting help earlier

There was a study in the UK on patients with back pain where they screened people as low, medium, or high risk of their pain becoming long-term. The ones at high risk were given more focused, hands-on care immediately, and they did better overall. A similar approach was tested twice in the US and didn't show the same results — but the reason this seemed to fail wasn't the idea itself. It's that the high-risk patients didn't actually get referred to the more intensive care they were supposed to get.

What If I Have Chronic Pain Now?

The best thing to do is increase your tolerance and improve your capacity. The common theme among almost all of my chronic pain clients is: I just want to walk a certain distance. I want to enjoy my time with my grandkids. I want to be able to play a certain sport again. Some of my clients recognize it's not really about their pain levels — it's that they need capacity, a bigger battery, to live life well.

There are things that can help decrease pain: medications, modalities, psychotherapy, meditation and mindfulness, pacing. But once there's some level of control where the pain is manageable enough to move, we need to build tolerance to movement — increasing your activity level and your capacity to move.

How Can Physiotherapy Help?

The first question to ask is whether there's truly a mechanical component. I do have clients who've already received help in the form of counselling, going to a pain clinic, pain science education around chronic pain, and pacing — all of which is very important. But they haven't necessarily tried everything available.

We're skilled in a movement diagnosis approach known as MDT. We use repeated movements to see if there's a pattern — does your pain change? Do you notice the location of your symptoms moving? Do you notice an increase or decrease in intensity? We use this first to see if there are clear patterns, then provide one specific movement for you to trial and see if your symptoms change.

Once we've used repeated movements to classify your injury and see whether there's a mechanical component, we start increasing capacity through strength and cardiovascular activity. By doing this, we improve your capacity to do more — keeping pain levels in mind, but not as the main focus.

If none of the above is enough on its own, acupuncture, dry needling, or manual therapy may also be of benefit. Soft tissue work, if tolerated, could help too. Sometimes these modalities can calm your nervous system and improve your capacity to move.

What to Expect at Your First Visit

We complete a detailed history asking about everything in the past that has led you to this point. We then complete a movement screen to see how you move and what your pain does. Afterwards, we provide you with a plan specific to your body and needs, and set goals together.

When it comes to timelines, chronic pain generally has a longer prognosis — meaning your healing time may look different than a typical injury. In the case of something chronic, the longer it's been around, the longer it will typically take to get better. Now, there are some people who do improve in a shorter period of time, because most of their pain was actually mechanical. But like we mentioned earlier about those plastic changes to your brain — if that has truly occurred, we have to do more work interpreting what your brain is telling us as you move. This can add complexity and time, since we need to figure out whether you're actually developing a new injury as you move, or whether your brain is just getting reacquainted with movement again.

Does Physiotherapy Help Chronic Pain?

Yes. Not by chasing pain levels directly, but by finding out whether there's a mechanical component we can classify and treat, and by helping you build the strength, movement tolerance, and understanding you need to get back to the life you actually want to live.

Frequently Asked Questions

Is my chronic pain "all in my head"?

No. Chronic pain is a real, physical experience — the difference is that with chronic pain, the story your nervous system is telling isn't always about ongoing tissue damage. That doesn't make it less real. It means the path to feeling better looks different than just waiting for something to heal.

Why do I hurt even though my scans are clear?

A clear scan means there's no structural damage showing up on imaging — it doesn't mean nothing is happening. Your nervous system can become more sensitive over time, independent of what's visible on a picture. This is exactly why understanding your pain, not just imaging it, is often the missing piece.

Will I always have this pain?

I can't guarantee whether pain will fully go away. I've had some amazing success stories of people being pain-free, and others having to manage pain on an ongoing basis while still being happy with how they're moving and what they're doing. It will generally depend on whether you're ready to accept a new normal, or whether you need more time to come to terms with your pain being a part of you and how it changes with you. Your relationship with your pain becomes more important for chronic conditions than the question of "will this ever go away." Pain is a subjective experience, meaning how you interpret what you feel is just as important as the modality, stretch, or exercise you're doing to help change the way you feel and move. If this isn't fully clear right now, that's okay — sometimes going through an assessment and talking it through together can help you find out what you're actually looking for.

Finding Help Today

We are committed to listening to you and doing our best to understand your story. We want to walk with you to see how we can help you function better and live life to your full capacity. Book with one of our physios to see if we can help you reach your full potential.

Book Your Assessment:http://breakfreephysio.janeapp.com/

References

Hill JC, Whitehurst DG, Lewis M, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. The Lancet. 2011;378(9802):1560-1571.
Stratified care to prevent chronic low back pain in high-risk patients: The TARGET trial. A multi-site pragmatic cluster randomized trial. eClinicalMedicine. 2021.
Cherkin D, Balderson B, Wellman R, et al. Effect of low back pain risk-stratification strategy on patient outcomes and care processes: the MATCH Randomized Trial in Primary Care. Journal of General Internal Medicine. 2018;33:1324-1336.
Lepri B, Romani D, Storari L, Barbari V. Effectiveness of pain neuroscience education in patients with chronic musculoskeletal pain and central sensitization: a systematic review. International Journal of Environmental Research and Public Health. 2023;20(5):4098.
Malfliet A, Kregel J, Meeus M, Danneels L, Cagnie B, Roussel N, Nijs J. Patients with chronic spinal pain benefit from pain neuroscience education regardless the self-reported signs of central sensitization: secondary analysis of a randomized controlled multicenter trial. PM&R. 2018;10(12):1330-1343.