This next blog post is a little left of centre and more of an anecdotal piece. I write this to primarily give you the client an insight as to what it’s like in the Physio position.

Pain Science is a huge topic in the health field currently, and rightly so. If we can develop a more comprehensive understanding of pain then we will be able to provide more assistance to those in pain. To date, our poor understanding of pain combined with our desire for instant gratification has taken us down the path of medicating for pain, which has resulted in widespread opioid addiction.  It is also the health care system’s poor understanding of pain that leads us to always associate an injury with both pain and how the structure looks on scan. I encourage you to refer to my colleague David Thwaites blog post, ‘Doc, should I get my back scanned? 2 reasons to think twice’…..It’s a must read.


Are you aware of the armour of toughness, which comes with telling a physio you have a ‘high pain threshold?’ Instead of toughness, why don’t we display resilience?

It’s important that we clearly define the difference between Resilience and Toughness. When we talk about one’s ability to deal with pain, toughness is often a word that is used by patients to describe how well they deal with their pain. Although it can be seen as a good thing to have a high pain threshold, it can actually be a more challenging rehabilitation process, as the focus is still on pain.

As the Japanese would say Nana korobi ya oki…. ‘you get knocked down 7 times and get up 8’. Rather than focusing on pain, resilience is about adapting and finding long-term ways to improve your function. What we often find in the rehabilitation process is while we are progressing and improving function, at least initially, pain may stay the same.  Although pain will often improve in the long run, the relationship between pain and function is definitely not linear. Understanding this, and shifting the focus away from pain to emphasis improvements in function will result in much greater improvements.

A lot of the onus is on us as clinicians.  We need to consider our language and how we communicate in clinical settings. If we continue reinforcing the pain message then the focus of treatment and rehabilitation becomes very pain orientated.  If we can demonstrate to a patient that their function is improving on a long-term basis with the management/advice that we are providing, it will ultimately result in a change to the patients pain profile. In essence, if they are doing more and focusing on function, then pain becomes less bothersome.  This process of managing your injury is really the end game. The start point is all about how open one is to change, how willing one is to not be identified by their pain, and is one able to acknowledge improvements but also be resilient to work through some challenges.

‘Pain-free’ is far too often thrown around as the ultimate result of having treatment. This can send some people down a dangerous path of medicating to ‘relieve’ the pain. We as physios can certainly help decrease pain levels through strength and developing tolerance. However, the law of diminishing returns will always be against us. So those last little niggles and sensations that hang around and can stonewall patients as they are very hung up on that euphoric place of ‘pain-free’.

That’s not to say that ‘pain free’ is unachievable.  But there is an inverse relationship at play here.  The more bothered we are by our pain, the less likely we are to achieve it.

There is a whole spectrum between painful and pain-free, so lets use it!

Top tips from this blog post:

  • Start looking at tolerance to functional outcomes like walking, standing, sitting rather than the pain levels
  • Start using language like ‘there is discomfort’, ‘it feels weak/stiff’, rather than using pain
  • Challenge your treating practitioner to look at and find ways to achieve your functional goals, not just massage the painful spot each session!
  • If you’re in pain while moving and you’re also in pain while sitting still, then choose to move.