Why Do I Hurt? – Part 2: How Does a Physical Therapist Help

Why Do I Hurt? – Part 2: How Does a Physical Therapist Help

Dr. Ethan Evert. DPT, CSMT

In the previous article, we gained a basic understanding of pain and why we experience it. We know that beliefs, fears, expectations, prior experiences and context, influence pain. Remember that pain is not always equal to the amount of tissue damage or injury. Pain is only a warning that something may be wrong. As the previous article mentioned, 40% of individuals have a bulging disc but do not have pain. This comes as a surprise to many because the term “bulging disc” has become associated with pain and dysfunction. While most acute pain subsides in a timely and expected manner, some pain becomes chronic. This is where pain switches from a symptom to more of a disease. There are many reasons why pain becomes chronic including cognitive, chemical and structural changes. Cognitive changes consist of hypervigilance, catastrophizing and attention distraction. Chemical and structural changes include neurodegeneration, metabolic changes and maladaptive plasticity. These changes can lead to mood disorders such as depression and anxiety8. In short, the nervous system becomes oversensitive.

The traditional view of pain was that it was bad and should be masked with opioids. However, opioids have many side effects and have little long term value when treating pain. As we have discussed the nervous system has many ways to produce pain. While pharmacological interventions may be a necessary part of pain management they should not be used alone. Injections and medications should only be used to create a window of opportunity to engage in activity and restore function. With opioid addiction at epidemic proportions, our society needs to embrace noninvasive and nonpharmacological solutions to pain. Physical and Occupational therapists are uniquely equipped to treat pain. Their ability to influence change through a variety of physical and educational interventions allows patients to return to a functional and productive life. By addressing the various components that contribute to pain we can begin to calm the sensitive nervous system.

Decreasing pain and sensitivity can be trying effort, particularly in chronic pain, but there are many techniques and treatments available. A physical therapist can help first and foremost by educating the patient and helping them understand their pain. When you understand that hurt does not equal harm, you can begin to increase activity in a controlled manner as not to upset the alarm system. Through a gradual process of restoring activity, the nervous system begins to learn that movements are safe. As the threat of harm decreases, the nervous system calms down. Remember that pain is completely normal, but being in pain all the time is not3. So, the next time we experience pain we can reassure ourselves that it is a normal part of living. It is only a warning of actual or potential tissue damage, it is different for everyone, and most importantly we do not have to fear it.


  1. International Association for the Study of Pain. (2017, March 2). Retrieved from Pain Taxonomy: http://www.iasp-pain.org/
  2. Butler DS, M. L. (2003). Explain Pain. Adelaide: Noigroup Publications.
  3. Louw A, P. E. (2013). Therapeutic Neuroscience Education, Teaching Patients About Pain. Minneapolis : OPTP.
  4. SZ, G. (2017). Pain Management: Road Map to Revolution. Physical Therapy, 217-26.
  5. Somotas AC, S. T. (2005). Neck Pain in Demolition Derby Drivers. Archives of Physical Medicine and Rehabilitation, 693-696.
  6. Videman T, B. M. (2003). Associations between back pain history and lumbar MRI findings. Spine, 582-588.
  7. Munk B, L. E. (2004). Long-term outcome of mensical degeneration in the knee: poor association between MRI and symptoms in 45 patients followed more than 4 years. Acta Orthopedica Scandinavia Journal , 89-92.
  8. Tracey I, Mantyh PW. (2007). The cerebral signature for pain perception and its modulation. 377-391




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