The Myth:
“Pain always means something is broken, torn, or injured.”
Many people avoid exercise, movement, or even everyday activities because of this belief. If you’ve ever wondered why your back or knee hurts even though nothing shows up on an X-ray or MRI, you’re not alone.
The Truth:
Pain does not always equal damage. Instead, pain is your nervous system’s protective alarm system. Sometimes that alarm is accurate—like when you sprain an ankle. But other times, the alarm is hypersensitive, firing off even when tissues are healed or perfectly healthy (Moseley, 2003).
Think of it like a car alarm that goes off when the wind blows: the system is trying to protect you, but it’s overreacting.
Why Pain Isn’t Always a Sign of Damage
Pain is not simply a direct signal from tissues. It’s an output of your nervous system designed to protect you. The brain evaluates inputs from muscles, joints, nerves, prior experiences, stress, and even emotions to determine whether a situation is threatening.
- When your nervous system senses actual injury, pain is an appropriate alarm.
- When your nervous system is hypersensitive, pain can occur even in healthy tissues.
This is why people can have chronic back, knee, or shoulder pain while imaging shows no structural damage (Moseley, 2003). Pain, in this sense, is a “threat perception”, not a damage report.
The Neuroscience Behind Pain Without Damage
- Central Sensitization
- In some chronic pain cases, the spinal cord and brain become overactive, lowering pain thresholds and amplifying normal sensations. This is called central sensitization.
- Even harmless movements or light pressure can be perceived as painful because the nervous system is “on high alert.” (Woolf, 2011)
- Peripheral Input Amplifying Pain
- Trigger points, tight fascia, or minor tissue tension send continuous signals to the nervous system. These inputs are often not harmful, but they keep the alarm system engaged.
- Myofascial release or gentle stretching reduces this peripheral nociceptive input, which in turn reduces central sensitization (Cheatham et al., 2016; Bialosky et al., 2009).
- Neuroplasticity and Threat Perception
- The nervous system adapts based on experience. Fear of movement, repeated injury signals, or stress can “train” your brain to interpret certain movements as dangerous.
- Pain Neuroscience Education (PNE) teaches your brain that hurt does not always equal harm, lowering threat perception and reducing pain (Louw et al., 2011; Louw et al., 2023).
How Movement and Manual Therapy Reprogram the Nervous System
Even when tissues are fine, research shows that mobility, stretching, and myofascial release improve pain perception by modulating the nervous system:
- Stretching & Mobility
- Raises pain thresholds locally and in distant areas, showing central nervous system modulation.
- Improves confidence in movement, reducing fear-avoidance behavior (Vaegter et al., 2015).
- Myofascial Release / Foam Rolling
- Provides sensory input that “recalibrates” the nervous system, reducing perceived threat.
- Studies show increased pressure pain thresholds and improved range of motion without structural changes (Cheatham et al., 2016; Bialosky et al., 2009).
- Gentle Strengthening & Movement
- Reinforces the message that movement is safe, rebuilding tissue tolerance while retraining the nervous system to interpret signals accurately (Moseley, 2003).
- Pain Neuroscience Education (PNE)
- Understanding how pain works can directly reduce fear, stress, and pain intensity.
- Combining PNE with movement-based interventions produces better outcomes than exercise alone (Louw et al., 2011; de Boer et al., 2021).
- Stress Reduction & Sleep
- A well-rested and calm nervous system is less likely to overreact, reducing central amplification of pain (Haack et al., 2020).
Practical Takeaways
- Pain is real, but not always dangerous.
- Movement is medicine: gentle stretching, mobility, and strengthening help retrain your nervous system.
- Manual therapies help calm alarms: myofascial release, foam rolling, and trigger point work reduce peripheral input that keeps pain alive.
- Education empowers: understanding pain can lower fear, stress, and perceived threat.
- Consistency is key: repeated safe movement teaches your brain that your body is safe to use.
By combining movement, manual therapy, and pain education, you can retrain both your brain and body, lowering pain sensitivity while improving function, strength, and confidence.
References
Bialosky, J. E., Bishop, M. D., & George, S. Z. (2009). The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model. Manual Therapy, 14(5), 531–538. https://doi.org/10.1016/j.math.2008.09.001
Cheatham, S. W., Kolber, M. J., Cain, M., & Lee, M. (2016). The clinical effectiveness of self-myofascial release: A systematic review. International Journal of Sports Physical Therapy, 10(6), 827–838.
de Boer, M., et al. (2021). Short-term impact of combining pain neuroscience education with exercise for chronic musculoskeletal pain: A systematic review and meta-analysis. Pain Reports, 6(2), e947. https://doi.org/10.1097/PR9.0000000000000947
Haack, M., Simpson, N., Sethna, N., Kaur, S., & Mullington, J. (2020). Sleep deficiency and chronic pain: Potential underlying mechanisms and clinical implications. Neuropsychopharmacology, 45(1), 205–216. https://doi.org/10.1038/s41386-019-0439-z
Louw, A., Diener, I., Butler, D. S., & Puentedura, E. J. (2011). The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Archives of Physical Medicine and Rehabilitation, 92(12), 2041–2056. https://doi.org/10.1016/j.apmr.2011.07.198
Louw, A., Diener, I., & Butler, D. S. (2023). A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: Short-term outcomes of pain and disability. Pain Practice, 23(7), 682–693. https://doi.org/10.1111/papr.13222
Moseley, G. L. (2003). A pain neuromatrix approach to patients with chronic pain. Manual Therapy, 8(3), 130–140. https://doi.org/10.1016/S1356-689X(03)00051-1
Vaegter, H. B., Handberg, G., & Graven-Nielsen, T. (2015). Similarities between exercise-induced hypoalgesia and conditioned pain modulation in humans. Pain, 155(1), 158–167. https://doi.org/10.1016/j.pain.2013.09.023
Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(3), S2–S15. https://doi.org/10.1016/j.pain.2010.09.030