What is Pain?


As a physiotherapist, the majority of work we do is centred around reducing pain. Yes, we also look to improve movement, strength, balance, coordination and general function, but all this is usually linked to trying to reduce pain as a primary goal. As a therapist then, it helps a lot to understand what pain actually is. A short answer might be anything that causes you to say “ouch!”, or anything that simply causes suffering. Pain on the most basic level is just a warning system alerting us to danger, but looking deeper, it is a much more complex phenomena that I think warrants a better, more thorough explanation.

History Lesson. Stay with me.

Throughout history pain is something that has baffled many a deep-thinker. In the very old days (this article probably won’t win any historical accuracy prizes) pain was thought of as something external, that happened to us as a punishment from God. In the centuries after that a chap called René Descartes came up with a new theory; that pain was something you experienced internally. This theory evolved over time into the idea that we had an independent sense of pain. Pain was felt through ‘pain receptors’ which sent signals to the brain telling us when we’re injured. The intensity and type of pain was thought to be directly linked to size, location and severity of the injury. Seems like a perfectly logical explanation? Well, not quite.


Not everything is quite as it seems..

In more recent times scientists have recognised that the level of pain experienced is not always proportional the the injury sustained. To use an example, if you imagine a boxer being punched repeatedly in the face, the damage being done, and how they are able to continue to function and focus with seemingly little pain response. Compare that to stubbing your toe on your bedside table whilst walking to the loo in the night, the boxer is probably sustaining far more tissue damage but the pain response from your big toe could seem far more intense!

How we perceive the intensity and severity of pain is to do with how the brain interprets the signals it receives from the sensory nerves. How the brain interprets the signal depends on a whole host of factors such as our internal biochemistry, the external environment, our past experiences and expectations.

One of the most prominent researchers of pain science in modern times, the very eloquent and witty Lorimer Moseley, explains this far better describing his experience with pain whilst out walking in the outbacks of Australia. The TEDx presentation he did a few years back (link here) is his story, which brings you nice and unto date with how we currently understand things.



Persistent pain

Persistent (or chronic) pain is the most interesting (and perhaps the most debilitating) part of this topic that we deal with as therapists. Lorimer Moseley touched on it at the end of the youtube video, pointing out how pain can change over time. This is because the nerve pathways are ‘plastic’, meaning the more a pain signal gets passed through a nerve, the stronger and more efficient that signal can become. I like to think of it as upgrading a rickety old set of train tracks with an old steam engine into a high speed railway with a bullet train running down it. The end result can be stronger pain signals that get set off much more easily. On top of this, our ‘threshold’ for pain can also become lowered, meaning we experience pain in response to a stimulus that normally would cause no problems. As a result, things such as cold metal on the skin or even light touch could become excruciatingly painful.

“Pain is experienced in the person, not just the brain”

With all this work into pain science being focused on the brains involvement, its important to not get too carried away and think its ALL about the brain. Mick Thacker, another prominent figure in the world of pain science, tells us that pain is something the person experiences more generally, and its not just isolated to the brain and associated nerves. Changes and reactions can occur through a number of the bodies systems including the immune system which can all influence our pain response.



Sleep and Stress

Following on from the idea that pain is part of the person as a whole, lifestyle factors such as sleep and stress can influence our pain levels. Not getting enough of restorative (deep) sleep can influence the hormone balance in our bodies and effect recovery. If we are fatigued due to lack of sleep, our perception of pain may also be greater. This may become a vicious cycle where pain affects sleep, which makes you feel worse, which then affects sleep more, and so on. This dysfunctional pattern can be something that contributes to the persistent pain mentioned above.

Acute stress should be considered a normal part of life, and can be helpful in certain situations, but chronic stress (sustained stress over long periods of time) can have a more negative effect on our hormones and increase our sensitivity to pain. Stress (like sleep) can be a significant factor in persistent pain, so monitoring pain levels and seeing if that relates to a stressful period at work for example, can be useful.



Understanding the subtleties of pain can help us as physiotherapists get the most out of the people we see. Being aware of, for example, someones past experiences of injury, can help us provide a more individualised treatment program set at the right level. Knowing to keep an eye out for factors such as stress and poor sleep, and having the tools to deal with them, means we can deliver a much more thorough treatment for those people that need it.

What on Earth is TMD?!

Welcome back! This month I’m going to touch on an interesting and more unusual topic. The subject… TMD. If you don’t know what this is, hopefully I can capture your curiosity, and get you read a little further. If you are aware of it, and have suffered with it yourself, then this article may be of particular interest to you.

TMD, or properly known as ‘Temporomandibular Dysfunction’ is related to pain with the joint between the jaw and the skull, or surrounding muscles, ligaments and tendons. 

The first question you might ask..

What are the signs and symptoms of TMD?

  • Pain in the jaw area! – This might seem an obvious one, but it can also include pain spreading up into the temple, chin, into the ear, and even into the neck. This pain can feel dull and achey, which is why it is often mistaken for toothache.
  • Jaw stiffness – One of the main tell-tail signs of TMD is difficulty opening the jaw fully or more general stiffness. Clicking, cracking or grinding when opening the mouth can also be associated with this problem.
  • Headaches – Not always present with TMD, but this can occur due to overactive muscles around the jaw.


Someone booking a physiotherapy appointment for TMD is quite a rare occurrence. This is probably the lack of awareness that the little joint that opens and closes their mouth could even be a problem! The first place most people go is straight to their dentist (which if I didn’t know better, would probably be the same place I’d go). Only when the dentist looks and finds no problems on X-rays or dental checks, might they suspect this is a problem. Having chatted to a dentist that works next door to one of our PhysioDirect clinics, they confirmed this is something they actually see a lot of.

The next query you might want an answer to..

What might contribute to TMD?

  • Stress! – The physical signs of stress such as clenching your jaw can play a role in this condition. Constant overactivity of the surrounding jaw musculature and tendons can lead to pain and dysfunction.
  • Impact to the jaw –  This can include things such as falling on the face when drunk.. Ouch! Perhaps not a common problem for most of us, but on the rare occasion we trip when drunk, our reaction times are slowed. This can mean landing on the face rather than outstretched arms. Impact from things such as fighting, also need to be considered. If there is pain involving impact trauma, ruling out anything more serious is always advised.
  • Braces – Worth also considering. A history of anything which has had a restrictive effect on our jaws and teeth may cause changes to the way our jaw moves, and therefore play a role.
  • Bad habits – Chewing gum, the end of your pen at work or even biting nails or teeth grinding at night can increase the total amount of work our jaws do throughout each day. Although one of these habits might not cause problems on their own, on top of one or two of the other problems above, it might all add a little towards the development of TMD symptoms.

The things we do, the habits we have and even our how stressed we are can all play a role in this condition.

Question number 3..

How can Physio Help?

  • Thorough Assessments – Going into detail about your symptoms, how they started, habits you might have all help put together a picture of your condition and how best to help. Ruling out other possible causes of your pain such as the neck will also be covered by your physio.
  • Manual therapy Techniques – More often than not, TMD presents with restriction in movement of the jaw. Hands on treatment to help get things moving can be very beneficial. More often than not it doesn’t mean going inside your mouth, as most techniques can be applied to the outside of the jaw. Soft tissue techniques to the surrounding musculature can also provide some relief.
  • Stress management! – Believe it or not, physio’s are well equipped to help provide tips to deal with this.
  • Tailored exercise programs – Specific stretching and strengthening exercises may be given depending on your symptoms. Self mobilisation techniques can be taught, and can often help make progress between sessions.
  • Working on your bad habits! – Knowledge of all the bad habits mentioned above, and making an effort to change can help get this condition on the right path. Often some support and guidance from your physio can give you the push you need. Some habits are harder to break than others after all.


So there you go. TMD in a nutshell. Hopefully some awareness of this condition might help point you or someone else you know in the right direction. If you have any questions or want to book in for an assessment, give us a call on 0115 956 2353. Thats it for another month, keep checking for our next update!

Physiotherapy and Ageing

Hello again! This months blog comes at a bit of a tangent from all the recent press around the ‘NHS Crisis’. News articles and TV broadcasters have been quoting figures and stats showing how things are almost at breaking point. The main reason cited for this, is not the quality of care that is delivered (which is predominantly excellent), but the sheer overload on the system. While many people have pointed the finger at the cost cutting (or as the government spins it.. ‘efficiency savings’), Jeremy Hunt has tried to divert this attention to the largely increasing ageing population putting more stress on the services.

This month I therefore want to delve into the topic of ageing. I hope to discuss how it impacts on our health, and how physiotherapy and exercise can help as we get older.


The Physical Effects of Ageing

Apart from the obvious grey hair and wrinkles, ageing affects the body gradually in subtle ways over time. Here are the main physical effects we should all expect as we get older:

  • Bones and joints – Over time our bones reduce in density. Cartilage can wear and our joints can thicken and lose water content. Connective tissue and ligaments around joints can become less elastic. All this can lead to joint stiffness.
  • Muscles and tendons – Due to hormonal, nervous system and metabolic changes, our muscles lose mass and strength over time. Our tendons also become less well hydrated and less elastic, making us less stretchy!
  • Our heart and vessels – Over time our heart becomes less efficient. When we exercise, the maximum blood able to be pumped round our body is less as we age. The overall effect is less oxygen to the bits that need it. This means not being able to exercise as long without getting tired. Our vessels can also stiffen over the years which can cause an increase in blood pressure.
  • Balance and reaction times – Changes in our nervous system can also cause us to react more slowly to things. Balance can also reduce as we age if we don’t work to keep sharp.


So What?

Unfortunately as we go through our lives, this can mean we can pick up niggles, aches and pains. We can also develop other general health problems related to ageing. This can seem like a reason to avoid activity, as you may fear further injury or making these health problems worse. However by making appropriate adjustments and keeping exercise as part of our daily routine, it’s often possible to reap some good benefits to your health, without risk or negative effects.

Here are a few simple things we can do for starters:

  • Choose an activity that is appropriate for you – If you suffer, for example, from osteoarthritis in your hips, knees or ankles, choosing running as your primary exercise (which creates a lot of impact through those joints), might not be most suitable. Looking at something like cycling or swimming or even pilates which are much easier on your joints can be a good alternative.
  • Take more time to warm up and cool down – Pretending you can jump straight onto a football pitch to play your Sunday league game when you’re 50 in the same way you did at 21, might not be the smartest move. Taking time to get the muscles, joints and tendons fully warmed up is more important to keep you injury free.
  • Progress things more slowly – As we age our capacity for recovery also decreases, and our ability to make progress when training for something can be less. If you therefore have the ambition of running a marathon, being realistic about how long it would take to build up the distances, and giving yourself enough time between sessions to recover can help keep you free of niggles.


The Benefits of Physiotherapy

If you have more complex health issues or a history of more serious injury and aren’t confident how to start exercising on your own, going to see a physiotherapist is in my (slightly biased) opinion, is the best thing you could do.

Physiotherapists are excellently positioned to help. Our profession comes from a medical background, and therefore any therapist you see should have to have a good understanding of any health conditions, operations or previous injuries you have, and how to work safely with them. We can often work with your doctor to help you achieve your goals.

Here are a few example of the things physiotherapists can help you with:

  • Osteoporosis – there is a body of evidence that shows exercise and more specifically resistance training can be helpful in the treatment of this condition. Physiotherapist can help start you off going through strengthening exercises that might be helpful, and then help you progress things in a very gradual way.
  • Chronic back pain – a topic I’ve touched on in a previous blog, and one of the most common issues people can stuffer with. Guidance from a physiotherapist can help you choose a form of exercise that is suitable, and get you doing the right amount of activity so that you don’t flare things up.
  • A history of falls – balance and reaction times can be affected as we age, and also made worse if someone is on lots of medication. All this can lead to an increased risk of falls, and is a reason a lot of people stop exercising. Physiotherapy can work on balance and lower limb strengthening to bring this risk down.
  • Osteoarthritis – this can be a real limiting factor for many people. A physiotherapy assessment can often highlight any weaknesses that have developed alongside arthritic pains, and some advice on altering your exercise habits and strategies to help with coping day to day can make this condition a lot more manageable, and exercise possible.

Above are just a few conditions we can directly influence. Indirectly keeping active has a whole host of benefits. This includes reduced risk of various cancers, reduced impact of type 2 diabetes, better digestive function, a positive effect on blood pressure and improved mental function. All this keeps people fit and health longer and can actually help slow down some of the effects of ageing.

Although it might not be on your mind, the knock-on effect of all this is that someone who keeps fit and active is likely need less input from their doctor or their local hospital. The argument for keeping active then, is pretty strong. And if you want any evidence that age is just a number, click this link to see some youtube videos of people doing some pretty amazing things!

Thats it for this month, keep checking back for more content and updates. If you want to enquire about how physiotherapy can help you, give our admin team a call on 0115 956 2353 or email us at info@physiodirect.com