Pain...why does it persist when an injury has healed?

Updated: Apr 22

by Samantha Berry

As I have discussed in my previous blogs, pain is a very complex thing. Although it is unpleasant, it can be useful when we have an injury in order that we modify our activities and behaviours to help the area to heal. But what about when pain lasts longer than the time it takes for our tissues to heal?

First of all, how long does it take for tissues to heal?

Well, generally it will take between 6 and 12 weeks dependent on your age and general health. For instance, if you are a smoker, heavy drinker or have a medical condition such as diabetes that is not well controlled, things may take a little longer. If you have ever experienced an injury you may have noticed that the pain has gone on for much longer than 3 months. You may have had that niggle when you are running or twinges in your back for many months or years. This does not mean that your injury has not healed.

Why do I still have pain?

Sometimes the pain persists simply because you are overloading your tissues (muscles, ligaments or bones) and you experience this as pain. Imagine that you have broken your ankle and have been in a plaster for 6 weeks. Your plaster will be taken off because a bone will heal over this length of time, however, you would not expect be able to walk up Ben Nevis the next day! This is because you would have weak leg muscles, stiff joints and the fracture itself, although healed, not at its maximum strength to cope with such a high demand on it. Over time you would have to gradually build up the amount of stress you put on these structures so they could strengthen to cope with what you are asking of them. Then they will no longer be painful, but this can take many months.

Another reason for pain lasting so long is generally less well known and understood. This is when pain is acting like a faulty car alarm, sending us false alarm signals when there is no danger or threat to the body!

This may sound odd but think about a car alarm..... it has a sensitivity switch wired into it so that it will only be set off if someone is trying to break into or damage your car and not when someone just brushes past it or there is a gust of wind. We've all come across those annoying car alarms that go off at the slightest thing, usually in the middle of the night! Our nervous systems are very much like this in that the nerves and the brain have built in sensitivity switches that can become overly sensitive after an injury. So things that shouldn't be painful become painful. Warning signals are sent to our brain and over time our brain learns to pay more attention to them. We then experience pain despite our tissues being healed and so these warning signals are false alarms, just like the car alarm going off in the wind. The sound you hear is real enough but the reason for the sound is false, just as the pain is real enough but it does not relate to harm or damage to our tissues.

When this is the cause of our ongoing pain we need to try to dampen down the excitability of our nervous system. Pushing through the pain and trying to force your body to move is not helpful, it just reinforces to your brain that movements hurt! It is best to work within a comfortable or tolerable level of pain and gradually build up what you are able to do. Of course this is very easy to say and not so easy to do! An experienced physio can help guide you through this process, a challenge we relish at Omnia.

Watch this short YouTube clip which shows really well how this process works when guided by an experienced physiotherapist.



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