Why Pain Isn’t Always a Tissue Problem

Pain is often spoken about as if it lives inside damaged tissue - a disc, a tendon, a joint, a ligament. It’s a simple story. Something is “wrong,” and therefore it hurts.

But anyone who has worked in rehabilitation long enough - or lived with pain long enough - knows that this story frequently falls apart.

Two people can have the same MRI findings. One is in constant pain. The other feels completely fine.

Some people experience severe pain with minimal tissue change. Others walk around with significant degeneration and no symptoms at all.

So where, exactly, does pain come from?

Who This Is For

- People with persistent pain that doesn’t fully match scan findings

- Anyone who’s been told “your imaging looks fine” but still hurts

- Clinicians trying to understand why pain sometimes behaves unpredictably

The Big Picture (Plain Language)

Pain is not a direct read-out of tissue damage. It is an output of the nervous system.

That doesn’t mean pain is “imaginary.” It means pain is a protective response - the brain’s best prediction that something may be threatening.

Sometimes that prediction is accurate and short-lived, such as with an acute injury.

Other times, the threat signal becomes amplified, persistent, and disconnected from the original tissue input.

Pain, in this sense, is not just about structure. It is about sensitivity, context, memory, load, and control.

The Deeper Layer (Anatomy, Physiology, Control)

Tissues send information to the spinal cord and brain through sensory nerves. These signals report things like:

- Pressure

- Stretch

- Chemical irritation

- Temperature

- Mechanical load

The brain then integrates this input with:

- Past injury history

- Emotional state

- Sleep quality

- Stress

- Beliefs about damage

- Current physical load

If the system perceives threat, it may produce pain - even when tissue health is relatively stable.

At a cellular level, repeated stress can alter:

- Ion channel sensitivity

- Neurotransmitter balance

- Local inflammatory mediators

- Blood flow and oxygenation

Over time, the nervous system can become sensitised, meaning it reacts faster and more strongly to smaller stimuli.

This is why pain can persist even after tissues have structurally healed.

What This Means in Real Rehab

If pain were purely a tissue problem, then rest, injections, and surgery would solve most cases. They don’t.

Effective rehabilitation has to address:

- Load tolerance of tissues

- Motor control and coordination

- Nervous system sensitivity

- Breathing and tone

- Sleep and recovery capacity

- Psychological safety in movement

Ignoring any one of these can stall progress - even if everything else looks “correct.”

What We Actually Do at Biokinetics

We don’t treat scans.

We don’t chase pain in isolation.

We don’t assume structure alone explains symptoms.

Our assessments integrate:

- Movement quality

- Load response

- Neural sensitivity

- Joint control

- Breathing patterns

- Training history

- Surgical history

- Recovery status

The plan that follows is not just about strengthening or mobility - it’s about restoring trust between the nervous system and movement.

When to Seek Help or Further Review

Pain should always be taken seriously.

Red flags that need urgent medical review include:

- Progressive neurological weakness

- Loss of bowel or bladder control

- Night pain with systemic symptoms

- Unexplained weight loss or fever

Pain that persists beyond expected healing timelines also warrants deeper assessment.

Closing Reflection

Pain is real.

But its source is not always structural.

Understanding this doesn’t invalidate suffering - it actually expands the number of ways recovery can begin.

If this article reflects your experience, the team at Biokinetics works closely with medical specialists and allied health professionals to guide complex rehab with clarity and structure.