Persistent pain is different from acute pain; it is pain that lasts beyond 3-6 months, and it no longer serves a protective purpose. Acute pain is what you feel when you injure yourself; when you cut your finger, break your arm, sprain your ankle or strain a muscle. After an injury, tissue healing follows a predictable path when there are no systemic conditions or medications that might hinder it. Pain that persists beyond the normal healing time is considered persistent pain. Because the injured tissue has healed, this type of pain no longer should be treated as strictly an issue with the tissues. 

Current research shows us that the brain and the nervous system play a big role in our experience of persistent pain. When you believe that your body’s tissues are the sole culprit of your persistent pain and when you hand control over your pain levels to practitioners who foster those beliefs, your pain is more likely to persist.    

We are starting to understand that variations in the body’s structure and tissues (ligaments, muscles, bones, joints) correlate poorly to pain that is felt. Fixating on diagnoses like “postural strain”; “improper alignment”; “fallen arches”; “degenerating discs”; and other such structural “faults” is unnecessary at best and harmful at worst. As Greg Leman, physiotherapist and educator, explains “you may have been told that your spine is out of alignment, that your muscles don’t work properly or turn on in the correct order, that your posture is horrible, your glutes don’t fire and you have a weak core. The proposed treatment is then about ‘fixing’ all of these things and until you ‘fix’ those things you can’t get back to being you and being out of pain.”

 What causes persistent pain is more complex than just what’s going on in the body’s tissues. Many factors contribute to persistent pain including inaccurate, negative perceptions of what is wrong in your body; stress; poor sleep; worry; fear; anxiety; past experiences of pain; expectations of pain; perceptions of the body being broken/needing fixing; general health status; nutrition…  the list goes on. 

A useful analogy for what causes persistent pain is that of a cup filling with water.  Your body has resilience and can deal with many things that can contribute to the emergence of persistent pain without persistent pain manifesting. Each of the things that can contribute to your pain (stress, poor sleep, expectations of pain etc.) add a little bit more water to the pain cup. Only when the pain cup overflows is persistent pain actually experienced. 

Understanding persistent pain in this way helps us understand that it is important to let go of the outdated idea that the body needs fixing by manual therapists. Instead of an approach that creates a reliance on manual therapists, we should embrace the evidence-based way of understanding persistent pain, which prioritises your empowerment. While passive manual therapies like chiropractic, massage, dry needling etc. can play an important role in reducing your pain, what makes the difference long-term is what you do and how you think every day.