Pain and Injury Myths: #1 - Does Pain Always Mean Damage?

Welcome to the Pain and Injury Myths Blog Series. My goal here is to highlight some of the misconceptions around injury and pain that may be holding people back from optimal recovery, and quality of life.

Injuries can range from acute and traumatic, such as bone breaks or tendon and ligament strains, to overuse injuries like tennis elbow or plantar fasciitis. Other pain conditions are innumerable, with their causes unknown. After pathology (tissue damage) has resolved, some still experience pain, a chronicity often caused by disregulation of the nervous system.

Pain is a normal human experience that we will all encounter periodically in our lives. When not associated with a specific incident, the pain experience is multidimensional, influenced by:

• Mechanical factors (body & movement)

• Psychological factors (beliefs & self-identity)

• Social factors (family and work)
  

As an Exercise Physiologist and Personal Trainer, I regularly meet with people experiencing pain to varying extents. Many of the explanations I hear - though understandable - are based on misconceptions that I feel may hold people back from recovery. Comments like:

• “I wore my knees out from running too much.”

• "I've got a slipped disc, so i can't do..."

• “My back is shot from bad posture.”

• “I’m injured because I don’t stretch enough.”
  

These are just some of the misconceptions I feel hold people back, and that I hope to shed light on in this Pain and Injury Myths series. Let’s get on with Myth #1.

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Note: What follows is not medical advice, but food for thought - ideas grounded in current evidence that you may wish to discuss with your healthcare provider. Let's also acknowledge that this information is general in nature, and that everyone's pain or injury experience is different.

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Myth #1: Pain Always Equals Tissue Damage (and Vice Versa)

A very common belief about injury and pain is that the pain sensation is a direct measure of tissue damage. It’s often assumed—and fairly so—that if something hurts, something must be structurally wrong with the body. Something must be torn, bulging, or wearing out. And while this could be true, the reality is far more complex.

The Reality: Even Pain Free Individuals Have Tissue Damage

This is not to dismiss the pain someone might be experiencing. It’s not imaginary. But many studies investigating the correlation between pain and tissue damage (measured by MRI) have shown the answer is not so clear-cut.

Examples include:

• People with shoulder pain from a broad range of ages have been found to have "degenerative" changes in both shoulders, despite only having pain on one side.

• In hundreds of pain-free knees, 97% were found to have abnormalities such as meniscal tears or cartilage lesions.

• Low back pain, the most common pain symptom, is often considered "non-specific," meaning the exact cause can't be determined. Clinical guidelines discourage routine imaging because:

  • Many findings of abnormalities are also seen in people without pain.

  • Imaging often does not change treatment or recovery outcomes.

  • Imaging may even lead to unnecessary or harmful treatments.

The Impact of Labels

One reason this matters is that people can begin to define themselves by their "injury" after receiving an imaging report. This can result in:

• Fear Avoidance: Avoiding movement due to fear of further damage.

• Low Self-Efficacy: A reduced belief in one's ability to recover from injury.

Both fear avoidance and low self-efficacy are known to be major determinants of poor recovery outcomes.

Another Reality: Some Pain Is Okay During Rehab / Exercise

If you are injured or experiencing pain, rehab or returning to activities may not always be completely pain-free - and that’s okay. Pain does not always equal damage.

• Sharp, intolerable pain (that screams STOP) may warrant stopping or modifying the activity.

• However, tolerable pain (less than 4/10 on a pain scale) that doesn’t worsen over the next 24 hours is generally acceptable.
  

This is often called the zone of adaptation:

• Tissues adapt by becoming more tolerant to stress.

• The brain becomes less reactive to perceived threat.

• You consciously become more confident in your physical capacity.

• Supporting muscles become stronger from consistent use.
  

The Risk of Doing Nothing

One of the biggest mistakes people make when feeling some pain is to stop everything and wait for it to go away before returning to activity. This can:

• de-condition the body

• reinforce fear avoidance

• delay recovery

While this will look different for everyone, and between different injuries, the goal is to move the body within tolerance and to maintain meaningful activities where possible, for the best chance of recovery.

When I work with clients, we are working together to find the entry point to building strength and capacity. As an example, if squatting is painful to the knee, we may:

• Do half squats (reduce range of motion)

• Use less or no weight (reduce load)

• Do less sets (reduce the overall workload)

• Do deadlifts instead (temporarily shift load from the knees to the glutes, while still building strength)
  

From here, their feedback is important. How does it feel throughout? How did it feel after? We’ll then use this information to adjust. We may:

• Modify further if pain spikes beyond tolerance.

• Hold steady with the program if pain is on the cusp of a 4/10

• Progress the stress if pain (awareness) was <4/10.
  

Understanding that pain doesn’t always equal damage can be a powerful first step in moving forward with your recovery. This is just one of several common misconceptions that can hold people back when it comes to pain and injury. Stay tuned for the next Myth in this series, where we’ll continue to challenge outdated ideas and help you take a more informed, balanced approach to managing pain.