Pain Sensation and Physical Therapy

June 11, 2019

Why Do I Experience Pain Without an Injury? Understanding the Biopsychosocial Model of Pain


One of the most common questions I’m asked as a physical therapist is “Why am I having pain when I don’t have an injury?” This is a good question, especially for a pro athlete who strives to always be in the best shape possible.


What is Chronic Pain and Why Does It Persist?


The answer is that we are still far from understanding how the pain sensation lingers and persists, in the case of chronic pain syndromes long after complete recovery and at times with no injury (structural damage) at all.


In this blog post I’ll try to explain the pain sensation through the biopsychosocial model, which is one of several suggested models and theories of understanding the pain sensation.


What is the Biopsychosocial Model?


The biopsychosocial model of pain states that the interaction between different variables, including biological, psychological and social-cultural factors, will cause a person to either sense pain or not. In addition it explains why certain activities/movements will cause more/less pain than other activities/movements.


Here is a quick summary of the progression of the pain sensation and the different variables that are taken into account:

  • Nociception – Most athletic injuries will result in tissue damage, either acute (traumatic) or chronic (as in the case of overuse injuries). Certain nerve endings that are located in and around the damaged tissue will target the pain receptors, also known as nociceptors, in the region to send the central nervous system a signal that tissue damage has occurred.
  • Pain – from this moment on, pain is interpreted and translated into the sensation itself as it affects the individual in the central nervous system. This stage includes complex interactions between different regions of the spinal cord and the brain.


From this point onwards psychosocial and biological factors will decide and affect the individual’s pain perception.


  • Pain appraisal – the pain can lead to different negative responses such as depression, anxiety and fear. You can imagine how stressful it would be for an elite NBA player to miss a whole season or even a couple of games because of pain, or injury. Therefore suffering is a distinct phenomenon from pain. Overall, pain appraisal is the meaning given to the pain experience itself.
  • Pain behaviors – both environment and culture can play a significant role in how you perceive pain and how it will affect your behavior, even as it relates to facial expressions and verbal behaviors. As an example, an athlete surrounded by people who believe that the injury is not as bad as it really is may change the athlete’s behavior to the point that he/she will try to ignore the movements that used to be painful. On the other hand, being surrounded by the wrong people may lead the athlete to avoid physical activities all together because of their beliefs. Needless to say, this is the number one reason physical therapists want athletes to stay active after an injury.
  • Social rules for pain and illness – these rules will directly affect how one will experience the pain and change his/her role in society.


At times not all variables are found to affect the injured person but should be considered in any injury to avoid acute pain becoming chronic, and to resolve pain all together. In the sports performance world, this model can explain why a NFL quarterback might be suffering (pain appraisal) and change his behavior more so than a software engineer after the same shoulder injury.


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Cupping therapy is an ancient technique that has been integrated into modern physical therapy to help alleviate pain, reduce inflammation, and enhance overall recovery. In my practice, I use cupping as part of a holistic approach to treat muscle tightness, improve blood flow, and accelerate the healing process. How Cupping Works: Cupping involves placing specialized cups on the skin to create suction. This suction helps to lift the skin and underlying tissues, promoting increased circulation to the affected area. The improved blood flow aids in reducing muscle tension, breaking up scar tissue, and encouraging the body’s natural healing processes. Benefits of Cupping Therapy: – Pain Relief: Cupping can help reduce muscle soreness and pain by releasing tightness and promoting relaxation. – Enhanced Recovery: By improving blood circulation, cupping accelerates the removal of metabolic waste from tissues, leading to quicker recovery times. – Flexibility and Mobility: Regular cupping sessions can improve joint and muscle flexibility, making it an excellent addition to your rehabilitation or performance enhancement program. What to Expect: During a cupping session, you may feel a pulling or stretching sensation as the cups create suction. It’s normal to experience some mild bruising or redness at the treatment sites, which typically fades within a few days. I ensure that each session is tailored to your specific needs, targeting areas that will most benefit from the therapy.
August 10, 2024
Blood Flow Restriction Training (BFRT) is a rehabilitation technique used to enhance muscle strength and growth by applying a cuff to partially restrict blood flow to a muscle during exercise. This method allows patients to gain the benefits of muscle hypertrophy and strength gains using low-intensity exercises. In physical therapy BFRT is particularly advantageous in settings where patients are recovering from injuries or surgeries, as it reduces the mechanical load on joints and tissues, minimizing the risk of re-injury.  The benefits and advantages of BFRT include: Muscle Strength and Growth : BFRT promotes muscle hypertrophy and strength gains even with low-intensity exercise, which is crucial for patients who cannot engage in high-intensity workouts. Accelerated Recovery : By enabling effective training at lower intensities, BFRT helps maintain muscle mass and strength during periods of limited mobility, aiding faster recovery. Reduced Joint and Tissue Stress : BFRT allows for significant muscle engagement without the high loads that could strain joints and soft tissues, making it suitable for patients with orthopedic issues or those recovering from surgeries. Versatility : BFRT can be applied to various body parts and adapted to different exercise modalities, making it a flexible tool in a therapist’s toolkit. Enhanced Safety : The low-intensity nature of exercises performed with BFRT reduces the risk of overtraining and injury, providing a safer rehabilitation option for patients at different fitness levels.
August 10, 2024
Force plates are a valuable tool in physical therapy, offering a range of benefits that enhance the quality of care and outcomes for patients. Here’s a detailed explanation of their advantages: – Objective Data Collection Force plates provide objective, quantitative data on ground reaction forces, which are essential for understanding how a patient’s body interacts with the ground during various activities. This data is critical for accurately assessing biomechanical performance and movement patterns, such as gait, balance, and jump dynamics. Unlike subjective assessments, force plates offer precise measurements, which lead to more accurate diagnoses and treatment plans. – Enhanced Assessment and Diagnosis With the detailed information force plates provide, physical therapists can identify subtle imbalances and asymmetries that might not be visible to the naked eye. For example, discrepancies in how much force each leg produces can indicate underlying issues, such as muscle weakness, joint instability, or improper technique. Early detection of these issues allows for timely intervention, potentially preventing more severe injuries. – Personalized Treatment Planning The data from force plates enables the creation of highly individualized rehabilitation and training programs. By understanding a patient’s specific movement deficiencies, therapists can tailor exercises and interventions to target these areas. This personalized approach increases the effectiveness of therapy, as interventions are specifically designed to address the patient’s unique biomechanical profile. – Progress Tracking and Outcome Measurement Force plates facilitate the objective tracking of a patient’s progress over time. By regularly assessing changes in force production, symmetry, and other key metrics, therapists can evaluate the effectiveness of treatment interventions. This ability to measure outcomes quantitatively helps in refining treatment plans and ensures that patients are making measurable improvements. – Injury Mitigation and Performance Enhancement For athletes and active individuals, force plates are particularly valuable for optimizing performance and preventing injuries. By analyzing the forces involved in specific sports movements, therapists can identify risky movement patterns that may predispose an athlete to injury. Interventions can then be designed to correct these patterns, enhance performance, and reduce the risk of future injuries. – Comprehensive Documentation and Communication The data collected from force plates can be documented and shared with other healthcare providers, coaches, or trainers, fostering a collaborative approach to patient care. This comprehensive documentation supports a continuum of care, ensuring that all parties involved have a clear understanding of the patient’s condition and progress. – Patient Education and Engagement Visual and numerical data from force plates can be a powerful tool in educating patients about their condition. When patients see the objective data, such as force distribution and asymmetries, they often gain a better understanding of their issues and the rationale behind their treatment plan. This understanding can enhance patient compliance and engagement in their rehabilitation process. Incorporating force plates into physical therapy practice elevates the standard of care by providing precise, objective data that enhances assessment accuracy, personalizes treatment plans, and tracks progress. This technology not only aids in injury prevention and performance enhancement but also fosters better communication and education, ultimately leading to improved patient outcomes.