What better time of year than the New Year to start fresh with a few weight loss and fitness goals, right? You are excited, motivated, and ready to make changes. Day one comes, and you put in a great workout. You head home, eat a good dinner, and get to bed excited to get back to the gym the next day. However, as you wake up and take your first step out of bed, you notice your knee hurts and feels a bit swollen. This is odd because you don’t remember your knee hurting yesterday, and you become concerned. Should you be worried? Well, it’s a bit more complicated than that, and the reality is most pain that we experience will disappear and how we label the pain or feel about our pain can affect the outcome.
Although pain gets associated with injury, the two terms are often poorly correlated. Take, for example, a bruise. Time and again, we may find a bruise and have no recollection of how that bruise got there. This is an example of tissue damage without the association of pain. Consequently, numerous studies use imaging scans on people without pain, showing regular age-related changes such as tears or joint space changes that historically would be associated with tissue damage or pain. 6,7
Realistically, pain should not be a measure of tissue damage but more a measure of protection against a potential threat. The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” Six key subcategories contribute to the variability and uniqueness of the pain experienced. Honestly, pain is much more complex in that the painful body part can be influenced by context, expectations, beliefs, and cognitions.
So, when you consider the pain you may be having, should you automatically worry that you are injured and damaged? No, probably not, but the pain likely is there to alert you to pay attention and learn about the pain. Yet, if the pain persists and continues to make you worry, you may begin to ask why?
The first step in learning why is to “label” or diagnose your pain. Currently, it has never been easier to do this, as most of us carry a smartphone in our pocket and within seconds can search “knee pain after working out.” Using that specific search term, the results may read: “Damaged tendons or ligaments, arthritis, and infection can all cause pain and stiffness.” This result is a broad spectrum of reasons for ANY knee pain, but taken in the wrong context, can lead to inappropriate labeling and treatment of the pain. Although many of these scenarios are possible, it is doubtful without associated trauma or mechanism.
Pain can affect us very differently which, is important to recognize. It is imperative to consider the biological, psychological, and social factors to understand the painful experience best. Traditionally, there has been a great emphasis on biological factors, like the tissues involved or the inflammatory response. Yet, research has shown that psychological and social factors play a significant role in pain. Evidence has shown that even just thinking you have an injury can increase symptoms and worry about your pain.3
Now that you are more aware of how you label pain and how you feel about it can significantly impact your pain, when should you worry about it? Without a major trauma or possible fracture, most pain we experience will disappear. However, given the uniqueness of the painful experience and the multitude of factors involved, pain can, and will, concern us when it doesn’t go away or respond to traditional treatments. Therefore, if you continue to have difficulties returning to your active lifestyle, reach out to an Athletico near you for a Free Assessment. Evidence suggests seeing a physical therapist first for your pain can have a significant role in reducing pain, improving function, and reducing healthcare cost.4, 5, 6, 7 Free Assessments are available in-clinic and virtually through our Telehealth platform.
The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.
1) Brinjijki W, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal or Neuroradiology. 2015: 36(4); 811-816.
2) Son KM, et al. Absence of pain in subjects with advanced radiographic knee osteoarthritis. BMC Musculoskeletal Disorders. 2020: 21; 640.
3) Bayer TL, Coverdale JH, Chiang E, Bangs M. The role of prior pain experience and expectancy in psychologically and physically induced pain. Pain. 1998 Feb; 74(2-3):327-31.
4) Fritz JFPP, Childs JD, Wainner RS, Flynn TW. Primary Care Referral of Patients with Low Back Pain to Physical Therapy. Spine. 2012; 37(25):2114-2121.
5) Childs JD, Fritz JFPP, Wu SS, et al. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Serv Res. 2015; 15(1):986–11.
6) Fritz J, Brennan G, Hunter S. Physical therapy or advanced imaging as first management strategy following a new consultation for low back pain in primary care: Associations with future health care utilization and charges. Health Research and Educational Trust. 50.6 (December 2015)
7) Frogner BK, Harwood K, Andrilla CHA, Schwartz M, Pines JM. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health Serv Res. 2018