• The Blog of Physical Therapist and Dancer Tony Ingram

  • Over 100 Articles and Blog Posts on Science, Training, Injuries and Dancing

  • Dance and Injury Prevention Workshops

  • Tony Ingram in 'Practice' dance video by Bold Creative

  • e-books: Common Injuries and their Recovery Explained Simply

Subscribe to BBoyScience by RSS! Connect with BBoyScience on LinkedIn! Watch BBoyScience on YouTube! Circle BBoyScience on Google Plus! Like BBoyScience on Facebook! Follow BBoyScience on Twitter!

Outdated Pain Theories, Conclusion – “What’s the harm?”

- "so if you move one more millimeter in this direction, your spine will asplode! lol!"

This article concludes the series on outdated pain theories by making an important point: “so what?”

It’s great to be a nerd and pick apart how things work and why for the sake of learning science, but what really drives a point home is discussing it’s relevance.

Why is it bad to hold on to outdated pain theories?

What’s the harm?

While some pain relief can be achieved using the techniques discussed in this series (and we’ll talk about why later), explaining pain with these outdated theories can actually cause harm.


Outdated Theories – Summary

If you haven’t read the previous articles yet, here they are:

These explanations for persistent pain assume that it’s caused by damage, degeneration, or abnormal forces. While such things can certainly cause pain, they do not adequately explain why persistent pain remains, especially after things have healed.

The common problem with each of these explanations is that they assume pain persists because of constant “pain signals”. But this isn’t exactly how pain works, and treatments based on them aren’t very effective for persistent pain. 1, 2

Unfortunately, many healthcare professionals still think of pain in these terms.

Pain, Fear, and Recovery

People often experience a level of fear about their pain. They worry about what might be causing the pain, and what it means to their well being. This is all normal, of course. But too much fear can be detrimental, causing undue stress and avoidance of activity.

When people have heightened “fear-avoidance beliefs” 3, they tend to think things like:

  • “I cannot do physical activities which (might) make my pain worse”, or
  • “I cannot do my normal work until my pain is treated”
  • “Being careful that I do not make any unnecessary movements is the safest thing I can do to prevent my pain from worsening”

They avoid activity out of fear. When people specifically fear movement because they believe it may cause pain or re-injury, it’s called “kinesiophobia”. 4

When people have higher levels of fear-avoidance beliefs and kinesiophobia, it tends to negatively impact their treatment outcomes, delaying recovery and increasing disability. 3, 5, 6 Generally speaking, it’s better for people in pain to stay active, 7 and typically, movement helps injuries heal! 8, 9, 10, 11

Words That Harm

- I will never get tired of this photo.

This is why healthcare professionals need to be careful with the words they use. 12 When someone is in pain, the last thing they need to hear is “your back is out”, “you have degeneration”, “wear and tear”, “your posture is malaligned”, “moving this way causes damage”, “your muscles are imbalanced”, “your core is weak” etc.

Patients often adopt the word choices and even the beliefs of the professionals they see. When professionals use scary “mechanical” and “degenerative” type words, their patients tend to have less hope, and more fear. 13, 14, 15

You certainly shouldn’t lie about the diagnosis, and they need to know if things are bad. If you are going to describe things in such terms, you have to be absolutely sure that’s what’s causing their pain, and that addressing it will help. According to the research presented in the previous articles, however, we cannot be so sure.

Words That Heal

Here is a great video of physical therapy professor Peter O’Sullivan working with a patient who came to him with significant fear-avoidance beliefs. This person had given up their athletic dreams and had even stopped working. Look at how O’Sullivan works with this person, and the effect it has on this persons life. Watch if you have eight minutes:

What people should understand is that when it comes to posture, alignment, symmetry, and muscle balance, the only “truth” is that everyone is different. There is no such thing as “normal”; just a normal range. And even “abnormal” people outside of this range can live their entire lives without a single pain problem.

People in pain need to understand that damage does not equal pain. They need to understand that they should keep moving. Our job as therapists should be to help guide them through this process.


It’s time to let go of these outdated theories and beliefs!

It’s time to learn some new science!

How things really work is actually far more interesting. Besides, relying on outdated theories does no good for the progression of science, or the public’s understanding of it. That’s just not good, for so many reasons.

How does pain work? More articles coming soon…

For now, check out the pain education section of this site. There are some quick videos near the top, which are a great starting point. Share the knowledge!

P.S. Thank you! – Over the last few weeks, I’m happy to say these articles were shared widely, providing an opportunity to connect with many other healthcare professionals. Many intelligent conversations ensued, and some of the topics made their way into this post. Thank you everyone for sharing my writing, and especially for the helpful comments.


References will be posted as a comment below, in the following format:

ResearchBlogging.org14. Darlow B, Fullen BM, Dean S, Hurley DA, Baxter GD, & Dowell A (2012). The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review. European journal of pain (London, England), 16 (1), 3-17 PMID: 21719329

Share the love!

    7 Responses to Outdated Pain Theories, Conclusion – “What’s the harm?”

    1. Tony Ingram says:


      1. Kuijpers T, van Middelkoop M, Rubinstein SM, Ostelo R, Verhagen A, Koes BW, van Tulder MW. A systematic review on the effectiveness of pharmacological interventions for chronic non-specific low-back pain. Eur Spine J. 2011 Jan;20(1):40-50. Epub 2010 Jul 31. Review. PubMed PMID: 20680369; PubMed Central PMCID: PMC3036024.

      2. van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, van Tulder MW. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J. 2011 Jan;20(1):19-39. Epub 2010 Jul 18. Review. PubMed PMID: 20640863; PubMed Central PMCID: PMC3036018.

      3. Rainville J, Smeets RJ, Bendix T, Tveito TH, Poiraudeau S, Indahl AJ. Fear-avoidance beliefs and pain avoidance in low back pain–translating research into clinical practice. Spine J. 2011 Sep;11(9):895-903. Epub 2011 Sep 9. Review. PubMed PMID: 21907633.

      4. Tkachuk GA, Harris CA. Psychometric Properties of the Tampa Scale for Kinesiophobia-11 (TSK-11). J Pain. 2012 Oct;13(10):970-7. doi: 10.1016/j.jpain.2012.07.001. PubMed PMID: 23031396.

      5. Ramond A, Bouton C, Richard I, Roquelaure Y, Baufreton C, Legrand E, Huez JF. Psychosocial risk factors for chronic low back pain in primary care–a systematic review. Fam Pract. 2011 Feb;28(1):12-21. Epub 2010 Sep 10. Review. PubMed PMID: 20833704.

      6. Grotle M, Vøllestad NK, Brox JI. Clinical course and impact of fear-avoidance beliefs in low back pain: prospective cohort study of acute and chronic low back pain: II. Spine (Phila Pa 1976). 2006 Apr 20;31(9):1038-46. PubMed PMID: 16641782.

      7. Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010 Jun 16;(6):CD007612. Review. PubMed PMID: 20556780.

      8. Faria FE, Ferrari RJ, Distefano G, Ducatti AC, Soares KF, Montebelo MI, Minamoto VB. The onset and duration of mobilization affect the regeneration in the rat muscle. Histol Histopathol. 2008 May;23(5):565-71. PubMed PMID: 18283641.

      9. Järvinen TA, Järvinen TL, Kääriäinen M, Aärimaa V, Vaittinen S, Kalimo H, Järvinen M. Muscle injuries: optimising recovery. Best Pract Res Clin Rheumatol. 2007 Apr;21(2):317-31. Review. PubMed PMID: 17512485.

      10. Kannus P, Parkkari J, Järvinen TL, Järvinen TA, Järvinen M. Basic science and clinical studies coincide: active treatment approach is needed after a sports injury. Scand J Med Sci Sports. 2003 Jun;13(3):150-4. Review. PubMed PMID: 12753486.

      11. Oldmeadow LB, Edwards ER, Kimmel LA, Kipen E, Robertson VJ, Bailey MJ. No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ J Surg. 2006 Jul;76(7):607-11. PubMed PMID: 16813627.

      12. Bedell SE, Graboys TB, Bedell E, Lown B. Words that harm, words that heal. Arch Intern Med. 2004 Jul 12;164(13):1365-8. PubMed PMID: 15249344.

      13. Sloan TJ, Walsh DA. Explanatory and diagnostic labels and perceived prognosis in chronic low back pain. Spine (Phila Pa 1976). 2010 Oct 1;35(21):E1120-5. PubMed PMID: 20838269.

      14. Darlow B, Fullen BM, Dean S, Hurley DA, Baxter GD, Dowell A. The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review. Eur J Pain. 2012 Jan;16(1):3-17. doi: 10.1016/j.ejpain.2011.06.006. Review. PubMed PMID: 21719329.

      15. Domenech J, Sánchez-Zuriaga D, Segura-Ortí E, Espejo-Tort B, Lisón JF. Impact of biomedical and biopsychosocial training sessions on the attitudes, beliefs, and recommendations of health care providers about low back pain: a randomised clinical trial. Pain. 2011 Nov;152(11):2557-63. Epub 2011 Sep 13. PubMed PMID: 21917377.

    2. Dave Nolan says:

      Love it Tony

    3. Jandro says:

      loved this series. I’ve always been one to try to “ignore” pain when i get an injury (within reason of course), but i never understood why i could and teammates or others could not as well. I just assumed i had been doing it for so long, i had some kind of pain tolerance built up (which, who knows, may have something to do with it). Both this series and past pain articles have really helped me understand whats going on in an otherwise not very known field. I wonder too, have you seen anything about the paitient’s approach to pain? like what you mentioned in the article about being afraid of pain. the more you know about it, the more you understand, and the less you worry about what pain means. anyways, and in summary, thanks!

      • Tony Ingram says:

        Thanks for the comment Jandro! And yes, actually, at some point I do want to write about patients approaches. For instance, patients expectations have been shown to predict their outcome with treatment, to an extent. And people who tend to focus emotionally on their pain have more difficulty. Along a similar theme, there’s a cool study that just came out showing that its not daily stresses that cause increased risk of chronic illness, but our emotional reaction to them. I think that’s pretty relevant to pain!
        Thanks for reading! Glad you enjoyed the series!

    Leave a reply