The Paradigm Shift in Pain

The Paradigm Shift in Pain

Why “Making Sense” Has Been So Confusing

If you’ve had persistent pain, chances are you’ve been on a journey to make sense of it.

At first, the story is simple:

“Something is damaged.”

That’s the traditional biomedical model.

Find the structure.
Fix the structure.
Problem solved.

And to be fair — that model worked incredibly well for many things:

• fractures

• infections

• surgical emergencies

• major tissue injuries

But when it came to persistent musculoskeletal pain, the picture became far less clear.

A huge percentage of people continued to have pain long after tissues were expected to heal.

Around 1 in 5 adults now live with chronic pain.

Many people with back pain, neck pain, tendon pain or knee pain never fully returned to normal despite scans, treatments, injections or even surgery.

In some cases, the endless search for “the damaged part” may have even amplified fear, hypervigilance and disability.

That’s when cracks started to appear in the old paradigm.

Then Came the Big Shift

Over the last 10–15 years, a new model took over.

Pain wasn’t about damage anymore.

It was about the brain.

This shift—driven by researchers like Lorimer Moseley—was huge.

And to be fair, it helped a lot of people.

• It reduced fear

• It got people moving again

• It broke the “fragile body” narrative

For many, it was a necessary correction.

But Something Strange Happened

The PNE model quickly became the dominant narrative in modern pain rehabilitation.

Because it was linked to neuroscience and the brain, it carried an immediate sense of authority and sophistication.

In some circles, it almost became assumed that a “brain-based” explanation must automatically be more advanced and more correct.

But as time went on, many clinicians and patients quietly started noticing something important:

understanding pain intellectually didn’t always translate into meaningful recovery physically.

And like most dominant ideas, it started to stretch beyond its limits.

Pain became explained as:

“Your brain is overprotective”
“Your nervous system is misfiring”
“It’s a learned response”

For some people, this clicked.

For others, it didn’t.

The Quiet Frustration

If you’re in that second group, you might recognise this:

• You understand the explanation

• You agree with it intellectually

• But your body hasn’t changed much

And when it doesn’t work, the explanation subtly turns back on you:

• “You haven’t fully let go of fear”

• “You’re still processing it wrong”

That’s a tough place to be.

Because now you’re not just in pain…

You’re also not doing the model properly

A Line That Stopped Me in My Tracks

Reading Nassim Nicholas Taleb, I came across this:

“When it comes to narratives, the brain seems to be the last province of the theoretician-charlatan… Add ‘neuro’ to something and it suddenly becomes more convincing… yet the brain is too complex for that.”

That hit hard.

Because it explained something I had been feeling for years but couldn’t articulate.

The Problem Wasn’t That PNE Was Wrong

It’s that it became too neat.

Too explanatory.
Too confident.

As if we could reduce something as complex as pain to:

“The brain thinks you’re in danger”

That’s a compelling story.

But it’s still… a story.

The Shift That Changed My Thinking

Then I came across the work of neuroscientist Bud Craig.

And his book How Do You Feel?.

It didn’t give me a better story.

It gave me something more useful:

A way to stop over-explaining… and start observing

A Different Kind of Understanding

Craig’s model is simpler, but deeper:

Pain is a feeling that reflects the state of your body.

Not just your brain.
Not just your tissues.

Your whole system.

This Changes Everything

Instead of asking:

“Why does my brain think I’m in danger?”

You start asking:

“What is my body actually dealing with right now?”

• load

• fatigue

• stress

• poor sleep

• deconditioning

• inconsistent movement

Pain becomes less about interpretation…

…and more about capacity vs demand

Less Theory, More Reality

This is where Taleb’s thinking becomes useful again.

He writes about avoiding over-explanation and focusing on:

Noticing the PATTERNS in your body over time

In other words:

• What happens when you walk more?

• What happens when you sleep better?

• What happens when you overload your system?

Not in theory.

But in reality.

This Is the Shift

From:

“What does this pain mean?”

To:

“What does my system do in response to what I’m doing?”

How I Work Now (Because of This)

I’m far less interested in:

• perfect explanations

• complex narratives

• convincing you of a model

And far more interested in:

• what you can do today

• how your body responds tomorrow

• what patterns emerge over time

We Use Simple Anchors

Not guesswork.

Things like:

• walking or running tolerance

• 24-hour response to activity

• energy levels

• recovery patterns

Because your body doesn’t lie.

No Ideology. Just Feedback.

We’re not trying to:

• fix a structure

• retrain a brain

We’re trying to:

help your system handle more… and see what happens

Why This Feels Different

Because it removes pressure.

You don’t need to:

• think perfectly

• believe the right thing

• interpret your pain correctly

You just need to:

observe, adjust, and build capacity

Final Thought

The biggest shift in pain isn’t from body → brain.

It’s from:

theory → reality

Takeaway

Pain is not something you need to perfectly understand.
It’s something you need to work with.

And the more your system can handle…

The less it needs to shout.

Mitochondrial health Seminar

“Mitochondrial health” is everywhere right now… but a lot of it is getting confusing.

I sat in on a talk today on mitochondrial medicine with Dr Carolyn Harris and walked away with mixed feelings — some REALLY valuable ideas mixed with a fair bit of noise.

Here’s the simple version that actually matters 👇

Your health = how well your body produces and manages energy.

Not just strength.
Not just flexibility.
Not just “fixing” body parts.

👉 Energy.

And this is where mitochondria come in.

Mitochondria are the tiny structures inside your cells responsible for producing energy.
They take the food you eat and the oxygen you breathe and convert it into usable energy for your body.

Every movement you make, every thought you have, every repair process in your body — all rely on this energy.

The more efficient and “well-built” your mitochondria are, the better your body can:

• sustain activity

• recover from stress

• regulate inflammation

• adapt and get stronger over time

When mitochondrial function is poor, people often notice:

• low or unstable energy

• fatigue

• slower recovery

• increased pain or sensitivity

So rather than just focusing on isolated body parts…

👉 it often makes more sense to zoom out and support the system that powers everything.

You don’t need fancy tests to start improving your mitochondrial health.

You can see it in:

• Your energy across the day

• Your sleep quality

• Your recovery

• Your ability to handle stress

• Your confidence to move

The big levers are simple:

• Move regularly (especially low intensity aerobic work)

• Sleep properly

• Eat mostly real food

• Avoid constant snacking

• Get natural light early in the day

No hacks. No extremes.

Where things start to drift…

You’ll hear:

• “Carbs are bad”

• “Fat is clean fuel”

• “You can make all the carbs you need”

• “Red Light heals everything”

There’s often a grain of truth… but it gets taken too far.

👉 The body is adaptable, not ideological.

The biggest mistake I see?

People chasing mitochondrial health with:

• supplements

• gadgets

• restrictive diets

…instead of building real capacity.

If you want to go deeper…

I’d highly recommend seeing someone like Dr Carolyn Harris for a proper review.

She can:

• measure key markers

• give you a baseline

• guide a structured trial-and-error process

👉 Small, targeted changes over time can lead to big results when they’re personalised.

Because in the end —

Your body doesn’t need a hack.

It needs the right environment to function well.

About Dr Carolyn Harris

Dr Carolyn Harris is an experienced GP with over 34 years in clinical practice. Her approach is centred around person-focused care, beginning with a clear understanding of each patient’s health goals. Carolyn’s work is grounded in the belief that many chronic health issues can be improved by addressing underlying metabolic dysfunction, particularly insulin resistance, inflammation, oxidative stress, and nutrient deficiencies.

Been Told Running Is Bad for Your Back?

Been Told Running Is Bad for Your Back?

Let’s slow this down.

For years, many people with chronic low back pain have been told:

“Stick to walking.”
“Swimming is safer.”
“Running will flare it.”

It sounds reasonable.

But in 2024, that belief was actually tested.

The Study

Christopher Neason and colleagues published a randomised controlled trial in the British Journal of Sports Medicine.

Forty adults aged 18–45 with chronic non-specific low back pain (pain lasting more than three months) were recruited.

They weren’t elite athletes.
They weren’t pain-free.

They were real people with ongoing back pain.

Half were assigned to a 12-week program.
Half were placed on a waitlist control group.

What Was the Program?

Not “just go for a run”.

It was structured.

• 3 sessions per week

• 30 minutes per session

• Digitally delivered

• Remotely supported

It started with mostly walking.

Short jogging intervals were introduced gradually.
Progression was time-based, not distance-based.
Pace was comfortable.

If pain flared, participants reduced the running dose.
They didn’t quit.
They adjusted.

That detail matters.

The Results

At 12 weeks, compared to the control group:

• Average pain reduced by around 15 points (on a 0–100 scale)

• Current pain reduced by nearly 20 points

• Function improved

No one dropped out.

Adherence was about 70%.

Only one back flare was reported.

This wasn’t dramatic.
It was steady.

But it was real.

My Take as a Physio

Running didn’t magically “fix” backs.

What helped was:

• Gradual exposure

• Clear structure

• Conservative progression

• Removing the fear of movement

In clinic, I see two extremes:

1. People who avoid running completely because they’re scared.

2. People who jump straight back in at their old level and flare.

Both miss the middle.

Backs don’t usually hate running.

They hate sudden spikes in load.

When you strip away the fear-based narrative and introduce running properly, something interesting happens:

People stop feeling fragile.

Their system adapts.

Pain becomes less threatening.

Confidence returns.

That’s powerful.

What This Doesn’t Mean

It doesn’t mean everyone with back pain should start running tomorrow.

It doesn’t mean running is superior to all other exercise.

It means this:

Running is not automatically harmful for chronic low back pain.

Dose matters.
Progression matters.
Context matters.

If You’ve Been Avoiding Running

If running has flared you before, it doesn’t automatically mean damage.

Often it means:

Too much.
Too soon.
Too fast.

The right plan usually looks smaller than you expect.

Walk 4 minutes.
Jog 1 minute.
Repeat.

Build from there.

Boring works.

If you’ve got persistent back pain and are curious about returning to running, I help people personalise a gradual plan that fits their body, history, and goals.

You don’t need to guess the dose.

You just need a sensible starting point.

Get in touch.

Persistent Knee Pain is a Capacity Problem

If you’ve ever been told “your knee is worn out”, “your scans explain everything”, or “you’ll just have to manage it”, I want to offer you a different way of understanding pain — one that actually makes sense of real life.

This idea comes from two very different people:

• An orthopaedic surgeon who spent his career operating on joints

• A neuroscientist who studied how the brain senses the state of the body

They worked in different worlds, but they arrived at the same conclusion.

The Joint Has a “Comfort Zone”

Orthopaedic surgeon Scott Dye described something called the Envelope of Function.

You don’t need the fancy name.
It simply means this:

Every joint has a range where it feels calm, safe, and comfortable.

Inside that range:

• You can move

• Load feels fine

• Pain stays quiet

Outside that range:

• The joint becomes sensitive

• Pain shows up

• Things feel “angry” or reactive

Here’s the important part:

Pain doesn’t mean damage.
Pain means you’ve exceeded your current capacity.

That capacity can change — up or down — depending on what’s going on in your body and life.

Pain Is the Body Asking for Help, Not Sounding an Alarm

Neuroscientist Bud Craig took this idea even further.

He showed that pain isn’t just about tissues.
Pain is part of the body’s internal monitoring system — the same system that tracks:

• Fatigue

• Inflammation

• Energy levels

• Stress

• Recovery

In simple terms:

Pain is how your body lets you know that its balance is under strain.

Not broken.
Not damaged beyond repair.
Just out of balance.

Why Scans Often Don’t Explain Pain

This explains something many people experience:

• Two people have the same scan

• One has pain, the other doesn’t

Why?

Because scans show structure, not capacity.

They don’t show:

• How well tissues are fueled

• How rested the system is

• How much load you’ve been carrying

• How stressed or inflamed your body feels

Pain lives in the relationship between load and capacity — not in a single image.

The Big Shift: From “Fixing” to “Rebuilding”

Once you see pain this way, the goal changes.

Instead of:

• “How do I fix this part?”

• “What’s wrong with my knee?”

The better questions become:

• “What is my system able to handle right now?”

• “How do I gently expand that capacity again?”

This is why:

• Pushing harder often backfires

• Rest alone rarely solves the problem

• Quick fixes don’t last

What works is gradual, intelligent rebuilding.

Why This Is Actually Good News

This perspective is hopeful — not dismissive.

It means:

• Your pain is real

• Your body isn’t broken

• And improvement is possible

Capacity can grow.
Tolerance can return.
Confidence can come back.

Not by forcing.
Not by fearing.
But by working with the body instead of fighting it.

One Line to Remember

If you remember nothing else, remember this:

Pain appears when load exceeds current capacity — and fades as capacity is rebuilt.

That’s it.
That’s the whole model.

And it’s the lens I use every day when helping people move forward — calmly, steadily, and with far less fear.

What the Research on Load and Injury Actually Shows

This idea isn’t just theoretical.

Sports scientist Tim Gabbett has spent years studying why people break down — from elite athletes to everyday movers.

His key finding is surprisingly simple:

Injury and pain are most likely when load increases faster than the body’s capacity to adapt.

Not because the body is weak.
Not because joints “wear out.”
But because the dose of stress exceeded what the system could currently handle.

Growth Follows a Simple Formula

When you strip away the noise, recovery and resilience come down to this:

Appropriate stress + appropriate recovery = growth

That’s how:

• Muscles strengthen

• Tendons adapt

• Joints become more tolerant

• Confidence returns

Too much stress without recovery → symptoms
Too little stress → loss of capacity

Pain often sits right in the middle — when the balance has been lost.

This Is Why “Wear and Tear” Misses the Point

If pain were just about wear and tear:

• Athletes would be in pain all the time

• Older bodies couldn’t adapt

• Rest would fix everything

But that’s not what we see.

What we see is that capacity is trainable at any age — when load is dosed well and recovery is respected.

That’s a very different story from protection, avoidance, and fear.

The Real Goal

The goal isn’t to protect your body from stress.

The goal is to rebuild your ability to handle it.

Not by forcing.
Not by pushing through pain.
But by applying the right amount of challenge — and giving the system time to respond.

That’s how resilience is built.
That’s how pain settles.
That’s how people return to living fully again.

10 Simple Tips to Maximize the Benefits of Dry Needling

10 Simple Tips to Maximize the Benefits of Dry Needling

Dry needling can be an effective tool in managing pain and promoting muscle recovery, but like anything, small tweaks can make a big difference.

Here are 10 straightforward tips to help you get the most out of your sessions, without feeling overwhelmed:

1. Hydrate Before and After
Proper hydration helps your muscles recover more effectively and flush out metabolic waste. Drink water before and after your session to keep things moving smoothly.

2. Breathe Deeply
When the needle goes in, it can trigger a muscle twitch or discomfort. Focus on deep, slow breathing to calm your nervous system and help the muscle release more easily.

3. Move Gently Post-Treatment
After your session, engage in gentle movement like walking or light stretching to encourage blood flow and prevent stiffness. It helps integrate the benefits of the treatment into your body.

4. Apply Heat Afterward
Depending on how your body reacts, applying heat to relax tight muscles can amplify the positive effects of the treatment. You can have a warm shower or use a wheat bag. Listen to your body and apply whichever feels more soothing.

5. Get a Good Night’s Sleep
Your body does its best healing while you sleep. Prioritize rest the night after your session to allow the treatment to fully take effect.

6. Stay Active, But Don’t Overdo It
While movement is key to recovery, avoid intense exercise immediately after your session. Gentle activity helps, but pushing too hard can negate some of the benefits.

7. Eat Nutrient-Dense Foods
Your muscles need fuel to heal. Eating foods rich in vitamins, minerals, and anti-inflammatory properties (like leafy greens, lean proteins, and berries) can aid recovery.

8. Communicate with Your Practitioner
Don’t hesitate to let your practitioner know how you’re feeling during and after treatment. Everyone’s body responds differently, and small adjustments in technique can lead to better results for you.

9. Stay Consistent
Like most treatments, consistency matters. Dry needling is most effective when integrated into a broader care plan, so stick with your sessions and give your body time to adapt.

10. Be Patient with the Process
Change doesn’t happen overnight. Focus on the small improvements and trust that they build over time. Sometimes the biggest differences come from these small, consistent steps.

Bonus Tip: Keep Stress in Check
High stress can keep muscles tense and make it harder for the body to heal.

Incorporate stress-reduction practices, like mindfulness or simple relaxation exercises, to enhance the benefits of your dry needling treatment.

Remember, sometimes the smallest adjustments can have the biggest impact on your recovery.

These simple steps can help you maximize the benefits of dry needling without adding complexity to your routine!