Why Strength Isn’t Enough, and What Will Really Fix Your Knee Pain

The Resilient Knee Project

Why Strength Isn’t Enough, and What Will Really Fix Your Knee Pain

When you’re struggling with knee pain, the first instinct is often to get stronger.

You’re told by well-meaning therapists, trainers, and experts, “If you’re in pain, just build up your muscles.”

And on the surface, that makes sense, right?

After all, strength equals stability, and stability should equal less pain.

But here’s the harsh truth: Strength alone won’t fix your pain.

In fact, if all you’re doing is trying to get stronger without addressing the bigger picture, you could be making things worse.

The Problem: Chasing Strength Without Capacity

Let’s use a simple metaphor: Imagine you’re really thirsty.

You grab a small cup and start filling it with water, but before long, it overflows—water spills everywhere.

That overflow? That’s your soreness, your pain.

Naturally, you think, “I need a stronger cup!”

So, you reinforce the cup, making it sturdier and thicker.

But here’s the catch—now, the cup is more rigid.

And what do we know about rigid things?

They’re more likely to crack or break under pressure.

This is exactly what happens when you chase strength without increasing your capacity.

Sure, you’re getting stronger, but without expanding how much your body can handle, you’re setting yourself up for failure.

When you overload a rigid, small cup (i.e., only focus on strength without increasing function), you’ll keep overflowing.

You might even break the cup.

What you really need is a bigger cup—more capacity, not just more strength.

The Truth About Strength: It’s Not the Only Answer

The “strength fixes pain” myth is powerful, but misleading.

Strength alone won’t solve the issue because it doesn’t address the root of the problem—your body’s capacity to handle load, recover, and adapt.

Without increasing your overall capacity—how well your muscles, tendons, bones, and joints can deal with stress and recover from it—focusing on strength alone makes you more fragile.

It’s like having a stronger but still small and rigid cup. Eventually, it will crack under the pressure of all the load you’re placing on it.

And here’s where it gets worse: The simplistic advice of “just get stronger” carries a subtle but harmful message that you’re “weak,” which can make you feel fragile.

It reinforces the idea that your body isn’t capable, and this fear creates a vicious cycle—making you feel more out of control over your symptoms.

The Solution: Capacity and Functional Resilience

What you truly need is functional capacity.

Instead of focusing on just getting stronger, focus on expanding your body’s ability to handle load without breaking down.

Think of this as building a bigger cup—one that can hold more without spilling over.

Capacity is your body’s ability to not only manage the load but also clear out the “waste” that builds up—like lactate, a byproduct of intense activity.

When your body can’t clear this waste efficiently, it contributes to soreness and pain.

Here’s the good news: Your body is designed to use lactate as fuel when your systems are functioning well.

And that’s where mitochondrial health comes in.

The more mitochondria you have, and the healthier they are, the better your body can clear waste and generate energy.

That’s capacity in action—building not just strength but the ability to handle and recover from stress over the long term.

The Resilient Knee Project: A Different, Innovative Approach to Knee Health

This is exactly what The Resilient Knee Project is all about.

It’s not just about building strength; it’s about creating resilience through functional capacity.

And running, believe it or not, is the perfect way to do this.

We need to respect the high load and force that running provides.

If channeled correctly, those forces can create resilience in your bones, muscles, tendons, and joints.

This is the real strength we’re after: genuine, long-term capacity.

Running builds capacity, but here’s the catch—it takes time.

Months, even years, to fully develop.

You won’t see immediate results.

This isn’t a quick-fix solution, but it’s one of the best long-term investments you can make in your body’s health.

What you’re developing is a powerful physical asset that will serve you for the rest of your life.

Once you build this capacity, you’ll have the knowledge and skills to manage your knee pain independently.

You’ll become the expert on your own body, and you’ll no longer need to rely on therapists or experts to “fix you” with simplistic solutions.

No more embarrassing narratives about being weak.

No more relying on medication, surgery, or avoiding movement out of fear.

Why the Desire for Strength is So Intuitive

Now, let’s address something important: the desire to get stronger is incredibly intuitive.

It makes sense—if you’re in pain or feeling fragile, getting stronger seems like the most logical response.

Most healthcare professionals will validate this desire, telling you strength is the solution.

But remember, strength alone isn’t enough.

Think of it like David vs. Goliath. David didn’t win by matching Goliath’s strength—he won with strategy.

And that’s exactly what you need: a strategy, not just a single-focus tactic like strength.

Your desire to be stronger is good, but we need to unpack it and turn that motivation into something more useful.

The real solution lies in building capacity.

This means not just lifting more weight but knowing when to push, when to back off, and how to recover. You’ll know exactly what to do when flare-ups occur (because let’s be real—they will still happen, just less often and less severe).

The Bottom Line: Invest in Capacity, Not Just Strength

If you’ve been chasing strength to fix your knee pain, it’s time to take a step back and look at the bigger picture.

Strength is important, but it’s only part of the solution.

What you need is to build capacity—giving your body the tools to handle life’s demands without breaking down.

Next time you feel the urge to just “get stronger,” remember: It’s not about building a stronger cup—it’s about building a bigger, more resilient one.

And if that sounds like a good plan to you, know this: It’s going to take investment.

But think of it as the best investment you’ll ever make.

Once you restore function and capacity, no one can take that away from you.

Imagine all the years ahead filled with physical activity, running races, hiking mountains, enjoying great times with friends and family—all without the fear of your knee letting you down, without being stuck in the endless cycle of rehab purgatory.

The Resilient Knee Project isn’t just about fixing pain.

It’s about empowering you to take control of your body, build long-term resilience, and live without limits.

ARE YOU READY FOR THE RUNNING REVOLUTION?!

TAKE THE FREE QUIZ HERE

Dan O'Grady is a results driven qualified Physiotherapist and member of the Australian Physiotherapy Association.  Dan has a special interest in treating knee pain.  He has been working in private practice for 20 years. He is passionate about helping people to move better, feel better and get back to doing what they love.

Hunger and Pain

Pain and Hunger: Why Sensory Pathways Matter

Pain Neuroscience Education (PNE) has gained popularity in recent years, with proponents arguing that pain is more about brain signals and emotions than about sensory input from the body.

Drawing from philosophies like the "pain neuromatrix" developed by Ronald Melzack, PNE advocates claim that pain is entirely a brain-generated experience, influenced by our thoughts, beliefs, and emotions.

But what if we compared pain to another fundamental experience that most of us understand well: hunger?

In this post, we’ll use hunger to challenge PNE’s neurocentric view and explain why sensory pathways from the body are essential for pain perception.

Hunger and Pain: Parallel Experiences

Both hunger and pain are essential survival signals based on homeostasis becoming disturbed.

Hunger motivates us to eat, while pain drives us to protect our bodies from injury.

Both sensations involve a complex interaction between brain signals and bodily inputs.

However, just as you cannot experience hunger without input from your body, you cannot truly experience pain without the sensory pathways that relay signals from the affected area.

How Hunger Works: A Brain-Body Partnership

Hunger is not just "in the mind."

It’s a perfect example of interoception—the way our brain interprets internal body signals.

When you’re hungry, your brain is responding to several cues from the body:

• The stomach stretches or contracts, sending signals via the vagus nerve to the brainstem.

• Hormones like ghrelin are released, which signal hunger to the hypothalamus.

• The body’s energy status is monitored, and when glucose levels are low, signals are sent to urge us to eat.

While emotions or habits can influence hunger (like seeing food commercials), the physical sensation of hunger still depends on these signals from the body.

The brain alone cannot generate the feeling of hunger without these sensory inputs.

Pain Needs Sensory Pathways, Just Like Hunger

Pain works similarly to hunger.

It’s a multi-dimensional experience, combining sensory input with cognitive and emotional components.

However, sensory pathways from the body are crucial for the brain to create the pain experience.

Just as the brain responds to signals from the stomach to generate hunger, it also relies on sensory signals from the affected tissue to generate pain.

Here’s why sensory input is critical in pain:

1. Nociceptors (homeostatic sensory receptors) in the skin, muscles, or joints detect potential damage (heat, pressure, inflammation) and send signals through the spinal cord to the brain.

2. The brain integrates these signals with emotional and cognitive factors, like fear or anxiety, but without the original sensory input, the pain experience wouldn’t happen.

3. In cases like phantom limb pain, while the brain can generate a pain experience in the absence of a limb, it’s often because the brain’s neural map still includes sensory memories from that missing limb. This phenomenon shows how pain requires a connection to past or present bodily sensations.

PNE's Neurocentric View: Where It Falls Short

PNE proponents argue that pain can exist without any sensory input from the body, relying heavily on the neurocentric "pain neuromatrix" theory.

According to this model, the brain constructs pain purely from a mix of emotions, past experiences, beliefs, and sensory inputs—sometimes even in the absence of any injury.

While it's true that pain is influenced by these factors, PNE oversimplifies by suggesting that pain is predominantly a "brain-made" problem.

This model is helpful for understanding some aspects of chronic pain, but it’s dangerously incomplete.

It implies that pain can exist without any ongoing input from the body, which is misleading and can lead to overemphasis on cognitive strategies (like reframing thoughts or beliefs) while ignoring the sensory pathways that play a fundamental role in pain perception.

Why Sensory Pathways Matter in Pain

Let’s return to the hunger analogy.

Imagine if you were told that hunger is just an emotion, purely generated by the brain, without any connection to your body’s energy needs.

You might be able to delay hunger temporarily through distraction, but ultimately, your body’s signals would push back, demanding attention.

The same is true for pain: while thoughts, emotions, and beliefs can influence pain, the underlying sensory inputs cannot be ignored.

1. Misleading patients: The PNE approach often suggests that pain can be "thought away" by changing beliefs or reframing the way patients think about pain. While these strategies can help, they neglect the reality that pain still needs sensory input from the body to fully exist. Ignoring the sensory aspect risks alienating patients who feel that their pain is being dismissed or minimized as "an output of the brain."

2. Manual interventions: Techniques like manual therapy, dry needling, or exercise affect the sensory pathways and are vital in managing pain. These are often overlooked by PNE advocates who favor cognitive strategies over hands-on treatment.

Moving Toward a More Balanced Understanding of Pain

The brain and body are in constant communication, and both are essential in understanding pain.

Sensory pathways from the body provide the brain with crucial information that influences how pain is experienced, just as signals from the stomach influence how hunger is perceived.

Dismissing these pathways in favor of a purely brain-centric model like the "pain neuromatrix" oversimplifies the complexity of pain.

Conclusion: We Need Both Brain and Body in Pain Management

Incorporating sensory pathways into pain education helps create a more comprehensive and accurate understanding of pain.

Instead of focusing solely on the brain's role in generating pain, we should recognize the critical role that body signals play, just like in hunger.

Cognitive strategies and emotional regulation are essential, but they must be balanced with respect for the sensory input that drives much of the pain experience.

Pain isn't just in your head—it’s in your body too.

For effective pain management, we need to move beyond the neurocentric models and embrace a more balanced, whole-body approach.

Phantom Limb Pain: Refuting the PNE Neuromatrix Trap

One of the most seductive arguments Pain Neuroscience Education (PNE) proponents make is the use of phantom limb pain to support their brain-centric neuromatrix model of pain.

According to this view, pain is constructed entirely by the brain, drawing from memories, emotions, and beliefs, and therefore, they argue that even when a limb is missing, the brain can "create" pain.

It’s an alluring idea: if you can feel pain in a limb that no longer exists, then clearly, the pain must be "all in the brain," right?

Wrong.

This oversimplified interpretation leaves out critical aspects of how pain really works.

While it’s true that the brain plays a role in pain perception, phantom limb pain doesn’t necessarily mean that pain is purely a brain-made phenomenon.

In fact, we can better understand phantom limb pain by looking at how referred pain works, which reveals how the brain misinterprets signals coming from other parts of the body.

Let's explore why falling into the trap of the neuromatrix model leads to a skewed understanding of pain—and how the concept of referred pain offers a more grounded explanation.

Referred Pain: A More Balanced Explanation

Phantom limb pain can be better understood through the well-known phenomenon of referred pain.

Referred pain occurs when pain is felt in a different area of the body than the one actually causing the disruption.

A classic example is heart attack pain that is felt in the arm or jaw, despite the issue being in the heart. Here’s how it works:

1. Disrupted Homeostasis: Referred pain occurs when something disrupts homeostasis in one part of the body (like an organ or muscle) but the brain mistakenly interprets the signals as coming from a different location. For example, muscles can directly refer pain to other areas—trigger points in the shoulder can cause pain in the arm or hand.

2. Sensory Confusion: The nervous system is complex, and the brain sometimes misinterprets signals, getting the location wrong. Just because you feel pain in your arm during a heart attack doesn’t mean the pain is purely emotional or brain-generated. The pain is still real, even if the brain misreads the location.

In phantom limb pain, this same mechanism could explain why the brain continues to feel pain in a missing limb.

The neural pathways that used to represent that limb are still active, and the brain gets confused by lingering signals from the body or even from nearby muscles and tissues that are still sending sensory input.

Why Phantom Limb Pain Doesn’t Prove Pain is "All in the Brain"

PNE pundits use phantom limb pain as a case to convince you that pain exists entirely in your mind, an argument that can lead to cognitive dissonance.

They try to show you that if the brain can "create" pain where no limb exists, then all pain must be brain-generated.

This is a slippery slope, and while it may sound plausible, it’s not the full picture.

Here’s why:

1. Misinterpretation of Signals: Just because the brain is involved in the interpretation of pain doesn’t mean pain is purely in the brain. The brain relies on signals from the body—whether they’re coming from an intact limb or the surrounding tissue that used to connect to a now-missing limb. The brain is simply misinterpreting the source of the pain, as it often does with referred pain.

2. Referred Pain Patterns: Many pain patterns are well-documented and follow predictable referral routes. If we can accept that the brain sometimes gets these signals wrong (as in heart attack pain referred to the arm), we can also accept that the brain might feel pain in a missing limb because it's mistakenly interpreting signals from surrounding tissues or nerves.

3. Not "All in the Brain": Referred pain proves that even when pain is felt in one area, the root cause lies elsewhere. PNE proponents like to point to brain imaging studies showing activity in the brain during phantom limb pain, but this only shows that the brain is part of the process—it doesn’t mean the brain is the sole cause of pain. The pain is a result of misinterpreted sensory signals, not purely emotional or cognitive constructs.

Don’t Fall for the Trap: The Role of Cognitive Dissonance in PNE

PNE pundits often push the idea that if you accept phantom limb pain as brain-generated, you must accept that all pain is brain-generated.

This tactic creates cognitive dissonance—a psychological state where you hold two contradictory beliefs at once. PNE advocates hope this dissonance will force you to see pain through their lens.

But here’s the problem: just because the brain can misinterpret pain signals doesn’t mean the pain is imaginary or only in the brain.

The PNE model oversimplifies pain by focusing too much on emotions, thoughts, and beliefs, while ignoring the critical role of body-based sensory pathways.

Just like referred pain, phantom limb pain shows that pain is complex and multi-dimensional—it involves both the brain and the body.

Conclusion: A More Comprehensive View of Pain

Phantom limb pain may seem like the perfect example to prove the PNE model, but when we dig deeper, it’s clear that it doesn’t tell the full story.

Like referred pain, phantom limb pain highlights how the brain sometimes misinterprets signals from the body—it doesn’t prove that pain is "all in the brain."

By understanding referred pain patterns and recognizing the importance of sensory input, we can see that the brain is not the sole creator of pain.

Pain is a complex experience that involves miscommunication between body and brain, not just emotional or cognitive constructs.

So next time someone tells you phantom limb pain proves pain is "an output of the brain," remember: the brain might misinterpret the signals, but that doesn’t mean the body isn’t involved.

Let’s not fall for the trap.

Instead, let’s embrace a more comprehensive and nuanced understanding of pain, one that recognizes the critical role of sensory pathways in shaping our experience.

References:

Erlenwein J, Diers M, Ernst J, Schulz F, Petzke F. Clinical updates on phantom limb pain. Pain Rep. 2021 Jan 15;6(1):e888. doi: 10.1097/PR9.0000000000000888. PMID: 33490849; PMCID: PMC7813551.

Ilfeld BM, Khatibi B, Maheshwari K, Madison SJ, Esa WAS, Mariano ER, Kent ML, Hanling S, Sessler DI, Eisenach JC, Cohen SP, Mascha EJ, Ma C, Padwal JA, Turan A; PAINfRE Investigators. Ambulatory continuous peripheral nerve blocks to treat postamputation phantom limb pain: a multicenter, randomized, quadruple-masked, placebo-controlled clinical trial. Pain. 2021 Mar 1;162(3):938-955. doi: 10.1097/j.pain.0000000000002087. PMID: 33021563; PMCID: PMC7920494.

Amoruso E, Terhune DB, Kromm M, Kirker S, Muret D, Makin TR. Reassessing referral of touch following peripheral deafferentation: The role of contextual bias. Cortex. 2023 Oct;167:167-177. doi: 10.1016/j.cortex.2023.04.019. Epub 2023 Jul 13. PMID: 37567052; PMCID: PMC11139647

Arendt-Nielsen L, Svensson P. Referred muscle pain: basic and clinical findings. Clin J Pain. 2001 Mar;17(1):11-9. doi: 10.1097/00002508-200103000-00003. PMID: 11289083.

Managing Neck, Back Pain, and Headaches with the Guitar Framework

What Would It Look Like If It Were Easy? Managing Neck, Back Pain, and Headaches with the Guitar Framework

Let’s face it.

Persistent neck, back pain, and headaches can make you feel like you’re starring in your own personal reality TV show: Pain Island.

Every day is a quest for survival, navigating the perils of flare-ups, discomfort, and endless expert opinions on what you should do to fix it.

"Stretch more!" they say. "Strengthen those muscles!" another expert shouts.

Before you know it, you’ve tried everything short of strapping yourself into a medieval torture device to stretch yourself out.

But what if, instead of doing more, the solution was about making things easier?

Cue Tim Ferriss’ golden question: “What would it look like if it were easy?”

You’re not broken; you’re just a little out of tune.

And just like a guitar that’s been knocked around one too many times, you don’t need to be rebuilt from scratch.

You just need to re-tune your strings.

Welcome to the Guitar Framework: a beautifully simple, dare I say, luxurious approach to persistent pain.

(And before you start thinking “luxury = expensive,” let’s clear that up right now: The luxury I’m advocating has nothing to do with money. It’s a state of mind, and it’s free.)

What Is the Guitar Framework?

Picture your body as a guitar.

You’ve got six strings, each one representing a modifiable aspect of your health.

When these strings are in tune, life is easy—even luxurious.

When they’re out of tune, life becomes complicated, painful, and, well, kind of like listening to a middle school garage band for hours on end.

But what if getting those strings back in tune wasn’t as hard as you think?

❌ What if more effort wasn’t the answer?

❌ What if more expert opinions wasn’t the answer?

❌ What if more money wasn’t the answer?

❌ What if more stretching wasn’t the answer?

What if it were, dare I say, easy?

The Science Behind It: Pain as a Homeostatic Emotion

The Guitar Framework is based on modern science, particularly Bud Craig's work on pain as a homeostatic emotion.

Just as emotions help us navigate social situations, pain helps us navigate our physical state, signaling when something is out of balance.

Instead of seeing pain as a sign of damage, the Guitar Framework views it as a homeostatic signal—a prompt to adjust your strings and restore balance.

You can read more about Bud Craig’s revolutionary work here

The Easy Path vs. The Hard Way

It’s tempting to think the solution to your pain is complex and hard.

That you have to try harder, do more, and follow every expert’s advice to the letter.

But what if the path to healing wasn’t about fighting or struggling?

Jean Cocteau said it best:

“You have comfort. You don’t have luxury. And don’t tell me that money plays a part. The luxury I advocate has nothing to do with money. It cannot be bought. It is the reward of those who have no fear of discomfort.”

The luxury here isn’t in paying for more treatments or pushing through more pain.

The luxury is developing the skill of knowing how to tune your strings and managing your body with ease.

That’s the kind of luxury that makes life a little bit easier, pain a little bit quieter, and stress a little less overwhelming.

So next time you feel that neck pain or headache creeping in, ask yourself: What would it look like if this were easy?

The answer might just surprise you.

Ready to Tune Your Strings?

If you're tired of pain controlling your life and you want to explore a simple, actionable approach to relief, take our free Tune-In Archetype™ quiz.

Find out which of YOUR strings is out of tune and which stress pattern is guiding your response to life’s pressures.

Hi, I’m Daniel O’Grady, a physiotherapist and coach, and I’m here to guide you—not fix you. The Guitar Framework isn’t about quick fixes or endless treatments. It’s about helping you tune your strings, regain control, and move toward your North Star functional goal.

We currently have limited spots available for those ready to take the next step. If you're an early adopter, you have nothing to lose—just an easier, more tuned life to gain.

Email me directly at dan@kinfolkwellness.com.au with a subject line of STARTNOW to join the waitlist today!

Top 3 Long-Term Benefits of Understanding Your Tune-In Archetype™ for Persistent Neck, Back Pain, and Headaches

1. Break the Pain-Fear Cycle: Each of the 9 stress reactivity patterns in the context of persistent neck, back pain, and headaches has blind spots that unintentionally make pain worse. By identifying yours, you can stop fueling the pain-fear amplifier and regain control.

2. Personalized Pain Relief: These stress patterns make you good at certain things in life but can be your Achilles' heel when managing persistent pain. You’ll know exactly what works for your body and mind, helping you make smarter, quicker decisions to reduce pain and prevent flare-ups.

3. Proactive Healing: Learn to tune into early signals from your body and take small, easy steps to prevent pain from escalating—leading to long-term relief without constant external treatments.

I will personally guide you through a simple, effortless approach.

First, we need to take a courageous step through the complexity—it might seem daunting, but with the Guitar Framework, we’ll guide your decision-making and help you tap into your internal power.

If you’re tired of winning the battle but losing the war, take the free Tune-In Archetype™ quiz and discover how your stress pattern can unlock lasting relief from persistent neck, back pain, and headaches.

We currently have limited spots available for those ready to take the next step.

If you're an early adopter and are curious, you have nothing to lose—just an easier, more tuned life to gain.

Email me directly at dan@kinfolkwellness.com.au with a subject line of STARTNOW to take the FREE Tune-In Archetype™ quiz.

Is It Time for a New Pain Model?

Is It Time for a New Pain Model?

In the early 2000s, pain neuroscience education (PNE) emerged as a revolutionary approach to understanding pain, spearheaded by prominent figures like Lorimer Mosley and David Butler.

Their work shifted the conversation away from a purely structural perspective and introduced the world to the concept that pain is not solely a result of tissue damage, but also a brain-driven phenomenon.

For some in the rehab profession, this helped us move beyond simplistic reductionist narratives (some other practitioners continued the narrative - see below).

How many overly simplistic nocebic inducing narratives could you fit in one physiotherapy session?

This was an exciting revelation at the time, and it gave clinicians and patients alike a new way to explain chronic pain.

However, as the years have passed, it’s become increasingly clear that PNE, while groundbreaking, may not have fully lived up to its promise.

Many have “drunk the Kool-Aid,” so to speak, fully subscribing to the PNE narrative without recognizing its limitations.

As a result, it may be time for a new explanatory model—one that embraces both the brain and the body in a more profound and grounded way.

Enter Bud Craig’s homeostatic model.

The Cognitive Focus of PNE: A Double-Edged Sword

Butler and Mosley’s PNE revolution gave us the gift of understanding the brain's role in pain perception.

It showed that pain is a complex experience that involves more than just signals from the body—our thoughts, beliefs, and prior experiences shape how we experience pain.

This has led to cognitive-based interventions aimed at reshaping our understanding of pain, helping patients reframe their pain experience and reduce fear.

But this approach has its downsides.

The heavy focus on cognition—the idea that it’s all in the brain—can stigmatize patients, making them feel like their brain is "broken" or diseased.

Just today I heard on the Curable podcast (link here - 38 min mark) Sophie Hawley-Weld discuss her negative experience with PNE as a stand alone approach - “It made me feel crazy, because I did ALL the things!”

Lisa Feldman Barrett points out in her book How Emotions Are Made:

“Scientists now consider chronic pain to be a brain disease with its roots in inflammation.”

Therapists, too, can get stuck in this model, sometimes doubling down when their approach doesn’t yield results, leading to frustration and cognitive dissonance on both sides.

While PNE has helped many, its reductionist trap—the idea that pain is purely a cognitive or brain-based experience—can leave patients feeling confused, alienated, and in some cases, harmed.

The Quiet Work of Bud Craig: A Model Ready for Its Time

While PNE experts have been front and center, promoting their work as being of the highest evidence-based standard, Bud Craig has worked quietly and diligently in his lab for over two decades.

Without any fanfare or jumping to premature conclusions, Craig has steadily built his homeostatic model of pain, focusing on understanding how the brain and body interact to maintain balance. His approach has been one of careful observation and deep research, avoiding the sensationalism that often accompanies new theories.

Unlike the self-promotion that has often characterized the PNE movement, Craig’s work has been humble yet profound.

While PNE experts have confidently marketed their approach and, at times, looked down on therapists who use what they consider to be outdated modalities, Craig has taken a more measured, thoughtful path.

This divide between the PNE camp and other healthcare professionals has created divisions within the profession that threaten to tear it apart. As the PNE model gained traction, those who embraced different methods, even those rooted in manual therapy or movement-based approaches, have often been labeled as being behind the times or lacking evidence.

This division is unhealthy.

When experts adopt a fixed stance, particularly when that stance dominates the conversation, it can prevent the evolution of new ideas.

The rigid adherence to the neuromatrix theory has made it difficult for PNE proponents to integrate other valuable insights, particularly those that focus on the body’s physiological processes.

Bud Craig’s Homeostatic Model: A More Balanced Approach

This is where Bud Craig’s homeostatic model offers a refreshing alternative.

Craig’s model doesn’t disregard the brain’s role, but it brings the body back into the equation in a more meaningful way. His model focuses on interoception—the way the brain perceives signals from inside the body—and homeostasis, or the body's ability to maintain internal balance.

Craig suggests that pain emerges from the brain's interpretation of signals related to disruptions in homeostasis.

In other words, pain is a result of the body trying to maintain balance, involving not just cognitive processes but also metabolic health, the immune system, and the autonomic nervous system.

This multi-dimensional approach goes beyond the brain to include a broader understanding of the body's physiological state.

Why PNE Has Reached Its Limits

The current PNE model, with its strong focus on the brain, misses out on these broader dimensions. While it’s been helpful for some, it has also led to iatrogenic harm—the unintended negative consequences of treatment.

Patients who don’t respond to PNE can feel as though their brain is at fault, or that they’re failing to think positively enough to overcome their pain. This can lead to a sense of disempowerment, where patients feel like they’re not in control of their own healing.

On the flip side, therapists who are deeply invested in the neuromatrix theory of pain, popularized by PNE, can become stuck in their thinking.

They may struggle to embrace newer models like Craig’s, falling into expert bias and resisting change due to their commitment to a theory that no longer fully explains the complexity of pain.

Big organizations or thought leaders who have built their careers on the neuromatrix theory may find it difficult to pivot, even when emerging evidence suggests a new direction is needed.

The Risk of Reductionism

When we boil down pain to a purely cognitive process, we risk oversimplifying a very complex experience.

Pain is not just in the mind, and it’s not just in the body—it’s an emergent experience that arises from the brain’s interpretation of the body’s internal state.

PNE’s reductionist approach may have been a necessary stepping stone, but it’s clear now that it’s not enough.

We need a model that honors the complexity of pain—one that integrates the brain, body, and emotions.

A New Paradigm for Pain: Bud Craig’s Homeostatic Model

Bud Craig’s homeostatic model offers the kind of paradigm shift that the pain world desperately needs.

His model moves beyond the brain-centric view of pain and looks at how pain is a signal of the body’s struggle to maintain balance.

It integrates brain and body, cognition and physiology, offering a more multi-dimensional and empowering view of pain.

This model suggests that pain is not just about faulty neural circuits or maladaptive thoughts but is a multi-dimensional signal that can arise from metabolic imbalance, poor immune function, or disruptions in the autonomic nervous system.

In this way, it respects the body's role in pain, and it offers patients a more empowering framework for understanding their pain and healing.

Instead of being told that their brain is “the problem,” patients can see how their body and brain work together to maintain balance.

Time for a New Direction

As with any scientific revolution, there comes a time when we must move forward. Karl Popper’s philosophy reminds us that science should be open to change, that we must always be ready to discard old theories when new evidence challenges them.

The PNE revolution, while groundbreaking, may now need to give way to a more nuanced, integrative approach. The homeostatic model offers a new direction—one that respects the brain’s role but also fully embraces the body’s physiological contributions to pain.

It’s time for a new pain model—one that’s more grounded in science, one that empowers patients rather than stigmatizing them, and one that helps therapists and patients alike see the bigger picture.

The time for Bud Craig’s homeostatic model has come.

Final Thoughts:

We owe a debt of gratitude to Butler, Mosley, and the pioneers of PNE for opening the door to a new understanding of pain.

But now, we have the opportunity to take the next step. By embracing the homeostatic model, we can help patients reclaim their power, and in doing so, move away from the reductionist trap that has limited our approach to pain for too long.

Let's bridge the divisions in the profession and build a new, unified path forward—one that honors both the brain and the body.