Ask a physio: Dealing with long-term pain? The answer may be to avoid avoidance

You bend to pull a weed or lift a laundry basket, something in your back catches, and a small voice says: “Careful now.”

So you are careful. You stop bending that way. You skip the walk. You brace when you stand up. Months later the pain is still there, and you cannot work out why, because you have been so careful.

Here is the hard part I spend much of my week explaining: the care might be part of the problem.

Start with the piece almost nobody is told. You can be safe and in pain at the same time. In the first days after an injury, pain is a sharp, useful alarm. But when pain hangs around for months, the alarm system itself grows more sensitive, the way a smoke detector can get touchy enough to go off at burnt toast.

The pain is completely real. It is simply no longer a reliable measure of harm. Your body can hurt while being perfectly safe to move.

That leads to the idea that changes everything for the people I work with. What starts a pain problem is usually not what keeps it going. The original tweak, strain, or bad day has almost always settled long ago. What maintains the pain is everything that grew up around it: the guarding, the bracing, the movements you quietly dropped, the sleep you stopped getting, the low hum of worry that your back is fragile. The injury left. The protection stayed. And the protection is now the problem.

Which is why the way out feels backwards. The instinct is to avoid whatever hurts. But avoidance is the fuel.

Every movement you give up shrinks the zone your body is willing to treat as safe, and a smaller safe zone means more and more things start to hurt. The reverse is also true, and it is the whole game. When you gently, gradually visit the edge of the discomfort, that zone expands. Push in a little, let it settle, and by next week the edge has moved. You are not damaging anything. You are teaching an overprotective system that the world is bigger and safer than it has decided.

So the single most useful thing I can tell someone stuck in long-term pain is short and a little rude: avoid avoidance. Not recklessly, and not by gritting through real agony, but by treating your own edges as something to experiment with rather than fence off for good.

I find this work hopeful for a reason most people find surprising. If what maintains your pain is different from what started it, then it does not much matter how long you have hurt or what the first injury was. That part is old news. What maintains a problem can be changed, and I watch people change it every week, people who had been told for years to simply live with it, who go on to get genuinely, fully better instead.

You are not fragile. You are protected, a little too well. And that, unlike the past, is something you can work on.

Sean Overin is a registered physiotherapist who coordinates the Chronic Pain Program at Tall Tree Health, which has a clinic in Port Coquitlam. This column is general information, not a substitute for individual medical advice.