As someone who has experienced long term pain, I know how frustrating it can be not to get better, not being able to do the sport you love and be told it’s ‘all in your head’.
Persistent or chronic pain is a complex brain response, more than it is a physical damage issue. Some people perceive this as "it's all in your head", which is not quite accurate, except that our brains are in our head and this is largely a brain issue.
There are many factors that contribute to long term injury and pain, not simply a physical injury; moreover, in many instances of persistent pain the physical injury is long since healed but the brain has learned over time that it needs to protect this sensitive area, which it does through creating pain.
Here’s the science bit: acute pain progresses into chronic pain when repeated or continuous nerve stimulation precipitates a series of altered pain pathways, resulting in central sensitization and impaired central nervous system mechanisms.
When pain becomes chronic, the nervous system becomes overactive.
The "pain alarm" in your brain becomes more sensitive to danger. Your sympathetic nervous system (fight or flight) becomes more easily activated which has an effect on your blood vessels, resting muscle tension, hormone levels and neurotransmitters, making you more sensitive to pain. This makes your nervous system activate pain signals more quickly and efficiently.
Essentially, the brain’s response to a particular stimulus goes a bit over the top in order to protect an area that is sensitive.
To say it’s ‘mental’ isn’t quite accurate - just the wiring in the brain has changed over time in response to the pain and your brain and nervous system are on high alert and sending off pain signals more readily. All pain is created by the brain, even though we feel it in specific body locations. This is why for example, people who’ve had a limb amputated continue to experience itching or pain in limbs that are no longer there. It’s the neural pathways and connections that are in place that are causing the pain.
It’s a bit like a smoke alarm that goes off when the toast burns instead of when there’s a real fire. Its job is to protect but in persistent pain, the alarm signal is activated too easily.
Sometimes pain is our body’s way of trying to communicate with us about something, and it will choose something we love doing in order to get our attention.
We can train our brains not to do so through physical exercises and mindset changes. Sometimes listening to the message it’s trying to give you, and implementing some changes to you life is enough to make the pain stop. Sometimes the thought of that can be daunting or even terrifying, which is why sometimes the pain needs to get really bad in order to sufficiently piss you off to get you to make that change.
I had this exact scenario - I was frustrated up to the eyeballs with knee pain that was stopping me from doing parkour, later yoga and eventually I couldn’t walk, sit or sleep without pain.
The intensity of frustration made me realise I needed to make some changes: in a moment of despair, I realised that it was time to rehome the beautiful dog I was struggling to live with as a “single parent”, take control of my life by pushing back at my dad who was encouraging me to take my career in a direction I didn’t want to go in, and fire my therapist who had helped me come to these realisations (the irony!) because I was fed up of doing the hard work.
Once I had implemented these changes - told my dad and the therapist to eff off and rehomed the dog, within two weeks my pain subsided. That’s not to say this is a miracle cure. Sometimes it isn’t. But seeing the pain in a different way - as something that is there to guide you to fulfil what is most meaningful for you - is usually enough to help you gain a new understanding of its purpose and appreciate it and your body in a new way.
When we do that, we are able to see the higher order of things, learn to listen to our body’s signals which helps us to accept the pain instead of trying to fight it. This then unlocks our body's innate powerful healing mechanism which changes our biochemistry and neurotransmitters, and rewires our brain to produce less pain.