Pain Doesn't Always Mean Damage

A medical professional examines digital X-ray images of a knee joint displaying inflammation or injury, highlighted in red, using a laptop and tablet at their desk.

When pain gets worse, it’s natural to think you have caused more damage. You might find yourself thinking “What have I done to cause this?” or “I shouldn’t have done that, I’d better avoid it in future”.

But pain is not an accurate measure of damage. The images below show X-rays of the knee joints of two patients. These images demonstrate that there can be significant damage without any pain, and there can be pain with no damage at all.

So how can we explain this? Let’s take a hypothetical situation:

Brothers Chris & Carl, both in their 50’s, have always enjoyed keeping active. They regularly walk or run & enjoy taking part in local 5k running events.

One day Chris started to notice a dull ache in his knee, at first he tried to ignore it and continued with his usual exercise, but the pain gradually got worse. Chris started to worry about the damage he was doing to his knee, so he decided to take a break from exercising to allow the pain in his knee to settle. Unfortunately, the pain remained the same, and as the weeks went on Chris became more worried, he now believed there must be some serious damage, he became anxious that he would never run again. After several months without his regular exercise Chris started to gain weight, normal day to day activity was noticeably more difficult, he was struggling to sleep, and he was feeling low in mood. When he eventually went to see his doctor, he was referred for an X-ray – the image looked like the one on the left – his knee was perfectly healthy!

Carl experienced similar pain in his knee a few years later. He was also referred for an X-ray, but, reassured by the result of his Brother’s Xray, Carl decided to continue doing what exercise he could while he waited for an appointment. Running made his knee sore, so he swapped it for cycling, and started doing some strengthening exercises. He was able to do this without any pain, so after a few weeks, Carl gradually re-introduced running, he remained completely pain-free and 6 weeks later he was back to running 5k. When Carl eventually had his X-ray, it looked like the image on the right!

So, in this story, Chris’ fear of damage may have amplified his pain, creating a cycle of pain, fear & avoidance of exercise. As a result, over time he would have become deconditioned, losing muscle mass & strength, this would have amplified his pain further and kept him stuck in this cycle.

On the other hand, Carl was able to adapt his exercise so he could remain active without causing pain, he wasn’t afraid of any damage to his knee because he was reassured by his Brother’s X-ray result. This meant his pain resolved quickly and had minimal impact on his overall health and wellbeing.

I like a happy ending, so I’ll add that Chris went on to seek advice (from me😊) and he was able to start exercising again, including a gradual return to running.

If any of this story resonates with you, I’d be happy to chat with you about how I can help.

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Thank you for reading.

Michelle