Chronic joint pain. Like a stone in your shoe

Chronic pain is something that can follow you for months, sometimes for years. Many patients choose to put the problem aside, hoping it will disappear on its own. But the pain stays. Limitations slowly increase. What once felt mild and manageable can gradually become part of daily life, shaping habits, movements, and decisions around pain.

What is chronic pain

Chronic pain is first and foremost a medical definition. It refers to pain that lasts longer than twelve weeks. This duration is not just a label. When pain persists for that long, the nervous system begins to change. Pain processing becomes more centralized in the brain. This shift is important because it influences how pain is perceived and maintained over time. This mechanism is known as nociplastic pain.

Nociplastic pain. A poorly understood mechanism

Nociplastic pain is not a familiar term for most people. It describes a situation in which the brain amplifies pain signals beyond what is happening in the tissues themselves. The problem is not only located in the joint. The brain increases the importance of the signal. It works like a zoom effect. At the joint level, pain input may be low, for example two out of ten. Yet the brain amplifies it, and the pain is experienced as five out of ten. The pain feels real and limiting, even though tissue damage alone does not fully explain it.

Why the brain plays a central role in pain mechanisms

Pain is not produced in the knee, the foot, or the lower back. Pain is processed in the brain. The brain is the main center that interprets danger and pain signals. Research shows that, over time, the brain can become overly reactive. It may respond strongly even when there is no real threat to the joint. This situation is often observed in chronic low back pain. The tissues have healed. The inflammatory phase has resolved. Yet the brain continues to react as if danger is still present.

What this changes in physiotherapy for chronic pain

When pain becomes chronic, physiotherapy must address two complementary aspects. The first one is physical. It focuses on the painful area through mobilization, strengthening, and stretching. The goal is to improve joint health, restore movement, and progressively reduce pain sensitivity. Mechanical input helps the nervous system regain confidence in movement.

The second aspect is patient education. Many patients are not aware of how chronic pain works. Understanding pain mechanisms helps reduce fear and excessive protection. In chronic low back pain, outdated beliefs are very common. Ideas about posture, disc damage, or degeneration are often seen as direct causes of pain, even though they are part of normal aging. Updating this knowledge based on current research is essential to reduce pain persistence. Education is a key part of physiotherapy care.

Chronic pain requires a global clinical approach

Chronic pain is not always explained by imaging or structural findings. Pain modulation depends more on brain processing than on what happens at the joint alone. For this reason, management must go beyond purely mechanical interventions.

Physiotherapy is not only about improving joint mobility. It is a global approach that considers the individual as a whole. Joint health, medical history, daily habits, and lifestyle all matter. In most cases, combining manual therapy, movement rehabilitation, pain education, and a supportive therapeutic environment leads to better outcomes. The goal is not only to reduce pain, but to help patients move freely and confidently in everyday life.

I provide structured and evidence-based online physiotherapy for patients worldwide, offering clinical assessment, diagnosis, and personalised rehabilitation.

I also receive patients in person at my physiotherapy clinic in Phnom Penh.

You can begin your online physiotherapy session through the dedicated platform:

https://www.studiohealthon.com/online-physiotherapy

More information on clinical standards and supporting evidence is available here:

https://www.studiohealthon.com/online-physiotherapy-clinical-evidence

Yannick Sarton, MSc Physiotherapist

International Online Physiotherapy & In-Clinic Care, Phnom Penh

References

Goldring MB, Goldring SR. Osteoarthritis. Journal of Cellular Physiology. 2007;213(3):626–634. doi:10.1002/jcp.21258

Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2–S15. doi:10.1016/j.pain.2010.09.030

Lluch Girbés E, Nijs J, Torres-Cueco R, López Cubas C. Pain treatment for patients with osteoarthritis and central sensitization. Physical Therapy. 2013;93(6):842–851. doi:10.2522/ptj.20120253