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Joint pain. Real damage or pain sensitization?
- Yannick Sarton
- 3 days ago
- 5 min read
When joint pain appears, most patients ask themselves the same simple question. Is my joint damaged? This question is legitimate. Pain is a direct personal experience and is often interpreted outside any medical framework. Without clinical reference points, it becomes difficult to understand what joint pain really means. This is where a healthcare professional plays an essential role, helping to clarify the nature of the pain and to distinguish between structural damage and pain sensitization.
What causes joint pain. Injury damage or pain sensitization
The onset of joint pain is one of the most important elements to consider. When joint pain clearly appears after a sports activity or after a fall, there is a real possibility of tissue damage. This is an important concept for the general public to understand. Sport is not a neutral activity for the human body. In physiology, this is referred to as physiological stress. Human tissues such as joints, ligaments, muscles, and tendons are exposed to mechanical loads that go beyond everyday activities. This is not negative in itself, but every sport comes with a known baseline risk of injury. A runner is more likely to experience injuries in the lower limbs, while a tennis player is more exposed to shoulder joint injuries. This is normal and part of the risk benefit balance of any sport.
How joint pain works. From tissue injury to nervous system sensitization
In musculoskeletal conditions, joint pain can originate from different mechanisms. One key distinction, especially for active individuals and athletes, is whether the pain is inflammatory or related to pain sensitization, often referred to as nociceptive pain. When a sports injury is associated with swelling, skin color changes, night pain, or pain that is not necessarily reproduced by movement, there is a higher probability that a tissue has been damaged and that the body has initiated an inflammatory response. Inflammation is not the enemy. It is a protective biological process that allows tissue healing.
When these signs are absent, another hypothesis can be considered. Small microscopic tissue damage may be present and require minor repair. However, when the sporting gesture is clear or when a fall is evident, a minor structural injury remains a more likely explanation than pure pain sensitization. In both inflammatory pain and nociceptive pain, the nervous system plays a central role. Pain signals are generated at the tissue level, transmitted through neural pathways, and interpreted by the brain, where pain perception ultimately occurs (1).
When joint pain is not related to joint damage
Some joint pains are not directly linked to structural damage of the joint itself. A common example is acute low back pain, which can appear suddenly in the morning without any obvious triggering event. In these situations, the pain mechanism is primarily related to nervous system sensitization rather than tissue injury. This corresponds to pain driven by altered nociceptive processing without clear structural damage (2).
Patient perception plays a major role in this context. If a patient becomes fearful of the pain and avoids movement, the prognosis of acute musculoskeletal pain can worsen. Pain duration may increase purely as a result of behavioral and cognitive responses. This relationship between beliefs, fear, and pain persistence is well documented in musculoskeletal research (3).
What science says about joint pain and pain sensitization
Pain science is an active and evolving field, and the subject is far from fully resolved. Today, pain is understood as a multifactorial phenomenon. Scientific research clearly distinguishes between phases of tissue damage and pain driven primarily by sensitization mechanisms. In many cases, these phases do not occur separately but follow one another over time. An acute injury may first generate inflammatory pain related to tissue damage. As the tissue heals and inflammation resolves, this inflammatory pain can progressively give way to pain sensitization (2).
This phase of pain sensitization often leads patients to believe that the tissue remains damaged, even though the structural injury has already healed. In chronic pain lasting longer than twelve weeks, pain mechanisms involve both sensitization at the peripheral level and altered central nervous system processing. The brain may amplify and maintain pain signals through mechanisms consistent with nociplastic pain, where pain experienced is no longer proportional to the current state of the tissues (2,4).
Although nociplastic pain is complex and still under investigation, it is now recognized as a central component of chronic musculoskeletal pain in a large proportion of patients.
What joint pain means for physiotherapy assessment and treatment
Physiotherapists with a high level of qualification work precisely within these timelines and mechanisms. They understand the biochemical and physiological processes of inflammation, as well as the clinical signs indicating when pain is no longer inflammatory but nociceptive, meaning that the tissue itself has healed. These elements are first identified during the case history, which is the initial clinical discussion that takes place before any treatment.
Physiotherapists then rely on orthopedic tests, which are research validated clinical tools used to identify whether a specific structure is responsible for the symptoms. Based on the presence of an inflammatory phase or a pain sensitization phase, the physiotherapist can determine which intervention is most appropriate and at what moment.
A major issue for many patients is the tendency to self manage acute inflammatory pain. By doing so, they may interfere with the natural tissue repair process, which is rarely favorable for long term recovery. This can negatively influence prognosis and prolong symptoms unnecessarily.
It is important for patients to understand that physiotherapy professionals specialize in musculoskeletal conditions. This is their field of expertise. Qualified physiotherapists work within scientific clinical guidelines and pursue the same goal as their patients, to restore function and help individuals return to a life free from pain.
This article aims to clarify a simple but essential question. Joint pain does not always mean damage. Understanding pain mechanisms is the first step toward appropriate care, informed decisions, and long term recovery.
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.
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Yannick Sarton, MSc Physiotherapist
International Online Physiotherapy and In Clinic Care, Phnom Penh
References
1. Kosek E et al. Chronic nociplastic pain affecting the musculoskeletal system. Pain. 2021.
2. IASP Task Force on Pain Classification. Nociceptive, neuropathic and nociplastic pain. Pain. 2021.
3. Vlaeyen JWS et al. Fear avoidance beliefs and chronic musculoskeletal pain. Pain Reports. 2020.
4. Macionis V. Nociplastic pain. Clinical implications and ongoing debate. Clinical Journal of Pain. 2025.
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