The scan says nothing is wrong… so why on Earth does it hurt so much!?

The scan says nothing is wrong… so why on Earth does it hurt so much?

This seems like a pretty good follow-on from my “Tom had a migraine and didn’t do anything about it for weeks” post.

I’ve been getting headaches, migraines and neck pain on and off for close to 10 years. I’ve spoken about this before, but I originally got into physio because of my knee injuries. I had multiple knee injuries, multiple surgeries and spent a ridiculous amount of time doing rehab.

But if I’m being truthful, the headaches have probably affected my life more than my knees ever did.

The interesting thing is that my knees were easy to explain. All of those injuries were structural. A specific thing in my body tore. I had scans. A specialist looked at those scans and could point to exactly what was damaged and, in my case, what needed to be fixed. My neck and headaches aren’t like that.

There isn’t a scan I could have tomorrow that I expect would suddenly explain why I can have horrible neck pain or a 9/10 headache.
And that’s because pain doesn’t always require something in your body to be damaged.

…. huh??

This is something that can be incredibly difficult to get your head around (I know it was for me when I started working as a physio!)

We naturally associate pain with damage:
Break your arm = pain.
Tear your ACL = pain.
Roll your ankle = pain.

So when you’re experiencing significant pain, naturally you think there must be something damaged somewhere. But that’s not always how pain works. Pain can be influenced by muscle tension, stress, sleep, activity levels, workload, sensitivity of the nervous system and a whole heap of other factors.

In my case, I know there are certain things that make an enormous difference:

1. Minimising stress.
2. Exercising properly and consistently.
3. Spending less time staring at screens.
4. Eating better.
5. Regular massage and hands-on treatment.

And I’m also very good at not doing those things consistently and then wondering why my neck hurts (classic physio move).

The thing that I find fascinating is that I can have absolutely horrendous pain one day and then wake up the next morning and it’s almost completely gone .. think about that for a second.

If I’d fractured a bone on Monday, it wouldn’t magically un-fracture itself on Tuesday. If I’d torn a ligament, it wouldn’t repair itself overnight. But pain can change incredibly quickly because pain and tissue damage aren’t the same thing.

And this is probably the most important bit.
If you’ve had scans that haven’t found a significant structural problem, that does not mean your pain isn’t real.
It doesn’t mean you’re imagining it.
It doesn’t mean you’re being dramatic.
And it definitely doesn’t mean there’s nothing that can be done about it.

I’ve had far worse pain from my neck and headaches than I ever experienced with some of my very obvious structural knee injuries. The pain is very real. The explanation for it just isn’t always as simple as pointing at something on an MRI. And that’s an important distinction!

Quick disclaimer: Guys, I’m fine 🤣 This isn’t a whinge fest and I’m not walking around with a migraine every day. Mine comes and goes, and after nearly 10 years I have a pretty good understanding of what helps me.. I mostly just need to pull my finger out and actually do those things consistently.

But if you struggle with persistent pain and you’ve never really been given a clear structural explanation for it, don’t be disheartened.
We see you.
We treat people with presentations like this every single day.
And sometimes the most important thing we can do isn’t find the damaged bit.
It’s help you understand why you’re hurting, work out what influences it, and start getting you back to doing the things you actually want to do.