A quick two-minute read:
Pain is real. But it isn't a damage meter. It's your body's alarm system, and like any alarm, its sensitivity can change. Some people have a lot of pain with very little damage. Others have big changes on a scan and barely notice them. When pain hangs around longer than expected, that difference matters.
When someone comes in with ongoing pain, I want to know more than where it hurts. How long has it been going on? What sets it off? Is it predictable? How does it respond to movement? If the pain seems bigger than the injury, spreads beyond the original area or flares with things that should be harmless, I start asking whether the nervous system is part of the picture.
Sometimes the alarm gets turned up. Your nervous system becomes more responsive to signals from your body, so things that shouldn't hurt much start to. You might hear this called central sensitisation. It doesn't mean the pain is in your head, and it doesn't mean there's nothing physical going on. It means the volume is up.
There's no simple self-test, but these questions are worth asking yourself:
Does my pain feel bigger than the activity I'm doing?
Do things that used to feel fine now hurt?
Does my pain spread, move around or show up in more than one place?
Can a small amount of activity cause a big or long-lasting flare?
Is my pain worse when I'm stressed, tired or sleeping badly?
Has my pain kept going even though the original injury has improved?
Saying yes to a few of these doesn't mean you have central sensitisation. Each one has other possible explanations, from an irritated tendon to a nerve-related problem. But they're useful clues to bring to your physio. And a sensitive system can settle. It takes understanding, patience and the right amount of movement.
Got a few more minutes? Keep reading.
How we look at it. At By Design, we look at three things when pain hangs around: Capacity, Coordination and Connection. Capacity asks whether the area can handle what you're asking of it. Coordination asks whether you're using it well. Connection asks how your nervous system is responding to movement and pain: guarding, avoiding, or staying on high alert. Sensitivity sits under Connection. We assess it alongside your tissues, your nerves and anything else that could be contributing, never instead of them.
What it can look like in real life. A knee that hurt after a fall now aches on the stairs, on the couch and in the car. A sore back that used to settle by lunchtime now flares after a gentle walk. You might notice pain hours later or the next day and feel like it came out of nowhere. It usually didn't. Often the alarm is reacting to your total load: the activity, plus sleep, stress and how much the pain has been on your mind.
Find the level your body tolerates now, then build. Pushing hard through significant pain tends to keep the alarm loud. Avoiding movement altogether can make it more sensitive over time. We use the middle path, and a simple traffic light system to find it.
Green, 0 to 3 out of 10: keep going.
Yellow, 4 to 6: proceed with care and adjust.
Red, 7 to 10, or anything sharp, new or scary: stop. Then we build from green, gradually, so your body gets more comfortable with movement again.
Understanding is part of the treatment. Knowing why something hurts can make it feel a lot less threatening. That's why we spend time explaining what we find, not just handing out exercises. Then we build strength and capacity on top of that understanding.
When to get checked sooner. Some symptoms need a medical review first, not just a physio plan. If you have new numbness or weakness, changes to bladder or bowel control, unexplained weight loss, fevers, or pain that's severe at night and doesn't ease with rest, see your GP promptly.
Pain is information, not a verdict. Sometimes it points to an injured tissue. Sometimes it points to a sensitive system. Often it's both. Our job is to work out which, and help you build your confidence and capacity again.
Understanding Your Pain Is Part of Your Recovery
If your pain has become persistent, unpredictable or hard to make sense of, a physiotherapy assessment can help work out what's contributing and what to do next.
Book an assessment at By Design Physiotherapy & Strength in North Hobart.
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About This Article
Author: Marissa Seeley, Physiotherapist and Co-Founder
Clinic: By Design Physiotherapy & Strength, North Hobart, Tasmania
Publication date: 14 November 2026
Last reviewed: 13 November 2026
By Design Clinical Framework
Capacity, Coordination and Connection (the 3 C's) and the traffic light system are internal frameworks used within By Design Physiotherapy & Strength to organise clinical reasoning and help clients manage their symptoms.
These are internal clinical frameworks, not independently validated diagnostic tools.
References
Raja SN, Carr DB, Cohen M, et al. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, 161(9), 1976–1982. DOI: 10.1097/j.pain.0000000000001939.
Nijs J, Lahousse A, Kapreli E, et al. (2021). Nociplastic pain criteria or recognition of central sensitization? Pain phenotyping in the past, present and future. Journal of Clinical Medicine, 10(15), 3203. DOI: 10.3390/jcm10153203.
Kosek E, Clauw D, Nijs J, et al. (2021). Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system. Pain, 162(11), 2629–2634. DOI: 10.1097/j.pain.0000000000002324.
Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. (2017). Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews, Issue 4, Art. No. CD011279. DOI: 10.1002/14651858.CD011279.pub3.
This is general information only. If you're managing pain or an injury, speak with your physio about what's right for you.
