Understanding Pain


Understanding Pain

The importance of pain

Pain affects us in many different ways, but it is important to remember that pain can only be initiated by changes to one or more of three things: temperature, mechanical force and chemical change.

Pain is our protector

The pain mechanism in all animals is designed to detect changes which could cause damage. We therefore understand, even as a child, that the mechanical impact from falling down or the heat from a fire and the sting of a nettle all result in a painful experience. We therefore learn and modify our behaviour. Pain helps to protect us from damage.

Pain can however become a real pain

The problem with this protection mechanism is highlighted when we develop changes to our body that cannot be healed. A very common problem is tissue degeneration simply from ageing. A worn knee joint for example, affects the mechanical function and stimulates an inflammatory response. Consequently both the mechanical and chemical changes are likely to initiate a pain experience.

This pain experience can be long lasting because the condition lacks the ability to recovery.



Pain can be deceiving !

Where we feel pain, how it feels, the words we use to describe pain and the impact it has on our life or not accurate in making a diagnosis !

The origin of pain lies within the chemical, mechanical or thermal changes within our body's tissues.

The first job of any examination is therefore to determine which tissues in the body are being affected.

Patient feedback; this could be you?

"Hi Chris

As requested, I wanted to give you feedback following my injection on the 25 August 2023.

Whilst i attended your clinic with an expectation that you would be injecting my knee you injected my hip through my groin.  The resulting decrease in my knee pain has been excellent.  Whilst I still have some discomfort in my right knee, I am able to get up and down stairs far more easily.  I have also been able to walk up to 5000 paces comfortably. I haven't been able to do that since September 2022.  My mobility has improved significantly."


How best to manage pain

The first step is to understand why you have a pain experience.

If, for example it is related to a worn joint, then the person needs to understand their problem in terms of mechanical and chemical changes.
Visit 'Your condition' page to see common problems explained in terms of  mechanical and chemical changes.
With this understanding the individual can search to find ways of decreasing the mechanical strain and improving their joint chemistry.

This may sound simple, but many people search to find whys of directly reducing their pain experience. And there is a difference!

The growing problem of pain

It is very tempting to hope for a solution that free's you of pain, takes very little time and is easy to do.
Because most people want this, pain mediation was developed. No need to alter the mechanical strain or improve joint chemistry, just take a tablet.

Unfortunately, this approach only works in the short term. The number of people with long term pain is now growing despite the fact that the amount of pain medication prescribed has increased.


What is the solution?

The solution involves education, understanding and appropriate expectations. With a focus on how to achieve best joint movement and the best living chemistry within our body's; we will attain our best health.

This does not mean we live a pain free life, it means we live our life as healthy as we can be.

But remember, as we attain better mechanical and chemical function then our pain mechanism does not have as much a reason to shout out its warning!


Please note this post, like all brief explanations only covers the basics for pain arising from muscle, bone, tendon and ligament structures. There are many other factors that influence the experience of pain and much research has been done on the emotional components of pain and the sensitisation of the pain mechanism. 

For more information and links to educational videos please visit 'virtual physio' on the QuickPhys website.


Pain, pain and more pain


Pain is a real pain


I often get asked by patients, 'why am I in pain?'
Its a natural question, but the real answer might not be what the person was expecting!
As with most things they are many personal opinions and lots of research which can be interpreted in different ways.

I like the first part of the answer to refresh a basic understanding that changes in mechanical forces, temperature and chemistry can all generate a pain response. In summation, you can hit yourself, burn yourself and become poisoned. All these things really do hurt.

With muscle and bone pain, temperature is not really an issue, so most people have pain due to abnormal mechanical stress and strain and chemical changes such as inflammation.
To be more specific, a persons posture or movement pattern can elicit a mechanical strain on any joint, which if repeated for a long time, or performed with force or at speed, will result in the body tissues initiating a warning.




The video shows the difference in lifting techniques whilst getting the same job done.
The top video will only ever result in back pain. Notice how the spine is flexed and there is no use of leg muscles to make the lift.
It might takes years before this movement generates a warning stimulus, but the pain will come because the movement is wrong.



Chemical changes such as inflammation will also initiate a pain response. The next picture shows an inflamed bursa within the shoulder. The inflammatory process  makes the tissue bigger, which can cause further problems as the tissue can then become mechanically squashed.
This situation is a 'chicken and egg' scenario. The mechanical compression causes the bursa to become irritated and inflamed, the inflamed bursa is bigger and therefore gets squashed.



So what is the answer?


The answer exists in a tissue based diagnosis.

What tissues are mechanically strained and which tissues are chemically inflamed.

You may experience pain because your shoulder movement is wrong resulting in an inflamed bursa. Or you may have joint irritation due to long term postural dysfunction and/or factors of ageing.

Sometimes 'pain' is more chemical than mechanical, as is the case with Gout.

In any situation, pain is a warning and the diagnosis is the determination of what tissues are mechanically strained or damaged and what tissues are inflamed.

A description of pain is not a diagnosis!


A description of pain will not determine what is strained and what is inflamed.

To determine a true diagnosis it requires observation, examination and investigation.
At the Injection Clinic we perform all three in one appointment for a set fee of £75.

If significant chemical changes are identified we can also administered medication. Price for a guided cortico-steroid injection is £75.

One visit: job done. Don't let your pain take over. Find out what is wrong and address the mechanical and chemical factors.

Please note this post, like all brief explanations only covers the basics for pain arising from muscle, bone, tendon and ligament structures. There are many other factors that influence the experience of pain and much research has been done on the emotional components of pain and the sensitisation of the pain mechanism. 

For more information and links to educational videos please visit 'understanding pain' on the QuickPhys website.


The error of chasing pain!

All too common problem
The error of chasing pain !
For over two years this person visited their GP with knee pain. Injections and physiotherapy did not improve the symptoms or the persons mobility.
The x-ray below shows the painful knee joint. There are no major changes seen on the x-ray, but because the experience of the pain remained around the knee, so did this persons treatment.

By staying focused on examining how joints and tissues are performing and not chasing the pain, we observed the whole person and in particular examined the joints above and below the knee.

The examination of the hip revealed significant changes. A loss of movement was quickly apparent and further investigation with x-ray highlighted the severe degenerative changes (bottom picture).


Its not uncommon for an experience of pain to mislead both patient and practitioner and therefore it is important not to be lead by an experience of pain alone.

Remember that an experience of pain is your body’s alarm, it is an essential warning mechanism, but the detail of your pain experience is not a reliable indicator of what the true nature of the problem is.

If in doubt get the problem checked out!

Examination and ultrasound scan to assist diagnosis £75. When indicated x-rays and MRI scans can be arranged.


Hip Pain

Hip Pain: a joint that often gets over looked.

The hip is a weight bearing joint and is affected by degenerative changes and inflammation. But despite these common and shared problems with the knee joint, treatment for hips is more limited.
Whilst there are some GP’s that will provide knee injections and day case surgery for knee arthroscopy’s is widespread practice; injections and surgical intervention for the hip joint is much more difficult to access.
This is mainly due to the depth of the joint and the costs involved with guided injections performed in Theatre .

However, with appropriate diagnosis and modern ultrasound scans the hip joint does not need to be a poor relation to the knee. For a new patient examination and ultrasound guided cortisone injection the cost is only £150.

There are two key areas that can benefit from injections; the Trochanteric Bursa and the joint capsule. Both these areas can be visualised on ultrasound scans and allow for accurate guided needle placement. The worry of touching a nerve or deep vascular structure is gone, because they are clearly visible.
Secondly, hip injections are relatively painless. In the Journal of Arthroscopic Surgery 49 out of 50 patients preferred ultrasound guided injections over x-ray guided. Most people comment ‘is that it’. The worry of the injection is typically far worse than the injection itself!

Hip joints also have a large number of surrounding muscles and therefore with appropriate exercises the mechanical stability of the joint can be improved.

The key to all muscle and joint related problems remains the same: Improve the joint chemistry by decreasing inflammation or adding joint lubrication and then optimise the movement pattern and supporting muscle strength.
If you feel you may benefit from a clinical examination and ultrasound scan of your hip joint and surrounding tissues then please phone 0114 267 1901 to check on appointment availability.

Book an appointment

Frozen Shoulder

Frozen shoulder is a common shoulder problem; it typically starts without any trauma and last for around 18 months. Quite often it affects the persons non dominant arm and after a period of several weeks it can cause the shoulder joint to loose its range of movement. Washing hair, fastening bras, putting on jumpers etc all become problematic.

Diagnosis is established by the presenting loss of movement and ultrasound scans can further ensure there is no tissue damage. A frozen shoulder on both ultrasound scan and x-ray will look normal.

Due to the high level of pain and limited movement, the condition has a significant impact on a persons life. Whilst treatments such as gentle exercises and soft tissue massage to the surrounding muscles can benefit, the main change in symptoms and movement is provided for by injection therapy.

Guided corticosteroid injections help reduce inflammation and in so doing decrease the pain experience. Hydro-dilitation or distention helps to stretch the shoulder joint capsule from the inside and can provide immediate improvement in joint range of movement.

It must be noted that all injections have to be administered under guidance. The joint space is relatively small and can be as deep as 6cm on some individuals. For Hydro-dilitation, the use of ultrasound scan enables a clear image of the expanding joint capsule.


Guided injections work well to suppress excessive inflammation. This can often improve night time rest, enabling better sleep.

To book an appointment with Injection Clinic and find out if you could benefit from a guided injection please ‘click here’.

Pain Scores: are they damaging us?

Are ‘Pain’ scores damaging the public’s health!


Ever been asked to score your pain out of 10?

Ever been asked to describe your pain and even draw a picture of where it is?

Ever wondered why?

We are taught to believe that a description of our pain and its intensity will help us to find out what’s wrong. This approach has grown in popularity, in part fuelled by a trend in cultural expectations that we should be pain free. In part driven by commercial practice that attempts to sell a ‘pain free’ lifestyle. It is both tempting and financially lucrative.

So does this approach work?

No. The number of people with long term pain is rising, mental ill health associated with pain is rising, the financial cost for the management of long-term pain is increasing and the health of the nation is decreasing. 

So why is it that a standard medical consultation spends time discussing a persons experience of pain and how it affects them?

There are several reasons, the key ones include:

  • All NHS contracts in orthopaedics stipulate that outcome measures based on pain scores are put in place as part of service contracts. Consequently, the clinicians have to ask and patients have to score high in order to gain access to care.
  • It is cheaper to talk about pain than it is to investigate.
  • Many clinicians are taught to ask about pain and there is trend in becoming more empathetic as opposed to diagnostic. ‘How do feel’ has gained priority over ‘this is what’s wrong’. 

Is this pain discussion really that bad?

At its current level, yes. As a consequence of our focus on ‘pain’, our time and financial resources are being spent on ‘pain’ driven pathways instead of appropriate investigation and medical intervention. The focus on ‘pain’ is like having focus on the noise a fire alarm makes. The alarm is not the real problem, the alarm is a warning. It is the resultant investigation that determines if there is a problem and if so, where it is and how big it is.

Side note: Veterinary practitioners have the luxury of avoiding the whole pain score and pain discussion because animals don’t speak. Veterinary clinics have ultrasound scans, x-rays, some even have MRI’s. Many have blood laboratories on site and as a result our pet animals have immediate focus on ‘what is wrong’. 

So, if we don’t measure ‘pain’ what should we do?

Firstly, we should make a tissue based diagnosis to determine the nature of the problem. Then we should deliver treatments that are backed by research.

Corrections to posture, alignment and strength, including surgery; all help improve body mechanics.
Corrections to chemistry within our bodies will always promote health.

If we stop chasing pain and start chasing after best health, then our healthcare resources will be used to improve the health of the nation. 

Book an appointment to find out what is causing your pain

If you are in pain but don’t know what tissues are damaged or irritated, then a physical examination enhanced by ultrasound is a great place to start. It costs £75.

Book your initial consultation including ultrasound scan 


Shoulder Pain

What does shoulder pain look like?
Shoulder pain and ‘pain’ in general cannot be seen. What can be seen are changes to the tissues that make up our shoulder joints.
Shoulder Bursitis
Common problems include shoulder bursitis, which is the inflammation of a fluid sac within your shoulder joint. This can be seen on the ultrasound image below (see the darkened band pointed to by the white arrow) . It is a common painful condition that responds very well to ultrasound guided cortisone injections.
Next picture shows a needle directed into the bursa. Note the measurement ‘A ‘(3.6mm). This is the size of the bursa after injecting with cortisone. To ensure accurate needle placement when the tissues are so small requires ultrasound guidance.
Rotator cuff tendon tear
Another common shoulder problem is a tear within the rotator cuff tendon. The image below shows a comparison between a normal supraspinatus tendon (left image) and a torn supraspinatus tendon (right image). This problem is not for injection, but requires surgical consideration and appropriate rehabilitation.
Acromio-clavicular joint inflammation
A common and often over looked problem is inflammation of the acromioclavicular joint (ACJ). When inflamed the joint responds really well to injection therapy.
If your shoulder is painful then first establish a diagnosis and then select the right treatment for your problem.
Call Active Healthcare Sheffield on 0114 2671901 and ask about an ultrasound scan and injection therapy.

Click here to visit booking page