Guide: chronic pain

Can physio help?

If you’ve been dealing with pain that just won’t go away, you’re not alone. Millions of Australians live with what’s called chronic pain — that is, pain that lasts longer than three months. And if you’re tired of relying on medication to get through the day, there’s something important you should know: movement and physiotherapy can be some of the most powerful tools you have.

Here’s what the research says — and what it might mean for you.

First, what is chronic pain?

Acute pain is your body’s alarm system. You twist your ankle, it hurts, it heals, the alarm turns off. Simple.

Chronic pain is different. Sometimes it keeps going long after the original injury has healed. Sometimes there’s no clear injury at all. Your nervous system — the network of signals that carries pain messages to your brain — can become oversensitive. Think of it like a car alarm that keeps going off even when nothing’s wrong.

This is sometimes called central sensitisation (when your nervous system gets “wound up” and starts amplifying pain signals). It’s not imaginary. It’s real, it’s measurable, and it responds to treatment.

Why movement helps

It sounds counterintuitive: your back hurts, so your physio wants you to move? But the science here is pretty solid.

When you exercise, your body releases natural chemicals — endorphins, endocannabinoids, and serotonin — that actually dampen pain signals. Think of them as your brain’s built-in pain relief system. Research published in the Journal of Applied Physiology shows that regular physical activity activates the same pathways in your brain that some pain medications target — without the side effects.

A large overview of Cochrane Reviews (one of the most trusted sources of medical evidence in the world) found that exercise reduces pain and improves physical function in people with a wide range of chronic pain conditions, including lower back pain, arthritis, and fibromyalgia (a condition involving widespread body pain).

The key word? Regular. A single session won’t flip a switch. But a consistent, tailored program can genuinely change how your nervous system responds to pain over time.

It’s not just about exercise

One of the most exciting areas of physiotherapy right now is something called pain neuroscience education (or PNE for short). In plain terms: understanding how and why your pain works can actually reduce it.

When you learn that chronic pain is often about an overactive nervous system — not necessarily ongoing tissue damage — it changes the way you relate to that pain. Research shows that people who receive this kind of education alongside exercise report lower pain levels, feel less afraid of movement, and get back to daily life faster.

A 2023 systematic review found that combining pain education with physiotherapy led to significantly better outcomes for people with chronic pain than either approach alone.

What will my physio do?

Every person’s pain is different, so a good physiotherapy plan is built around you. But it might include:

Graded exercise — starting gently and building up at a pace your body can handle
Manual therapy — hands-on techniques like joint mobilisation or soft tissue work
Movement coaching — learning how to move in ways that protect rather than aggravate painful areas
Pain education — understanding what’s happening in your body so you stop fearing movement
Goal-setting — working toward things that matter to you, like walking the dog, playing with your kids, or getting back to work

The Australian Commission on Safety and Quality in Health Care includes physiotherapy as a core part of evidence-based care for conditions like chronic lower back pain — and for good reason. It works.

Do I have to ditch my medication?

Not necessarily. For many people, the goal is to reduce reliance on medication over time — not go cold turkey overnight. Physiotherapy works well alongside medical care. It’s about giving you more options and more control, not taking anything away.

What’s possible?

Living with chronic pain is exhausting. But it doesn’t have to be your permanent normal.

At Therapy Inc, our physiotherapists take the time to understand your pain, your life, and your goals — and build a plan that actually fits. Whether you’ve tried physio before or you’re not sure where to start, let’s have a chat about how to improve things.

References

Geneen, L.J., Moore, R.A., Clarke, C., Martin, D., Colvin, L.A., & Smith, B.H. (2017). Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews, 4. https://pubmed.ncbi.nlm.nih.gov/28436583/
Nijs, J., Malfliet, A., Ickmans, K., Baert, I., & Meeus, M. (2015). Treatment of central sensitization in patients with chronic pain: time for change? Expert Opinion on Pharmacotherapy, 15(12), 1671–1683. https://pmc.ncbi.nlm.nih.gov/articles/PMC4534717/
Sluka, K.A., & Frey-Law, L. (2016). Exercise-induced pain and analgesia: underlying mechanisms and clinical translation. Pain, 157(S1), S49–S55. https://pmc.ncbi.nlm.nih.gov/articles/PMC5491894/
Malfliet, A., Ickmans, K., Huysmans, E., Coppieters, I., Willaert, W., Van Bogaert, W., … Nijs, J. (2018). Best evidence rehabilitation for chronic pain part 3: low back pain. Journal of Clinical Medicine, 8(7). https://pmc.ncbi.nlm.nih.gov/articles/PMC5628368/
Wood, L., & Hendrick, P.A. (2019). A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: short-term outcomes of pain and disability. Neurorehabilitation and Neural Repair. https://pubmed.ncbi.nlm.nih.gov/37395152/
Ji, R.R., Nackley, A., Huh, Y., Terrando, N., & Maixner, W. (2018). Neuroinflammation and central sensitization in chronic and widespread pain. Anesthesiology, 129(2), 343–366. https://pmc.ncbi.nlm.nih.gov/articles/PMC10001851/
Hayden, J.A., Ellis, J., Ogilvie, R., Malmivaara, A., & van Tulder, M.W. (2023). Exercise therapy for chronic low back pain: systematic review and network meta-analysis. British Medical Journal, 381. https://pubmed.ncbi.nlm.nih.gov/38035307/
Australian Commission on Safety and Quality in Health Care. (2022). Low Back Pain Clinical Care Standard. https://www.safetyandquality.gov.au/standards/clinical-care-standards/low-back-pain-clinical-care-standard