Pain, Pain, Go Away!

Updated: Sep 14, 2021

This is a big topic in healthcare, and also something that we throw boat loads of dollars at trying to get rid of. Just to give some perspective, the United States spent an estimated $560 to $635 billion in this category, which includes direct healthcare costs, missed work days, lower wages and earning (source: So, what can we do to make things easier on ourselves and reduce the burden? I hope to shed some light on ways to look at pain and how to manage it.

I always like to start with the foundation of things before I go into how to treat. Pain perception (nociception) occurs through three pathways including mechanical, chemical, and thermal. Your nerves extend from your brain and spinal cord to the periphery where they pick up signals and send them back to be processed. Typically, if there is tissue injury or damage, you will go through stages of healing. For example, when you get a cut you will experience fast blood clotting, swelling, and inflammation & pain initially. Following after is the part where your cells begin to replicate, fill, and ultimately mature. This example is helpful to understand mostly chemical pain perception, but also can include mechanical such as when being cut. Thermal nociception is not much different.

Depending on the type of pain and how recently you've experienced it, you would manage it differently. For reference, you can think of it in terms of time frames such as acute (0-6 days), subacute (7-21 days), and chronic pain (21+ days). You can also frame it conceptually in terms of healing with the inflammation (hours to days), repair (days to weeks), and remodeling (weeks to months) stages. If you notice, these have very similar time frames so it's reasonable to use them interchangeably.

Now, when the injury is recent, such as during the acute/inflammation stage, you wouldn't want to try an exercise that would significantly stress that tissue. For example, after a recent low back injury, you might want to practice some mid-range movements and isometrics to keep your muscles and joints active. Then once you're feeling better in the subacute/repair stage, you could consider progressive loading back toward your prior performance. It's very important to realize that the term progressive is not specific in terms of timeline, and is entirely context dependent. The more severe your injury, the more time you give yourself to return back to your previous performance.

Once you're back into the swing of things with the chronic/remodeling stage, that is when you're trying to load more in line with where you were prior to the injury. This means working on mobility, conditioning, strength, power, etc at higher intensities to challenge the tissues and forcing them to adapt to the strain. Making sure you're allowing proper time to warm-up and cooldown will help tremendously, in addition to proper sleep, nutrition, and recovery strategies.

For quick reference, you can use the following table:

Differentiate between time points of healing and how to treat it.
Stage of Healing

Thanks for taking the time to read this far. If you have questions, as always, please leave your questions in the comments or reach out to me directly.


In good health,

Dr. James Babana PT, DPT, LMT

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