After an basic injury how do you know if you fall into the normal healing time frames or not? How do you know if you are in a abnormal state or normal pain state?
For some individuals, there can be pain without damage or pain from an overly sensitive nervous system. This would be a more unhealthy pain state.
Right after the injury, pain can be constant due to hypersensitivity of your nervous system. But usually the pain is due to sensitized nerves exposed to inflammatory mediators and increased pressure of confined spaces due to localized swelling.
After about day seven, the effects of inflammation decrease and thus there should be less pain, but the tissue is still relatively fragile.
Around day 20 tissue is stronger but also needs exposure to stress to develop load tolerance. This process of stressing tissue can also be uncomfortable as the nervous system adapts. But overall sensitivity is low in the healthy adapted state.
Normally, there should be a significant reduction in pain around 2 to 3 weeks after an injury. Pain that remains elevated beyond that point indicates other factors are causing the pain to remain elevated.
In some cases pain does NOT imply harm, only warnings.
For example, when you stretch a joint, the discomfort will increase as the brain interprets the signals from the mechanoreceptors as you go further into the stretch. If you hold it in a sustained position with only mild discomfort, then it isn’t perceived as threatening. But if you pull more, then certain mechanoreceptor thresholds are reached and then the brain responds with more pain in anticipation of damage.
When you have pain or discomfort, do you cry, move or not move?
Sensation depends on context or circumstances around the pain such as having a pin stuck in the finger and a feather lightly brushing the skin.
The nervous system normally will process these two sensory experiences differently. Input also doesn’t have to be physical, it can be also psychological, as indicated by the blue circle.
This is the more obvious example of interpreting pain. In the event of a fall, there is usually joint, soft tissue damage and maybe even bone if there is a fracture thus triggering a significant pain response.
And if the pain experience cannot get more confusing , sometimes a person can experience pain without having any damage. This is usually a chronic or persistent pain state in which the nervous system has undergone some maladaptive changes in how it perceives a threat – when there is no threat present.
For instance in this picture, a light touch by a feather can trigger a hypersensitive response which we call Allodynia. This a specific category of pain called ‘Neuropathic pain’ and reflects nervous system changes rather than structural changes in the joints or muscles.
Like being hypersensitive to normal light touch, People with a new back injury can develop a persistent or chronic pain state called neuroplastic pain or nociplastic (noseeplastic) pain. In this pain state, normal activities can become overly painful.