Understanding Tissue Tolerance: Getting back to pain free activity

Pain is a complex phenomenon, often baffling in its persistence and variability. Whether it’s a nagging ache in the back or a sharp twinge in the knee, pain can significantly impact our daily lives and limit our ability to do things. Sometimes it can stop us from doing something completely, and other times it can be just an annoying niggle that is always there with certain activities.

So why is it that after the initial painful episode has passed we often find ourselves still unable to perform tasks completely pain free that previously were routine and easy? The answer lies (in part) in understanding tissue tolerance.

Tissue tolerance refers to the capacity of our tissues (muscles, joints, ligaments, tendons, fascia) and other body structures to withstand stress and strain without succumbing to injury or pain. Think of it as the threshold at which your body says ‘That’s enough now thanks’. This is the point where you body believes that if you keep doing the activity there could be DANGER.

Side note about pain…

It’s important to remember that pain is your brain’s interpretation of 'danger’ messages. The tissues and structures of your body send danger signals to the brain, the brain weights them up and considers them within context of your current situation and may or may not create feelings of ‘pain’. This is how we often get sensations that are ‘pain’ but not pain. The situation when you might say ‘I can feel it, but it’s not painful’, or the classic ‘yeh that’s my pain, but it’s not bad’.

Pain Science

So to understand why we may struggle to perform activities after a pain episode, we need to relive into the fascinating world of pain science. The amazing researchers Lorimer Moseley and David Butler have spent decades researching pain and have helped us understand the intricate interplay between brain and body, highlighting the role of neuroplasticity and cognitive processes in shaping our experience of pain.

One of the most important insights from their work is that pain is not solely determined by tissue damage. Instead, it is a multifaceted phenomenon, influenced by factors such as emotions, beliefs, past experiences and the brain’s interpretation of danger. This means that even after the initial injury to the tissues has healed, the brain may still perceive certain movements or activities as threatening or dangerous and hence trigger a protective response in the form of pain.

Once you can begin to understand this, you can begin to wrap your head around the sometimes baffling behaviour of pain.

So how do we overcome this and regain the ability to move freely without pain or ‘niggles’?

The answer lies in gradually rebuilding tissue tolerance. Just as you wouldn’t expect to be able to lift heavy weights without first building strength through progressive training, you can’t expect your body’s tissues to suddenly bounce back to being fit and strong. Your body’s danger system is also on high alert and your brain is ready to protect at the first sign of danger. Things like doing too much and doing activities that aggravate and stress the tissues can push you into pain and a ‘flare up’.

A gradual approach to movement and exercise systematically exposes your body’s tissues to progressively increasing levels of stress, while also respecting its limits and allowing adequate time to rest and recover. Rebuilding tissue tolerance must be done gradually to allow the tissues to adapt, repair and feel more comfortable in coping with that amount of stress, thus making them less likely to send danger signals to your brain. We want to avoid sending these danger signals to the brain but we also want to challenge the tissues so that we trigger them to adapt and grow (thank you bioplasticity!).

Is it just about doing more exercise?

Your brain needs the exercise as much as your muscles

No, rebuilding tissue tolerance isn’t just about exercise; it’s about cultivating the right mindset and adopting habits that support your recovery. Remember, this isn’t just about your muscles and joints, this is about your brain.

Mindfulness, meditation, deep breathing and visualisation techniques all can help to calm the nervous system and reduce pain signals. Paying attention to factors like your nutrition, sleep and stress management can also play a crucial role in optimising tissue health and your nervous system state.

Take home message

In essence, rebuilding tissue tolerance is about treating pain not as an enemy to be fought against or defeated, but as a signal from your body that something needs attention and care. By understanding the underlying mechanisms at play that are driving the pain signals and adopting a holistic approach that encompasses both the physical and psychological factors that are at the root of pain, you can move towards a place of pain-free, niggle-free, ‘it feels completely fine’ movement.

One last important side note

Remember that progress may be gradual, and setbacks may occur along the way. Changing your brain requires patience, perseverance and a comprehensive approach.

Pantene and Rachel Hunter said it best: It won’t happen overnight, but it will happen.