"Why do I hurt?"

Pain is a complex phenomenon that extends beyond simple tissue damage. While injuries can initiate pain, chronic pain often arises from dysfunctional movement patterns, muscle imbalances, and impaired neuromuscular control. Understanding these underlying causes is crucial for effective treatment and pain resolution.

We often think pain is just a sign that something is physically broken — a torn muscle, a slipped disc, or worn joint cartilage. Those things can play a role, but they’re rarely the full story. Why did these things occur? Sometimes there is a clear cause or trauma, but often — especially when pain develops without a clear injury — it’s a deeper pattern of how the body is functioning, compensating, or failing to adapt due to imbalance.

At New Ground Physical Therapy, we don’t just chase symptoms. We ask: Which systems are stuck? Which muscles are doing too much? Which ones aren’t doing enough? Why? When we restore balance — not just strength or flexibility — the conditions for healing emerge. Below, we’ll explore:

• Dysfunctional movement patterns and muscle inhibition

• Tissue stress and the healing environment

• Pain science beyond tissue damage

• What the research says about what actually influences pain

• How restoring alignment and balanced movement supports true recovery

Dysfunctional Movement Patterns and Muscle Inhibition

Our bodies are designed for efficient, coordinated motion. But when habitual postures, repetitive activities, or asymmetrical breathing patterns take hold, movement becomes inefficient. This often leads to muscle inhibition — where certain muscles underperform — and overcompensation, where others work too hard.

For example, individuals with chronic low back pain often show altered strategies like reduced lumbar flexion and over-reliance on the hips or paraspinals. Over time, these compensations overload tissues and perpetuate pain.

Research Insight: A review of exercise and physical activity in chronic pain (Geneen et al., 2017) found some modest benefit from exercise in reducing pain severity and improving physical function, although results are variable and depend on intervention specifics. PMC+1

Tissue Stress and Healing Environment

Chronic pain can arise when tissues are continually overloaded or misused. Poor alignment and faulty loading cause microtrauma, low-grade inflammation, and reduced ability to heal. Restoring alignment and efficient movement redistributes forces more evenly, reducing stress and creating an internal environment where tissues can actually recover.

Muscle Misuse & Overload: Too Much, Too Often

When one muscle becomes inhibited, another steps in to help — often too much. For example, weak glutes can cause overuse of the tensor fasciae latae or hip flexors. An underactive diaphragm can force neck and chest muscles (like the scalenes and SCM) to overwork.

Muscles that are constantly “on” lose their ability to rest, circulate blood, and clear waste. Like a congested freeway, metabolic byproducts build up, fatigue increases, and tissue resilience decreases.

Meanwhile, underused muscles lose tone and coordination, reducing overall efficiency. The result: poor support, reduced variability, and an increased likelihood of pain and injury.

Research Insight: Mertens et al. (2022) found that exercise therapy aimed at restoring movement quality — rather than simply focusing on strength — improved range of motion, function, and pain in musculoskeletal patients. PMC

Pain Science: Beyond Tissue Damage

Pain isn’t a simple reflection of tissue injury — it’s a protective response shaped by the brain, nervous system, and context.

Central Sensitization

When pain persists, the nervous system can become hypersensitive — a process called central sensitization. The brain amplifies normal signals, interpreting them as threats even when tissue damage is minimal or absent.

The Pain–Repair Mismatch

Healthy tissue remodels when given proper load and rest. But when the body’s mechanics remain faulty, even well-intentioned exercise can continue to stress vulnerable tissues. This mismatch between demand and recovery perpetuates the pain cycle.

Pain ≠ Damage

Pain is better understood as the body’s alarm system — not a damage meter. Two people with identical MRIs can experience vastly different pain levels because the nervous system filters pain through perception, memory, and emotion. Studies exploring pain modeling show how multidimensional it is — not just a linear damage sensor. (E.g. work via arXiv modeling) arXiv

Research Insight: A review by Viseux et al. (2022) observed that chronic pain influences postural control and sensorimotor processing, reinforcing maladaptive movement and maintaining symptoms. Frontiers

What the Research Says About What Actually Influences Pain

Over the past two decades, hundreds of studies have tried to identify which physical factors predict pain — strength, flexibility, alignment, asymmetry, range of motion, and more. The results are remarkably consistent: these variables alone do not reliably explain why people hurt.

What Doesn’t Predict Pain

Strength Systematic reviews show inconsistent relationships between muscle strength and pain levels. For example, knee osteoarthritis and low back pain are not reliably linked to weakness once activity level and fear of movement are controlled for. While strength deficits are commonly observed in individuals with chronic pain, improving strength alone does not always lead to pain reduction. A systematic review by Hayden et al. (2021) emphasized that exercise therapy improves strength and function but its direct impact on pain is variable. Cochrane Library

Flexibility / Range of Motion (ROM) Multiple reviews demonstrate that people with pain often have the same or even greater range of motion (ROM) than those without pain. Static stretching does not consistently reduce chronic pain. Limited ROM is often associated with pain, but increasing range without addressing why certain muscles are tight (e.g., compensation or instability) provides only temporary relief. Mertens et al. (2022) found that exercise therapy improves ROM, function, and pain, highlighting the importance of addressing movement patterns in conjunction with ROM. ScienceDirect.

Posture / Static Alignment Alone Despite decades of focus on “good posture,” studies show minimal association between static alignment and pain. People with forward head posture, scoliosis, or asymmetries may be pain-free, while others with ideal posture may suffer chronic pain. Poor posture can contribute to pain by altering load distribution across joints and muscles. A study by Cramer et al. (2018) found that postural awareness is associated with pain intensity and physical impairments, suggesting that improving postural awareness can aid in pain management. BioMed Central

What Does Predict Pain

• Movement variability: Ability to move efficiently across multiple planes

• Neuromuscular coordination: Timing, inhibition, and sequencing of muscles

• Psychosocial factors: Stress, fear, belief, and perceived threat modulate pain signals

• Physiologic recovery capacity: Sleep, nutrition, autonomic balance, and systemic health

This evidence helps explain why just getting stronger or more flexible doesn’t always lead to lasting pain reduction — even though that’s the traditional approach in many physical therapy settings. If underlying movement patterns and neuromuscular imbalances aren’t addressed, strength training may only reinforce existing dysfunction. Likewise, stretching a tight muscle without resolving why it's tight (often overuse due to poor inhibition elsewhere) may provide only temporary relief.

At New Ground Physical Therapy, we focus on restoring functional balance — helping your body move, breathe, and stabilize efficiently. Once the right muscles are working and others can rest, strength and mobility gains naturally begin to translate to less pain and greater resilience. We use objective tests to guide this process and prioritize strategies that support long-term change.

How Restoring Alignment and Balanced Movement Supports True Recovery

Postural Restoration® (PRI) offers a systematic framework to identify and correct underlying imbalances, restore alignment, and optimize movement patterns. By inhibiting overactive muscles and activating underused ones, PRI helps re-establish balance, efficient breathing mechanics, and stable posture.

When alignment improves, movement becomes more efficient. Forces distribute evenly through the body, mechanical strain reduces, and the body has a better environment to heal.

Research Insight: A systematic review by Cardoso et al. (2025) on Global Postural Re-education (a posture-based method similar in concept to PRI) showed pain reduction and improved function in individuals with chronic neck pain, supporting posture-restoration approaches as valuable tools in pain management. arXiv

In practice, we test for asymmetries, reposition, then integrate those corrections into functional movement—walking, lifting, tasks of daily life. Sometimes, persistent blocks may stem from upstream systems — visual, dental, foot mechanics, or airway. In those cases, we may refer to expert collaborators to remove obstacles to change.

Conclusion

Pain rarely has a single cause. More often, it arises from a body out of balance — inefficient movement, overworked muscles, misalignment, and a nervous system stuck in protection mode. Traditional prescriptions like “get stronger,” “stretch more,” or “fix posture” can help, but without system-level coordination, they often fall short.

By addressing asymmetry, restoring breathing and alignment, and retraining how your body moves, we can create conditions for real recovery and improved quality of life. At New Ground Physical Therapy, we pair advanced movement testing, PRI-based re-education, and collaborative referrals when needed to help you break free from chronic pain. That’s how you transition from temporary relief to a pain resilient body.

If you’re ready to stop chasing symptoms and begin restoring balance, book a one-on-one session or schedule a discovery call today. (503)454-6236 Book Online | New Ground Physical Therapy LLC (janeapp.com)