Chronic Pain Management

When pain is new, the injured tissue and the pain usually track each other reasonably closely. When pain has been around a long time, that relationship gets looser. The sore area might have settled structurally while the pain hasn't. Sleep, stress, fear of a particular movement and months of avoiding it all end up woven into the picture.

None of that means the pain isn't real or isn't physical. It means the useful question changes. It stops being "what's torn?" and becomes "what's driving this now, and what can we change?"

Those are different questions, and they need a different kind of appointment to answer.

We start by investigating, properly. Your first session is longer on questions than you might expect. How long it's been going on. What it stops you doing. What you've already tried and what happened. How you're sleeping. Which movements you've quietly stopped attempting. Then we look at how you move, where your load tolerance currently sits, and where the restriction and the sensitivity are, which often isn't the same place.

We tell you what we find, in plain English. If there's a mechanical driver we can work on, we'll say what it is. If part of the picture is a nervous system that has become very good at producing pain, we'll explain that too, without dressing it up as something it isn't. You should leave the first session understanding your own situation better than when you walked in.

We set a starting point below your flare-up threshold. This is the part that usually differs from what people have tried on their own. Most people with long-term pain have cycled between doing too much on a good day and doing nothing for the three days afterwards. We work out where your current tolerance sits, start below it, and build from there in steps small enough that the pattern doesn't repeat.

We agree on when we'll check. We don't book an indefinite series of sessions. We set a point, usually a few weeks out, where we reassess against something specific and measurable to you. Walking further. Sitting through a shift. Getting through a night. If it's working we keep going; if it isn't, we change the plan instead of repeating it.

The goal isn't a number on a pain scale. It's whatever the pain has taken off you.

Getting through a full workday without needing to lie down afterwards. Sleeping without waking at two in the morning to reposition. Picking up your grandkids. Going back to the gym without negotiating with yourself first. Driving to Wollongong without planning the stops.

We ask what yours is at the start, because it decides everything else: what we load first, how fast we progress it, and how we know whether the program is working. A plan built around a goal you care about is one you're far more likely to keep doing on the weeks we don't see you.

We're also straightforward about scope. The aim is to reduce your pain and get function back, and for many people that adds up to a substantial change in how the day feels. We don't promise to cure long-term pain, and you should be cautious of anyone who does.

Plenty of people arrive with a diagnosis attached, and the program gets built around it. Long-term lower back and leg pain from sciatica or a lumbar disc bulge is one of the most common versions we see.

If you're still at the stage of working out what's going on, or you've been given a label like fibromyalgia and nobody has explained what it means for your day-to-day, our blog covers physiotherapy for chronic pain and fibromyalgia in more depth than a service page should.

Most persistent pain is worth assessing because you've stopped doing things you'd like to do. That's reason enough. But book sooner rather than later if:

• The pain has been there more than three months and hasn't meaningfully changed
• It's spreading, or new areas have started hurting
• You're getting numbness, pins and needles or weakness in an arm or leg
• Your sleep has been affected for weeks
• You've started avoiding activities you used to do without thinking about them
• What you're doing at the moment is holding steady but not improving

Some symptoms need medical review rather than physiotherapy first: unexplained weight loss, fever alongside the pain, changes to bladder or bowel control, or pain that's severe and unrelenting at night. If any of those apply, see your GP, and see them promptly. If they don't, an assessment here is a reasonable next step.