Understanding Central Sensitization: Why Some Injuries Hurt Longer

Most people expect pain to fade as an injury heals. But for many, the pain lingers - sometimes for months or even years - long after the tissues themselves have recovered. This prolonged pain is often the result of central sensitization, a condition where the nervous system becomes overly reactive, amplifying pain signals and creating a cycle that is difficult to break without the right strategies.

Central sensitization is real, common, and treatable. Understanding how it works is the first step toward lasting relief.

What Is Central Sensitization?

Central sensitization occurs when the brain and spinal cord become hypersensitive to pain. Instead of accurately interpreting signals from the body, the nervous system becomes “stuck” in a heightened state of alertness.

As a result:

• Pain feels stronger than expected
• Pain lasts longer than expected
• Movements that shouldn’t hurt begin to feel painful
• Even light touch or normal activity may cause discomfort

This doesn’t mean the pain is “in your head” - it means the central nervous system has learned to overreact, similar to how a car alarm becomes overly sensitive with repeated triggers.

How Central Sensitization Develops

Several factors can contribute to this heightened pain response:

1. Persistent or Repeated Injury

When pain signals repeatedly travel to the brain, the nervous system can become more efficient at sending them - making the system overly responsive.

2. Reduced Movement

Avoiding movement due to pain leads to stiffness, weakness, and altered body mechanics, all of which reinforce the pain cycle.

3. Stress and Emotional Load

Stress, anxiety, and poor sleep amplify pain sensitivity through the sympathetic (fight-or-flight) system.

4. Inflammation or Illness

Prolonged inflammation can sensitize the nervous system, making it easier for pain pathways to activate.

5. Fear of Reinjury

Fear - often referred to as fear-avoidance - causes muscles to tighten and movement to become guarded, further contributing to pain.

Over time, the nervous system learns to respond to even normal sensations as if they are threats.

Common Signs of Central Sensitization

You may be experiencing central sensitization if you notice:

• Pain that persists beyond normal healing time
• Pain that moves or changes location
• Hypersensitivity to touch or pressure
• Pain that worsens with stress, poor sleep, or lack of movement
• Fatigue or brain fog accompanying pain
• Discomfort with light activities or stretching
• Pain that fluctuates widely without clear triggers

These symptoms can feel frustrating - but they are explainable, predictable, and treatable with the right approach.

How Physical Therapy Helps Calm the Nervous System

Physical therapy is one of the most effective treatments for central sensitization because it focuses on retraining both the body and the brain.

1. Graded Exposure to Movement

Slowly and safely reintroducing movement helps the nervous system learn that activity is safe rather than threatening. This reduces hypersensitivity over time and encourages healthier movement patterns.

2. Aerobic Exercise for Nervous System Regulation

Low-to-moderate intensity cardio:

• Reduces stress hormones
• Releases endorphins
• Improves blood flow
• Enhances pain modulation pathways

This helps retrain the nervous system to reduce overactive pain responses.

3. Motor Control and Movement Retraining

Pain often leads to:

• Muscle guarding
• Poor coordination
• Inefficient movement

PT focuses on restoring smooth, efficient motion, which reduces unnecessary strain and decreases pain signaling.

4. Manual Therapy for Tissue and Nervous System Relief

Hands-on treatment can help:

• Relax muscle tension
• Improve mobility
• Decrease protective guarding

Manual therapy can calm the nervous system, especially when paired with active movement.

5. Education on Pain Science

Understanding why pain persists helps reduce fear and breaks the cycle of anxiety-driven sensitivity. Education empowers patients to move confidently, which is essential for nervous system retraining.

6. Breathing and Stress Reduction Techniques

Diaphragmatic breathing and gentle mobility help shift the body out of fight-or-flight mode and into a calmer parasympathetic state, decreasing sensitivity.

7. Strength Training to Increase Tissue Capacity

As tissues become stronger, the nervous system becomes less reactive. Strength training helps:

• Improve load tolerance
• Reduce flare-ups
• Restore confidence in movement

Strength is one of the most powerful tools against chronic pain.

Central Sensitization Is Treatable

Even though central sensitization makes pain feel unpredictable or overwhelming, improvement is absolutely possible. By retraining the nervous system through movement, education, strength training, and stress reduction, individuals can significantly reduce pain and regain functional, confident movement.

At Core Performance Physical Therapy, we help patients understand their pain, break out of the hypersensitivity cycle, and rebuild strength and mobility with individualized, evidence-based care.

You don’t have to live with long-lasting pain - your nervous system can change, and recovery is within reach.