Pain can feel worrying, especially when it starts to affect sleep, work, or daily activities. This page explains, in simple terms, four common pain patterns seen in physiotherapy: non specific mechanical pain, nerve root involvement, referred pain from joints (e.g. facet, SIJ, hip), and patterns suggestive of central sensitisation.
Non specific mechanical pain
Non specific mechanical pain is pain that relates to how your joints, muscles, and ligaments are moving and loading, rather than a single clearly damaged structure. It is common in the spine and limbs and often changes with position or activity, such as sitting, bending, or lifting.
Typical features include:
⦁ Pain and stiffness focused in one area (for example, one part of the neck or lower back).
⦁ Pain that gets worse with certain movements or postures and often eases with gentle movement, position changes, or pacing activities.
This type of pain, while uncomfortable, is usually not a sign of serious damage. In many cases, it improves with movement, exercise, and simple activity modifications over time.
Clear nerve root involvement
Nerve root involvement occurs when a nerve as it exits the spine becomes irritated or compressed. A common example is “sciatica”, where a nerve in the lower back sends pain down the leg.
Typical features include:
⦁ Sharp, shooting, burning, or electric like pain that travels along a clear path down an arm or leg.
⦁ Possible numbness, pins and needles, or weakness in the limb, sometimes with reduced reflexes found on examination.
Movements that put extra stretch or pressure on the nerve can increase symptoms. In many cases, nerve pain can improve with time, targeted exercises, and careful activity management, but it should always be checked by a health professional, especially if weakness or bladder/bowel changes are present.
Referred pain
Sometimes pain is felt in a different area to where the problem starts. Joints such as the small spinal facet joints, the sacroiliac joint (SIJ), or the hip can cause “referred pain” into nearby regions because they share nerve pathways.
Examples include:
⦁ Facet joints in the lower back referring a dull ache into the buttock or upper thigh.
⦁ SIJ irritation causing pain around the buttock or back of the pelvis, often aggravated by standing on one leg, walking, or rolling in bed.
⦁ Hip joint problems causing pain in the groin, side of the hip, or even the knee, particularly with weight bearing or twisting.
Referred pain often feels more like a deep, aching discomfort rather than a sharp, shooting sensation, and it does not usually follow a narrow “line” like nerve root pain. Understanding the source joint helps guide which movements and exercises are likely to be helpful.
Patterns suggestive of central sensitisation
Sometimes the nervous system itself becomes extra sensitive and protective. This can happen after an injury, after pain has been present for a long time, or alongside stress, poor sleep, or other health conditions. The brain and spinal cord start to “turn up the volume” on pain signals, even when tissues are healing or when only light touch or mild movement is involved.
Possible signs of central sensitisation include:
⦁ Pain lasting longer than expected after an injury or surgery, or pain without a clear recent injury.
⦁ Pain in several areas of the body, or symptoms that move around or change from day to day.
⦁ Increased sensitivity to touch, pressure, movement, temperature, stress, or lack of sleep, where even light or normal activities can feel very sore.
This does not mean the pain is imaginary or “in your head”. It means the pain system has become over protective, and management often focuses on gradually calming and retraining the nervous system, alongside graded movement, education, sleep, and lifestyle strategies.
When to seek further help
These descriptions are general patterns and not a diagnosis. Pain can blend features from more than one category, and serious causes of pain are less common but important to rule out. If you notice:
⦁ Sudden, severe weakness; changes in bladder or bowel control; or numbness around the groin.
⦁ Unexplained weight loss, fever, night sweats, or a history of cancer with new pain.
⦁ Persistent pain that is not improving or is worrying you.
A physiotherapist can help identify which pattern best fits your symptoms, explain what is going on in your body, and work with you on an appropriate, personalised plan.
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