Why low activity levels can influence pain perception – even without injury

Pain is often associated with tissue damage, wear, or something being structurally “wrong.” However, modern pain science shows that activity level itself can influence how pain is experienced—even in individuals without identifiable injury or disease.

Pain is more than signals from tissues

Pain is a complex interaction between:

• Sensory input from the body

• Processing within the central nervous system

• Prior experiences, stress, and expectations

This means pain does not always reflect structural damage. The brain interprets and prioritizes signals based on context, load, and perceived safety.

What happens when activity levels become low?

Prolonged low activity levels lead to several physiological and neurological changes:

• Reduced tolerance to mechanical loading

• Lower pain thresholds within the central nervous system

• Altered blood flow and metabolic responses

• Reduced efficiency of endogenous pain inhibition

Over time, this can make normal daily loads feel disproportionately painful.

Central sensitization and physical inactivity

Research indicates that physical inactivity can contribute to increased central sensitization, where the nervous system becomes more reactive to stimuli that were previously non-threatening.

This pattern is commonly observed in individuals with:

• Persistent musculoskeletal pain

• Unclear or non-specific pain mechanisms

• Fluctuating symptoms without clear structural findings

Importantly, this does not mean the pain is “psychological,” but rather that nervous system regulation has changed.

Movement as a regulatory mechanism

Regular physical activity contributes to:

• Enhanced pain modulation capacity

• Improved regulation of stress hormones

• Normalization of sensory processing

• Increased confidence and safety in movement

Even low-intensity activities, such as walking, have demonstrated long-term benefits for pain perception.

Why rest alone is rarely the solution

Short-term rest may be appropriate during acute pain episodes. Problems arise when rest becomes a long-term strategy.

Sustained activity reduction may:

• Increase pain focus

• Reduce self-efficacy

• Heighten fear of movement

• Create a negative cycle of inactivity and pain

Practical implications for daily life

For many individuals, the goal is not “more exercise,” but rather:

• Slightly more daily movement

• Gradual increases in tolerance

• Emphasis on safety rather than performance

• Consistency rather than intensity

This approach is often more effective than brief periods of high motivation followed by

prolonged inactivity.

Summary

Low activity levels can influence pain perception through changes in nervous system regulation, even in the absence of structural injury. Regular movement acts as a biological regulator of pain and plays a key role in both prevention and management of persistent pain.

Sources

• Nijs, J., et al. (2011). Central sensitisation: A biopsychosocial explanation for chronic widespread pain in patients with musculoskeletal pain. Manual Therapy, 16(5), 424–432. https://doi.org/10.1016/j.math.2011.04.006

• Sluka, K. A., & Clauw, D. J. (2016). Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience, 338, 114–129. https://doi.org/10.1016/j.neuroscience.2016.06.006

• Geneen, L. J., et al. (2017). Physical activity and exercise for chronic pain in adults. Cochrane Database of Systematic Reviews, 4, CD011279. https://doi.org/10.1002/14651858.CD011279.pub3