A Galileo Moment for Chronic Pain: Challenging the Tissue-centric Orthodoxy

In 8th grade, I joined my Junior High Track and Field team. Our training was run like a military boot camp, and stretching exercises were no exception. We were expected to touch our toes, of course, and I still vividly recall the image of my shoes just out of reach, my fingers straining toward them. I remember telling myself that I wasn’t flexible—at least not as flexible as I should be. That gap between my fingers and toes became a persistent reminder of my perceived inflexibility, one that followed me well into adulthood.

Stretching

As an adult, I occasionally attended yoga classes. Some were dreadful, with militant instructors and walls plastered with images of perfectly balanced bodies, subtly shaming inflexible folks like me. But others were gentler, with instructors who inspired me to believe that with a few more months of discipline, I could finally achieve the holy grail: getting my fingers to meet my toes. I imagined that each day I was adding a millimeter of length to my muscles or tendons.

Popping

Many years earlier, when I was in 5th grade, I began visiting chiropractors. They were always eager to answer the endless anatomy questions that I threw at them year after year. By the time I was in college, I had developed a clear image of how my vertebrae were chronically misaligned and why regular chiropractic adjustments were necessary to pop them into place and help me feel better.

Pushing and Pulling

A few years later, I was taught that tight hamstrings—like mine, evidently—could throw my pelvis out of alignment (posterior tilt), leading to further problems in my already misaligned back and neck, which was further exacerbated by my forward head position. I also learned that anterior tilt could cause the same issues. Then came the buzz about fascia: how it could be too short or too long in one area and throw everything else off-balance, like a suspension bridge with uneven cables.

Releasing

Similarly, I learned that adhesions were allegedly a primary cause of pain and that breaking them up would "release" the fascia or muscle tissue. This idea of being “stuck” and then “released” soon found its way into discussions about trauma as well. There was always someone enthusiastically offering a solution—be it pushing, pulling, or releasing muscles, fascia, adhesions, or prescribing a movement practice to do the same.

Insight

For years, I tacitly went along with these ideas, even as it became increasingly difficult to reconcile them all. None of it quite fit together, but I kept trying to make sense of it.

Then one day, I realized that none of it was true. I didn’t have tight hamstrings. My spine wasn’t misaligned. Chiropractors weren’t actually moving vertebrae. Muscular asymmetries weren’t important. My muscles and tendons had never gained even a millimeter in length. Fascia didn’t have far-reaching effects. Adhesions didn’t exist, and neither fascia nor adhesions could be “released.” It was all smoke and mirrors. All of it. And by "all of it," I mean the entire tissue-based or mechanistic model that underpinned these ideas about exercise and pain.

This dominant perspective is rooted in our everyday understanding of the physical world because, from an early age, we learn how objects work, how gravity acts on them, and how they can be deformed or stretched. It’s only natural that we apply this intuitive understanding of objects to our bodies.

But intuition can lead us astray. It feels intuitive to think the sun revolves around the Earth. It feels intuitive to think our vertebrae are "adjusting" when we hear popping sounds. It feels intuitive to think hamstrings are getting longer when we gain more range of motion. It feels intuitive to think chronic pain stems from tissue damage—after all, that’s what we’ve observed in acute pain situations our whole lives. Yet, if neuroscience has taught us anything, it’s that things are rarely as they seem. In fact, neuroscience dismantles these very ideas I went along with for so long.

Anesthesia as a Big Hint

Did you know that when an “inflexible” person like me is placed under general anesthesia, they can easily be brought into a position to touch their toes? This means that my inability to reach my toes was never about tendons, muscle tissue, fascia, or adhesions. It was my nervous system all along, saying, "That’s far enough." While I imagined my muscles or tendons gradually lengthening, what was really happening was my nervous system lowering its guard.

The Posture Mistake

Did you know that research has not found a significant relationship between posture and pain? In fact, encouraging people to adopt “good posture” often increases pain. From a neuroscience standpoint, the tissue-based idea that posture causes pain is completely backward. We know that organisms naturally move and adjust to minimize pain—our nervous system dictates these adjustments, even during sleep. So how can posture both be the cause of and the remedy for pain?

Chronic Pain

Did you know that chronic pain doesn’t operate like acute pain and that it rarely has to do with tissue damage alone, and often not at all?  Instead, chronic pain involves intricate interactions with the endocrine and immune systems, as well as with the individual's beliefs, past experiences, and emotional states. These intricacies are far better understood than they used to be, but professionals and the public at large lag behind, still pursuing strategies rooted in the tissue-based paradigm.

A Galileo Moment

It’s tempting to think that what I learned as a teenager might be far removed from professional knowledge about pain, posture, and manual therapy, but when I listen to how most people—including manual therapists—talk about these subjects, I find that the tissue-based beliefs that I held are still widely accepted. Most people still believe that parts of the body can be stretched, popped, pushed, pulled, or released into a better state. But these intuitive, mechanistic ideas are outdated. And when it comes to chronic pain in particular, it’s essential to replace this tissue-based view with one that puts the nervous, immune, and endocrine systems at the center.

Of course, this new understanding won’t come easily. It can take time to accept that long-held beliefs, no matter how intuitive, are wrong. Galileo didn’t win much love for insisting that the Earth orbits the sun, and it took 200 years before most people accepted this view. Nevertheless, this is a Galileo moment for our culture’s understanding of the nervous and immune systems' roles in pain and other body phenomena, and I’m inviting everyone to switch from their old, intuitive paradigms to a more sophisticated one that is better suited for supporting individuals with chronic pain and providing an accurate explanation for why stretching, popping, pushing, and pulling are helpful.

If you’d like to learn more about a neuroscientific approach to pain and the details of how chronic pain really works, you can register for my Neuroscience of Pain, Posture, and Bodywork class.

Author

Dr. Mark Olson holds an M.A. in Education and a Ph.D. in Neuroscience from the University of Illinois, specializing in Cognitive and Behavioral Neuropsychology and Neuroanatomy. His research focused on memory, attention, eye movements, and aesthetic preferences. Dr. Olson is also a NARM¨ practitioner, aquatic therapist, and published author on chronic pain and trauma-informed care.  He offers a variety of courses at Dr-Olson.com that provide neuroscientific insights into the human experience and relational skill training for professionals and curious laypersons.