Author’s Note:
This piece comes from years of clinical practice and conversations with people who felt confused by pain that did not resolve. It is not a dismissal of physical treatment, but an invitation to widen the lens.
There is a quiet frustration I see again and again.
People arrive with pain, fixated on a muscle, a ligament, or a diagnosis they’ve been told is “the cause.” They’ve tried physiotherapy, osteopathy, Pilates, acupuncture, injections, sometimes even surgery. And yet the pain persists.
Often, one crucial element hasn’t truly been considered: the mind, its relationship with the body, and how this shapes the experience of pain.
This is not the old, dismissive “it’s all in your head.”
Quite the opposite.
It is this: what the body cannot say in words, it will often say in sensation.
Pain Is Not Just in the Tissue
Modern pain science is clear on one thing: pain is not a direct measure of damage. It is an output of the nervous system, the brain and body deciding, this is not safe.
Two people can have identical scan findings, the same disc bulge or degeneration, and one is in agony while the other has no pain at all. That difference cannot be explained by tissue alone.
Psychological factors such as depression and anxiety are consistently associated with greater pain intensity and disability in chronic conditions. Behavioural patterns like fear-avoidance, avoiding movement for fear of pain, often lead to de-conditioning, hyper-vigilance, and, over time, more pain.
None of this means the pain is imagined.
It means the nervous system is processing far more than tissue load:
- Past experiences
- Current stress
- Mood and beliefs
- Sense of safety or threat
- Relationships and support
The “score” is kept not just in muscles and joints, but in how the whole system experiences itself.
When the Mind Says “I’m Fine” and the Body Doesn’t
Clinically, I often meet people who can explain their situation very clearly.
They know their MRI report by heart.
They understand which movements hurt.
They may even recognise that stress makes things worse.
And yet, their body behaves as if it is still under threat.
The breath remains shallow. The shoulders stay braced. The jaw is tight. Despite intellectual insight, the nervous system is operating from a different set of assumptions.
This mismatch matters. Explanations may satisfy the mind, but the body organises itself around expectation, context, and safety.
Placebo and nocebo research illustrates this clearly. Expectation alone, believing something will help or harm, can measurably alter pain by activating brain circuits involved in stress, threat, and natural pain relief. The effect is not imagined; it is physiological.
Similarly, studies on social pain show that rejection, loss, and relational rupture activate many of the same neural networks as physical injury.
The nervous system does not sharply distinguish between a broken bone and a broken bond.
It registers threat or loss, and organises a response.
“The Body Weeps the Tears the Eyes Never Shed”
Bessel van der Kolk describes how overwhelming experiences become encoded in posture, breath, muscle tone, and reflexive responses.
Gabor Maté traces how chronic emotional suppression and over-adaptation often accompany physical illness.
Together, their work gives clinical language to something humans have long intuited, and expressed by poet Robert Bly:
“The body weeps the tears the eyes never shed.”
In practice, this can look like:
Back pain flaring after bereavement or divorce
Migraines clustering around conflict or exhaustion
IBS worsening during emotional strain
Pelvic pain emerging after years of ignored boundaries
Pain becomes the language of what has not yet been expressed, processed, or acknowledged.
When the Body Says No
Sometimes the body simply refuses to continue in the way we’ve been living.
An injury that lingers.
Fatigue that rest doesn’t resolve.
A flare-up that returns whenever limits are overridden.
Maté describes this as the body saying no when the mind cannot.
From an osteopathic perspective, this often shows up as patterns rather than single events: shallow breathing, a rigid ribcage, a clenched diaphragm, a nervous system that never fully settles. These are not just mechanical findings, but long-term adaptations that often mirror emotional history.
The mind may insist, I’ve dealt with it.
The body is less easily persuaded.
So What Do You Do With This?
This is not an invitation to blame yourself.
If pain is shaped by more than tissue damage, then healing has more entry points than tissue alone.
Notice context, not just structure.
Ask not only What did I do to my back? but also:
What was happening in my life when this began?
When does it ease or worsen?
What seems to flare it that has nothing to do with movement?
Let the body have a say.
Gentle, attentive movement such as walking, breath work, strength training, martial arts, dance. These can offer the nervous system new experiences of safety. The key is not intensity, but quality of attention. Presence.
Allow discharge.
Tears, trembling, anger, sudden fatigue, when they arise in a safe context, are not regression. They are often completion. Much like an animal that shakes or self-grooms after a stressful event, the body may need to finish what was once interrupted.
Use hands-on work as conversation, not command.
Good manual therapy is not about “putting things back in place.” It is about facilitating regulation, inviting repair rather than imposing correction. But it doesn’t need to be in a clinical setting, comforting, non-sexual human touch can have powerful soothing effects.
And keep both truths in view.
Tissue matters. Load matters. Sleep, strength, and nutrition matter.
And so do grief, boundaries, relationships, and unspoken truths.
The Mind Will Always Lag Behind the Body
The mind is fast. It builds narratives that allow us to keep going.
The body is slower. It holds what has not yet been digested.
When we say the body keeps the score, we are really saying this: the body remembers what the mind finds inconvenient.
If pain persists despite good treatment, it may not mean something is broken. It may mean something has not yet been fully listened to.
When the story in the mind and the truth in the body begin to align, something important shifts.
You move from fighting your body to being in relationship with it.
And in that relationship, change becomes possible — sometimes in the tissue, sometimes in meaning, often in both.
