Managing Chronic Pain with Physical Therapy
Chronic pain can be one of the most frustrating medical conditions.
Many people are told their imaging is normal, that nothing is structurally wrong, or that they just need to “push through it.”
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But persistent pain is real — and it often requires a different approach than standard orthopedic care.
Our clinic in Waco specializes in treating complex pain conditions using a nervous-system-informed physical therapy approach.
What is Chronic Pain?
Chronic pain is defined as pain lasting longer than 3 months.
Chronic pain does not mean the body is broken - it is an indicator that the nervous system has become more sensitive, and the pain itself is more of a defensive mechanism, or form of protection, rather than an injury
Traditional PT is designed to treat acute injury
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Stretching and strength training to rebuild muscle tissue after injury
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Use of modalities to reduce inflammation, possibly accompanied by pain medication
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Healing anticipated within a few weeks to months
Chronic pain requires a different approach
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Nervous system sensitivity requires a neurosomatic approach
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​Neurosomatic refers to the connection between mind and body. Understanding your mind and how you interpret pain is key to managing and improving chronic pain conditions
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Altered movement patterns from chronic pain can take time to "unlearn" in the process of learning to relax and trust your body again
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Strength training can exacerbate symptoms so load tolerance increase must come after stabilizing joints
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Protective muscle guarding takes time to gradually reduce sensitivity
The Therapy323 Approach:
1. Calm the nervous system using​ vagus nerve stimulation and gentle manual therapy
2. Restore joint control and stability with neuromuscular retraining and proprioception work
3. Build load tolerance through low-intensity, progressive strengthening
How does chronic pain relate to other conditions?
Many people who experience chronic pain also notice symptoms like joint instability, fatigue, dizziness, or rapid heart rate. In some cases, these symptoms are connected through conditions involving the body’s connective tissue and nervous system.
Understanding how these conditions relate can help explain why symptoms can be complex or difficult to treat.
Hypermobility refers to joints that move beyond the typical range of motion. This usually occurs because the connective tissue that stabilizes joints—such as ligaments—is more elastic than average.
Some people with hypermobility have no symptoms, but others may experience:
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Joint instability
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Frequent sprains or subluxations
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Muscle fatigue from stabilizing joints
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Chronic pain
What is Hypermobility?
Hypermobility can occur as Hypermobility Spectrum Disorder (HSD), or as a symptom of other conditions such as Ehlers-Danlos Syndrome (EDS).
Ehlers-Danlos Syndrome (EDS) is a group of genetic conditions that affect connective tissues
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The most common type, hypermobile EDS (hEDS), is characterized by:
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Joint hypermobility or instability
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Chronic joint or muscle pain
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Soft or stretchy connective tissue
Because connective tissue is found throughout the body, EDS can affect multiple systems—not just the joints or muscles.
Frequently Asked Questions
What is considered chronic pain?
Chronic pain is typically defined as pain that lasts longer than three months or continues beyond the expected healing time for an injury. Unlike acute pain, chronic pain often involves changes in how the nervous system processes signals. This means pain can persist even after tissues have healed.
Can chronic pain exist even if imaging is normal?
Yes. Many people with chronic pain have normal MRI or X-ray results. Pain is influenced not only by structural issues but also by the nervous system, movement patterns, and how sensitive the body has become to certain input.
Can physical therapy help with chronic pain?
Yes, when the treatment approach is adapted for chronic pain. Instead of focusing only on specific injuries, neurosensitive physical therapy addresses nervous system sensitivity, movement confidence, joint stability, and gradual load tolerance increase.
Why does strengthening make chronic pain worse?
Strengthening exercises can flare symptoms when they are too intense, progressed too quickly, or when the nervous system is highly sensitive. A well-designed program stabilizes first, then gradually builds load tolerance so the body can adapt without triggering flare-ups.
What causes chronic pain if there isn’t a clear injury?
Chronic pain can develop from a combination of factors including previous injuries, nervous system sensitization, joint and connective tissue instability, stress, and movement patterns that overload certain tissues. Often there is not a single cause but a interrelated complications.
Do you treat hypermobility-related chronic pain?
Yes. Joint hypermobility can contribute to chronic pain because muscles must work harder to stabilize joints. Treatment often focuses on improving joint control, building strength gradually, and helping the nervous system feel more stable during movement.
How long does it take to improve chronic pain?
Recovery timelines vary depending on the individual, their condition, and how long symptoms have been present. Many people begin noticing improvements within several weeks of consistent treatment, but long-standing pain may require a longer process of gradual capacity building. Some medical conditions require more long-term maintenance treatment as they cannot reach full healing.
What treatments are used for chronic pain in physical therapy?
Our treatment approach includes guided therapeutic exercise, neurosensitive manual therapy, dry needling, soft tissue mobilization techniques, and strategies that help regulate the nervous system (vagus nerve stimulation). The goal is to reduce sensitivity while improving stability and movement confidence.
Is it safe to exercise with chronic pain?
Yes, movement is an important part of physical recovery. The key is choosing the right exercises and progressing them gradually so the body adapts without triggering flare-ups.
Do I need a referral for chronic pain physical therapy?
In Texas, patients can begin physical therapy without a physician referral due to direct access laws. After your initial visit, we will contact your primary care provider to receive a referral for continued treatment.
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When should I see a physical therapist for chronic pain?
If pain has lasted several months, keeps returning, or interferes with daily activities, it may be helpful to consult a physical therapist. Early evaluation can help identify patterns contributing to persistent pain and guide a safe plan for recovery.