Let's Talk Health

Is pain all in your head? (& why movement helps) | with Tim Trevail

• Torrens University Australia • Season 1 • Episode 5

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Pain is something everyone feels, but few truly understand. In this episode, physiotherapist and educator Tim Trevail helps us unpack why pain is such a complex experience. We’ll explore why two people with the same injury might feel pain differently, how the brain shapes what we sense, and why education can sometimes be the best medicine. Tim also discusses how elite athletes reframe pain, and the myths that keep patients - and practitioners - from fully
understanding it.

In this episode, we cover:

  • Why pain isn’t always a sign of damage
  • How the brain and nervous system influence pain perception
  • The truth about posture and why “motion is lotion”
  • The impact of sedentary lifestyles and screen time on pain
  • Simple ways to meet your weekly movement goals
  • How strength training supports healthy ageing (& reduces injury risk)
  • The connection between stress, anxiety & persistent pain
  • Why understanding pain is the first step toward living pain-free

Curious about how the body heals and moves? Explore your path in Health at Torrens University Australia.

Interested in helping others manage pain and improve movement? Discover the Myotherapy course at Think Education.

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Natalie Cook:

Welcome to Let's Talk Health. I'm your host, Natalie Cook, Director of Innovation, Industry and Employability in Health and Education at Torrens University Australia. On this podcast, you'll hear from experts who'll share their knowledge to help you make more informed choices about your health. Today we ask the question, Is pain all in your head? And I'm not just talking about headaches. Understanding what pain is, what's happening in our brains as much as in our bodies, and what impacts how we experience it are all topics we'll cover in today's podcast. Joining me to delve into this topic is Tim Trevail, Program Director of Physical Health Programs at Torrens University and Think Education, and a practicing sports and exercise injury specialist. Tim, thanks for joining me.

Tim Trevail:

Thanks very much, Nat. Pleasure to be with you today and looking forward to getting into the conversation.

Natalie Cook:

Won't be too painful, I think.

Tim Trevail:

Hopefully not. Let's see, let's see how we go.

Natalie Cook:

Pain. It's a word we use in ways like you're being painful and you're a pain in the neck. We've got a concept of it. I don't know, do we even know what it is? Like where's pain?

Tim Trevail:

Great question to start us off. And there's an old adage of I went to my doctor and told him I'm in pain, and he came back and said, Well, that's great. It means you're a human. Everyone experiences pain. And that talks to the fact that pain is universal. Everyone gets pain at some point in their life, but it's also deeply individual. Everyone will experience pain differently. And I think what's so interesting about pain is that we used to just have a concept that is really about biology and it's about how things might hurt as a direct result of an injury as such. But now we understand that it is deeply emotional. We can't have pain without it going through the emotional centers of the brain. And it's also very much driven by context and environment around us. So there's a lot of kind of really interesting ways we can approach pain. If we take it back from a just a definitional perspective, it would be an unpleasant sensory and emotional experience that's associated with actual or perceived tissue damage. That's a breakdown by the International Association of the Study of Pain. They tried to put that in simple enough language that makes sense across the board, but it also factors in that kind of biology and then the other ways that we experience pain that's more than just biology.

Natalie Cook:

That's interesting. And so there's plenty of research on it. And as you said, I guess it sounds like it was historically like what's damaged versus a much broader understanding. Is there anything about the world of us today in 2025 versus a hundred, a thousand years ago? Does modern life change the types of pain we have?

Tim Trevail:

Or look, it's interesting. People will argue, you'll read on social media, that the pain's getting worse and that our Western culture and Western life is damaging us in so many ways. And with pain, it's difficult to know historically, we don't have good records of how much pain humans were in, you know, hundreds of years ago. But I think what we can say is that sedentary lifestyles are certainly associated with greater levels of persistent pain. Across the Western world, about 20% of the Western world is suffering with some sort of persistent pain condition, much of that being musculoskeletal. And I think the current lifestyles that are associated with longer periods of time in stagnant positions is associated with greater pain. So there's probably an influence of screens where we're sat in sort of similar postures. Now, posture isn't inherently, there's no inherent bad or good posture, but there are stagnant positions that we can get stuck in. And for the musculoskeletal system and nerves and muscles and joints, motion is lotion and rest is rust. Meaning that if we were sat in similar positions, like we might be sat here for however long we sat, without movement and without regular movement or incidental activity to break up the day, then I think that there's some sort of greater chances or risk of us being in pain. I think through COVID, we probably a lot of us saw some of that. Like you're going into the office, you used to have just you go to your office, you do some emails, you work there, you'd you have that incidental walking and movement. Just that little bit of motion in between each bit. And then we go through COVID or working from home, and we're suddenly sat for eight hours and you realize you've only actually got up once for a loop-breaking cup of tea. And what impact is that having on our sort of musculoskeletal system is something to be definitely questioned and talked through.

Natalie Cook:

I think a lot of people would relate to that, just that difference because when you had a meeting, mostly it used to be with someone else, and you'd go to a meeting room, so you had to walk there, and you had to walk to get a coffee, you'd come back. Whereas now all of our meetings were sitting in a screen. And you see some of those images of people's posture at screens.

Tim Trevail:

I used to walk into an office and I'd say, right, you look around the room and I'll tell you who's in pain. It's all those people with the perfect posture because all sat upright, they're really conscious about their posture. If you look at the data, posture is really poorly correlated with pain. Lots of people think it is, and the sort of public messaging is that it's correlated with pain. But you can have every different variety of posture, and there's not one that's actually associated with pain. You could sit perfectly, but if you sit in perfect posture, shoulders back, head tall, chin tucked, you're going to be in just as much pain if you maintain that static position as if you're going to be sat down here. It's the not moving. It's not moving. Our muscles and our joints, they respond really well to contraction and relaxation and load of like regular load and regular movement. And when we take that away, because of sedentary lifestyles or whatever other influence is causing you to be static and to lose that movement, that's what's linked to pain rather than any specific posture.

Natalie Cook:

I spoke recently about standing desks, and someone made a comment that said they're not inherently better because standing all day is no better than sitting in some ways.

Tim Trevail:

And going back to that sort of meetings. You used to go into a meeting and you'd be in a boardroom and there'd be 10 different people and you'd look all over the place and you just get natural little bits of motion. But now our 10 people are within a little box on the screen on Zoom, and so we're just sort of locked into that. So those habits, if we don't understand that those are they're problematic and building its dental incremental activity throughout the day, that's when I think we're gonna be in chance of occupational related increases in pain.

Natalie Cook:

And look, you think about people going to uni. In the past, you'd go to uni and like one lecture down at one end of the campus, and there's a lot of walking, whereas again, if you're studying online, it's super convenient, but yeah, you're staring at that same screen.

Tim Trevail:

Yes, the online world brings lots of benefits, but the sedentary nature of it, if we're not counteracting that and meeting our physical activity guidelines from the World Health Organization and getting regular movement throughout the week, then we get in trouble.

Natalie Cook:

Sidebar, how much movement should we be doing in a week?

Tim Trevail:

Good question. Most people go to the WHO guidelines for those, and that's 150 minutes of moderate exercise per week or 75 minutes of vigorous exercise per week.

Natalie Cook:

Okay, so 150, like five days a week of 30 minutes.

Tim Trevail:

Exactly. So it could be 30-minute walk, or we can reduce that down to 15 minutes if it's raising your heart rate up, so it's more like jogging rather than walking. The good thing about physical activity is that there's no one best physical activity. Whatever works for you, whether that's yoga, whether that's dancing, for me that's martial arts and jujitsu, for other people that's tiddlywinks, whatever it is that gets you moving as long as you're moving and getting your heart rate up a couple of times a week. And on top of that, the recent updates to the guidelines a couple of years ago came out to show that we should be adding some strength training to that. So twice a week of resistance training, making sure that we are moving our muscles with enough resistance that it becomes quite difficult to do at the end of those sets. So we get a close to failure and building and maintaining muscle mass, that has huge benefits for many parts of the body as well. Just the importance of strength training. We know that from the age of 30, we start to lose muscle mass. It's a real problem. Counteracting that through regular resistance training is huge, particularly for women, risk of fractures. We know that if you're over the age of 65 and you fracture your hip, your chance of dying within five years go dramatically up. So we can reduce our fool's risk through regular strength training and physical activity. So my research interest is particularly in how we look at people's overall volume of physical activity and how that influences people's pain. So I've done some work around step count, for example, and we did a large meta-analysis on how many steps are people taking per day for people who have got persistent musculoskeletal conditions. It's not as high as we once thought. Certainly diminishing returns. Everyone should probably be aiming for around six or seven thousand. And there is some large studies out there. Look, over six or seven thousand, you're going to get improvements up to about 12,000, and it's diminishing returns up to that. So for general cardiovascular health, aim for sort of minimum of six or seven. My research looked particularly at people who have got musculoskeletal pains, then the levels are lower. But it does show that people are more physically active, have an improved quality of life, have less disability and reduce pain if they just move a little bit more, walk a little bit more. So we're looking into some other some other areas, trying to understand people's relationship with physical activity because when you're in pain and you've got persistent pain for a while, physical activity can be really scary to get moving. People aren't really don't have a lot of confidence in how they should move. They're often worried that there's some magic type of way they should be moving, and that's usually not the case. It's just about general kind of physical activity and movement. So much of the benefits in the sort of pain space is probably related to general physical activity qualities. If you think of anything that's good for your heart health, like whether that's just good general nutrition, general exercise, strength, all of those things are good for persistent pain too. We've moved away from routinely scanning everyone with lower back pain. So it's actually not recommended that if you've got a lower back pain, unless you've got some specific symptoms which are really suggesting a large-style disc bulge or something serious underlying pathology, that we don't really move away from a scan. And the reason is if I scanned every 40-year-old female and you would have a percentage, 20, 30%, that would have disc bulges. That's not very well correlated with who's actually got pain. So essentially we can create fear and we can create nocebic language, meaning that these are languages we're associating with danger or associating with fear. And that can actually cause people to stop being physically active. Once we stop being physically active, we go into a bit of a cascade of spiral. So we move towards those sedentary lifestyles, we're losing conditioning and resilience of the musculoskeletal system, and that lack of activity can further sort of send us a little bit on a downward spiral. So it's our job as pain specialists to help people understand and almost put a stop to that and support people to be physically active, to build up that resilience again and to move out of that kind of worry and fear around pain and move into better quality of life.

Natalie Cook:

I know um a friend of mine who's a physio but work works in NES and she said if you opened up half the population's knees, you'd find some damage in there. Button movement is exactly what you need to do to keep it functional. Otherwise, if you don't, yeah. What do you say? Something rust?

Tim Trevail:

Rust is rust.

Natalie Cook:

You were saying with children, you know, that do they experience pain differently? And I'm I guess what I'm thinking about is like when kids might go, they use very generic terms, you know, I feel sick, or is that because the pain is less localized or they just don't have the language to describe it?

Tim Trevail:

Like I think it's probably a bit of both. There's definitely learning around their own bodies, the learning around what is safe, what do I actually need to worry about. It's something that is an important, I think, growing area of pain management to sort of almost educate kids about. And I think we do a lot of that through physical activity and through play to understanding what is sort of an appropriate amount of pain, where do I need to actually pull back from things and where do we just need to sort of push through and keep moving? Because I think if we don't learn that appropriately in childhood, that's when we start to get more persistent pain populations in adolescence and adulthood.

Natalie Cook:

Well, you mentioned before the biopsychosocial model of pain. Has that changed the way we train health professionals and the way they treat pain?

Tim Trevail:

Like rather than just looking for the bit that's broken or damaged, it might not even so if you um I'll I think I'll just try and put that into a bit of context of what people might experience themselves commonly. If you say you've got a shoulder pain, you could go to a chiropractor will tell you one thing and treat you one way, you go to an osteopath that would treat you one way and say you're someone completely different. Am I a therapist, a physio, a doctor? Yeah, all of those people could come out with actually, you could come out feeling better. So I think what's really interesting about that is that you've got five different worldviews, you've got five different ways that we you could treat that. And one is not necessarily objectively better than all of the others. We we sort of try to have clinical guidelines and things that help with that. But what's really interesting is what are the shared parts of all of those different types of treatments, which is actually the effective part of that treatment. You'll go in and you'll get a certain amount of yeah, you might get some massage, you might get some hands-on work, you'll get taught, hopefully, about in education with some pain neuroscience and background of where you might be. All of the things might come together in different ways. But I think what's exciting with this biopsychosocial model is that there's lots of different ways to treat pain because so much influences pain all around us. There's the the the cultural impacts of pain, the context around it, your social networks, all of that sort of that sort of social component of pain is a growing interest area, I think, across the board, moving away from just the biological. Biology is still important. If you've got inflammation in your knee, it's gonna hurt because the inflammation and the biology, biology's still important. It will always be important, but the psychological, the way that people sort of think and are framing the way that they're in pain is probably the more important way to get out of it. Biology, we don't really change biology that well. We might proke things and prod things and ice things or heat things. Cool. But biology kind of is biology. Body's amazing and it will work through the process of healing. But I think where the blocks are for people is how you're framing that. Do you have the confidence to be able to maintain physical activity around that healing and live life as normally as possible? Because as soon as those things break down, then the biology is in a little bit of trouble because you're going to start to lose those physical qualities around that knee or whatever your issue is.

Natalie Cook:

In learning to be a health practitioner, you can't just learn how to prod and poke, I guess, is what you're saying. Exactly.

Tim Trevail:

And you can learn in lots of different options to work with people that work with your skill set. And it's no longer we have to tell a health professional you have to work like this. These are the ways that you can work with people, and these are the ways it will help. You find that niche, you find that specialist area that resonates with you as a person and the areas that you're interested in, and the way that you can help people. It's more interesting to me because it's less rigid. It's more person-centered because you can adapt these things to the person that you're working with rather than if someone comes in with a knee pain, this is how they should be treated. I think we're teaching the new generation of health professionals to think critically, to understand the evidence base. Obviously, the evidence-based framework is there's a whole evidence base that they should be aware of. These are my clinician's experience. We used to think of it as almost like a three-legged stool, but it's really a funnel. We should think about the totality of evidence first, and then we get the students to think about how they can apply that evidence base. And then of those options that are remaining, the patient has that choice of what that this is the way we could treat it. We could do this, X, Y, or Z. These are the reasons why each of those will work. And then the patient can decide what of those they want to take out there. So it's patient-centered and patient-informed, and it's patient-driven in terms of that information. But our students are giving the patient the framework they need to make that informed decision. And I think that's where we're going.

Natalie Cook:

A whole lot less hierarchical than perhaps a really traditional medical one.

Tim Trevail:

Yeah, I'm in a I'm in a white coat. I'm going to tell you exactly what you need and you're going to go ahead and do it. You're the expert in your own body, not a doctor, just because they they're an expert in medicine in general, but you're an expert in your own body, and you've got to that's an important part of that evidence-based framework to bring that into conversation. And that's what I see as my main role is to help people get back to be living physically active lives and doing things that they want to do. And if it means that explaining pain or understanding pain for people because poor understanding is stopping them from doing those things that they want to do, then that's my job to sort of help them understand that and then get back onto that path of you know, quality, good quality of life and doing the things they want to do.

Natalie Cook:

In those sort of more holistic assessments of people, patients, how did anxiety, stress, depression relate to people's perception of pain?

Tim Trevail:

It's an interesting one. When we understand that pain is about protection, and we know that the brain and the central nervous system can modulate pain, meaning that they can dial that down. So if it's like a radio, you've got a volume knob on that radio, you can either dial those things down by suppressing some of those signals coming up, or it can dial them up and amplify those signals. When you've got stress and anxiety, the brain is focused on simple must-do tasks right now, and it's not as good at dialing down some of those pains, those feedback signals that are coming up to the brain. Therefore, pain can become a large part of people's lives. Managing stress and managing that anxiety is an important part of pain management as a whole to make sure people are not unduly stressed about the conditions. Start to what we call catastrophizes, where they worry about the risk of doing certain activities or moving in a certain way. We particularly see that in lower back pain populations where people become really rigid over time because there's a perception of damage, for example, or they think they might have a disc bolt, or they think they might have some other damage. But we need to move, or we have been moving away from core stability as a focus of back pain. You would have seen over the last 20 years ago, there was a whole way of looking at, right, I've got a bad back, I need to be more stable, right? And so we had a whole Pilates, a whole industry of how do we get us back as stable as possible because it must be extra movement, which is causing the problem. And that's probably made back pain worse. So over the last 20, 30 years of that push, back pain's got worse globally. Lots of influences to that. But part of the reason is because stability isn't the only answer. It's not the one size fits all for everyone. For lots of people, they're actually an overprotection of the nervous system. So we know the nervous system is a top-down driver. If we've had an injury, a short-term injury, we'll produce pain, but we'll also produce a top-down guarding mechanism where we'll cause local spasm in the area. Everyone's had a neck or a shoulder issue where it's kind of gone into spasm and you can't move for a few days. And that's a protective mechanism. And sometimes when if that doesn't go away, we don't allow that free movement. Movement should be free and thoughtless. If you take your wrist fully and you try and really tight as you can and then try and move it, doesn't that feel horrible? Now, why would you want to do that for your lower back? You want free, thoughtless movement. Your muscles would switch on as much as they need to. They don't need that extra tension. And the extra tension can put pressure on pain-sensitive nerve endings in the area and make things worse. So just as many people need to just relax and move freely and not worry about the symptoms, there'll be a subgroup that need more of that kind of tightening up, a little bit more rigidity. So it's about moving away from one size fits all, assessing the patient in front of you, and then coming up with a treatment plan that makes sense to them. Pain is a whole lot easier when you don't have a low, lots of other comorbidities. Pain becomes very complicated when we've got obesity, smoking, sedentary lifestyles. And they all of those things really make moving away from chronic pain more difficult for various different reasons. When you've got athletic populations like combat sports athletes, they are really just they've got a passion for the sport and they want to get back to doing what they've done. So, yes, for those ones, we can focus more on the biology, talk about ligament healing times, talk about how we're gonna focus on that. And then it they have a very kind of linear program, right? We're gonna start with some sort of protection of the area, then we're gonna go into strength. It's quite a kind of step-by-step process that people can see and you can map that out in the rehabilitation space. And they're generally quite fit and healthy around that. We're supposed where that differs from persistent pain populations is that there's often lots of things going around, like challenges for that person. You know, we know the pain is worse with people who are on work cover, for example. There's lots of problems around that, and there's a whole social, occupational construct and challenge around around that. Uh, and that's I suppose where you need to dig into that whole person more than you might just need to with combat sports athletes. Any last myth you'd like to bust or look, if I had to bust one myth, it would probably be that pain equals damage. And if we have a uh a mindset that pain always equals damage, we live in a protective state where I'm gonna move into deconditioning rather than take the path. So there's a fork in the road when you get a pain. We can understand, and I want more people to know that pain isn't always about damage. There may be some initial damage, but pain is so much about protection that we want to be able to move onto the pathway of maintaining our physical activity and moving into more movement, more activities, maintaining all the things that we enjoy doing in life and not perceiving pain as damage. And if health professionals could get on board with that and stop telling people they're damaged or broken because there's a whole industry around that, the world will be better off.

Natalie Cook:

I love it. It's been super fascinating, Tim. I really appreciate your time today. Pleasure. Thanks for having me. And a disclaimer the information discussed in this podcast is for general information purposes only and is not intended as medical advice. The content should not be relied on as a substitute for professional healthcare. And if you have any concerns about your health, please do consult a qualified healthcare professional.

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