Why Do I Hurt: Part 2


Pain is one of the few common experiences everyone can relate to. Everyone has experienced pain at least once in their lives. No one enjoys being in pain but it’s a necessary part of life that keeps us alive. Last year I wrote a blog article about common pain myths titled “Why Do I Hurt?

This time I will to explain the various parts of the brain that are involved during a painful experience in order to give you a deeper understanding of what happens when we experience pain.

To recap my first article, pain is defined as “An unpleasant sensory or emotional experience that is associated with actual or potential tissue damage,” which was developed by the International Association for the Study of Pain.

Pain is an output from the brain when the brain thinks we are threatened. Tissues (muscles, joints, ligaments, and nerves) are just one input for the brain. The brain receives millions of inputs every second before it determines the output (pain or no pain) and processes them at an incredibly rapid rate.

These inputs are messages sent to the spinal cord and brain, letting the brain know about temperature (so you know whether to wear a tank top or winter coat), blood flow (is it time to get up and move?), stress levels (hormones including adrenaline and cortisol), movement (your eyes are moving as you read this), and the immune system (such as when you have the flu).

If the brain determines that something is a threat it can make you to feel pain even in the absence of tissue damage. Processing pain is much more complicated than this, so let’s take a deeper look.

Scientists once thought that when tissue is damaged only the “pain center” in our brain lights up. We now know through brain scans that when we experience pain nine areas of our brain light up, we call this our neuromatrix. Everyone experiences pain differently, my pain is different from your pain, and your pain is different than your neighbor’s pain, but we all have the same nine areas light up, they just light up differently. So what are the nine areas, what are they responsible for, and why does the neuromatrix matter?

  1. Premotor/Motor Cortex: Organizes and prepares us for movement
  2. Cingulate Cortex: Concentration and focus
  3. Prefrontal Cortex: Problem solving and memory
  4. Amygdala: Fear and addiction
  5. Sensory Cortex: Sensory discrimination
  6. Hypothalamus/Thalamus: Response to stress and motivation
  7. Cerebellum: Movement and cognition
  8. Hippocampus: Memory and fear conditioning
  9. Spinal Cord: First stop to process information from peripheral inputs before sending the information up to the brain.

Understanding that there are several areas of the brain that light up when we experience pain is important. We now know that these nine areas do not just light up together when we experience pain, but also communicate with each other during other activities such as organizing memories and coordinating movement.

This helps explain why when some people experience pain for prolonged periods, they report difficulty concentrating at work, feel stressed, and have a hard time completing physical activities—all without injury.

The good news is that we can change the way our brains light up through physical therapy. Treatment includes education, manual therapy, physical activity, and modalities to modify brain inputs, which helps people experience less pain and increase our ability to perform functional activities.

Our goal at Foothills Sports Medicine Physical Therapy is for you to live a full and pain-free life. I have eight years of experience working in outpatient physical therapy, and I can’t wait to help get you back on track.


Ted Carter

PT, DPT, OCS, CSCS, Cert. TDN Ahwatukee Location