The Difference Between Injury, Sensitivity, and Deconditioning
“Do you think I’ve actually injured something?”
This is one of the most common questions we receive as Osteopaths.
It’s a completely fair question. Pain can be uncomfortable, confusing, frustrating, and at times concerning - especially when it lingers or returns after rest, stretching, or exercise, leading you unsure of what to do. But pain doesn’t always mean the same thing for everyone, and treating all pain as an “injury” can actually slow recovery rather than speed it up.
In practice, musculoskeletal cases often fall into one of three broad categories: injury, sensitivity, or deconditioning. Understanding the difference between these is a really important step in choosing the right treatment approach, avoiding unnecessary fear, and building long-term resilience.
Not All Pain Is the Same
Two people can present with “back pain,” “shoulder pain,” or “knee pain” and require completely different management plans - even if their symptoms seem similar on the surface.
Pain is influenced by far more than tissue damage alone. Factors such as:
How tissues are being loaded
How strong and conditioned they are
How sensitive the nervous system has become
How much movement has been avoided
Lifestyle factors like sleep, stress, and workload
These will all play a role.
Generic advice will often miss the mark when it comes to managing pain. Because without understanding why pain is present, it’s impossible to choose the most effective path forward.
Injury — When Tissue Has Been Overloaded
An injury usually occurs when tissues are exposed to more load than they can tolerate at that point in time.
This might happen after:
A sudden or awkward lift
A fall or impact
A rapid increase in training volume or intensity
Repetitive strain without appropriate recovery
In these cases, pain is often:
Quite localised and clear
Linked to a clear mechanism or incident
Aggravated by specific movements or loads
Protective in nature
Pain here serves a purpose – to protect you. It’s the body’s way of saying, “This area needs time and appropriate management to heal.”
How Injury Is Managed
Management often involves:
Temporarily modifying or reducing load
Maintaining movement where possible
Avoiding aggravating activities in the short term
Gradually and constructively rebuilding strength and capacity
Importantly, injury does not always mean complete rest. In fact, appropriate movement and progressive loading are often really important for optimal healing. Prolonged avoidance can delay recovery and contribute to future problems, such as stiffness, deconditioning, or sensitivity.
What Relative Rest Actually Means
When managing an injury, rest is often misunderstood as doing nothing. Relative rest means temporarily modifying load, rather than eliminating movement entirely. This may involve reducing range, intensity, or frequency while keeping the area moving within tolerable limits.
The goal is to protect healing tissue without allowing the rest of the system to decondition in the process.
Sensitivity — When the System Is on High Alert
Sensitivity refers to pain that is driven more by the nervous system than by ongoing tissue damage.
This commonly develops:
After an injury that has healed, but the pain remains
During periods of high stress or poor sleep
When movement has been avoided for long periods of time
When fear and uncertainty around pain or re-injury are high
In sensitive states:
Pain may vary day to day
Symptoms can be vague, or spread, or possibly change location
Movements may feel painful without clear damage
Scans often show little or no change
This doesn’t mean the pain or the problem isn’t real — it absolutely is. But the driver becomes less to do with tissue injury. Instead, the nervous system has become protective and reactive, interpreting normal movement as a potential threat.
Why Sensitivity Persists
When pain persists, the brain becomes better at producing pain. This heightened alert system is influenced by:
Stress and fatigue
Previous pain experiences
Beliefs about damage or fragility
Lack of confidence in movement
In this context, rest alone rarely helps and often makes things worse.
How Sensitivity Is Managed
Management focuses on:
Restoring confidence in movement
Graded exposure to feared or avoided activities/movements
Improving load tolerance
Education around pain and safety
Aiming to reduce unnecessary threat signals
The goal is to teach the nervous system that movement is safe again.
Deconditioning — When the Body Lacks Capacity
Deconditioning occurs when tissues and systems are no longer prepared for the demands placed on them.
This can happen after:
Prolonged time away from exercise
Extended sedentary work
Chronic pain leading to avoidance
Repeated cycles of flare-up and rest
In these cases, pain may appear:
During activities that used to be easy
After long periods of sitting or standing
When returning to exercise
During everyday tasks like lifting or walking
Here, pain is not a sign of damage; it’s a sign that capacity is lower than demand.
Why Deconditioning Feels Like Injury
Deconditioned tissues fatigue quickly and send strong signals to the nervous system. This can feel very similar to injury, even though little to no damage is occurring.
How Deconditioning Is Managed
Management typically involves:
Rebuilding strength and endurance
Gradually increasing activity tolerance
Reintroducing movements that have been avoided
Improving overall movement variability
Stretching alone rarely fixes this problem. Capacity must be rebuilt through appropriate loading.
When These Categories Overlap
In reality, many people don’t sit neatly in to just one of these categories. Injury, sensitivity, and deconditioning can often overlap and feed into one another over time.
For example, an initial injury may settle from a tissue healing perspective, but the pain can persist because the nervous system can remain protective. As movement becomes uncomfortable or frightening, certain activities are avoided. Over weeks or months, this avoidance leads to deconditioning - reduced strength, endurance, and tolerance, which then makes normal activity feel harder again.
This cycle can look like:
An injury that heals, but pain remains
Pain leading to movement avoidance
Avoidance leading to reduced capacity
Reduced capacity increasing sensitivity
Sensitivity reinforcing fear and avoidance
Understanding where you sit within this cycle is really important. Treating only one part, without addressing the others, will often leads to recurring flare-ups rather than long-term improvement.
Why These Categories Matter
Treating sensitivity like an injury can lead to unnecessary rest.
Treating injury like sensitivity can prolong healing.
Treating deconditioning like damage can keep people stuck in cycles of pain.
This is why basic advice may not work. An exercise that helps one person may flare another — not because the exercise is “bad,” but because the context is different.
How Osteopathy Helps Make the Distinction
An osteopathic assessment looks beyond the painful area and considers:
How your body moves as a whole
Where the load is being absorbed or avoided
What movements provoke or relieve symptoms
Training, work, and lifestyle demands
Whether pain reflects injury, sensitivity, deconditioning, or maybe even a combination
Treatment may include:
Hands-on therapy to reduce protective tension
Movement and load modification
Strength and mobility work
Education to reduce fear and uncertainty
A tailored plan to rebuild confidence and capacity
The aim isn’t just pain relief — it’s helping your body tolerate life again.
The Takeaway
Pain doesn’t automatically mean injury.
And injury doesn’t automatically mean rest.
Understanding whether pain is driven by injury, sensitivity, or deconditioning changes how it’s managed and how you recover.
If you’re unsure which category your pain fits into, we can help. At Osteopathic Movement South Yarra, we take the time to understand the why behind your pain, so we can build a plan that fits you — not just your symptoms.
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Written By Dr. Matthew Keys (B.Sci(Osteo), M.H.S (Osteopathy)) - Associate Osteopath, Osteopathic Movement, South Yarra.