How is physiotherapy different at Evolving Pain?

Pain Physiotherapy is a different approach to managing chronic pain compared to typical physiotherapy, osteopathy, or chiropractic clinics. We work with complex, chronic pain and illness presentations, which often require an in depth, holistic assessment to help formulate a diagnosis and identify the key contributors to persistent pain.

Pain management is a challenging process, and knowing what to do or where to start can feel overwhelming. You may have tried many things including exercise programs, manual therapy, pacing, resting, pushing through, interventions, medications, and multiple tests or investigations. This can feel deeply frustrating when these approaches do not lead to meaningful or lasting change.

Despite receiving many different recommendations and opinions, your history and lived experience are valuable information. They help us understand what has worked, what has not worked, and often why.

Persistent pain does not behave like an acute injury. Over time, pain becomes shaped not only by tissues, but also by the nervous system, stress, life context, and habits or beliefs that once made sense but may no longer be helping. Because of this, pain management needs to be holistic, flexible, and responsive, and willing to change direction when something is not working.

Management and treatment often involve reviewing your routines, identifying physical, environmental, and mental stressors, improving wellbeing habits, and learning strategies to manage flare ups and boom bust patterns. We do not always focus on manual therapy or exercise prescription, particularly if these approaches have not been helpful in the past. Instead, we assess and identify strategies that are more likely to improve your tolerance, capacity, and ability to participate in life over time.

Understanding the History Before Forcing Change

An important starting point in this work is taking time to understand your history. This often takes time, and our initial assessment involves an in-depth discussion to understand not only your pain history, but also how you’ve learned to manage your body, your energy, and your wellbeing over time.

Your history can tell us a lot:

• What has been tried before

• What helped temporarily and what didn’t help at all

• Where progress stalled or plateaued

• How stress, work, family, relationships, illness, or trauma have interacted with pain

• What patterns keep repeating

• Key timelines or events that help explain pain presentations

This isn’t about analysing the past for the sake of it. It’s about listening to what your system has already shown us.

If we look at the history and see that certain approaches have been applied consistently without meaningful change, that tells us something important: continuing to do the same thing is unlikely to create a different outcome. Sometimes progress requires doing things differently, even when that feels unfamiliar, uncomfortable, or at odds with what you’ve previously been told should help.

Why Changing Direction Can Feel Unsettling

Many people arrive feeling conflicted. They’ve been told certain strategies are essential, even when those strategies haven’t led to progress. Pausing, modifying, or stepping away from something that has been labelled as “helpful” can feel risky.

Part of this process often involves collaboration, where we discuss:

• Pausing or modifying routines that have become habitual

• Stepping back from strategies that are consuming energy without return

• Observing how the system responds when effort is reduced or redirected

• Gathering real data from your own experience, rather than assumptions

This is not about giving things up permanently. It’s about creating space to understand whether something is genuinely serving you now.

Sometimes stopping, shifting, or changing how something is done gives us clearer information than continuing out of obligation. This process is collaborative, with the aim of providing you with knowledge and understanding about your pain and your current state.

Different Phases, Different Priorities

Pain management isn’t one continuous mode of action. There are different phases, and each has a different priority.

At times, the focus needs to be calming the nervous system and increasing safety. At other times, it’s about reviewing routines, energy use, weekly loading, and stressors that are reducing capacity. When the system is more settled, it may be appropriate to gradually build tolerance, movement, and confidence again.

And sometimes, the focus is less about pain at all, and more about reconnecting with activities that are meaningful, heart-centred, and aligned with how you want to participate in your life.

Moving between these phases is not a setback. It’s a normal part of working with a living system.Problems arise when we try to apply challenge when the system needs stability, or when we remain in protection when the system is ready to move forward.

Pain management with physiotherapy can involve the following areas:

• Pain science education

• Managing or referring for co-existing conditions

• Liaise with medical and allied health team for collaborative care

• Pacing which includes planning and prioritising

• Sleep assessment and management

• Flare up reflections and plan

• Load management with activities and exercises

• Energy management using capacity vs load

• Capacity building strategies across physical, environmental and mental domains

• Somatic Tracking, mindfulness, meditation, and nervous system regulation

• Problem solving with potential barriers and events

• Movement coaching and planning for functional and activity based tasks

Why Working With an Evolving Pain Physiotherapist Can Help

One of the hardest parts of persistent pain is knowing where to start.

When you are inside the experience every day, patterns can be difficult to see clearly. Pain management brings an external perspective grounded in experience with many people living with chronic pain.

Through observation, listening, and clinical reasoning, an experienced pain physiotherapist can help identify:

• Patterns that commonly show up in persistent pain

• When the nervous system appears overloaded or sensitised

• Whether the priority is stabilisation, adjustment, or challenge

• What may need to be reviewed, paused, or approached differently

• Where change is most likely to be helpful right now

This work relies on collaboration and trust, not blind trust, but trust built through explanation, shared understanding, and ongoing review.

The goal is to empower you with knowledge about chronic pain, and about what your presentation and patterns mean, both historically and currently.

A Longer Term View of Wellbeing

The goal of this approach is not to chase pain relief in isolation. It is to support longer-term shifts in patterns, capacity, and wellbeing, so life can gradually expand again.

Pain may still be present at times. Stress will still come and go. But with the right sequencing, flexibility, and support, people often develop more confidence in their body, greater resilience through flare-ups, and a stronger sense of agency in their own care.

Pain management becomes less about constantly fixing, and more about learning how to respond with skill over time.

To book an an appointment wth Marie:

Appointments