The Importance of Clarifying Hurt vs. Harm

The Importance of Clarifying Hurt vs. Harm

This article provides four quick chronic pain concepts, including practical tips for relaying “Hurt vs. Harm,” plus a downloadable infographic to help educate patients for improved clinical outcomes.

1. Yellow Flags Delay Recovery

“Patients who report chronic LBP [and] maladaptive psychosocial factors… have a significant increase in the risk of poor outcome.”


Evidence-based chiropractic physicians are painfully aware of how faulty patient beliefs can delay or halt clinical progress. Two of the most frequently encountered yellow flags include fear avoidance and kinesiophobia, and for LBP patients, fear of movement is overwhelmingly the most common psychosocial roadblock to progress. (2)

2. Chronic Pain is Learned

Avoiding discomfort is an instinct for most people; however, that healthy perception can sometimes morph into virtual paralysis. And unhealthy coping strategies fuel chronic pain, which has the potential to lower pain thresholds or even generate pain referral to distant sites. This hypersensitization happens primarily in the brain, not at the site of symptoms, meaning patients must reprogram how their minds think about everyday activities and movements.

3. Patient Re-Education is Essential

While chiropractic manipulation and manual therapy benefit many musculoskeletal complaints,these treatments alone can’t overcome unhealthy beliefs. (3) However, multiple studies have shown that patient education can help and is essential for resolving chronic pain.

“Individuals … receiving pain education reported lower pain intensity and higher expectations of recovery than their counterparts… (4)

“Education, as part of multi-disciplinary programs, is likely to improve self-management and self-efficacy in people with chronic pain of any etiology.” (5)

4. Start with Hurt vs. Harm

Exercise and movement are essential for recovery, and understanding the concept of hurt vs. harm is equally critical to overcoming a fear of movement. So here are five educational points to help your patients cope:

  • Stay Active – there is a vast difference between hurt and harm. Just because something hurts does not mean it’s harming you. Movement can be uncomfortable, but it does not necessarily mean that you are harming yourself. Recognize that the amount of pain you are experiencing does not correlate with the amount of tissue damage. Slow down for acute or radiating pain, but unless directed otherwise, nudge into manageable discomfort.
  •  No Pain, No Gain Is Not a Proper Mindset Either – Overdoing it will often set you back. The balanced “sore but safe” approach is usually best.
  • Start Slowly – Pick one activity you would like to perform, i.e., walking. Identify your baseline for what you can comfortably achieve, i.e., five minutes on a flat surface, then nudge it each day, i.e., add one minute or increase the pace slightly. Be patient.
  • Refocus – It’s natural to focus on discomfort, but next time you sense irritation, refocus your attention to another healthy part of your body. i.e., when your back hurts, focus intently on how good one specific knuckle feels, or sing a song in your head. Your brain can de-sensitize an area whenever you focus on something else. This can trigger lasting changes in your brain that will help you recover.
  •  Continually Refuel Your Brain – Choose a healthy diet with plenty of water, and strive for 7-9 hours of quality sleep each night.

Want to share this information with your patients? Download the ChiroUp Understanding Chronic Pain infographic.


1. Cruz EB, Canhão H, Fernandes R, Caeiro C, Branco JC, Rodrigues AM, Pimentel-Santos F, Gomes LA, Paiva S, Pinto I, Moniz R. Prognostic indicators for poor outcomes in low back pain patients consulted in primary care. Plos one. 2020 Mar 27;15(3):e0229265.

2. Patel MS, Lee KC, Dhake RP, Longworth S, Sell P. Ability of Spine Specialists to Identify Psychosocial Risk Factors as Obstacles to Recovery in Patients with Low Back Pain-Related Disorders. Asian Spine Journal. 2021 Apr;15(2):224.

3. Kamonseki DH, Christenson P, Rezvanifar SC, Calixtre LB. Effects of manual therapy on fear avoidance, kinesiophobia and pain catastrophizing in individuals with chronic musculoskeletal pain: Systematic review and meta-analysis. Musculoskeletal Science and Practice. 2021 Feb 1;51:102311. Link

4. Mittinty MM, Vanlint S, Stocks N, Mittinty MN, Moseley GL. Exploring effect of pain education on chronic pain patients’ expectation of recovery and pain intensity. Scandinavian journal of pain. 2018 Apr 25;18(2):211-9. Link

5. Joypaul S, Kelly F, McMillan SS, King MA. Multi-disciplinary interventions for chronic pain involving education: A systematic review. PloS one. 2019;14(10). Link

About Author

Tim Bertelsman, DC, DACO

Dr. Bertelsman graduated from Logan College of Chiropractic with honors in 1991 and has been running a large successful multi disciplinary practice in Belleville, IL for over 20 years. He is an expert on establishing relationships within the medical community.He has lectured nationally for many years on clinical and business topics and has been published extensively. He has served in various leadership positions within the Illinois Chiropractic Society and currently serves as President of the executive board. Dr. Bertelsman is a Co-founder of ChiroUp.


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