You've had a scan. Someone has pointed at an image of your spine and used words like "degenerated" or "worn". And ever since, you've moved a little more carefully, avoided a few things, and quietly started to believe your body is breaking down. If that's familiar, this episode is for you.
I brought exercise physiologist Mitchell Hooper back onto me&my health up to talk about pain, because it's the part of his work he enjoys most — and because what he had to say genuinely reframes how most of us think about hurting.
Mitch's central point is deceptively simple: pain is always a sensation; it is not always damage.
The field has been steadily moving away from using imaging alone to explain someone's pain, and for good reason. You can scan two people's spines, find identical degenerative changes, and one will be in significant pain while the other feels nothing at all. Mitch pointed to research on shoulder tears where a large majority of people over a certain age showed tears on imaging — and the qualifying criterion for being in that study was that those people had no pain whatsoever. (That prevalence figure is one he recalled from memory on air, and it's a number widely cited in his field rather than something I can verify here.)
So the picture inside your body and the sensation you're experiencing are not as tightly linked as we assume. That's not a reason to dismiss pain — it's real, and it deserves attention. It's a reason to stop treating a scan as a verdict.
When someone arrives in pain, Mitch's priority is working out why. What were the circumstances? When did it start? What else was happening in your life?
Take back pain with a diagnosis of degenerated discs. That may or may not be driving the pain. The cause could be inactivity. It could be a period of genuine distress in your life. Or, very often, you simply hurt yourself and need a couple of weeks.
And when there's no pain, he's still screening function — because people compensate for damaged tissue constantly without feeling a thing. In those cases the work is rebuilding function and movement within normal healing timeframes.
What I appreciate here is where he places the practitioner's responsibility: screen for the why, give the person realistic expectations about how long this will last, map a pathway back to full function, and tell them clearly that they are not broken.
Mitch gave an example that has stuck with me. Someone can't tolerate bending forward while standing — they hurt their back on a deadlift, or felt something go while picking up a pen, and now they're convinced a disc has slipped. Put that same person in a seated position, in the same spinal flexion, under the same load, and they're fine.
That difference tells you something important about whether you're dealing with a genuinely damaged tissue or a learned protective response — and it changes how you'd introduce and build load.
He also described handing a hesitant client a three-kilo weight and asking them to carry it across the room. They do it without hesitation. Then he points out they just performed a deadlift. It sounds like a trick, but the lesson lands: the mind is extraordinarily powerful in deciding what you can and can't do, and education is what gets people moving fastest.
Mitch's broader health philosophy has two pillars, and the first is simply move more. Our lives have become more sedentary — cars, desks, working from home — and more movement means better weight management, lower risk of comorbidities, and less likelihood that arthritis causes you pain.
The second is get strong, and his reason for it is the one I repeat most often to clients. Strength, he says, is the number one correlate with independence. You meet older people who walked five kilometres a day for decades — excellent heart, excellent lungs — who can no longer stand up from a toilet unaided. Cardiovascular fitness alone doesn't preserve that.
Then the line I'd put on a poster: your body is not a car. You don't wear out because you moved too much. Everything is about building tolerance, and whatever you want to build tolerance to, you can.
Mitch's first tip is to find out what it is. See an allied health professional and get it properly screened. His general position is that if you have pain you can probably still move — but there are circumstances requiring surgical intervention, and if you've torn an Achilles, "you'll probably be fine" is terrible advice. Get the diagnosis first.
His second tip is to understand what the sensation means. He uses a lovely analogy: pinch your skin and it hurts, so you stop — but that doesn't mean you were in serious danger. Hurt and harm aren't the same thing. And if you pinched the same spot repeatedly over time, it would stop hurting as much.
That desensitisation is directly relevant to conditions like arthritis. Moving the joint may well be painful at first — he's not dismissing that, and nobody should be in excessive pain — but over time it typically becomes less painful and feels better. Avoidance is what entrenches the problem.
Where there's a clear psychological or emotional dimension, he'll work alongside a broader team. The approach is explicitly case by case: as he put it, there is no one size fits all, which is more or less the definition of exercise physiology.
This is why I keep coming back to a holistic view of health at me&my wellness. Pain is rarely just mechanical — it sits at the intersection of tissue, nervous system, stress, sleep, activity history and the beliefs you've picked up along the way about what your body can withstand. Treating only the tissue leaves most of the picture untouched. And as Mitch and I agreed, our job isn't to fix you; it's to empower you with enough understanding that you can walk the path yourself.
Want to go deeper on this? Book a free 30-minute discovery call with Anthony at meandmywellness.com.au