Dysregulation over dysfunction or damage! 29/4/26

When you start to read the research around back pain, you realise how many factors beyond anatomy, pathology and biomechanics matter!

This is why I think we need to replace a damage or dysfunction perspective with one that reflects dysregulation of the whole human and the associated sub systems.

Dysregulation is:

“A condition in which a process/es in the body are not controlled in the way that they normally should be”

A damage model often doesn’t explain many presentations, especially recurrent or chronic and dysfunctions may better reflect the wide variety of human functioning than they relate to pain. How do we know this? So many of them have been researched and found wanting in explanatory power.

Tendinopathy seems to be better explained by dysregulation of normal tendon physiology or a pathophysiology rather than simply a structural pathology. Something being discussed more and more.

We are learning dysregulation of many systems from the nociceptive or immune to the metabolic can influence what we experience in terms of health, mental health and pain!

This fits with the idea of making the forest dry and creating an environment where pain becomes more likely to emerge

The perfect pain storm IMO……

• Metabolic and immune system dysregulation through lifestyle and poor health behaviours leading to pro inflammatory or nociceptive eco systems

• Nociceptive dysregulation such as peripheral or central sensitisations of nociceptors after previous pain episodes

• Psychological dysregulation that creates an unhelpful set of behaviours feeding the forest being dry

This may create an attractor state that feeds and maintains pain, and we may find this is why back pain becomes a recurrent and episodic condition.

An attractor state is:

“An attractor state is a stable, long-term configuration or pattern that a dynamical system (physical, biological, or social) tends to evolve toward and remain in over time”

Really an attractor state is a bunch of habits and behaviours that are associated with the current dysregulated state.

Perhaps back pain is most reflective of the human eco system and its current state, hence why it is so prevalent and sticky?

Treatment should be focused towards disrupting the dysregulated attractor state in some way, maybe health, ,maybe psychology or maybe something else that can help the system regulate and find a new attractor state.

We can do this through good listening, assessment and focusing beyond just the idea of a damaged tissue or finding a disfunction to blame such as a weak or unstable core.

Do we need a new lens to view humans through? I reckon so, but only if you can be bothered : )