Acute pain vs. chronic pain: a clinical distinction
In the first six to twelve weeks after an injury or the onset of pain, the body's tissues are responding to a specific event. The pain reflects a real ongoing process — inflammation, tissue healing, or joint restriction — and responds reliably to targeted physiotherapy.
Beyond this window, the central nervous system begins to adapt. Pain thresholds change, protective movement habits become embedded, muscle recruitment patterns alter, and what started as a mechanical problem increasingly involves central sensitisation. This does not mean the pain is imagined — it means it now has additional drivers that require a different treatment approach.
BPPV is a specific example: most acute episodes resolve with one to three canalith repositioning manoeuvres when assessed promptly. When left untreated for weeks, compensatory balance strategies develop that require additional vestibular rehabilitation beyond the repositioning itself. Early assessment consistently produces faster resolution.
For sports injuries, delayed loading is now understood to be actively harmful to tendon and ligament repair. Rest without progression prolongs recovery; structured graduated loading, begun under physiotherapy guidance, promotes stronger tissue healing.
Acute (0–6 weeks)
Tissue-level drivers. Responds well to manual therapy, targeted exercise, and electrotherapy modalities. Best prognosis.
Sub-acute (6–12 weeks)
Tissue healing plus early movement pattern adaptation. Still highly responsive but requires greater attention to motor control and posture.
Chronic (>12 weeks)
Central sensitisation, muscle inhibition, and psychological factors involved. Effective treatment remains possible but requires a broader approach and more sessions.