מה קורה לנו אחרי פציעה?

כאשר אנו חווים כאב, למשל בקרסול, באופן אוטומטי משתנה תבנית התנועה שלו. הכאב יכול להיות בגלל נפילה או חבלה (נקע, שבר וכדומה) או מסיבה שאינה ברורה לחלוטין ("מאמץ יתר", דלקת וכו). התנועה בקרסול עשויה להשתנות באופן משמעותי או בצורה עדינה יותר, בהתאם לרמת הסכנה שהמוח שלנו חש מהקרסול הסורר.
דוגמא פשוטה לכך יכולה להיות אדם הסובל מכאבי צוואר, וכאשר אדם אחר העומד לידו קורא לו, הוא אינו מפנה את הראש, אלא מסתובב כולו.
בשנים האחרונות מצטברות יותר ויותר ראיות מחקריות שהשינוי הזה בדפוסי התנועה של האזור הכואב עלול להיות גורם משמעותי מאוד בהפיכת הבעיה לכרונית.
כאשר מדובר בכאב אקוטי (הנמשך כמה שעות עד ימים ספורים), שינוי דפוס התנועה שומר עלינו מפני נזק נוסף, והמדע מלמד שישנה בתקופה זו ירידה משמעותית בפעילות ה'קורטקס המוטורי' שהוא האזור במוח שאחראי לתנועה באותו האזור.
עם זאת, כאשר הכאב מתמשך יותר נצפתה תופעה הפוכה באותו קורטקס מוטורי, כלומר עלייה משמעותית בפעילות, אפילו בהשוואה למצב שלפני תחילת הכאבים. ההשערה היא שהמוח כעת מפתח אסטרטגיות חלופיות כדי לבצע פעולות נדרשות ללא שימוש רגיל באזור הכאוב.
התרחשות זו במוח דומה לכל תהליך למידה של תנועה או פעילות חדשה, כמו למשל כאשר אדם לומד לרכב על אופניים בפעם הראשונה, דבר המלמד שבמצב של כאב כרוני המוח מנסה 'לחשב מסלול מחדש'.
הפעולה החדשה שנלמדה תהיה מעתה 'ברירת המחדל' של המוח כאשר הוא מתכנן תנועה מסוימת, ואכן הפעילות תתבצע עם הרבה פחות כאב. עם זאת, כאשר יהיה בכל זאת עומס מסוים על האזור הפגוע, המוח ימשיך להפעיל את אזעקת הכאב, כי כעת הנחת היסוד שלו היא "עבודה ללא עומס על האזור המסוכן". כך מתפתח כאב כרוני ומוגבלות קבועה.
הפתרון המוצע הינו חשיפה הדרגתית של הפעולה המאיימת (זו שביודעין מעמיסה על האזור הפגוע) כדי ללמד את המוח מחדש לעבוד עם אותו אזור, עד שהנחת העבודה שלו תחזור להיות 'עבודה עם עומס רגיל על האזור שהבריא"

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