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People in my yoga classes often ask for hip openers, and more than once I’ve heard instructors say we hold a lot of tension in our hips. I always thought that was a little weird — for me, it’s always been my neck and shoulders — so I looked into it for The Guardian for a recent column.

I interviewed some smart people for the story, including Greg Lehman, a physiotherapist and chiropractor in Toronto. Something he said near the end of our call stuck out to me. If you have pain — anywhere, not just in your hips — it’s fine to look for a fix, he told me. But sometimes, accepting some pain as just part of your life is easier. And what’s wild is that accepting some pain often reduces the symptoms.

This wasn’t the first time I’ve heard someone say that perseverating on symptoms makes them worse, and that letting go makes them better.

What’s going on here?

Your body makes a constant hum of sensations. Your heart beats, your gut churns, your joints creak, and most of the time, you don’t notice any of it.

That’s by design. In her book The Age of Diagnosis (which I haven’t been able to shut up about since I read it), neurologist Suzanne O’Sullivan describes how the brain filters out this “white noise” so we can focus on things that matter.

Worry pokes holes in that filter. O’Sullivan gives the example of someone who has just learned that heart disease runs in their family. They climb a flight of stairs, feel their heart speed up the way everyone’s does, and decide something is wrong. Et voilà: symptoms. Or at least, the suspicion that you have them. 

There’s a technical name for what’s happening here: hypervigilance. In one study of people with chronic pain, researchers found that pain pulled patients’ attention away from a mental task most strongly when they were also afraid of it. Fear of pain determined how much attention the pain grabbed — not just pain intensity.

That finding became part of what’s called the fear-avoidance model, one of the most influential frameworks in pain research. It goes like this: someone hurts, interprets the pain as a sign of serious damage, becomes afraid of it, watches for it constantly, and avoids anything that might set it off. The avoidance leads to deconditioning — loss of physical fitness — and the deconditioning leads to more pain.

The step where people interpret pain as catastrophic matters a lot. Researchers have found that catastrophizing — expecting the worst, ruminating on pain, feeling helpless about it — likely predicts of how much pain and disability people with musculoskeletal pain go on to have. 

Attention and worry don’t just change what you feel — they can change how your body performs. This happens in completely non-pain-related situations: Ever been pee-shy in a public restroom? Or flubbed the solo in front of others despite consistently nailing it when you practice? The phenomenon is a big part of why the fields of sports and performance psychology exist. 

I’ve personally noticed this phenomenon in people with Parkinson’s disease, whose gait and tremor often worsen when they’re worried about them or trying to control them. Researchers have documented this, too: Four out of five people with Parkinson’s in one survey said stress makes their tremor worse, and the effects can extend to walking.

In Parkinson’s, this is thought to occur in part because stress chemicals amplify activity in the brain circuit that drives tremor. Stress acts on pain through different circuits — that’s a story complicated enough for its own post.

If worry makes pain worse, can reducing worry make pain better? Probably! In a 2021 randomized trial, researchers tested something called pain reprocessing therapy on 151 adults with chronic back pain. The therapy teaches people to see their pain as a signal from a sensitized nervous system rather than evidence of damage.

After four weeks of treatment, 66% of people who got the therapy were pain-free or nearly pain-free. So were 20% of people who got a placebo injection, and 10% of people who got usual care. The benefits largely held a year later.

That’s one trial, in one condition, and it needs to be replicated. But it lines up with decades of research on the fear-avoidance cycle.

None of this means pain isn’t real. Lehman was emphatic that the nervous system changes involved are physiological, not imaginary.

It also doesn’t mean you should ignore new or worsening symptoms. Pain that keeps getting worse, or doesn’t improve after several weeks of sensible self-care, is worth getting checked out.

What it does mean is that how closely you watch a symptom can affect how it feels. O’Sullivan’s phrase for what helps is “less worried attention.” The point isn’t to ignore your body — it’s to stop treating every twinge as a signal of impending doom.

In other words, if you can let that shit go, do.

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Got a tip on any of the stories I’m covering? Email me at [email protected], fill out this form, or find me on Signal at kerenlandman.07.

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