As a psychologist who works closely with clients who are living with chronic pain, one of the most common (and confusing) questions I hear is: “How do I know if this pain means I’m injured or if my nervous system is just stuck on high alert?”
Here’s a helpful way to think about the difference between injury pain and pain driven by central sensitisation.

Pain from injury is usually protective. It tends to:

• Be linked to a clear event (a fall, strain, surgery)
• Be localised and consistent with the injured tissue
• Improve gradually as healing occurs (typically over weeks to a few months)
• Increase predictably with specific movements that stress the tissue

In contrast, pain from central sensitisation happens when the nervous system becomes more sensitive and reactive over time. The “alarm system” stays turned up, even after tissues have healed. Signs pain may be driven more by sensitization than ongoing injury include:

• Pain lasting well beyond normal tissue healing time
• Symptoms that spread or move around the body
• Pain triggered by light touch, stress, fatigue, or even temperature changes
• Flare-ups that feel disproportionate to activity
• Coexisting issues like sleep disturbance, brain fog, or heightened stress response

A helpful metaphor is injury pain is like a smoke alarm responding to a real fire.
​Central sensitisation is like a smoke alarm that goes off when you make toast.
This doesn’t mean the pain is “in your head.” It’s very real but it’s being amplified by a sensitised nervous system rather than ongoing tissue damage. And the good news is that nervous systems can calm down. If pain has been persistent and confusing, it may be worth exploring not just what’s happening in the tissues, but also what’s happening in the nervous system.

As a psychologist, I often work with clients who live with Postural Orthostatic Tachycardia Syndrome (POTS) and the emotional toll that comes with feeling fatigue, dizziness, brain fog, anxiety, and the frustration of feeling limited in daily life. What many people don’t realise is how powerful vestibular physiotherapy can be as part of a truly holistic approach to managing POTS symptoms.
POTS affects the autonomic nervous system, which plays a key role in heart rate, blood pressure, and balance. When this system is dysregulated, the brain can receive confusing signals about movement, position, and safety. Over time, this can heighten symptoms like dizziness, unsteadiness, visual disturbance, nausea, and even panic. From a psychological perspective, repeated experiences of feeling unsafe in your body can understandably increase anxiety, hypervigilance, and avoidance of movement.
This is where a vestibular physiotherapist becomes incredibly valuable.
Vestibular physios are trained to assess how the brain, inner ear, eyes, and body communicate about balance and motion. For clients with POTS, they can design gentle, graded exercises that help retrain these systems without overwhelming the nervous system. Rather than pushing through symptoms, the focus is on restoring trust in the body at a pace that feels safe and achievable.
Clinically, I see several benefits when clients work with a vestibular physio:

• Reduced dizziness and motion sensitivity
• Improved tolerance to upright posture and movement
• Less fear around standing, walking, or leaving the house
• Greater confidence in daily activities

From a psychological standpoint, this physical progress often leads to reduced anxiety, improved mood, and a stronger sense of agency. When the body feels more predictable, the mind can relax.
Importantly, vestibular physiotherapy aligns beautifully with psychological work. While I help clients understand the stress response, process grief or trauma, and build coping strategies, the physio supports the bottom-up regulation of the nervous system. Together, this mind–body approach reinforces recovery rather than treating symptoms in isolation.
For anyone living with POTS, collaboration between psychology, vestibular physiotherapy, and medical care can be life changing. You deserve support that recognises your symptoms as real, complex, and treatable—and that helps you feel safe in your body again.