Opening the Case

Ask most people when their chronic pain started, and they’ll give you the headline story. The car accident. The torn ligament from the ski trip. The fall down the last two stairs with a full laundry basket. One date, one place, one clean sentence.

But sit with it a little longer — which is basically my job — and the timeline gets messier. There’s almost always an earlier file already open. The trip on the stairs at nineteen you laughed off. The bike spill at six that was just a scraped knee, or so it seemed. The Tuesday you cut into a watermelon at the wrong angle and your wrist ached for a week before you forgot about it entirely.

None of it felt worth remembering. That’s exactly the problem. Your body was keeping score anyway.

Now — you might reasonably wonder what a nutrition counsellor is doing writing about pain. Fair question. The short answer is that I was never trained to look at food in isolation. Holistic nutrition training is a training in systems — how inflammation, blood sugar, stress hormones, sleep, and tissue repair all talk to each other, and how a symptom in one place often starts somewhere else entirely. Pain is one of the loudest examples of that. It’s rarely about the thing that hurts.

The other half of the answer is that I spend time with people in pain. Through my volunteer work as a peer health coach with Pain BC, I sit with people and listen to how they describe the start of their pain — and I’ve heard the same pattern often enough now that I stopped thinking of it as coincidence.

What I’m not is your doctor, your physio, or your rheumatologist. I don’t diagnose, and I’ll point you toward them more than once in this file. What I do is look for the clues nobody had time to ask about — and then hand you the evidence.

So here’s what I actually want to dig into: why do some people carry decades of these small, forgettable bumps and never think about them again, while others end up with pain that seems to show up out of nowhere and doesn’t leave? Turns out it’s not one answer. It’s four, and they talk to each other more than any single one works alone.

Clue #1 — Why the Nervous System Never Forgets

Every time tissue gets hurt — even a little — your nervous system can get a bit more trigger-happy about it. Researchers call this central sensitization, but you can think of it more simply: the alarm gets more sensitive each time it goes off, and the volume doesn’t always turn back down once the injury’s healed. That’s a big part of why pain and actual tissue damage don’t always line up the way you’d expect.

And this isn’t reserved for the big, dramatic injuries. Studies on orthopedic trauma have found measurable changes in how the spinal cord and brain process pain signals afterward — and that mechanism doesn’t need a dramatic threshold to switch on. Which means the six-year-old on the bike and the twenty-eight-year-old hauling too much laundry up the stairs weren’t building separate stories. They may have been writing entries in the same file.

The Small Signal

Here’s one you can feel right now. Next time you’ve been sitting a while and stand up, notice the first few steps — that stiffness in the hips or knees that eases once you get moving. Nine times out of ten it’s nothing more than tissue that’s been held in one shape too long, loosening as circulation returns. Worth watching, not worth worrying about. But if that stiffness stops easing with movement, starts showing up first thing in the morning and lasting more than half an hour, or settles into one specific joint, that’s the version worth mentioning to your doctor — because that pattern is one of the ways early arthritis first says hello. The signal itself is ordinary. What it’s doing over time is the clue.

Clue #2 — The Pain Threshold You Were Born With

There’s a gene called COMT that helps regulate how your body handles pain signalling, and researchers have found three common versions of it — nicknamed low, average, and high pain sensitivity — that between them cover almost everyone. People with the low-sensitivity version turn out to be far less likely to develop a common jaw and joint pain condition than people without it.

So if you’ve ever watched a friend shrug off the exact injury that put you on the couch for a week, now you know — that was never a fair fight to begin with.

Clue #3 — Is It the Muscle?

Muscle does matter here. It’s part of what holds a joint steady and soaks up the small, everyday jolts that would otherwise land straight on your cartilage and connective tissue. Research on older adults generally points to somewhere around 1.0 to 1.2 grams of protein per kilogram of body weight a day as the sweet spot for keeping muscle and strength.

But — and this is the twist I love finding — more isn’t automatically better. A large study following older twins actually found that protein intake above about 1.3 grams per kilogram a day was linked to more muscle loss, not less, while the moderate range was the protective one. So the honest answer isn’t “eat more protein.” It’s “eat enough, spread it across the day, and let go of the idea that maxing it out is the goal.”

And if you’ve noticed your strength quietly slipping over the last few years, that’s worth paying attention to. Low muscle mass on its own raises fall risk and slows recovery after a joint injury. Not vanity. A clue.

Clue #4 — Is It the Frame?

Joint flexibility sits on a spectrum. Something like one in five adults stay noticeably flexible well into adulthood, and for most of them, that’s neutral — sometimes even an advantage. But at the far end of that spectrum, joints that move more than they can stabilize tend to rack up small, repeated injuries — sprains, subluxations, strains from almost nothing — and those can add up into chronic pain over time, especially when the connective tissue itself is stretchier than average.

This is a smaller, more specific group than “I’ve always been the bendy one at parties.” I’m not diagnosing anyone here — just naming a pattern worth mentioning to your healthcare provider if joint instability, frequent minor injuries, and chronic pain keep showing up together in your own file.

From the Field

Some of what I know here doesn’t come from a database. It comes from sitting across from people through Pain BC, listening to how they actually describe the start of their pain. The pattern I hear most isn’t “I got hurt and it never got better.” It’s “Honestly, I don’t know when this started” — followed, a few minutes later, by a small, half-forgotten story that sounds exactly like the ones above. The stairs. The bike. The watermelon knife. Nobody thinks those moments matter at the time. That’s exactly why they’re worth asking about.

If reading this has you mentally flipping back through your own timeline — the falls you laughed off, the aches you filed under “just getting older” — that’s exactly the instinct worth following. I pulled the five most-overlooked ones into a short guide, The Five Body Clues Women Ignore, for anyone who wants a place to start looking.

Nutritional Support for the File

If pain has a structural, connective-tissue thread running through it — and after four clues about tissue, nerves, and joints, it does — then the nutrition that matters most here is the raw material your body actually rebuilds with.

— Protein, spread across the day is the anchor. Muscle and connective tissue are built from it, and your body uses it far better in steady amounts — roughly 20 to 30g a meal — than in one big dinner-time load. This is the single most useful lever in this whole list.

— Vitamin C is protein’s quiet partner here. Your body physically cannot build collagen — the scaffolding in tendons, ligaments, and cartilage — without it. Pairing collagen-friendly foods like bone broth with citrus, berries, or bell peppers gives the repair job both the bricks and the mortar.

— Omega-3s (EPA/DHA) from sardines, salmon, or a quality fish oil help settle the low-grade inflammation that tends to hang around old, grumbly joints.

— As for hydration: cartilage and the fluid cushioning every joint are mostly water, and a joint that’s spent years quietly compensating is the first to feel it when you run dry. Sip steadily through the day rather than trying to catch up at dinner.

Red Flags — When to Stop Investigating Alone

These are your cue to call in your doctor, physiotherapist, or pharmacist rather than keep digging on your own. This piece is about understanding patterns, not replacing the people trained to treat them.

And when you make that appointment, bring the timeline with you. “My knee has hurt for years” is easy to file under aging. “It started after a fall at nineteen, flared when I went back to running at forty-five, and now aches after every long drive” is a case a clinician can actually work with. You’re not being difficult — you’re handing over the evidence instead of hoping it gets noticed in a fifteen-minute window.

Closing the Case

Follow the clues. That’s what the rest of this file is for.

These four clues are all physical. But pain doesn’t stay in one lane — how long you sit, what you feel, and how you think about the pain itself all leave their own marks. Over the next three case files, we follow it into each of those rooms.