Why an enactive approach to pain treatment may be what you need

The main focus of my work in clinical practice is chronic pain. While I do still work with athletes and help people with return to sports, most people who seek out my services are patients who have lived with back pain or neck pain for many years.

Why pain theories are important to you.

spine damage disc herniation
In 2015 (aka old news), Brinjikji and friends looked at 3110 PAIN-FREE individuals (across thirty-three articles) to find that “spinal degeneration are present in HIGH proportions of asymptomatic individuals”.

If you cannot tell by this stage, I super love research. This is because research makes us make sense of the world. In my work as a chiropractor, this is particularly useful.

It allows me to better help you with your recovery.

Take for example, a structure-based approach to pain. Most of us think something is wrong when we experience pain. When we have back pain, we think we have a back injury.

However, pain science tells us that this is not true. In fact, you can have damage without pain and pain without damage. The Lancet recently affirmed this in their latest paper to assert that pain is not an indicator of tissue damage.

False beliefs lead us down the wrong rabbit hole.

chiropractor points to recovery
As an evidence-based chiropractor, I don’t use my hands to make your pain magically disappear. I work as a guide to help you help yourself find freedom from pain.

A client I saw earlier this week had massive back pain after playing golf. In fact, his pain was so bad that he saw a specialist within the next couple of days and had a MRI done.

His rationale for booking in with a pain specialist was because he wanted to know exactly what was wrong.

His MRI scans came back completely normal. Thanks to the detailed reporting of the radiologist, we know there was no observable soft tissue damage in his lower back as well.

In short, despite his back-breaking pain, his tissues are totally healthy!

Without an evidence-based approach, there’s no way he could have known this.

Chiropractors may start selling him 100-session packages because of his poor spinal alignment while orthopaedic surgeons may suggest operating on the normal age-associated changes on his MRI. These are, in my opinion, unnecessary treatments for his case.

What is the enactive approach?

painful chef cooking stew
You do need a whole-person approach to get good treatment results. Focusing on the physical aspects of your pain alone is simply not good enough. You already know this from our past experiences — your pain always comes back. This is why you are looking for a better pain solution.

If you have lived with pain for years, you would know your pain is real. It’s not just all in the head like what some people suggests.

Well, technically your pain is indeed all in the brain. What I am trying to say is that it is 100% not imaginary and made up by you.

In that sense, you can’t just shut it out by just telling yourself you don’t have pain.

Come on, you have tried that. You know I am right — you cannot block your pain out in a meaningful way.

This is where an enactive approach comes in.

“Enactivists reject the idea that sense-making is simply in the head or can be reduced to neural processes.”

We believe that people are embodied action takers. In that sense, our pain is the output of how we make sense of our brain, our body, and our environment.

Making sense of your pain with a whole-person approach

back pain singapore flow chart
Your pain is not just pain. How you think of your pain, your emotional and behavioural response to your pain, can all change your pain experience.

I talk about approach pain with a whole-person approach because it makes sense.

You know that your pain is worse on days you have poorer sleep or higher work stress.

We know your thoughts and your beliefs can change our pain experience.

In fact, your thoughts and beliefs can change your behaviour. Your behaviour can inturn change your thoughts and your belief. This is why cognitive behavioural therapy is one of the first-line treatment for low back pain.

We know your mindset can change your recovery trajectory.

A 2004 (aka old news) study published that,

Self-efficacy and fear avoidance, in turn, are more important determinants of disability than pain intensity and pain duration.

We think we suffer because our pain is very painful. However, research tells us that our mindset have a bigger influence than how much pain we have.

It’s probably not what you want to hear but hey, this is why we need science. We need science to tell us what is true so we know what to focus on to get you to where you want to be.

It works out well to your favour.

At the end of the day, you are probably reading this because you are looking for a pain solution. Your previous treatments are not long-term resolutions. They may help for a while but your pain always come back.

You are looking for something better. You know you have to do things differently. Book in for an appointment with us to find out how our whole person approach can help you help yourself find freedom from pain.


Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.