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Dr Neil Cuninghame

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Dr Neil Cuninghame

Helping you break free from pain and live fully again. Empowering patients and practitioners with expert pain insights.

Chiropractor and pain management specialist | Speaker & educator | Husband, father, athlete. I am a Chiropractor with a special interest in pain, chronic pain specifically, and how the nervous system plays a role in our function and outcomes

26/02/2026

Pain is a decision, not a damage meter.

That doesn’t mean pain is imagined and it doesn’t mean tissue damage is irrelevant. It means pain is a protective response. Your brain is constantly asking “How dangerous is this situation right now?”

In the boxing clip at the end, the fighter breaks his wrist during the match. Strangely he doesn’t seem to feel it and keeps fighting. Only after he has won does the break become obvious and the pain sets in.
The injury didn’t suddenly appear after the fight but the danger level changed.

During the fight his adrenaline was high and the threat felt immediate, performance and survival mattered most. In that moment, pain would have reduced his ability to respond and so the brain temporarily turned the volume down. When the fight ended and the threat dropped, protection was no longer competing with something more urgent and the pain increased.
This is how the system works.

Tissue state is one input, but so are stress, fear, context, memory, expectation, and emotion.
Your brain integrates all of it, and pain is the output.
The same system that can turn pain down can also turn it up.

Understanding pain changes how we respond to it and how we recover.

Boxing video:

24/02/2026

WHAT A DAY!

Capital City Marathon was yet again a rollercoaster of emotion from start to finish!

8km into the race turned to me and said ‘go, I don’t think I’m going to carry on’. She was dizzy, nauseous, and just couldn’t run. Fast forward a few hours and not only did she keep pushing through the pain and urge to jump into the closest car but she came sprinting in across the line to the cheers and screams of not only me but all the Hillcrest Villagers lined up along the track, cheering her on. In one of the most incredible acts of perseverance and resilience Niki crossed the line within the qualifying time and secured her place in Two Oceans. Proud is an understatement!

Qualifier done! Onwards and upwards 💪🏻

12/02/2026

Many people confuse pacing with avoidance.
 But here’s the key difference:
Avoidance shrinks your world whereas pacing expands it.

Avoidance = reacting to fear
* stopping because of panic
* never attempting difficult things
* removing activities permanently
* reducing life demands
* reinforcing danger memories
Avoidance increases fear and sensitivity.

Pacing = planning your energy, and allows you to:
* stay active
* avoid overwhelming your system
* build tolerance gradually
* gain confidence
* reduce flare-ups
* stay consistent
* prevent the boom–bust cycle

Here’s how to start pacing effectively:
1. Break tasks into smaller steps
2. Add rest before you get tired
3. Alternate physical and mental loads
4. Prioritise, plan, and pause
5. Maintain consistency rather than intensity
6. Stay inside your “safe but challenging” zone

Pacing keeps you moving, safely. And the nervous system learns from safe movement.

09/02/2026

Slow progress is not failure, it is accurate, evidence-based recovery.

When your nervous system is sensitive, rushing movement signals danger.
 Going slowly signals safety. Slow is more effective because when you move slowly, you give your brain time to:
* scan the environment
* confirm there’s no danger
* relax unnecessary tension
* reduce protective guarding
* update movement predictions
* desensitise gradually
* and stay below the fear threshold
This allows healing to happen without triggering alarm responses.

Fast pushes → fear rises → pain rises.

People often think they need to push through, but pushing:
* spikes sympathetic activation
* increases protective tension
* reinforces fear
* increases flare-ups
* and slows down long-term recovery

Slow movement teaches safety.

Try this at home if you are battling to overcome pain or are fearful of movement:
1. Start with a small, gentle range
2. Move at half your usual speed
3. Exhale through the movement
4. Pause if you feel fear rising
5. Repeat 5–10 gentle reps

Slow builds confidence. Confidence builds capacity. Capacity reduces pain.
Slow is not weakness. Slow is wisdom.

06/02/2026

A core principle is that pain and safety are inversely related.
 When your nervous system feels unsafe both physically, emotionally, or cognitively, it increases protection, and pain rises.

This means pain is not a measurement of damage. It’s a measurement of perceived threat.

- Threat can rise because of things like:
* stress
* fear
* exhaustion
* unpredictability
* emotional overload
* past traumas
* movement avoidance
* worry about the future
* feeling unsupported
* catastrophising

None of these involve tissue injury. They involve a nervous system trying to protect you.

- How to increase your sense of safety:
* slow breathing (especially long exhales)
* predictable routines
* gradual exposure
* reassuring self-talk
* controlled movement
* guided imagery
* positive emotional states
* grounding practices

- Here is a simple safety exercise:
Place a hand on your chest. Long exhale. Say softly: “I’m safe. This is discomfort, not danger.”
Safety quiets pain. And safety is a skill you can retrain.

02/02/2026

Flare-ups can be broken into predictable phases:

1. Alarm spike
The nervous system suddenly increases sensitivity.

2. Emotional surge
Fear and catastrophising jump in.

3. Muscular tension
Your body braces, trying to protect you.

4. Misinterpretation
You assume something is damaged, but it’s not.

There are many reasons why flare-ups happen:
* stress
* fatigue
* unexpected movements
* overactivity
* emotional overwhelm
* reduced sleep
* fear
* old pain memories
* tension buildup

Here’s what to do during flare-ups:
Pause → Breathe → Reassure → Adjust → Continue
1. Stop and settle
2. Slow exhale (double length of inhale)
3. Say: “This is sensitivity, not damage.”
4. Reduce the range or speed
6. Continue gently, not aggressively

Flare-ups are communication, not catastrophe.

29/01/2026

There is a concept that people often confuse and that is that pain is a sign of tissue damage and that the level of pain is an indication of the amount of tissue damage.

If these were true people wouldn’t have:
* phantom limb pain
* headaches from stress
* “flare-ups” despite normal scans
* persistent symptoms long after healing
* pain during grief, anxiety or exhaustion

Pain is the nervous system’s best guess about threat, not a scan of your tissues.

Protection becomes excessive because of many reasons:
* past danger
* high stress
* low sleep
* movement avoidance
* fear of injury
* scary medical language
* or old memories of pain

Your nervous system is there to try to help and protect us from threat, but can end up overreacting.
One way that we can reduce this threat is by using graded exposure.

Graded exposure gives your nervous system a repeated message, “this movement is safe enough”, and over time:
* the alarm becomes quieter
* the sensitivity dial turns down
* the protection becomes proportionate
* and movement becomes easier

Try this at home:
Take a feared movement → shrink it → slow it → breathe with it → repeat it regularly
You are re-teaching your brain the truth. And the nervous system always listens to repeated truth.

26/01/2026

People often miss the early signs of recovery because they’re only measuring pain.
 Don’t forget that confidence often comes before pain reduction.

Here are some early signs that you are healing:
* You’re less afraid of movement
* You’re moving more naturally
* You recover faster after a flare
* You don’t spiral into panic as easily
* You can do more before pain rises
* Pain feels less threatening
* Thoughts are calmer
* You feel more in control
* You trust your body slightly more
* You notice small wins
* You stop avoiding everything

So why does pain disappear slower?
Your brain updates its safety predictions slowly. Confidence grows when your body experiences safety and pain fades once your brain fully believes it.

Here’s how to start building trust again:
* predictable routines
* slow breathing
* graded exposure
* positive self-talk
* body awareness
* avoiding overthinking
* celebrating progress

Keep going! You’re healing more than you realize.

22/01/2026

Healing is not an intellectual process, it’s experiential.
You can understand pain science perfectly and still hurt.

The nervous system learns through:
• movement
• repetition
• safety
• predictability
• experience

This is why information alone isn’t enough!

You can’t think your way out of pain.
Your brain needs to feel safe, not just believe it conceptually.

Safe experience = new prediction.

When you perform a feared movement safely, your brain updates its prediction:

“This is okay now.”

Repetition locks in the new learning
• safe movement
• repeated often
• with calm breathing
• and no fear spikes

This rewires your system at a deep level.

Try this:

Choose one feared movement.
Make it tiny.
Do 3–6 reps daily.
Relax your jaw and shoulders.
Exhale slowly.

Information starts the journey.
Experience finishes it.

19/01/2026

Pain intensity is heavily influenced by emotion. Fear acts like a magnifying glass and it makes pain feel louder, sharper, and more alarming.

- Why fear magnifies pain
Fear increases:
* sympathetic activation
* protective tension
* attention to the area
* catastrophising
* avoidance patterns
* muscle guarding

All of this increases sensitivity and makes movements feel more painful.

Calm doesn’t erase pain instantly.
Calm simply removes the “amplifier.” This allows the volume to drop over time.

Here’s how to reduce pain with calm:
* long exhalations
* slow movement
* reassurance statements
* grounding (feet on floor)
* mindfulness of sensations without judgment
* breaking tasks into smaller steps
* gradual exposure

Repeated calm teaches the nervous system that the situation is safe.
 And safe nervous systems produce less pain.

28/12/2025

Pain is one of the most misunderstood experiences in healthcare, not because it’s mysterious, but because it’s often oversimplified.

I don’t see pain as a direct readout of tissue state.
I see it as a protective response, shaped by tissue input and by context, learning, and uncertainty.

Tissues matter. Injuries matter. Healing matters.
But tissues exist within a nervous system that is constantly deciding how much protection is required.

Clinically, this explains why pain can:
• persist after healing
• fluctuate without new injury
• change with stress, sleep, or expectations
• improve before strength or flexibility return

Understanding pain helps reduce fear.
But experience, carefully guided, graded experience, is what actually changes sensitivity.

I have found that this way of thinking doesn’t minimise pain, it makes it more navigable.

23/12/2025

🎄✨ Festive Season Opening Hours ✨🎄
The holidays are a time for family, food, travel… and sometimes a few extra aches and pains.

We’re open throughout the festive season to keep you moving and feeling your best, except for Christmas Day and New Year’s Day, when we’ll be taking a short break.

Whether it’s post-travel stiffness, end-of-year tension, or getting your body ready for a well deserved holiday, we’re here for you.

Wishing you a joyful, restful, and pain-free festive season! 🎅

Address

2 Meyrickton Place
Hillcrest
3650

Opening Hours

Monday	07:30 - 16:30
Tuesday	07:30 - 16:30
Wednesday	07:30 - 16:30
Thursday	07:30 - 16:30
Friday	07:30 - 16:30

Website

https://www.drneilcuninghame.com/chiropractic-online-booking/

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