How Do I Know If My Symptoms are Neuroplastic?
One of the most frustrating things about chronic symptoms is that sometimes they make absolutely NO sense.
Your back hurts every time you sit at your desk, but somehow you sat through an entire movie last weekend without thinking about it.
You can eat a certain food one day and feel completely fine, then eat the exact same thing three days later and have symptoms for hours.
Your pain starts in your neck, moves into your shoulder, disappears for a few months, and then shows up somewhere else entirely.
Or maybe you’ve had test after test, tried treatment after treatment, and still don’t have a satisfying explanation for why you feel the way you do.
It’s easy to look at all of that inconsistency and think, My body is completely unpredictable.
But what if the inconsistency is actually telling us something?
Sometimes, the things about your symptoms that make the least sense can give us useful clues that the brain and nervous system may be involved.
First, what are neuroplastic symptoms?
Neuroplastic symptoms are real physical symptoms that are created or amplified when the brain and nervous system respond to safe signals as if they are dangerous.
This can include chronic pain, but the brain’s alarm system can affect much more than pain. People can experience symptoms involving digestion, fatigue, dizziness, headaches, muscle tension, and other body systems.
The word “neuroplastic” refers to the brain’s ability to change and learn.
Most of the time, we’re pretty grateful for that ability. It’s how you learned to drive a car without consciously thinking, Okay, right foot on the brake. Check the mirror. Turn the wheel. Eventually, your brain learned the pattern and started doing most of it automatically.
Unfortunately, the brain can also learn patterns we don’t want it to learn.
Sitting can become associated with back pain. Eating can become associated with stomach symptoms. Exercise can become associated with fatigue. A particular movement can become associated with danger.
Eventually, the response can happen so automatically that it feels like something that simply happens to you.
And in a way, it does.
You aren’t consciously creating the symptom.
Your brain has learned it.
So how can you tell if that might be happening?
I wish there were one test that could give us a nice, clear answer.
There isn’t.
Instead, I think of it as gathering evidence.
One clue by itself may not mean much. But when we start putting several pieces together, sometimes a pattern becomes pretty hard to ignore.
These are some of the things I pay attention to when I’m looking at symptoms with a client.
The symptoms don’t always follow their own rules
Maybe sitting usually hurts, but occasionally it doesn’t.
Maybe walking for twenty minutes around the grocery store is miserable, but you spent an hour walking around somewhere you love and realized afterward that you were fine.
Maybe mornings are normally awful, except for that random Tuesday when you woke up and felt surprisingly good.
When that happens, it’s very easy to dismiss the exception.
I just got lucky.
It was a good day.
I probably did something differently.
Maybe.
But I’m interested in the exception.
If the exact same body can do the exact same activity without producing the expected symptom, I want to know why.
That doesn’t prove the symptom is neuroplastic. But it tells us the response is capable of changing.
And that matters.
The symptoms have a habit of moving around
Maybe the pain started in your back, then your hip joined in.
Eventually the back improved, but now your neck hurts.
Maybe one side hurts for a while and then the other does. Or one symptom disappears just as another one seems to take its place.
Bodies are complicated, so symptoms moving around does not automatically mean they are neuroplastic.
But when symptoms repeatedly move, change, disappear, return, or behave in ways that are difficult to explain structurally, I pay attention.
The brain is capable of producing symptoms in more than one place.
It doesn’t have to stay loyal to the original location.
Stress and symptoms seem to know each other
Sometimes this connection is incredibly obvious.
Every time work gets crazy, my pain gets worse.
Other times, we have to do a little detective work.
What was happening around the time the symptoms first started?
Was there a major transition? A loss? Conflict? Illness? A scary experience? A period where you felt overwhelmed or under enormous pressure?
Do symptoms flare during stressful periods and settle when life feels safer?
Do they mysteriously improve when you go on vacation?
And sometimes I hear, “But I wasn’t stressed when this started.”
That may be completely true.
The nervous system responds to much more than the conscious feeling of I am stressed right now.
So rather than deciding stress is or isn’t involved, I’m usually more interested in whether there is a pattern.
Your brain seems to have memorized certain triggers
This is one of the more fascinating things the brain can do.
A headache starts every afternoon around 3:00.
Your stomach hurts before you leave the house.
Your back starts hurting within minutes of sitting in that chair.
Symptoms show up when you drive, exercise, eat a particular food, lie down to sleep, enter a certain building, or sometimes just think about doing the thing that has caused symptoms before.
Understandably, this usually makes the trigger look guilty.
See? Every time I do this, I get symptoms. This must be causing them.
Sometimes it is.
But sometimes the predictability itself is worth looking at.
Brains learn associations. If something has repeatedly happened alongside pain or another frightening symptom, the brain can begin anticipating danger when it encounters that same situation again.
It has learned: This thing = danger.
And that expectation can become part of the symptom cycle.
Your symptoms can get quieter when you’re not paying attention to them
This is an interesting one because people sometimes feel almost offended by it.
You’re having symptoms. Then a friend calls, something happens with your kids, you get absorbed in a project, or you start watching a movie that completely pulls you in.
An hour later you realize:
Wait. Where did the pain go?
And almost on cue, you check for it.
There it is.
That does not mean you imagined the pain the first time.
Attention can influence our experience of symptoms. So when a symptom changes substantially depending on what you’re doing, where your attention is, or how threatened you feel in that moment, I consider that another piece of the larger picture.
Not proof.
A clue.
The injury healed, but the alarm didn’t get the memo
Not all neuroplastic symptoms appear out of nowhere.
Sometimes there really was an injury.
You hurt your back. Sprained an ankle. Had surgery. Got sick.
Your brain had a very good reason to protect you.
But eventually the tissue healed—and the symptoms stayed.
In some cases, the nervous system can remain protective even after the original injury has healed.
The fire is out. The smoke detector is still going off.
That doesn’t mean there was never a fire.
It means the alarm system may still be responding as though there is one.
The medical findings don’t explain the whole story
Sometimes every test comes back normal, even though the symptoms are anything but mild.
Other times something does show up on an MRI or another test, but it still doesn’t explain everything.
Maybe the symptoms are much more widespread than the finding would suggest.
Maybe treatment aimed at the suspected problem didn’t work.
Maybe it worked for three weeks and then everything came back.
Or maybe you’ve been given several different explanations over the years and none of them have quite accounted for what your body is doing.
None of this means medical findings should be ignored.
And a normal test does not automatically make a symptom neuroplastic.
It just means I don’t want to stop asking questions simply because we found something on a scan.
I want the explanation to make sense of the whole story.
And then there are the times your body surprises you
These are some of my favorite pieces of evidence.
You’ve been convinced you can’t walk more than half a mile without pain, then you accidentally walk much farther because you’re having fun and not thinking about it.
Sitting for an hour is supposed to cause a flare, but somehow dinner with friends lasts two hours and you’re okay.
You’ve been carefully avoiding a certain movement because it hurts every time you do it—and then you catch yourself doing the exact same movement automatically without pain.
Those moments are incredibly easy to explain away.
It was a fluke.
I got lucky.
I’ll probably pay for it tomorrow.
But hold on.
Your body just did the thing you thought it couldn’t do.
I want to know about that.
This is why I love an Evidence List
When you’ve been dealing with symptoms for months or years, your brain becomes an excellent lawyer for the case that something is wrong.
It has receipts.
Every flare. Every bad day. Every painful movement. Every time you tried something and regretted it.
The evidence on the other side tends to disappear pretty quickly.
That random pain-free afternoon?
We forget about it.
The walk you thought would hurt but didn’t?
Probably just a good day.
The symptom that disappeared completely while you were on vacation?
Interesting, but then it came back, so apparently it didn’t mean anything.
Except maybe it did.
That’s why I often have clients create an Evidence List.
We write down experiences that may point toward the brain and nervous system playing a role: inconsistencies, symptom-free experiences, changes with stress or attention, symptoms moving around, things the body unexpectedly tolerated, or anything else that doesn’t fit neatly into a purely structural explanation.
We aren’t trying to convince ourselves of something that isn’t true.
We’re making sure both sides get to present their case.
What if I’m still not sure?
You might be.
That’s okay.
You don’t need to reach 100% certainty before you can start considering whether neuroplasticity may be part of what’s happening.
At the same time, PRT is not about deciding that every unexplained symptom must be neuroplastic.
New, unexplained, or concerning symptoms should be appropriately evaluated, and medical conditions that require treatment should be treated.
And sometimes it isn’t either/or.
You can have a structural or medical issue and have a nervous system that has become sensitized and may be amplifying the symptoms associated with it.
So instead of only asking: Is this physical or neuroplastic?
I think a more useful question is: What does all of the evidence tell me about what might be driving my symptoms?
Want to look at your own symptoms?
If you were mentally checking boxes while reading this, I created a free Neuroplastic Symptoms Self-Assessment to help you look more closely at some of these patterns in your own experience.
It isn’t a diagnosis, and no questionnaire can tell you with certainty what is causing a symptom.
But it can help you start gathering your own evidence.
And if you’re wondering what we actually do once we believe symptoms may be neuroplastic, you can read What Is Pain Reprocessing Therapy (PRT)? next.
Want to talk it through?
I also offer free 15-minute connect calls where we can talk a little about your symptoms, what you’ve already tried, and whether PRT and working together might make sense for you.
