Exercise and pain they are often interlinked. I’m not necessarily talking about full-blown exercise, but simple stretches or strength exercises you might be given as a part of your recovery and rehab. It depends on the person but maybe people in pain will normally do either two things, they will either be very enthusiastic going straight into rehab doing everything possible to get better or they will do the minimum or in many cases nothing. In my personal recovery from chronic pain I am convinced my success came from doing exercise starting with 30 secs reps on a bike to getting fully back into running. I am still the person that when injured will try to do exercise as I know I will feel better mentally after. However what is the real benefit from exercise and does it actually change the amount of pain that we do feel?
Exercise affecting pain perceptions:
The positive benefits of exercise on pain is not a new phenomenon, exercise has been proven effective at preventing, delaying and lowering the risk of long-term pain. (Sabharwal et al 2016)
In healthy individuals when you exercise the body will activate and inhibit the pain pathways from the brain increasing your pain threshold, making you feel less pain during and immediate after exercise. It can also increase the body’s natural opioid levels, reward pathways and reduce the amount of corticosterone that is produced in the body. (Pitcher et al 2017) Theses affects can also be seen in patients with chronic lower back pain. Furthermore they have found that muscle contraction in the area of pain in patients with both rheumatoid and osteoarthritis can also create a generalise pain killing effect throughout the body. Another factor that was found was if you exercise muscles away from your area of pain, say you do an arm workout in the gym when you have an ankle injury ,it will actually cause generalised pain relief actually helping reduce the pain in your ankle. Unfortunately it doesn’t work the other way around if you exercise the area near to your injury it doesn’t help with either general or local pain relief for your injury. (Nijs et al, 2012)
After a 12 week period of higher reps and increased number of exercises compared to a normal rehab in patella-femoral pain (runners knee) research showed that patients reported less pain by 1.6 on a scale of 0-10 as well as a increase in what they were able to do in their day to day life, with these benefits being maintained or increased a year later. (Osteras et al 2013)
However there has been research to show in some conditions where patients suffer from long-term pain and central sensitisation including fibromyalgia, the effect of exercise doesn’t have the same positive effects on pain thresholds. A review looking at exercise and lower back pain came up with some interesting results they found that exercise is not more effective than no treatment but is better than standardise care. Bit odd right? They also found that no particular exercise is better than others at helping their pain either. (Van Middlekoop et al 2010)
Exercise affecting physical aspects of chronic pain:
It isn’t very difficult to find articles stating that exercise is good for your health. Pilates for example has been proven to increase muscle flexibility and strength, quality of sleep and general quality of life. (Leopoldino et al 2013) Exercise even walking to the shop instead of taking the car, help develop and strengthen every part of your musculoskeletal system as well as your heart and lungs. Regular exercise will also help in weight loss and management as well as reducing your risk of high blood pressure, heart disease, stroke, diabetes and some cancers by up to 50%. (NHS) Regular exercise will also lower your risk of an early death by 30%. Weight-bearing exercise helps in improving your bone health, keeping them strong and increases their mineral density.
When researching this topic I have to say this next piece of research was the most interesting to read by far and certainly caught my eye. A study was done by Thomas et al (2016) that tested the affect playing virtual reality dodge ball had on chronic lower back pain, sounds fun right? The study showed that while there was no effect on the patient back movements when the patients weren’t playing dodge ball while they were playing the game they were actually able to bend forwards 10% more than when they weren’t. The researchers were excited that it might actually change the way that they body maps the area of the brain in chronic pain which is an indicator of whether the pain will be a long-term problem.
Exercises affecting Cognitive or mental factors of chronic pain:
Unsurprisingly I am not alone in feeling that exercise helped with my mental well being while I was in pain, though I have to say it has the same effects pain free. The evidence shows that it helps in increasing self worth, confidence as well as decreasing fear avoidance mechanisms. These may seem obvious and not a big deal but these factors can accuracy predict the treatment outcome in long and intermediate musculoskeletal pain conditions. Exercise can also be a great way to meet other people and manage symptoms of anxiety and depression even if it’s just walking the dog. The research with the patients playing dodge ball also found that by playing the game actually decreased their expectations of being in pain in the future. It also showed that it reduced their fear avoidance and got them doing movements that they would have considered too painful. However as they didn’t see the activity as threatening but actually fun, the patients were happy to attempt them.
On the other hand there has been research to show that patient with chronic pain actually perceive distance to be longer and hills to be steeper as it would take more energy to complete compared to being pain free. (Witt et al 2009)
Other affects of exercise on pain:
It was also shown that people doing exercise as a part of a long-term rehab structure actually took less time off work as a result, helping save companies millions of pounds. (Osteras et al 2008)
Research by the national sleep foundation has shown that physical exercise is now considered a treatment option for people with sleep conditions. As it helps improve their sleep quality, efficiency as well as helping in regulating their heart rate, mood, fatigue and energy levels, body composition. (Attarian et al 2014) Exercise is also proven to help reduce the risk of developing cognitive conditions such as depression, dementia and Alzheimer’s. There is also many studies showing the use of exercise in patients with long term pain helping their quality of sleep but also reducing symptoms and episodes of insomnia with as little as 1 and half hours of exercise a week. (Llanas et al 2008)
Recreational exercise has also been linked to increasing your immune system making you more resistant to viral and microbial infections. (Fleshner 2005)
Exercise may not be the miracle cure in every conditions and it is best to consult your medical practitioner before trying to do strenuous exercise however it is certainly worth trying to see if just adding a 5 minute walk or taking the stairs will help.
Østerås B, Østerås H, Torstensen TA, & Vasseljen O (2013). Dose-response effects of medical exercise therapy in patients with patellofemoral pain syndrome: a randomised controlled clinical trial. Physiotherapy, 99 (2), 126-31 PMID: 23219636
Østerås H, Arild Torstensen T, Arntzen G, & S Østerås B (2008). A comparison of work absence periods and the associated costs for two different modes of exercise therapies for patients with longstanding subacromial pain. J Med Econ, 11 (3), 371-81 PMID: 19450093
Medical exercise therapy breaks the chronic pain cycle, even in the longer term, in patients with persistent anterior knee pain. Body in Mind. MARCH 7, 2014
van Middelkoop M, Rubinstein SM, Verhagen AP, Ostelo RW, Koes BW, van Tulder MW. Best Pract Res Clin Rheumatol. 2010 Apr;24(2):193-204. doi: 10.1016/j.berh.2010.01.002. Review
Benefits of exercise, NHS Choices 13/07/2015
Fleshner M. Physical activity and stress resistance: sympathetic nervous system adaptations prevent stress- induced immunosuppression. Exerc Sport Sci Rev;33:120-126, 2005.
Sabharwal R, Rasmussen L, Sluka KA, Chapleau MW. Exercise prevents development of autonomic dysregulation and hyperalgesia in a mouse model of chronic muscle pain. Pain;157:387-398, 2016.
The long road of pain: chronic pain increases perceived distance. Witt JK, Linkenauger SA, Bakdash JZ, Augustyn JS, Cook A, Proffitt DR. Exp Brain Res. 2009 Jan;192(1):145-8. doi: 10.1007/s00221-008-1594-3.