I’m in pain, can exercise help?

Back pain

Over 1.1 billion people suffer from musculoskeletal (e.g. muscles, bones, joints, tendons, ligaments) conditions every year and with these often comes chronic pain [1]. Over half of people with chronic pain experience some form of disability [2]. Often when we feel pain we have a desire to stay still and hope it passes and for those experiencing long-term (i.e. chronic) pain it can mean leading very sedentary lives and their pain levels increase over time, rather than decreasing. 

Knee pain

So, what can help?

To manage musculoskeletal pain, exercise is an option. Why is that you say? Because it can be effective (according to science), cheap and a safe therapeutic option and does not produce adverse effects like medications or surgery [2]. There are also added benefits because we know being physically active improves our sleep quality, activities of daily living, quality of life, physical function, mood and how we are feeling [2]. If you are leading a sedentary life, you will be more likely to experience some form of pain compared to those who are leading an active lifestyle [3]. For those who start to feel musculoskeletal pain they are also more likely to begin adopting a more sedentary (i.e. limited activity) lifestyle rather than getting moving to help reduce their pain [4].

Neck and shoulder pain

So, what should you do if you suffer from chronic musculoskeletal pain?

It’s important to remember that no single therapy will achieve significant pain relief [2]. However, having a multi-component approach is likely to maximise your benefits, reduce pain levels and minimise the adverse effects [2]. Often programs that combine different exercise types (e.g. aerobic, strength, flexibility and balance training) will be more effective and can be adapted more easily to the actual condition of the person. It is important when getting advice from a health or exercise professional that they understand your medical conditions, where you suffer from chronic pain, your strength and endurance levels, range of movement and balance, without these as a starting point you will just be given a program everyone else is given which may not help you to succeed. 

Swimming - aerobic exercise

The types of exercise that are most effective in reducing pain are aerobic and strength training. Stretching is less likely to see benefits and interestingly exercise may be more effective in reducing pain than massage [2]. You don’t need to be in a gym to achieve reductions in pain, but you do need to start moving, because that’s where the journey to pain reduction can begin. When we talk aerobic and strength exercise we often speak about intensities; low, moderate or vigorous. Some people think you have to go flat out (vigorously) to reduce pain, but some research shows that low and moderate intensity activity can achieve reductions in pain and often are more effective than vigorous intensity activity for some people [5]. However, the evidence is still unclear for how often you should be exercising to reduce pain, for people with knee osteoarthritis three times a week is recommended but more evidence is needed to be really sure. When looking at how much exercise should be undertaken each week to gain benefits and reduce pain, a study that combined many studies and then analysed the results (i.e. a meta-analysis) suggested no more than 120 minutes of exercise may be needed to see pain reduction, however they also stated there were limitations because so many of the studies had small sample sizes and the evidence about dose of exercise for pain reduction still isn’t clear [6].

Enjoying cycling at low intensity

I can try and give you all the data and evidence available, but for me the number one takeaway should be that the ideal amount, type of exercise, intensity of exercise and everything else you can think of is dependent on YOU and your condition (if you have one). If you suffer from chronic pain my suggestion is to work with an experienced health professional (e.g. exercise physiologist) who knows how to personalise your exercise program to your needs. This will require some experimentation, it’ll also require lots of questions and answers to find out what you like and what you don’t like, checking on your pain levels as you progress, and seeing this as a journey, not something that will be completed in the first week. If you find your pain levels don’t reduce when working with the first person, try someone else. Keep trying until you find someone who gets you and who is making a difference. If your pain doesn’t reduce and you’re doing land exercises, try doing something different in the water, this can often help relieve pain, for others it might be cycling that helps. It is incredibly important that you as the client or patient are actively involved in your training program; make sure you are happy with what gets prescribed for you, whether you like the type of activity (if you don’t you are likely not to continue so please speak up) and also be aware of what might stop you from doing it (the barriers). You need to be honest and let them know why you won’t do something because chronic pain is likely to not reduce but increase with doing nothing. Yoga can help some people with lower back pain and Tai Chi people with osteoarthritis and fibromyalgia, but if you don’t like the idea of doing either, can’t afford it or don’t want to travel to get there then there is no point in saying you need to try these types of exercise!

What will you do to try and reduce your pain levels if you have any? 

• If you don’t suffer from chronic pain, I am so pleased for you, hopefully you are leading an active lifestyle and if so, I encourage you to keep going

• If you do suffer from pain, what are you going to do to try and reduce it?

• Who will you seek help from? In Australia, older adults can get access to five free allied health appointments per year (chat with your GP about this), this may be a starting point if you can’t afford to see someone privately

• Please know that remaining sedentary over long periods of time is not great for your health (mental or physical) and is not good for reducing pain. Movement with purpose, especially aerobic or strength exercises can be of benefit

• Strength exercises that simply use body weight as resistance can be beneficial, start slowly and build up, your body will thank you

• Keep a log of your pain levels, even if it is from 1-10 and try and work out whether different exercises helped reduce that pain, it’s your body and you know it better than anyone

• If you start exercising for the first time in many years you may feel some different pain which is often called delayed onset muscle soreness or DOMS, this is just your body telling you you haven’t used those muscles in a long time, however, in the next 4-5 days your DOMS will reduce but your strength and endurance will start to improve, keep going

• You don’t have to exercise like an Olympian, light and moderate intensity exercise can reduce pain levels

• If you like setting goals, then set some for this too, open goals with no time limit can sometimes be less daunting, if you prefer this then give it a go

• Most importantly, do what you enjoy and what you will stick to over the long term. You may not fully get rid of all of the pain, but surely a reduction in pain is better than high levels that feel debilitating

• You can do this!

Live the good life!

Reference:

[1] World Health Organization. (2022, July 14). Musculoskeletal health [Fact sheet]. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions

[2] De la Corte-Rodriguez, H., Roman-Belmonte, J. M., Resino-Luis, C., Madrid-Gonzalez, J., & Rodriguez-Merchan, E. C. (2024). The role of physical exercise in chronic musculoskeletal pain: Best medicine—A narrative review. Healthcare, 12(2), Article 242. https://doi.org/10.3390/healthcare12020242 

[3] Zhaoyang, R., & Martire, L. M. (2019). Daily sedentary behavior predicts pain and affect in knee arthritis. Annals of Behavioral Medicine, 53(7), 642–651. https://doi.org/10.1093/abm/kay073 

[4] Bontrup, C., Taylor, W. R., Fliesser, M., Visscher, R., Green, T., Wippert, P.-M., & Zemp, R. (2019). Low back pain and its relationship with sitting behaviour among sedentary office workers. Applied Ergonomics, 81, Article 102894. https://doi.org/10.1016/j.apergo.2019.102894 

[5] Xu, Z.-H., Nan, A., Rui, C. J., & Yong-Long, Y. (2023). Modulation of pain perceptions following treadmill running with different intensities in females. Physiological Reports, 11(18), Article e15831. https://doi.org/10.14814/phy2.15831 

[6] Polaski, A. M., Phelps, A. L., Kostek, M. C., Szucs, K. A., & Kolber, B. J. (2019). Exercise-induced hypoalgesia: A meta-analysis of exercise dosing for the treatment of chronic pain. PLOS ONE, 14(1), e0210418. https://doi.org/10.1371/journal.pone.0210418