Exercise against pain. Part II

When we experience pain, it’s tempting to retreat into bed, but sometimes it can make the problem worse. In fact, people who exercise are able to manage their pain much better than those who don’t. There are several ways in which exercise can help in pain management, and each is due to effects in the body or in the brain.

Improving biomechanical factors, such as muscle strength, flexibility and joint alignment, is thought to have an important role in management of chronic painful joint conditions, such osteoarthritis. A systematic review* of trials investigating the effectiveness of exercise for knee arthritis - a common cause of chronic pain - found that both aerobic exercise and muscle strengthening exercise were effective for pain relief.  Another systematic review found that exercise reduced reported pain levels by 12 points on a scale of 0-100, with an accompanying small reported improvement in overall quality of life. A subset of studies followed up between two and sixth months later found that the improvement was sustained.

Back pain - the leading cause of work absence and disability - is more complex, as the physical causes are sometimes interleaved with emotional causes, such as stress or depression. This is where the brain comes in - exercise is uniquely placed to reduce stress and alleviate depression at the same time as improving physical factors. Exercise produces endorphins, which interact with the opiate receptors in the brain to reduce our perception of pain in a similar way to drugs such as morphine and codeine but without the risk of addiction. It is particularly effective in social exercise activities, compared to similar solo training (laughter in social situations has a similar effect). Well-meaning friends will tell you to “take it easy” when you have back pain, and at one time doctors even prescribed bed rest, which is fine for a few days after a pulled muscle, but if we rest too much, the supporting muscles of the back will begin to weaken, potentially reducing recovery, and if we miss out on our regular social activities for too long, our mood may be adversely affected.

Those of you who do Pilates will not be surprised to learn that in a randomised controlled trial, Pilates has been shown to alleviate chronic low back pain. However, a systematic review found that other prescribed exercise training also helped with low back pain, and there was no evidence to demonstrate that Pilates was superior. However, I would argue that the accessibility of Pilates and its integration into daily life gives it a very important place in the prevention and management of back pain.

More generally, exercise improves mood, and people who are in a better mood report less pain and demonstrate increased pain tolerance. In other words, it takes more pain for you to feel uncomfortable. Even if you are not suffering pain, it is self-evident that improved mood is a good thing.

So, before you reach for the painkillers and wrap yourself in a duvet, just think about when you’ll be getting out of there, and how you’re going to move yourself when you do. And even if you can’t go all out with your regular exercise regime, keep moving, keep socialising, and laugh.

*I have referred mainly to systematic reviews here, because individual studies can have misleading results, due to small sample sizes and potentially weak methodologies. Systematic reviews pool together the results of the best studies in a meta-analysis to find the overall picture.

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