Chronic pain is inherently a multi-factorial experience, influenced by things such as past experiences with pain, how family/friends have described their pain experiences, pain-tolerance, beliefs about the causes and treatment of pain, the list goes on.
Naturally the response to experiencing chronic pain is vast and varied, ranging from naturopathy, medications, surgery and most commonly, rest. In some cases, these treatment methods are warranted and recommended by health professionals. However in virtually all cases, there is strong evidence in the science literature that recommends active treatment for long-term pain management, which has been demonstrated for a long time and continues to be demonstrated.
Chronic, or persistent pain is characterised as pain that exists for more than 3 months. There exists a multitude of reasons why persistent pain may occur, varying from a traceable event where trauma had occurred (such as an accidental contact in sports) to a non-specific cause (this refers to persistent pain where there is seemingly no medical cause for it, such as no traceable injury or no pathology detectable in a scan). In either case, the best case scenario for treatment is active treatment (whereby there is self-direction and proactivity in remaining active such as performing exercise with an exercise physiology) with passive treatment (where there is little to no self-directed movement such as relying on massages as treatment) as an adjunct.
There are various reasons why it’s the case that exercise therapy benefits persistent pain. The following are some of such benefits:
- Change physical parameters – Lack of strength, tightness, immobility or lack of motor control can result in compensatory postures or movements that gradually accumulate intolerable loading on certain body parts, ultimately resulting in either an injury or persistent pain. A thorough physical assessment via a physiotherapist or exercise physiologist can identify such physical parameters
- Psychosocial factors – These factors are as important if not more important than targeting physical parameters. These are things such self-efficacy, beliefs about pain, previous experiences with persistent pain, pain avoidant behaviours, catastrophising, etc. All of these has an influence on how one perceives their pain, where for example a rugby player will experience traumatic pain events such as a strong tackle far less significantly than someone who has never experienced pain before. As such, someone with many pain avoidant behaviours (such as never bending over if they have back pain due to fear of experiencing pain) will have an elevated pain perception. The role of exercise therapy is to demonstrate in a gradual and controlled manner that certain movements would not aggravate or worsen pain symptoms, easing one’s perception of their pain.
Although rest is important to people who experience acute pain, it is important to note that remaining active in a safe manner is vital to long term management of persistent pain, a specialty for both a physiotherapist or exercise physiologist.
Source: Cosio D, Lin E. Role of Active Versus Passive Complementary and Integrative Health Approaches in Pain Management. Glob Adv Health Med. 2018 Apr 10;7:2164956118768492. doi: 10.1177/2164956118768492. PMID: 29662720; PMCID: PMC5896844.
Title: Role of Active Versus Passive Complementary and Integrative Health Approaches in Pain Management
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