If I Have Chronic Pain, Should Exercise Hurt?

Pain, although a necessary part of living our lives, is a nuisance when we are trying to return to things we enjoy or trying new activities. But is all pain bad during exercise? I came across a great article by Smith et al., which breaks down the impact exercise may have on pain (Article here). To summarize, here are the main points:

It Can Help Reduce Fear of Pain

Chronic pain may lead to fear of exercising or doing activities because it hurts. This may lead to a cyclical pattern where people become fearful of movement/activities. When you have this fear it may lead to more avoidance of activities. It becomes what seems like a never ending cycle. Exercise can be the way to break this cycle.

Allowing yourself to experience some controlled pain during exercise can serve to reduce the threat of pain and increase self-efficacy. Confidence in one’s ability to achieve a task in a certain situation can shift the expectation on how they will respond to the activity. These are all important aspects when uncertainty and fear are so high.

It Can Actually Reduce Pain

There are 2 proposed theories of how exercise can reduce pain.

  1. Endorphins
    1. This is probably the more common of the 2 theories. When exercising β€œfeel good” endorphins such as dopamine, serotonin and norepinephrine are released which help reduce the amount of pain we are experiencing.
  2. Conditioned Pain Modulation - Block Pain with Pain
    1. This is a process similar to what is seen with different soft tissue techniques in manual therapy/massage/myofascial release, etc. Where it hurts when a practitioner pushes on a sore spot but then this is followed by a relief of your pain.You are essentially blocking pain with pain.

Enhances Immune System Function

As our understanding of chronic pain increases, we see just how many body systems are involved. The immune system is thought to be a key player in chronic pain. Exercise has been shown to have a positive effect on our bodies ability to fight off bacteria and viruses through a cascade of mechanisms. Exercising with pain can reduce the amount of signals being sent to areas that increase inflammation in our body and improve our immune systems response to different stimuli.

In summary, the area of research around  the role exercise plays in chronic pain management is continuing to grow. In general, exercise is promoted because of the numerous proven health benefits. You can always start by moving a little more, challenging yourself a little more and setting attainable goals. When it comes to managing chronic pain and exercising, setting reasonable expectations/goals and appropriate safety measures can lead to success in returning to activities you enjoy.

Smith BE et al. Br J Sports Med July 2019 Vol 53 No 14