Chronic musculoskeletal disorders are a prevalent and costly global health issue. While the “old-school” way of addressing chronic pain may have been finding exercises and activities which do not elicit any discomfort or pain, a newer form of exercise therapy focused on loading and resistance programs which temporarily (key word) aggravate a client’s symptoms has come to light. While many medical professionals may lack the confidence or communication skills required to prescribe this type of exercise approach, this article by Smith et al looked to compare the effect of exercises where pain was allowed and encouraged during exercise and how post-treatment results compared to those individuals who were prescribed non-painful exercises.
When looking into their data analysis and comparing subjective client-reported pain outcomes, there was a significant benefit within the short-term for exercises performed into pain as compared to pain-free exercises. When it came to comparing medium-term and long-term follow-ups, there seemed to be no difference when comparing painful vs pain-free exercises. So what does this tell us? For individuals experiencing chronic pain for greater than three months, there is proven benefit to prescribing exercises that will challenge and cause discomfort in session. The results of this very study prove that there will be positive, pain-related changes within the short-term when working into discomfort and minimal pain. With this however comes a challenge…to be able to educate and communicate to your clients that this soreness is safe and allows for a greater positive tissue response. The combination of having the confidence and competence to properly dose while educating your chronic pain clients will set you up for both immediate post-treatment pain relief as well as building a stronger therapeutic alliance.
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Smith BE, Hendrick P, Smith TO, et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. British Journal of Sports Medicine 2017;51:1679-1687.
