Author: Emilio Petras // Treating Professional
This article will provide an overview of the relationship between pain management and Exercise Therapy, including an explanation of why Exercise Therapy is essential, how exercise aims to assist in the management of pain and two case studies which explore what mechanisms and techniques Exercise Physiologist’s use to minimise the impact of pain on quality of life.
“One in 5 Australians aged 45 and over are living with persistent, ongoing pain. This pain can be disabling and stressful, making it hard for a person to work and do the things they enjoy.” Australian Institute of Health and Welfare (2020)
What is Exercise Therapy?
Exercise Therapy is a combination of physical treatment techniques to determine how the body responds to short-term physical stress (exercise) and how the body adapts to repeated exposure over time. An Exercise Physiologist, thus, applies Exercise Therapy to benefit those who are suffering from acute, sub-acute and chronic conditions allowing them to regain function and reduce their pain experience.
Why does pain occur?
When our body does not like the action we are completing, e.g. touching a hot stove or stubbing your toe, it sends a message to your brain which causes a pain response so that you recognise that this is not an ideal action and respond appropriately to the stimulus.
Subsequently, after your body has been exposed to an injury and does not complete specific actions for long periods of time (e.g. moving your arm overhead after a rotator cuff tear or weight-bearing after an ankle break) your body sends a pain response as it is afraid of the injury re-occurring from this action. This mechanism is subconscious, so despite it seeming like a reasonable action to complete, your mind is slowly changing this to create fear-avoidant behaviours, causing further pain.
So, how does exercise aim to reduce this pain?
The main point is repetitions. “Neurons that fire together, wire together” was a phrase that I was taught when I was still at University, and it is one of the most important that I have learnt. So, therefore, by conditioning the body with exercise therapy to become more comfortable with a stimulus, over time, the learnt pain experience associated with this stimulus will reduce.
“Many people live with chronic pain 24/7. It is debilitating, exhausting and has an impact on all parts of a person’s life. Living like this takes courage and strength and could be referred to as “putting up with” the pain. The pain is in control and unpredictable.” #NPW2020
Exercise Therapy in action: Case study #1
The clearest example that I have seen of exercise therapy assisting in the management and reduction of the pain experience is with a gentleman that I treated last year. He was in his late 60’s and had completely torn his rotator cuff after falling off a ladder at work (he was a carpenter). For months he was suffering from significant pain that would increase dramatically when using his arm in any capacity, as a result he adopted a highly protective movement patten and avoided a large number of activities. During initial assessment, my client reported uncontrollable pain and was unable to identify specific aggravating movements, only confirming ‘everything hurt’. My client was deep into a boom/bust pain cycle and felt he had lost control of his ability to manage his recovery. Further to this, pain and pain management had never been explained to him across his treatment intervention to date; from that point I knew we had to start there.
When we first commenced his rehabilitation, we focused pain management education; using techniques in pain education, pacing strategy and implementing an activity diary to assist in identifying pain provoking movements and how to pace activities cross the day to ensure a significant flare-up in symptoms was avoided. This would allow my client to re-gain some control and understanding over his symptoms and his pain. Across this time, my client was also required to complete a daily ‘quota’ of movement and exercise therapy to improve motion, strength and confidence in movement. He continued to experience pain, but my client began to learn how is pain worked, what his pain tolerances were and how he could work within these tolerances and still engage in his life.
As treatment continued, my client continued to utilise pain management techniques (in particular pacing and his activity diary) in addition to his daily exercise therapy. Across time, he started reporting less pain for the same activities he was performing at the commencement of treatment, he noted his tolerances to activity had increased, despite his pain experience, in fact his pain experienced had reduced as well. Across a 12 week period, my client was able to progress from a fearful, avoidant individual who was riddled with and controlled by his pain, to a gentleman moving with ease, completing daily exercise therapy, attending the gym and a thorough knowledge of how to manage his injury, his pain and as a result engage in his life.
Exercise Therapy in action: Case study #2
Another example of this, was a middle-aged lady that I treated due to a whiplash injury. This client had a history of previous neck and shoulder injuries, being involved in two car accidents dating back ten years. She would consistently complain of instability when moving through full extension and rotation of her neck that would then cause a significant increase in pain. Through Exercise Therapy consisting of repetitive exercises in a comfortable range of motion, slowly increasing her strength and mobility, the results were the same. Suddenly work became thoughtless again, and she was able to complete her pre-injury tasks to return to work without concern.
These are only two examples, but time after time, I have seen the best results and recovery through the combination of consistent supervised and unsupervised sessions under the direction of an Accredited Exercise Physiologist prescribing evidence based Exercise Therapy techniques combined with pain management education in the management of pain.
Bringing it Together
Through completing exercise therapy under the guidance of a qualified Accredited Exercise Physiologist individuals can put their minds at ease knowing that their recovery is supported by evidence based practice in the area of the management of chronic and persisting pain.
Every year at the end of July, Chronic Pain Australia promotes National Pain Week to raise awareness of the impact of chronic pain on the lives of many Australians. I invite you to join this cause and being an advocate and let those who are experiencing extreme pain know that they are not alone. To learn more about pain, I highly recommend you visit the resources below: