Physical exercise is used as a tool for chronic pain relief

For 25 years, Wei Liu has practiced and taught tai chi, including for people with chronic knee pain, believing that the exercises strengthen the legs and impart calm.

So he started experimenting with tai chi and was surprised. A physical therapy professor at the University of Texas Health Science Center at San Antonio, he used motion capture sensors to analyze people’s movements during a typical tai chi session. He’s noticed people swaying and crouching, movements that can actually stress the knees and exacerbate pain for some people, not relieve it.

Today, Liu still tells students that tai chi is good for chronic knee pain — but not all the movements, or shapes, that make up a typical session. People with creaky knees should probably skip form 5 and 16 [movimentos da técnica milenar chinesa], which cause greater strain on the knee, according to their study. They could continue with form 2 and any other form that did not increase pain.

Liu’s study, and a large body of additional studies and experiments, demonstrate that movement is desirable and therapeutic for nearly all chronic pain sufferers. But finding the best activities to help someone deal with their specific pain may require mixing and matching exercise options, asking the right questions about why the person felt pain afterwards, and finding the right coach or physical therapist.

Exercise helps with pain relief

Not too long ago, most doctors and therapists advised people with chronic pain to rest and avoid activities, according to a 2017 review of studies related to exercise and chronic pain.

But evidence accumulating over the past few decades has shown that “being inactive tends to reinforce pain sensitivity pathways,” said Daniel Belavy, a professor of physical therapy at the University of Applied Sciences in Bochum, Germany, who studies how movement influences chronic pain, especially back pain.

Exercise, on the other hand, often reduces the sensation of pain immediately afterwards and raises people’s pain threshold, studies show. Its benefits, in fact, often eclipse those of other common treatment options, such as massage and stress management.

Today, “international clinical guidelines for most chronic musculoskeletal pain conditions recommend exercise therapy and physical activity as main treatments,” said Jonas Bloch Thorlund, a professor of musculoskeletal health at the University of Southern Denmark, who studies exercise and pain.

The problem is, while some form of exercise will usually help almost everyone deal with chronic pain, finding the right workout to relieve your particular pain often requires trial and error and persistence. Even activities that are famous for relieving pain don’t work for everyone.

find the right routine

Do yoga. In a 2020 review of research on yoga and similar practices, the authors concluded that yoga generally improves physical function, quality of life, and pain for many people with “osteoarthritis of the knee, rheumatoid arthritis, neck pain, back pain, head and low back pain”. But, according to the review, relief is usually mild, and some participants end up reporting more pain after starting yoga.

The same dynamic occurs in other studies of exercise therapy for chronic pain. “Some people respond well” to yoga, tai chi, swimming, strength training or walking, and others don’t, said Melissa Phuphanich, a resident of physical medicine at the University of California at Los Angeles, one of the authors of the 2020 analysis.

The good news is that this same inconsistency opens up options. “In osteoarthritis of the knee, which is one of my areas of research,” said Thorlund, “researchers can’t really find a big difference between different types of exercise” for pain control.

So, you could start with a short walk in a scenic spot, like a park, and see how your body reacts (after talking to your doctor, of course).

find the right place

Once you are authorized to exercise by a healthcare professional, assess your pain, life, schedule, tastes and finances as objectively as possible, as each of these influences your ideal exercise routine.

“Certain activities may be friendlier to people with certain limitations,” said Kirsten Ambrose, associate director of the Osteoarthritis Action Alliance at the University of North Carolina’s Thurston Arthritis Research Center.

“Weightless activities, such as water or pool exercise or cycling, may be more tolerable for some people with joint pain.” But joining a gym with a pool or buying a bike and riding the roads and paths can be intimidating or prohibitively expensive.

In that case, start small. “You don’t have to stick to traditional exercise, like walking on a treadmill for a certain number of minutes or miles,” Ambrose said. “You can garden or walk the dog. The goal is to increase the amount of time spent moving versus sitting.”

Follow the two-hour rule

Anyone starting a new exercise program, however, should be aware that exertion often hurts at first. A little soreness a day or so after an unfamiliar workout is normal and even desirable, as it indicates the muscles are reacting as they should to the exercise, Belavy said.

But it can be difficult to distinguish that pain from that which indicates further damage. So follow the two-hour rule, Ambrose said. “If the pain is worse two hours after you finish exercising than before you start, it’s a sign that you’ve overdone it and should lessen it next time.”

Also consult a physical therapist or clinical exercise physiologist if you are concerned that your physical activity routine will make your pain worse.

“Sometimes there are things you can’t see for yourself, like the way you’ve stressed yourself doing a particular move,” Belavy said. And ending this exercise in a hesitant or truncated manner can make it ineffective and even harmful to your joints and body.

As a result, “you may need to be gradually exposed to certain types of movements, even if they seem scary,” he said.

People with knee pain who worry about going up and down stairs, for example, may start by walking in the same spot, lifting their knees as if they were going up stairs, until they feel confident in that movement. “Professional guidance can help.”

Exercise is a placebo — and that’s okay

Know that some of the pain relief through exercise likely originates in your mind. “For many patients with chronic pain, whatever the treatment, much of the effect is contextual,” said Thorlund, who last year studied the impacts of telling people that exercise would decrease or increase their pain sensations afterwards, which , then it happened.

Contextual factors, he continued, are aspects of exercise that can be psychological or emotional, such as whether you like your physical therapist, like the color and size of your workout clothes, remember physical education classes in elementary school with nostalgia or fear and, yes, your instructor’s irritating enthusiasm in spinning class.

According to a broad review Belavy wrote with colleagues, exercise is only marginally better for treating chronic pain than placebos such as pills or fake electrical pulses that participants thought were painkillers. But people felt some relief in all cases, suggesting that placebos help lessen pain.

“Exercise definitely has beneficial effects on chronic pain,” Belavy said. But some of these effects depend on how well you expect the exercise to work.

So, if you’ve been exercising and your pain barely subsides, try changing something – or everything – in your workouts until you feel confident of the benefits. Try a variety of spinning instructors to find the one whose energy matches yours best. Buy new comfortable shoes, ask your physical therapist to update your waiting room playlist, or practice tai chi for the first time.

“Find the exercise that works for you and keep going,” Belavy concluded.

Translated by Luiz Roberto M. Gonçalves