Most would agree that exercise is a key component for any type of rehabilitation whether it be following an injury or for when managing chronic pains.
So.... what type of exercise? How much of it should I do? Does it depend on my specific condition? How long will any pain killing effects last? How big will these effects be? These are all sensible questions that will probably surface in your mind.
These are similar to the questions that Kelly Naugle and her team in the US at the pain research and intervention centre for excellence set out to answer when they reviewed a group of key papers addressing this topic source…
In healthy people, aerobic exercise (cardiovascular exercise) , resisted isometric exercise (working a muscle while it stays the same length e.g holding a bag of shopping) and resisted dynamic (muscle changes length) exercise were all were found to have significantly large effects when it came to reducing pain.
For those with chronic lower back pain, a moderate to high level of improvement was seen with all three types of the prementioned exercises. For those with fibromyalgia and chronic fatigue a good effect was found only with low level isometric exercises while aerobic exercises at a moderate to high intensity only made symptoms worse. Interestingly, patients that presented with widespread chronic pain found that exercising their non painful muscles on their symptom free side lead to a significant reduction in their pain levels.
More specifically to chronic lower back pain patients, Hoffman and his team source found that 25 mins of cycling at 70% effort led to a reduction in pain in the regions of 2 mins later (28%) and 32 mins later (22%). The patients in his study were on average 40 years old with a 7 year history of lower back pain.
What can we take from this?
Exercise in general, has a mostly positive effect on reducing pain. How you exercise for your specific condition may be slightly different from others. This can be guided by your Consortium physiotherapist. In general however, if you suffer from chronic lower back pain, then the research strongly suggests a combination of all types of exercise and that a moderate to high intensity is likely to be most effective. The fact that Hoffman and his team had such good results from cycling may be because a bike could be less likely to aggravate their back when compared to walking and running activities. Alternatively, if you suffer from other chronic pain states such as fibromyalgia then his research suggests it may be more sensible to start with low level isometric exercises for the best analgesic effects.
It is clear therefore that exercise has a significant systemic effect (one that effects the whole body rather than an individual joint) on reducing pain levels in both healthy individuals and in those with complex pathologies. Exercise is likely to activate a number of natural pain killing hormone systems that the body possesses. These include opiod systems source (release of central endorphins), non opiod systems source (release of serotonin and noradrenaline). An increase in heart rate and blood pressure leads to the production of neurotransmitters source such as a number of neuropeptides that block signals from crossing junctions between nerves (similar to how pain killers work).
Exercise should therefore remain an essential component in any rehabilitation program, especially if you have chronic pain. Hopefully this article provides you with some insight into how best to go about this. This can obviously be guided more accurately by any of our skilled physiotherapists and used in combination with other interventions we can provide to get you as active and as symptom free as you can realistically be.
Thanks for reading