Should all of our exercises be “pain-free”?

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I recently attended the Australian Physiotherapy Conference in Adelaide about a month ago. What I found very interesting while I was there, were the numerous discussions surrounding pain and how best we should answer the common questions asked by pain suffering patients, such as “why do I hurt?” and “what can I do so that I am no longer in pain?”. While these questions seem simple, they instead open up a world of answers comprising of the complex pain processes that exist within our brain. One of the hardest questions we have as physios, and more so to our patients, is understanding why pain can persist after we have given our injuries plenty of time to heal. For example, if you exercise, and you feel pain when exercising, why should you believe that exercise is helpful for it?  

First of all, what is pain? Pain is something that is described as a sensory and an emotional experience, and many factors will influence an experience of your pain. This is somewhat to the contrary of our traditional views of pain, where pain is perceived as a direct sign of tissue damage and that it should be avoided. And that is why, when exercising, it would be appropriate for you to believe that if you experience pain, that you should cease everything at once. This traditional view however implies that the pain experience is purely biomechanical i.e. pain = tissue damage. The flaw in this view is you cannot distinguish between sensation and your perception of pain. To put it simply, pain is a protective response – it is when our central nervous system perceives something as a threat. And psychosocial factors such as your memories, anxiety, beliefs and pain behaviours will influence the input of pain. That is why, when you feel stressed, you may feel all of your pains and aches heighten.

So why does exercise play a role in improving your pain? It’s because advice is often given by healthcare practitioners, by family and by friends on how to manage exacerbation of your musculoskeletal pain during activity and exercise. Usually this advice is rest. There is actually no literature out there that pain during exercise will exacerbate your pain in the long term, and in fact there is a short term benefit. If pain is perceived as non-threatening, it can help you maintain a good activity level, which can have a good influence on your recovery. Now, this is not to say that if you’re in a lot of pain that you should just “exercise through it”, but physiotherapists have the skills to encourage those with persistent pain, through education and rehabilitative interventions, to remain as physically active as they can. This relates directly to my ‘load and capacity’ blog written earlier on in the year where we as physiotherapists work with our patients to figure out what exactly is driving your persistent pain, looking at you holistically, so that you’re still able to achieve your rehabilitation goals without feeling like you need to be a couch potato in order to achieve tissue recovery.

Blog Article by: Dayna Fimmano, Physiotherapist @ComoPhysio

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