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Pain: to move or not to move: that is the question

When pain strikes many people reach for what they perceive to be the best way to manage it, namely pain killers, and then they rest, hoping that this combination will help. Sometimes it does, in the case of an acute injury, the first few days may require this approach.

In the case of back pain, the first thing to say is that, in most cases the cause is unknown. Though it can vary from aches to acute debilitating pain, it is still generally termed as non-specific low back pain. The reason being that on X-Ray/MRI there is usually no identifiable structural cause for the pain. That does not mean it is not there, it simply means that there is no significant causative damage.

Pain relief in the form of paracetamol and ibuprofen anti-inflammatories are the typical go-to analgesics used in these circumstances. Stronger versions and alternatives like antidepressants and muscle relaxants can also be prescribed by GPs but the most important thing you can do is MOVE.

Movement provides what is termed exercise analgesia. You may have heard of the "runners’ high" but there is also a thing called "runners’ analgesia. This occurs because the body releases endorphins. Endorphines are the body’s own version of morphine. So not only does exercise make you feel good but it also induces pain relief.

There are various ways that this happens:

Pain control from above:

Pain is in your head, literally. The brain has an active say in whether pain occurs and how painful it is. This is pain control from above means that the brain can reducing the sensation of pain though certain nerve pathways descending into the body. The suppression focuses on certain nerve fibres (called C fibres). Information from them is tuned out while still on the alert for new information from faster acting A fibres. Vigorous exercise activates this system and people who exercise like this tend to have high functioning descending inhibitory systems while those with chronic pain tend not to.

Immune System Changes:

Physical activity can affect pain by causing changes to the way the immune system works. Exercise can, for example, influence types of cells that are more likely to release anti-inflammatory rather than pro-inflammatory substances.

Pain Stops Pain:

Exercise may reduce pain through conditioned pain control or counter-irritation. This is where pain inhibits pain. So if pain is caused by pressure, for example, and the individual person is exposed to cold water which is also uncomfortably painful, the next time they are exposed to the pressure pain they will report this as being less painful. This mechanism is thought to be the likely mechanism for pain reduction in manual therapy. This includes deep massage, acupuncture, soft tissue manipulation and even foam rolling.

It is worth mentioning that exercise is less effective in those with IBS, TMJ dysfunction, tension headache, fibromyalgia and depression.

In the next post you will find out more about how exercise can help with pain management.

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