I want to make it very clear from the start that I’m an enthusiastic advocate of exercise. I make my living out of helping people to exercise. Everyone can exercise, and we all should. The general benefits of regular exercise are almost endless, from reduced risk of many diseases, including many forms of cancer, cardiovascular disease, diabetes and some types of dementia, to increased self-esteem, improved emotional regulation and facilitation of social connections. Regular exercise is proven to increase both life expectancy and quality of life.
Exercise also has a significant role in managing pain, but the link is not as direct as most people think.
As a physiotherapist, and head of physiotherapy at Airspace, I always have in the back of my mind, ‘How can I get this person back exercising again?’ or ‘how can I help this person find a way to start to exercise regularly?’ regardless of why they present to me. This is because regular exercise, of any kind, is the best thing that a person can do for their health.
It’s more important for people to find a form of exercise they enjoy and can be consistent with than to focus on specific exercises or types of training to chase more targeted benefits. Yes, particular exercises can convey specific benefits (e.g. cardio for improving aerobic capacity and lower body strength for reducing the risk of falls); however, exercise only ‘works’ if you do it.
It’s a pervasive belief that specific exercises can fix pain, and it’s just not that simple. A classic example is core exercises for low back pain. Early studies identified reduced activation of core muscles in people with pain. The reasonable but inaccurate conclusion was that people have low back pain because of weak core muscles, so core strengthening will fix low back pain. May studies have since shown that reduced core activation is a symptom of pain, rather than the cause, and the vast majority of episodes of low back pain are not related to core weakness at all. Of course, a lot of people do find doing core exercises help their back pain. This doesn’t prove their core was weak, but rather highlights the general benefits of regular exercise and the amazing ability of our bodies to heal and adapt.
Some of the confusion about the role of exercise in managing pain is due to oversimplified understandings of what pain is. Pain is a complex, multifactorial, and subjective experience that is never only about what’s happening in tissues. In fact, the longer a person experiences pain, the less it is about injury, damage or tissue health and the more it relates to their psychosocial context and their systems perception of vulnerability to threat. While this seems counterintuitive, we all experienced pain in the absence of tissue damage (e.g. stepped on a lego) and injury in the absence of pain (e.g. unexplained bruises), so it’s clear the link between pain and damage isn't direct. While pain is often ‘mechanical’, meaning particular movements or activities trigger it (e.g. sitting for long periods), it doesn’t mean the cause of the pain is mechanical, that there is something wrong with you, or that you are somehow misusing your body. Rather than informing us of damage, pain is a sign that we are more vulnerable or susceptible to damage. Increased pain may be a sign that we are sick, stressed, overworked or generally not as healthy as we could be.
If we are not in pain because we are ‘too stiff, ‘weak’, ‘too mobile’ or there is something ‘wrong’ with us, then exercises that target these concerns won’t have any more benefit than general exercise, excepting the significant meaning effect due to the popularised belief that exercise directly impacts pain. Of course, if people are adamant they need core exercises to fix their back pain, ill give them core exercises whilst gently trying to guide them towards regular exercise that they may enjoy more because believing an exercise helps, helps but regular exercise helps more. Unfortunately, some people become despondent that exercise doesn’t ‘fix’ their pain when they think it should. It can be hard to encourage people to continue to exercise when they don’t see the direct effect. Regular exercise is even more important for these individuals because it provides consistent reassurance of safety and intention to self-care to vulnerable systems and the other well-documented benefits of exercise.
Exercise for pain is like money for happiness. The link isn’t direct, but it’s significant. You can’t buy happiness, but a certain income level will allow you to do what you need to, with enough to do things you enjoy or cope with unexpected ill-fortune. It’s possible to be happy with less money, but usually, life will be more stressful and less certain. In contrast, you could earn much more money and still be unhappy. Exercise doesn’t bulletproof you from experiencing pain, nor does it fix pain. If you don’t exercise, it doesn’t mean you will experience more pain than someone who does. Instead, exercise reduces the impact of pain on your life and increases your capacity to deal with times of increased vulnerability and sensitivity.