Exercise for pain – undated , sometime after 2012
This article points out the effects of exercise are very non-specific and different for individuals, and it may not be possible to know which are responsible for causing or alleviating pain.
A question I often ponder is – “Do we really know the mechanisms behind how exercise might help with pain?” And the honest answer is I don’t think we really do!
Article at a glance.
- We are mostly unsure of exactly HOW exercise can help for pain
- Part or all of this may not be specific to physical factors
- WHY people get better is not always clear when thinking critically
- We can under consider the non specific effects of exercise
- These include altering perceptions, locus of control, self efficacy and predicted expectations of outcome
- Non specific effects CAN affect more specific physical effects
- Your bias does NOT predict potential non specific effects
- There are very REAL neurobiological effects from non specific aspects on pain
- Collaboration, education and interaction may ALL help elicit non specific effects.
This paper HERE looks at whether exercise ACTUALLY helps, and it can, but HOW is a completely different question that is still mostly unclear.
Exercise in a therapeutic setting is still prescribed in very similar ways to how it is implemented in a non-therapeutic settings, in terms of sets & rep ranges, even though the therapeutic parameters or mechanisms of action maybe quite different and currently remain under explored.
I have previously discussed the subject of dosing HERE
I am increasingly drawn to the concept that a fair proportion of the effects of exercise may NOT be specifically physical in nature. We may not be able to attribute them solely to increasing range of movement, stability, strength, posture or whatever else we choose to measure and then attempt to effect.
This article HERE explores some non specific effects
We should also consider, however, how someone actually feels about what we are doing TO them or WITH them and how this affects the outcome.
Learning lessons from Manual therapy
The current understanding of the mechanisms behind manual therapy have not really aligned with what they were once thought to be since they have been explored in a research setting, even though they DO appear to have an affect on pain.
We can take a leaf out of the book of critical thinkers on this subject, such as Zusman HERE and Bialosky HERE, who critiqued the traditional biomechanical explanations and offered some alternative perspectives for WHY these techniques may have a positive effect.
Many of these factors will of course be present across lots of interventions, INCLUDING exercise.
The article goes on to elaborate on this point of view.