Stop doubting exercise. It works for chronic pain!

As a chiropractor, we know for decades (yes, decades) that exercise works well for chronic pain. Since the 1990s, research is able to show that exercise is an effective treatment. If we were to dig back further, exercise has been part of chiropractic since over a hundred years ago. So in that sense, exercise, really is the OG of musculoskeletal treatments.

Exercise is good for your body

We talked about how pain science tells us pain is not entirely physical. What we mean is that you can experience pain without any form of tissue damage. In fact, Lancet, one of the world’s most prestigious journals, have repeatedly emphasised that chronic pain often comes without tissue damage.

So in that sense, our recovery methods need a paradigm shift. We need to stop thinking exercising is bad for our joints. Ironically, we can show that not exercising is literally bad for your joints. And that weight-bearing (i.e., loading your joints) is important for joint health.

Wear and tear? Nope, Rheumatology (another prestigous journal) has downright published that the “wear and tear” narrative is archaic, pejorative, and inaccurate.

The moral of the story? Exercise away! It’s good for you. But if you have chronic pain or injury, maybe you need a little professional help with that.

We are all subject matter experts. True. But not in every field.

Let’s face it. We all need professional help in our lives. You did not build the house you are living in. Neither did you grow the vegetables you had yesterday for dinner. When it comes to recovery, it is no different.

If you are not getting better after 12 weeks, your pain is considered chronic (also known as persistent). This means you need a professional to help you help yourself find freedom from pain.

Yes, you are right in saying that there are lots of free resources online that can help you. However, knowledge on its own doesn’t translate to skill or expertise. You can read how to drive a car off a textbook and can even watch tutorial videos on YouTube. But does doing so make you a competent driver? No.

In fact, even with driving instruction, novice drivers still make mistakes. There’s no reason to think that the free resources that are available on the internet is enough to help you.

Exercise not only for your body but also for your brain

A new paper published a few days ago confirms that exercise is amazing. It’s not just me who is saying this. Virtually all clinical guidelines for musculoskeletal conditions such as back pain and neck pain agrees. Exercise is first-line treatment for your pain. In other words, choose exercise first.

But why?

Beyond that exercise builds healthy muscles and joints, they also affect how your brain work. We briefly discussed this previously when discussing about movement errors. When researchers assessed the bodily awareness of neck pain patients, they were found to be poor. Not only that but they found chronic pain patients to have lower grey matter density at regions of the brain which processed movement.

Okay, I know that’s a lot to process. To put it in simple words, living chronic pain changes the structure of your brain. It also literally makes you move more poorly compared to people without pain.

So, exercise for persistent pain is not just about making you stronger or fitter. It’s also about changing your movement patterns, and hopefully in doing so reverse some of the structural changes in your brain.

Altering your neural networks for better recovery outcomes

I promised you I am not just making this up. I promise you this is also not one of those new-age mind of matter junk science. JAMA, that is the Journal of the American Medical Association, published a few days ago that brain retraining works better than no brain retraining.

In their study of 276 participants, they found that pain patients who received graded sensorimotor retraining intervention responded than patients who didn’t. It’s super important to know that this exercise intervention is carried out while the patients are having lower back pain.

Ya, you can exercise with pain. Ya, it helps for you to exercise with pain. But again, don’t go around and anyhow humtum exercises from YouTube or Instagram okay? If it’s so easy to DIY from chronic pain, then why do we still see so many people who live in pain?

According to GSK, 85% of Singaporeans experience pain on a weekly basis. So ya, it’s a big deal. No, you cannot DIY your own recovery. No, it will not go away on its own (that’s why it’s called chronic/persistent).

Why am I tell you all this?

You need to know pain is not just pain. Yes, we trivialise it because we think can tahan equals we strong. No, it doesn’t. You tahan equals you suffer. The pain is still there. You are still living with it.

Pain is complex and multifaceted. Anyone who comes up with any singular hypothesis about why your pain hurts is probably wrong. Chiropractors like to say it’s all in the alignment. And chiropractic adjustments can fix it. Well, that’s not true. It’s too reductionistic to be true.

Similarly, tight muscles, muscle imbalances, posture etc are all not independent predictors of pain. In other words, they can aggravate your pain experience but they are not the “root cause” of your pain.

Yes, it challenges your belief system. Yes, it challenges what people say on social media. Again, this is why research is important and working with an evidence-based chiropractor can give you the best recovery outcomes.