Exercise for Pain Relief
October 13, 2009 Written by JP [Font too small?]The last thing anyone wants to do when in pain is exercise. Certain injuries require allowing the body time to recover. However, mental and physical discomfort shouldn’t always be used as an excuse to slow down. In fact, many times, the desire for bed rest may actually be counterproductive. This certainly appears to be the case with some very common, inflammatory conditions that affect both the body and the mind.
A new scientific publication called the Cochrane Database Systematic Review was just released. The focus of the current issue is the role exercise can play in the management of rheumatoid arthritis (RA). RA is an inflammatory condition whereby the body’s immune system attacks its own connective tissue and joints. This disease is not only painful, but it is also progressive and can lead to various degrees of physical disability. The Cochrane summary examined 8 studies that involved a total of 575 participants. The authors determined that specifically tailored exercise programs helped to improve endurance, strength and overall physical function in patients with RA. They also point out the utility of water based exercises in this population. (1)
Pool exercise has recently been studied with regard to another syndrome known as fibromyalgia (FM), a condition that affects both the body and mind. Common physical symptoms include aches and pains (tender spots) in joints and muscles. On the psychological front, anxiety, depression, fatigue and poor sleep are frequently reported. A new study involving 134 women with FM and 32 with “chronic widespread pain” was presented in the September issue of the Journal of Rehabilitative Medicine. Half of the female participants engaged in 20 sessions of pool exercises and attended 6 educational classes relating to their respective conditions. The remaining study volunteers only took part in the class work – which included no added exercise. Two tests were used to determine the effects of the different treatments – a Fibromyalgia Impact Questionnaire (FIQ) and a 6-minute walk test (6MWT).
- All those in the pool exercise group reported significant improvements in their FIQ scores.
- Women who attended at least 60% of the pool sessions found benefits in both FIQ parameters and the 6-minute walk test.
The effects of the water-based exercise appeared to be long lasting, but those with milder symptoms responded in a more profound manner. Another 32 week trial recently found reductions in body pain, emotional problems and improvements in general health, muscle strength and vitality in 30 women with fibromyalgia who participated in “warm water exercises”. (2,3)
The strategic use of exercise can also improve the prognosis for patients with a very common, degenerative form of arthritis known as osteoarthritis (OA). 389 older, overweight patients with knee arthritis were randomly placed in one of two treatment groups. The first set was put on a prescribed diet to promote weight loss. The second group was assigned “quadriceps strengthening exercises” and the same eating plan. The diet called for a calorie reduction of 600 per day. Both treatments were performed by the volunteers in their own homes. They were regularly monitored by researchers from the University of Nottingham over the course of two years.
- The leg muscle strengthening exercises did, in fact, significantly reduce knee pain and improve knee function as compared to diet alone.
- Weight loss was not associated with decreased pain but did lead to declines in depression.
It’s important to note that the benefits of this treatment protocol were most apparent at the 24 month mark. This is both a blessing and a curse. The good news is that the effects appear to be cumulative and long lasting. The down side is that this sort of program requires dedication and patience. (4)
Physical pain isn’t the only variety of discomfort that responds to an appropriate exercise routine. Another study, also from the University of Nottingham, recently determined that “mentored exercise” can assist women with chronic depression. Previous studies at the university found that physician prescribed exercise programs rarely improved psychological outlook because of low rates of compliance. So for this experiment, 40 depressed women were asked to attend a specially designed program that set out to improve attendance. The newly designed routine involved: a) three visits to the gym a week; b) a half hour “motivational coaching session” prior to exercise and; c) treadmill walking that was supervised by a “sports therapist”. The women exercised as a group in a friendly environment which provided emotional and social support. A comparison group was asked to engage in a more standard “exercise as usual” program. The women who took part in the mentored routine reported dramatic improvements in their mood, quality of life and self esteem. The standard exercise group didn’t detect any noteworthy benefits. (5)
It is my sincere hope that the future of medicine will include more specialized exercise programs. The potential of such therapies seems boundless, yet largely untapped. When I read trials about exercise benefiting breast cancer survivors or helping those with binge eating disorders, I wonder why this isn’t a cornerstone in modern health care. My sense is that doctors need more conviction about the efficacy of such practices. A long term exercise routine is a significant investment that requires a commitment of time and energy. I think some physicians believe that their patients aren’t willing to put forth that level of effort – especially if they’re already in pain. Taking a pill or undergoing a surgical procedure seems so much easier. But the difference is that exercise can often times improve the condition of both body and mind. Instead of side effects from drugs or complications from surgery, we can reasonably predict “side benefits” from physical therapy. I personally believe this a pretty good trade off. If you agree, please let your doctor know that you’re interested in learning more about the use of exercise to promote true wellness. (6,7)
Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!
Be well!
JP
Tags: Arthritis, Exercise, Fibromyalgia
Posted in Alternative Therapies, Bone and Joint Health, Mental Health
October 14th, 2009 at 4:34 am
just visited your blog and found really nice articles thanks for sharing also done email subscription so i can get posts daily thanks
October 14th, 2009 at 12:25 pm
Thanks!
Be well!
JP
October 15th, 2009 at 2:06 am
I am impress with the table you have here. It is really the reality why people can’t go out and do exercise for so many reasons. This article can make them change there mind and might be we all bumped together on the park after reading this.
October 15th, 2009 at 11:30 am
Thank you, Dean. 🙂
Be well!
JP
October 26th, 2012 at 1:08 pm
Nice read, good advice and great way to present it!
March 2nd, 2015 at 2:37 pm
Update: Omega-3 fatty acids may reduce exercise-induced muscle damage and inflammation …
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342081/
J Int Soc Sports Nutr. 2015 Feb 19;12:10.
The effects PCSO-524®, a patented marine oil lipid and omega-3 PUFA blend derived from the New Zealand green lipped mussel (Perna canaliculus), on indirect markers of muscle damage and inflammation after muscle damaging exercise in untrained men: a randomized, placebo controlled trial.
BACKGROUND: The purpose of the present study was to evaluate the effects of PCSO-524®, a marine oil lipid and n-3 LC PUFA blend, derived from New Zealand green- lipped mussel (Perna canaliculus), on markers of muscle damage and inflammation following muscle damaging exercise in untrained men.
METHODS: Thirty two untrained male subjects were randomly assigned to consume 1200 mg/d of PCSO- 524® (a green-lipped mussel oil blend) or placebo for 26 d prior to muscle damaging exercise (downhill running), and continued for 96 h following the muscle damaging exercise bout. Blood markers of muscle damage (skeletal muscle slow troponin I, sTnI; myoglobin, Mb; creatine kinase, CK), and inflammation (tumor necrosis factor, TNF-α), and functional measures of muscle damage (delayed onset muscle soreness, DOMS; pressure pain threshold, PPT; knee extensor joint range of motion, ROM; isometric torque, MVC) were assessed pre- supplementation (baseline), and multiple time points post-supplementation (before and after muscle damaging exercise). At baseline and 24 h following muscle damaging exercise peripheral fatigue was assessed via changes in potentiated quadriceps twitch force (∆Qtw,pot) from pre- to post-exhaustive cycling ergometer test in response to supra-maximal femoral nerve stimulation.
RESULTS: Compared to placebo, supplementation with the green-lipped mussel oil blend significantly attenuated (p < 0.05) sTnI and TNF-α at 2, 24, 48, 72 and 96 h., Mb at 24, 48, 72, 96 h., and CK-MM at all-time points following muscle damaging exercise, significantly reduced (p < 0.05) DOMS at 72 and 96 h post-muscle damaging exercise, and resulted in significantly less strength loss (MVC) and provided a protective effect against joint ROM loss at 96 h post- muscle damaging exercise. At 24 h after muscle damaging exercise perceived pain was significantly greater (p < 0.05) compared to baseline in the placebo group only. Following muscle damaging exercise ∆Qtw,pot was significantly less (p < 0.05) on the green-lipped mussel oil blend compared to placebo. CONCLUSION: Supplementation with a marine oil lipid and n-3 LC PUFA blend (PCSO-524®), derived from the New Zealand green lipped mussel, may represent a useful therapeutic agent for attenuating muscle damage and inflammation following muscle damaging exercise. Be well! JP
March 19th, 2015 at 12:53 pm
Update: Hydrotherapy also benefits patients living with fibromyalgia …
http://www.ncbi.nlm.nih.gov/pubmed/25786047
Clin Exp Rheumatol. 2015 Mar-Apr;33 Suppl 88(1):73-81. Epub 2015 Mar 18.
Effects of a hydrotherapy programme on symbolic and complexity dynamics of heart rate variability and aerobic capacity in fibromyalgia patients.
OBJECTIVES: To evaluate the effects of a hydrotherapy programme on aerobic capacity and linear and non-linear dynamics of heart rate variability (HRV) in women with fibromyalgia syndrome (FMS).
METHODS: 20 women with FMS and 20 healthy controls (HC) took part in the study. The FMS group was evaluated at baseline and after a 16-week hydrotherapy programme. All participants underwent cardiopulmonary exercise testing on a cycle ergometer and RR intervals recording in supine and standing positions. The HRV was analysed by linear and non-linear methods. The current level of pain, the tender points, the pressure pain threshold and the impact of FMS on quality of life were assessed.
RESULTS: The FMS patients presented higher cardiac sympathetic modulation, lower vagal modulation and lower complexity of HRV in supine position than the HC. Only the HC decreased the complexity indices of HRV during orthostatic stimulus. After a 16-week hydrotherapy programme, the FMS patients increased aerobic capacity, decreased cardiac sympathetic modulation and increased vagal modulation and complexity dynamics of HRV in supine. The FMS patients also improved their cardiac autonomic adjustments to the orthostatic stimulus. Associations between improvements in non-linear dynamics of HRV and improvements in pain and in the impact of FMS on quality of life were found.
CONCLUSIONS: A 16-week hydrotherapy programme proved to be effective in ameliorating symptoms, aerobic functional capacity and cardiac autonomic control in FMS patients. Improvements in the non-linear dynamics of HRV were related to improvements in pain and in the impact of FMS on quality of life.
Be well!
JP
May 18th, 2015 at 4:10 pm
Update 05/18/15:
http://www.jissn.com/content/12/1/22
Influence of a montmorency cherry juice blend on indices of exercise-induced stress and upper respiratory tract symptoms following marathon running—a pilot investigation
Background: Prolonged exercise, such as marathon running, has been associated with an increase in respiratory mucosal inflammation. The aim of this pilot study was to examine the effects of Montmorency cherry juice on markers of stress, immunity and inflammation following a Marathon.
Methods: Twenty recreational Marathon runners consumed either cherry juice (CJ) or placebo (PL) before and after a Marathon race. Markers of mucosal immunity secretory immunoglobulin A (sIgA), immunoglobulin G (IgG), salivary cortisol, inflammation (CRP) and self-reported incidence and severity of upper respiratory tract symptoms (URTS) were measured before and following the race.
Results: All variables except secretory IgA and IgG concentrations in saliva showed a significant time effect (P <0.01). Serum CRP showed a significant interaction and treatment effect (P < 0.01). The CRP increase at 24 and 48 h post-Marathon was lower (P < 0.01) in the CJ group compared to PL group. Mucosal immunity and salivary cortisol showed no interaction effect or treatment effect. The incidence and severity of URTS was significantly greater than baseline at 24 h and 48 h following the race in the PL group and was also greater than the CJ group (P < 0.05). No URTS were reported in the CJ group whereas 50 % of runners in the PL group reported URTS at 24 h and 48 h post-Marathon. Conclusions: This is the first study that provides encouraging evidence of the potential role of Montmorency cherries in reducing the development of URTS post-Marathon possibly caused by exercise-induced hyperventilation trauma, and/or other infectious and non-infectious factors. Be well! JP
June 6th, 2015 at 7:47 pm
Update 06/06/15:
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127012
PLoS One. 2015 May 26;10(5):e0127012.
Hyperbaric oxygen therapy can diminish fibromyalgia syndrome – prospective clinical trial.
BACKGROUND: Fibromyalgia Syndrome (FMS) is a persistent and debilitating disorder estimated to impair the quality of life of 2-4% of the population, with 9:1 female-to-male incidence ratio. FMS is an important representative example of central nervous system sensitization and is associated with abnormal brain activity. Key symptoms include chronic widespread pain, allodynia and diffuse tenderness, along with fatigue and sleep disturbance. The syndrome is still elusive and refractory. The goal of this study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) on symptoms and brain activity in FMS.
METHODS AND FINDINGS: A prospective, active control, crossover clinical trial. Patients were randomly assigned to treated and crossover groups: The treated group patients were evaluated at baseline and after HBOT. Patients in the crossover-control group were evaluated three times: baseline, after a control period of no treatment, and after HBOT. Evaluations consisted of physical examination, including tender point count and pain threshold, extensive evaluation of quality of life, and single photon emission computed tomography (SPECT) imaging for evaluation of brain activity. The HBOT protocol comprised 40 sessions, 5 days/week, 90 minutes, 100% oxygen at 2ATA. Sixty female patients were included, aged 21-67 years and diagnosed with FMS at least 2 years earlier. HBOT in both groups led to significant amelioration of all FMS symptoms, with significant improvement in life quality. Analysis of SPECT imaging revealed rectification of the abnormal brain activity: decrease of the hyperactivity mainly in the posterior region and elevation of the reduced activity mainly in frontal areas. No improvement in any of the parameters was observed following the control period.
CONCLUSIONS: The study provides evidence that HBOT can improve the symptoms and life quality of FMS patients. Moreover, it shows that HBOT can induce neuroplasticity and significantly rectify abnormal brain activity in pain related areas of FMS patients.
Be well!
JP
November 2nd, 2016 at 6:44 pm
Updated 11/02/16:
https://www.ncbi.nlm.nih.gov/pubmed/27797669
Int J Yoga Therap. 2016 Jan;26(1):93-100.
Mindful Yoga Pilot Study Shows Modulation of Abnormal Pain Processing in Fibromyalgia Patients.
Published findings from a randomized controlled trial have shown that Mindful Yoga training improves symptoms, functional deficits, and coping abilities in individuals with fibromyalgia and that these benefits are replicable and can be maintained 3 months post-treatment. The aim of this study was to collect pilot data in female fibromyalgia patients (n = 7) to determine if initial evidence indicates that Mindful Yoga also modulates the abnormal pain processing that characterizes fibromyalgia. Pre- and post-treatment data were obtained on quantitative sensory tests and measures of symptoms, functional deficits, and coping abilities. Separation test analyses indicated significant improvements in heat pain tolerance, pressure pain threshold, and heat pain after-sensations at post-treatment. Fibromyalgia symptoms and functional deficits also improved significantly, including physical tests of strength and balance, and pain coping strategies. These findings indicate that further investigation is warranted into the effect of Mindful Yoga on neurobiological pain processing.
Be well!
JP