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Best Of Exercise for Pain Relief

February 7, 2011 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 recent Cochrane Database Systematic Review focused on 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 painful 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 recent trial involving 134 women with FM and 32 with “chronic widespread pain” was presented in the September 2009 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)

Update: February 2011 – What’s becoming more and more clear about the use of exercise for pain relief is that it must be applied in an individualized manner. Two recent studies in middle-aged women with fibromyalgia (FM) highlight this principle. The collective findings reveal that: a) isometric exercises tend to benefit women whose “fibromyalgia occurred at a younger age” and those “with the greatest experimental pain before exercise”; b) lower intensity exercise may be preferable from the standpoint of long term compliance. Also of interest is a current review in the Journal of Aging Research. It cites a number of mechanisms that underlie reduced pain perception in patients with osteoarthritis (OA) who stay active. The authors of the summary emphasize the seldom made point that “muscle weakness precedes the onset of OA symptoms”. They also single out “land-based aerobic exercise” as a particularly efficient means of protecting against OA, reducing arthritic pain and slowing osteoarthritic progression. Pilates and “therapeutic climbing” are other forms of exercise that have recently graced the pages of prestigious medical journals. A newly published meta-analysis involving 7 randomized controlled studies determined that Pilates exercises are capable of controlling nonspecific low back pain. However, the benefits were not found superior to other forms of physical activity. While the December 2010 issue of the journal Spine reveals that a specialized form of climbing therapy outperformed standard exercise therapy in patients with chronic low back pain. The authors of the trial noted that the therapeutic climbers experienced “greater perceived health and physical functioning” compared to the standard exercise group. This just goes to show you that there’s almost always a “right” way to exercise for everyone. But it’s up to you and your health care team to find it. (8,9,10,11,12)

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


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Posted in Alternative Therapies, Bone and Joint Health, Exercise

11 Comments & Updates to “Best Of Exercise for Pain Relief”

  1. lori sica Says:

    Hey JP,very timely post. I was just told I have shaved off cartilage in my hip.I was a college athlete and just turning 41, I am at my strongest and healthiest.The last three years included everything from snowshoeing to mma training. I have a challenge here, but plan to strengthen the surrounding muscles with PT and research like crazy to implement nutrition as well. I have been off training for 3 months, but plan to be an example of what this article embodies….thanks for the post.

  2. JP Says:

    Lori,

    Your dedication is inspiring. I wish you all the best in your healing quest!

    Be well!

    JP

  3. Tom Says:

    I have battled with back pain for the majority of my life now, at least as far back as I can remember. Like my father and grandfather did before me, we all lived a very active and sometimes carefree lifestyle from a young age. Although all the sports, racing dirt bikes, jumping off bridges and wrestling were all fun, we know that it all turns into a big pain in the back down the road.

    My father and grandfather have undergone back surgeries, both receiving artificial discs from the Texas Back Institute. I was beginning to take guesses at when I would be scheduling an appointment to get my new ones too, but I am hoping to put it off for as long as possible.

    After years of physical therapy and visits to the chiropractor I had begun to realize one recurring theme, it was the stretches. Stretching is key, each and every day. To me it makes a world of difference whether I get my morning stretch in or not. For me its all about routine and my fathers trainer recently suggested a great new product to him that makes it easier than ever.

    The TrainerMat contains a series of 28 stretches specifically engineered to strengthen the back and core muscles. Many of the exercises I was already using, but I did learn a lot of new ones from this mat. Also, the ease of use is phenomenal. Its hard to skip my routine when its laying out in the morning and all I have to do is look down to see which stretches and how long to hold them for.

    I do not think this product is some sort of miracle or gimmicky cure-all, but it takes proven routine and exercises and makes them very simple to follow. I have shown it to my doctor and he loves it.

    http://www.selftrainermat.com

  4. Pradip Gharpure Says:

    Nice information on pool exercise. New addition to our knowledge. I was many times wondering what some senior ladies or gents are doing in the pool , just standing or walking, when i visited some pools. NIce post . thanks again.

  5. JP Says:

    Update: Collagen supplement supports exercise recovery …

    http://www.jissn.com/content/pdf/1550-2783-11-S1-P48.pdf

    Effects of BioCell Collagen® on connective tissue protection and functional recovery from exercise in healthy adults: a pilot study

    Background: The extracellular matrix (ECM) of muscle, tendon, and ligament is sensitive to exercise-induced mechanical stimuli. Exercise-induced muscle damage is associated with not only myofibrillar injury, but also the involvement of connective tissue elements such as collagen, proteoglycans (PG), tendon and ligament. However, little is known about the impact of nutritional agents and metabolic optimization for enhancing adaptation and recovery of the connective tissue elements that support musculoskeletal function. BioCell Collagen® (BCC) is a patented hydrolyzed chicken sternal cartilage extract that contains a naturally-occurring matrix of hydrolyzed collagen type II, and low molecular weight glycosaminoglycans such as chondroitin sulfate and hyaluronic acid. The purpose of this pilot study was to determine the potential impact of daily supplementation with BCC on functional indices and molecular biomarkers of recovery from intense exercise, and identify effect sizes on various outcome measures.

    Methods: Eight healthy, recreationally active subjects (29.3 ± 9.2 y, 173.1 ± 8.2 cm, 77.3 ± 13.5 kg) volunteered to participate in this study and were randomized in a double-blind, placebo-controlled fashion to ingest either 3 g of placebo or BioCell Collagen® daily over a 6-week period prior to an upper body muscle-damaging resistance exercise challenge (UBC) on day 43, and a re-challenge on day 46. At the end of the 6-week supplementation period, participants completed a UBC consisting of 8 sets of barbell bench press at 75% of body weight load to exhaustion with a 4/0/X repetition tempo and 90 seconds rest between sets; the UBC exercise challenge was repeated 72 hours later to assess recovery of function. Consent to publish the results was obtained from all participants.

    Results: Daily intake of BCC for 6-weeks attenuated an increase in serum markers for muscle tissue damage in response to bench press exercise, creatine kinase (CK), lactate dehydrogenase (LDH), and C-reactive protein (CRP). Change in CK: +20 U/L (BCC) vs. +4726 U/L (placebo); change in LDH: -3.5 U/L (BCC) vs. +82.9 U/L (placebo); change in CRP: +0.07 mg/L (BCC) vs. +0.7 mg/L (placebo). In terms of performance, the decrement in bench press repetitions to failure was only 49% (day 43) and 43% (day 46) in the BCC group vs. 60% (day 43) and 55% (day 46) in the placebo group.

    Conclusion: The preliminary data of this proof-of-concept study suggests that daily intake of BCC for 6 weeks may favorably impact key biochemical markers of connective and skeletal muscle tissue damage and enhance stress resilience following intense resistance exercise. Supplementation was well tolerated and did not adversely affect markers of health or side effect profiles.

    Be well!

    JP

  6. JP Says:

    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

  7. JP Says:

    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

  8. JP Says:

    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

  9. JP Says:

    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

  10. JP Says:

    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

  11. JP Says:

    Updated 08/26/17:

    https://www.ncbi.nlm.nih.gov/pubmed/28840379

    Rheumatol Int. 2017 Aug 24.

    A comparison of the effects of exercises plus connective tissue massage to exercises alone in women with fibromyalgia syndrome: a randomized controlled trial.

    This study aimed to compare the effectiveness of a 6-week combined exercise program with and without connective tissue massage (CTM) on pain, fatigue, sleep problem, health status, and quality of life in patients with fibromyalgia syndrome (FMS). Patients were randomly allocated into Exercise (n = 20) and Exercise + CTM (n = 20) groups. The exercise program with and without CTM was carried out 2 days a week for 6 weeks. Pain, fatigue, sleep problem with Visual Analog Scales, health status with Fibromyalgia Impact Questionnaire (FIQ), and quality of life with Short Form-36 were evaluated. After the program, pain, fatigue and sleep problem reduced, health status (except of the scores of FIQ-1 and FIQ-10), physical functioning, role limitations due to physical health, bodily pain, role limitations due to emotional health, vitality, and general health perceptions parameters related to quality of life improved in the Exercise group, (P < 0.05). In the Exercise + CTM group, pain, fatigue and sleep problem decreased, health status and quality of life improved (P < 0.05). Pain, fatigue, sleep problem, and role limitations due to physical health improved in the Exercise + CTM group in comparison to the Exercise group (P < 0.05). The study suggested that exercises with and without CTM might be effective for decreasing pain, fatigue and sleep problem whereas increasing health status and quality of life in patients with FMS. However, exercises with CTM might be superior in improving pain, fatigue, sleep problem, and role limitations due to physical health compared to exercise alone. Be well! JP

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