New studies show exercise does not promote exacerbation of chronic back pain

Results were not what many health care professionals expected in terms of exacerbation of chronic back pain

One of the oldest pieces of advice for treating an injury is rest, ice, compression, and elevation, known more commonly as the RICE method.

However, one recent study suggests that rest may not be the best course of action when it comes to relieving pain that, as opposed to being acute, is more chronic in nature.

Exercise on chronic pain conditions

This study was a meta-analysis conducted by researchers at Duquesne University in Pittsburgh, Pennsylvania and involved the re-analysis of 75 different studies, each of which included exercise as a treatment intervention for pain.

The results were published by PLoS One in January of 2019 and were likely not what many health care professionals expected in terms of exacerbation of chronic back pain and exercise.

After reviewing all data collected in these 75 different studies, researchers noted that there was “a significant positive correlation” between the participants’ engagement in physical activity and exacerbation of chronic back pain.

Additionally, though this meta-analysis focused solely on pain that existed in the neck area, researchers suggest that increasing physical activity “is most likely to have a positive effect” for patients currently experiencing other types of chronic pain conditions.

In an interview with NPR, Benedict Kolber, one of the study’s researchers, explains that exercise is beneficial in these types of instances because it engages the body’s endogenous opioid system. This is the system responsible for the production and utilization of our own natural opioids, an action which ultimately helps ease chronic pain.

Certainly, this study isn’t the only one that has found how beneficial exercise can be for patients struggling with chronic pain as there have been several others before it. For example, a 2001 study published in the Clinical Journal of Pain reported similar results, citing that exercise helped participants better manage their chronic low back pain for as long as one year.

Putting research into practice

As a DC who specializes in physical therapy or sports chiropractic, studies like these can be used to better help patients who want to be more active, yet are struggling with exacerbation of chronic back pain or other chronic pain issues.

In other words, instead of suggesting that they rest in an effort to reduce the discomfort felt with their pain-based conditions, it may be more beneficial to help them develop a program that increases their physical activity instead.

The National Institute on Aging (NIA) shares a few basic guidelines for exercising with chronic pain. Though these are designed specifically for older adults, they could be helpful for any age person with a chronic pain condition and include creating a program that combines:

• Strength training – using weights or body weight to build muscles that are able to better support the joints;
• Endurance training – performing low-impact aerobic exercises to reduce joint swelling;
• Flexibility exercises – improves range of motion and reduces stiffness in the joints.

A program that encompasses all three of these facets could also be helpful for patients who are not yet active, but wish to increase their physical movement in an effort to lose excess weight.

Combining exercise and chiropractic for even better results

Research indicates that another way to help patients who face chronic pain daily — and perhaps a way that can help them even more — is to develop a health care regimen that combines chiropractic care with in-office exercise therapy.

For example, in a 2012 study published in Spine, 270 patients with chronic neck pain were divided into three groups. The first group engaged in supervised exercise therapy and spinal manipulation therapy, the second did exercise therapy only, and the third group exercised at home.

After 12 weeks, researchers noted “a significant difference” in the amount of pain reported by those who received both supervised exercise therapy and spinal manipulation therapy when compared to those who were advised to exercise at home. Even the exercise therapy only group had lower levels of reported pain than the at-home exercisers.

This suggests that working directly with patients not only to provide chiropractic services, but also as they participate in exercise therapy offers benefits that appear to be much more effective than just giving them an exercise regimen to complete at home, in between treatment sessions. The first step is helping patients understand that, even though it may be uncomfortable, especially at first, combining exercise therapy and chiropractic may help them get better results. Results that can improve their quality of life versus simply lying on the couch or other inactivity that can lead to exacerbation of chronic back pain or other chronic pain.