If you’ve ever dealt with chronic pain, the thought of exercising can feel overwhelming. How do you work out when it hurts just to bend over, stand up from a chair, or carry groceries?
It’s a valid concern and one I hear often from my physical therapy patients. Fortunately, exercise is a proven way to reduce pain. A 2024 review published in Healthcare highlights the link between specific exercise strategies and reduced pain intensity over time. In fact, exercise can offer immediate relief by affecting hormones and the nervous system. Research from The Journal of Pain shows that exercise can lower pain sensitivity and severity almost instantly.
But what if it hurts too much to exercise? And, can exercise sometimes make the pain worse? Yes, that can happen—but the right type of exercise can help.
Finding the Right Type of Exercise
The phrase “no pain, no gain” does not apply to musculoskeletal pain. If you’re injured, pain is a warning that you might be causing more harm. With chronic pain, anxiety and fear often contribute, and pushing through can make it worse. Instead, the key is finding exercises that don’t cause pain, like adjusting the range of motion or intensity.
The safest types of exercise include isometrics and moderate-intensity cardiovascular activity. Research published in Medicine & Science in Sports & Exercise shows both can reduce pain. Isometrics, like wall sits, strain muscles without movement, making them a great option for reducing pain. Cardiovascular exercises, such as walking, swimming, or cycling, can also help if they don’t trigger your pain.
When I work with patients, I focus on reducing their range of motion. For example, performing a half-squat instead of a full squat or using resistance bands for lighter chest presses are great ways to start. As your capacity improves, you can gradually expand your range of motion.
A Proven Exercise Program
A 2024 study in BMJ Open Sport & Exercise Medicine found that adults with chronic low back pain (LBP) benefited from a targeted strength and conditioning program. The program lasted six months, combining gym-based and home exercises to enhance strength, conditioning, and proprioception (balance and body awareness).
Participants trained twice a week for the first 13 weeks, then 1–2 times a week for the remaining 13 weeks. The program included aerobic conditioning, balance exercises, and resistance training, adhering to the WHO guidelines of two strength-training sessions per week.
Each session started with a 5-minute aerobic warm-up, followed by 15 minutes at 65–85% of maximal heart rate. Resistance exercises included pushing, pulling, squatting, and core work, with each set performed until near-fatigue.
Progression and Personalization
One critical aspect of this program was that progression was time-based, not pain-based. This “graded activity” approach helps patients continue improving even with some discomfort. The program showed an average pain reduction of 10.7 points over six months.
However, even after six months, most participants still had some pain. Chronic pain can take a long time to resolve, so consistency and gradual progression are key. Personalizing the program to your body’s needs and abilities is just as important. Stick with it beyond the initial relief, as continued physical activity is crucial for preventing pain relapse.
For a deeper dive, check out my Medium article on the topic (free article link)
References
De la Corte-Rodriguez H, Roman-Belmonte JM, Resino-Luis C, Madrid-Gonzalez J, Rodriguez-Merchan EC. The Role of Physical Exercise in Chronic Musculoskeletal Pain: Best Medicine-A Narrative Review. Healthcare (Basel). 2024 Jan 18;12(2):242. doi: 10.3390/healthcare12020242. PMID: 38255129; PMCID: PMC10815384.
Rice D, Nijs J, Kosek E, Wideman T, Hasenbring MI, Koltyn K, Graven-Nielsen T, Polli A. Exercise-Induced Hypoalgesia in Pain-Free and Chronic Pain Populations: State of the Art and Future Directions. J Pain. 2019 Nov;20(11):1249-1266. doi: 10.1016/j.jpain.2019.03.005. Epub 2019 Mar 21. PMID: 30904519.
Hoeger Bement MK, Dicapo J, Rasiarmos R, Hunter SK. Dose response of isometric contractions on pain perception in healthy adults. Med Sci Sports Exerc. 2008 Nov;40(11):1880-9. doi: 10.1249/MSS.0b013e31817eeecc. PMID: 18845975.
Naugle KM, Naugle KE, Fillingim RB, Samuels B, Riley JL 3rd. Intensity thresholds for aerobic exercise-induced hypoalgesia. Med Sci Sports Exerc. 2014 Apr;46(4):817-25. doi: 10.1249/MSS.0000000000000143. PMID: 24002342; PMCID: PMC4056570.
Neason C, Miller CT, Tagliaferri SD, Belavy DL, Main LC, Ford JJ, Hahne AJ, Bowe SJ, Owen PJ. Exercise prescription variables predict reductions in pain intensity in adults with chronic low back pain: secondary analysis of a randomised controlled trial. BMJ Open Sport Exerc Med. 2024 Jan 5;10(1):e001744. doi: 10.1136/bmjsem-2023-001744. PMID: 38196942; PMCID: PMC10773405.
Lorenz D, Morrison S. CURRENT CONCEPTS IN PERIODIZATION OF STRENGTH AND CONDITIONING FOR THE SPORTS PHYSICAL THERAPIST. Int J Sports Phys Ther. 2015 Nov;10(6):734-47. PMID: 26618056; PMCID: PMC4637911.
Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011 Mar;152(3 Suppl):S2-S15. doi: 10.1016/j.pain.2010.09.030. Epub 2010 Oct 18. PMID: 20961685; PMCID: PMC3268359.
Malfliet A, Ickmans K, Huysmans E, Coppieters I, Willaert W, Bogaert WV, Rheel E, Bilterys T, Wilgen PV, Nijs J. Best Evidence Rehabilitation for Chronic Pain Part 3: Low Back Pain. J Clin Med. 2019 Jul 19;8(7):1063. doi: 10.3390/jcm8071063. PMID: 31331087; PMCID: PMC6679058.
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