Many conditions are thought to be caused by instability or weakness in the body. Rehab exercises are used to strengthen these areas of the body, mainly focusing on the small stabilizing muscles like the core or rotator cuff. So it makes sense that the reason exercise works is that they made the body more stable by strengthening the muscles. While rehab exercises can definitely help to strengthen muscles, strength might not be the only mechanism of how exercise can decrease pain. Monitoring pain during exercise is common place. The general rule of thumb is to avoid an exercise or movement that produces pain. But can exercise be used to decrease the pain with movements? 

Pairing Movement and Pain 

Pain is a protective feeling for the tissues in the body from actual and perceived threats. As the pain persists, it becomes less about actual threats to the tissues in the body and more about perceived threats. The brain begins to associate a variety of movements with a threat to the body, leading to the production of pain. Do you remember when grandma would bake chocolate chip cookies? That sweet aroma filling up the entire house. Those warm, soft, delicious chocolate chip cookies fresh out of the oven. And you know what would go well with these sweet chocolate chip cookies? A cold glass of milk. 

The brain has learned to pair chocolate chip cookies with milk. 

Similarly, movements can be paired with the threat of injury to the body tissues leading to pain. The area in the brain responsible for pain, called a neurotag, has learned to activate when the area in the brain responsible for movement activates. This is one of the reasons why bending over to tie your shoes can be painful with persistent low back pain or why reaching overhead is painful with persistent shoulder pain. 

Exercise to Decrease Pain 

Exercise can be used to alter the neurotag associations described above. By promoting safety during movements, the brain can unlearn the “movement equals threat” neurotag link.The target is to find an exercise modification that reduces the pain during the specific movement. For example, there are several modifications that can be made when a patient has pain with squatting. An exercise band can be placed around the knees or the hands to change the movement activation. This change in movement activation activates a different neurotag, avoiding activating the pain neurotag. The brain can then begin to pair the squat with being a non-threatening movement. [embed]https://youtu.be/pBnMfZjLtVM[/embed]

Assessment as Treatment 

There are several advantages to using exercise to decrease pain. One of those is patient empowerment. Pain, especially persistent pain, can take an emotional toll. Using exercise to modify the pain empowers patients and allows them to be in control of their pain. While it may not completely alleviate the pain, it demonstrates that the pain is modifiable.Since the exercise is itself a treatment, the patient can remain active while receiving treatment. And there is no shortage of health benefits from exercise, both physical and psychological. The pain relieving exercise can also lead to other exercises that would benefit the patient. 

Exercise can decrease the association that movement equals threat

In summary, exercise has many benefits including strengthening the muscles of the body. Exercise can also be used to break up the association between movement and pain. This approach empowers the patient to manage their own pain while also allowing them to remain active.