People with chronic joint/soft tissue pain tend to fall into two categories – 1) those who refuse to do any or minimum exercise and reduce all movement in the hope of suffering less and not making the “damage” worse and 2) people who think that all exercise is beneficial whatever the issue (these people from experience tend to be in the minority!!).

So what is the truth about exercise and muscular skeletal pain?

First of all it would be useful to think about what pain is.  It is generally believed there are 3 types of pain.

• Acute pain – this is where there is an injury and trauma leading to structural damage eg sprained ankle.  This pain tends to be very sharp.

In these cases the principles of P.R.I.C.E. should apply (protection, rest, ice, compression and elevation) to the damage area.  Only after 72 hours should gentle exercise be started and only after the pain has settled.  EXERCISE INDUCED PAIN IMMEDIATELY FOLLOWING INJURY MAY INDICATE FURTHER DAMAGE.

After pain has subsided, mobilisation followed by targeted stretching and strengthening is helpful.

• Inflammatory Pain – this happens when a chronic inflammatory reaction occurs caused by injury and/or the body’s immune system going into “overdrive” eg rheumatoid arthritis.  Pain perception can also be heightened.  This type of pain is often systemic and felt around the body.  Generally further exercise (although often painful) is unlikely to cause further tissue damage.

Gentle movement and breathwork are often very useful here.  Indeed any exercise that stimulates a para sympathetic (“rest and digest”) response in the nervous system is useful eg Yoga and Pilates.

• Mechanical Pain – this is the chief form of chronic musculoskeletal pain.  Exercise tends to ease (or make worse) this type of pain and there is a postural element involved.  Specific movements trigger the pain.

Mechanical pain is essentially caused by muscle weakness, joint misalignment/sub optimal joint loading, poor muscle balance and poor exercise technique.  Mechanical pain in the vast majority of cases DOES NOT MEAN MORE TISSUE DAMAGE IS BEING DONE when moving or exercising !  Mechanical pain is a weakness and movement habit problem.

People with long term mechanical pain need to mobilise joints, stretch out tight muscles and strengthen weak areas.  If certain exercises/activities stimulate pain, then specific exercise/sports techniques need working on.

Working with a good personal trainer/coach can often work wonders for this type of pain.