In this post we look at why getting stronger helps reduce pain, particularly if you’re suffering with chronic or ongoing injuries.
There are few things in life that we know are certain, apart from death and taxes as Benjamin Franklin famously once said.
Most of us believe that getting stronger will help if we have physical issues like sore knees or painful shoulders however.
As you might imagine I’m firmly of that opinion. The question is why?
You might have heard things like getting stronger helps support your joints. Or resistance training helps you maintain better posture, or improves how you move.
Whilst these things might be true, it’s not clear how they would reduce pain. There’s certainly little evidence for this.
We know that resistance training releases substances that can reduce pain. The same substances that some pain medications attempt to mimic.
This may explain transient changes in pain, but doesn’t necessarily explain the long term effects.
Why for example, does a particular exercise cause pain when you start training, even with minimal resistance, then 3 months later the exact same exercise with 5 times the weight causes no pain at all?
Why does getting stronger help reduce pain?
This was the subject of a recent presentation given by world leading tendon expert Professor Peter Malliaras.
In it he describes research that found significant changes to tendon health from a resistance training programme. Interestingly this had no correlation to pain.
In other words you could see changes to the structure of a previously injured tendon, and see strength improvements in the associated muscles, but this had no connection to what the person actually felt.
I’ve discussed before the nebulous relationship between what you see on a scan and what you actually feel.
And that you can feel better without your scan changing.
What this suggests is you can still have pain even if a scan shows improvements in the tissues.
What else might be responsible for reducing pain?
Have you ever booked a doctor’s appointment only to find the very thing you were seeking help for has inexplicably improved?
Or visited the doctor and been reassured your pain is nothing serious and found the pain dissipate almost immediately?
This study explored this effect by explaining to patients their shoulder pain did not indicate tissue damage and they were safe to move. This improved reassurance when compared to a structural explanation, which emphasised a connection between tissue damage and pain.
It doesn’t seem to matter whether education is focused on pain science, or more on pathophysiology either. Just the fact the patient is receiving accurate information about their condition and how best to manage it has been shown to improve outcomes.
So education and reassurance appear to be critical aspects in reducing pain.
Generally speaking interventions that combine both education and exercise do best however. So what additional value does resistance training provide?
The role of resistance training in reducing pain
Let’s first think about what pain represents. In the case of chronic injuries it’s unlikely to represent tissue damage as we’ve seen.
It’s more accurate to think of pain as a sensitive alarm in this context. A bit like a car alarm that keeps going off on a windy day.
The role of exercise is to provide a compelling case that you’re safe and there’s no cause for er… alarm.
Resistance training helps you do this in two ways:
First it gives you a level of control that is unmatched by other forms of exercise. Enabling you to isolate joints and prescribe how far and how fast you move and under how much load.
This means you can accurately increase the dosage, whilst taking care not to trip the alarm. A bit like that scene in Apollo 13 where they’re trying to power up the lunar module with just enough voltage so as not to drain the battery.
Second, it begins to update the story in your brain with new information. It’s difficult to conclude that your Achilles tendon for example, is vulnerable and weak if you’ve just single leg calf raised your own body weight for 8 repetitions.
This combined with the knowledge that pain in this context doesn’t mean injury, provides the ideal conditions to reduce pain in the long term.
Summary
Whilst resistance training is an invaluable tool in helping to reduce pain, it may not be for the reasons that we once thought.
Its most significant role might be to convince your brain that there’s no need to trigger a pain response as you are perfectly safe.
Apply it with care and pay attention to your symptoms. If you have an increase in pain that lasts longer than 24 hours, you may want to back off a bit.
In time you will see progress.