Exercise Therapy for Pain

Exercise Therapy for Pain


Physiotherapists give out exercise therapy programmes to our patients as part of the overall treatment, including to those with chronic, i.e. long-term, musculoskeletal conditions. These conditions include long-term back and neck pain among others.


The results of this review and meta-analysis show that there is small but significant short-term benefit from exercise programmes that go into pain compared to those programmes that are pain-free. There appears to be no difference at medium-term or long-term follow-up, with moderate to low quality of evidence, demonstrating pain need not be ruled out or avoided in adults with chronic musculoskeletal pain. The findings of this review also showed adults with musculoskeletal pain can achieve significant improvements in patient-reported outcomes with varying degrees of pain experiences and post-recovery time with therapeutic exercise, and pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes.


A theoretical rationale for a positive response to exercises into pain is the positive impact on the central nervous system. Specifically, the exercise addresses psychological factors such as fear avoidance (avoiding certain movements and activities in case they cause pain), kinesiophobia (fear of movement)  and catastrophising (worst case scenario thinking), and is set within a framework of ‘hurt not equalling harm’, thus, in time, reducing the overall sensitivity on the central nervous system, with a modified pain output. This then improves the quality of life and pain levels for people with chronic musculoskeletal. However this study concludes that more work needs to be done in assessing the long-term benefits of moderately pain-provoking exercises.


Take home message: “Hurt does not equal harm.”

This is from an “open access” online first systematic review from the British Journal of Sports Medicine (BJSM) and is available at:


Smith, B.E. et al (2017) Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. BJSM, 0:1–10. doi:10.1136/bjsports-2016-097383



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 Aine Tunney MISCP


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