175. How Exercise Relieves Pain: 4 Pathways Every PT Should Know

This episode explains how exercise can act as pain relief, addressing common patient concerns about exercise hurting and offering an alternative or complement to medications and passive treatments. We outline four key pain-modulating mechanisms: central modulation at the brain and spinal cord, immune and inflammatory changes, peripheral tissue and nerve effects, and psychological/behavioral pathways. 

00:00 Welcome to PT Snacks
00:57 Does Exercise Hurt?
03:08 Four Pain Relief Pathways
03:44 Brain and Spinal Cord
05:28 Immune Inflammation Shift
06:10 Peripheral Tissue Effects
06:50 Psychology and Behavior
07:24 Choosing the Right Dose
09:44 Educate Without Jargon
10:48 Wrap Up and Connect

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Transcript

 Hey guys. Welcome to PT Snacks podcast. This is Kasey, your host, and if you're tuning in for the very first time, what you need to know is that this podcast is meant for physical therapists and physical therapist students who are looking to grow your fundamentals in bici segments of time. And as a brief reminder, remember that this podcast we have now switched over to more of a bi-monthly episode format rather than a weekly format. But if you would like to support this show, 'cause the show's still going, it's just decreasing in frequency. You can do that in several ways. You can tell a friend about it that you think would really be benefited from it. You can leave a review wherever you listen 'cause that actually really helps people to find the podcast. Or you can support financially. There is a support the show button. Uh, keep in mind that this is a one woman show. I do everything related to the podcast. So that just helps me to be able to invest in more resources to make things as efficient as possible. So all that being said, today we are going to talk about, a fascinating topic that, we could probably dive into a lot deeper, but we're not, 'cause this is PT snacks and, and we're just keeping things really small. So we are talking about how exercise is actually utilized as pain relief because we know, I don't know about you, but I still treat in the clinic and a lot of times patients will come in with several conceptions. One is. How is exercise gonna make this feel better when exercise hurts? So obviously that comes down to more educating and making sure we're starting people at an appropriate level, uh, and the types of exercise and intensity that we're doing. But also a lot of times people tend to gravitate more towards, not everyone, but pain medication to help calm things down. And I know there's a lot of people out there that would. Prefer to not have to rely on that and be able to utilize their own body, especially if it's something that. Additionally helps them to, in the long term, build up their tissue resiliency to be able to tolerate more stress, AKA, being able to have less pain with activities or sustained positions with time, uh, and being able to feel strong and not feel broken. I think that's a big deal. So when we can explain things like this to our patients. That helps them to get their buy-in and also gives them more tools in the toolbox where they can manage their own pain even when they're not with you, and not have to always rely on modalities for pain relief or pain medication. The last thing I'd want for my patient who maybe would benefit from being able to get stronger is the only thing, the only treatment they ever get is dry needling and manual. And passive things because that's not helping them to be able to do active things. There are different treatment methodologies out there. I'm just admitting that I would prefer my patient to be able to feel like they're getting stronger with time and being able to tolerate more with time with their own body modalities can be a very useful tool in the toolbox. So let's actually talk about. The different ways that exercise can help different aspects of our body to create a pain modulating effect or pain relieving effect. So there's four main things that we're gonna go over. Today's episode is pretty brief, but there is that the brain and spinal cord level there is at our immune and inflammatory system level. Our peripheral tissues and nerves, and then also psychological and behavioral pathways. These are all the different ways. That exercise can help to create a pain relieving effect. So if we're gonna start off with more at our brain and spinal cord levels, that's where we have more central modulation. So with this exercise, and what I mean by exercise could be just anything that gets your heart rate up gets a little bit more blood flowing. It could be something like walking, um, gentle cardio. Uh, it could even just be like they're going through their workout session and they feel better by the time they leave therapy because it's an appropriate activity level for what their tissues are ready for. But you're getting more blood flow and more activation pretty broad. So don't get too caught up in the details yet. Back to the brain and spinal cord. So exercise can actually activate certain. Inhibitory pathways that are in the brainstem, that help to dampen incoming pain signals. So essentially systems in our brainstem that help us to not really notice the pain. That's the message that's coming in from wherever the pain is sourced from, whether it's in your ankle, whether it's in your elbow. We don't really even notice those inputs as much. So over weeks of time training can actually help increase pain thresholds, meaning that it takes more and more of a stimulus to even tell our brain that then issue is there and can improve condition pain modulation. Especially with motor control and other active programs, so what an awesome way to help our patients build up tolerance to stress in a way that is not constantly painful and distracting and helps them to be able to just mentally focus on other things. That's just one system. The other system that we're highlighting right now is our immune and inflammatory system. So repeated exercise actually can help shift the immune profile by fewer pro-inflammatory cytokines. I'm gonna read this off a list. IL six IL one beta, TNF alpha and more anti-inflammatory ones like IL 10 IL four. IL one RA in our tissues, in our dorsal root ganglia and even in our blood. So in inflammatory and neuropathic pain models, this immune shift can help reduce peripheral and central sensitization and produces analgesia. So pain relief. Pretty cool, right? The third level that exercise actually acts as a pain reliever would be in our peripheral tissues and in our nerves. So this exercise can help to improve muscle oxygenation. And microcirculation. It counters, peripheral sensitization and conditions like fibromyalgia. It can help to even modulate peripheral neurons in glial cells like Schwan and LEA and Mykines released from contracting muscle can actually. Signal to the nervous system to decrease pain. So that's pretty cool too. So not even just from a central aspect, but also from a peripheral aspect we can have pain relief. And then lastly, psychological and behavioral pathways. Regular exercise can help reduce pain, catastrophizing, fear avoidance, depression, and it helps to improve self-efficacy and sleep, which all feed into lower pain and disability in our patients. Multimodal programs, that combined exercise with cognitive behavioral strategies actually showed larger improvements. Than exercise alone in some chronic pain groups. So something to keep in mind if you are treating some of these patients that may be dealing with that. So essentially what exercise can help your patient the most, it's the one that they can do successfully. They might not be able to tolerate. 10 minutes of what is traditionally known as cardio. Uh, so you need to make sure that it's something that person in front of you can safely and successfully do, um, and that they're willing to do as a walking pool. Yoga, weights exercise doesn't show that any single mode is universally superior. It's generally preference and adherence are gonna be the things that matter most. 'cause if your patient doesn't wanna do it and they don't do it. Where is the benefit of that? Right. Uh, so you do wanna start off with low manageable doses, even if it's just five to 10 minutes, two to three times a week. Help them to build that habit and be able to build some momentum and hopefully see some effects of this and their, uh, relief. Before you go gung ho and maybe. Overload them a little bit, and then you can build towards increasing the amount of time that that patient is doing. Now, you do want to make sure you have a conversation with your patient on what pain is okay to feel and what's not okay, because that's their body. Give them a sense of autonomy over understanding what's happening in their body and what you're trying to shoot for. Tell them that because if they feel any pain, they're not sure if I should just fight through it, or should I completely stop, help them to navigate that. So this depends on what you are treating. If they have symptoms that tend to spread or if they have any comorbidities that might be affecting this, but help to lay out some guardrails. And explain to them of, Hey, also the benefits of, with exercise, making sure that you are getting good recovery too. Uh, whether that's good sleep, good nutrition, good stress management, um, usually those are things that people struggle with the most in my experience. And then with time, it's not an immediate thing. It takes some time for the body to adapt, but that should be slowly and with time away for them to notice, oh, maybe this actually feels good. And exercise in medicine instead of something that either is pain invoking or not fun. So the key here. Is understanding how to educate your patient about this. 'cause their eyes might glaze over if you just name off every single pro-inflammatory cytokine that I just listed off. But being able to frame it in a way where they get excited about the journey that they're on. Where sometimes they'll say, Hey, like. This kind of stuff, as long as it's feeling okay to, you can help to send a message up to our body and say, Hey, I'm moving and I'm not in danger, you can calm down. Now, it does not need to be super medical jargon heavy things. Depending on. The patient in front of you who you're talking to, you're just gonna cater your education level to that person. So, um, all that to be said, we can feel confident in our research. That exercise has some really cool, awesome pain relieving effects in our patients. These are just more specific ways that they've been testing to measure. The actual responses. So exciting stuff. I hope that you use this information to maybe take some deeper dives in your own research. And, um, and if you have any questions, feel free to reach out at pt Snacks podcast@gmail.com. You can also find me on Instagram, YouTube, TikTok. I am not a vending machine company. It is PT Snacks podcast, so definitely hunt for me there. And if you want email updates on. The episodes that are coming out, tidbits that come out in the episodes, if you'd rather read it than listen to it on podcasts or on YouTube, um, definitely sign up for the newsletter below. But other than that, I hope you guys have a great rest of your day and that you get to inspire someone today or that you feel inspired. And until next time.