Exercise as Medicine: The Key to Overcoming Pain

As a chiropractor many people come to me looking for pain relief, and that’s what the general public thinks of the profession. You go to a chiropractor, they twist you up like a pretzel, and magically cure you of all your pain. Although getting that crack, massage, or whatever other technique someone decides to use may feel nice, the effect only lasts for a short period of time. It’s a temporary relief that makes you feel good enough in the moment to create positive associations and feelings with going so that you are already thinking about that next appointment when the pain comes back that night after you tried to pick something up from the ground. The point of this article today is that the pain relieving treatment that gets done to you, also known as passive care, doesn’t help get at the root problem of what is causing pain in the first place. Most of the time all that is needed is some education around pain, a mindset shift, and to GET STRONGER.

Today I am going to use a patient example in order to show 1. Just how important and impactful getting stronger can be to decrease your pain and 2. Show that you can get stronger at any age, since they were able to do it at the age of 64 after initially not seeing themselves as someone who goes to the gym to workout.

** Shared with explicit patient consent**

Before we get into the baseline scores for their strength values, why did they come to see me and why did I assess their strength? They came to see me for knee, back, neck and shoulder pain. Pretty typical for someone in their 60s. After hearing about their pain I noticed that it often came on after activity and they were saying how their daily life was getting more difficult: walking caused them pain, going up the stairs caused them pain, cooking, cleaning, and recreational activities, all caused them pain. It seemed like this pain was limiting their life, and most people who would treat them - and have treated them in the past - would focus on the pain and provide temporary pain relief treatments like adjustments, massage, TENS, and so on. The problem with this is that the pain isn’t the problem, it is just another symptom of the root issue which is a lack of strength. When your strength is low, life becomes a workout. Every task in your normal daily life becomes harder, and requires you to work near your max capacity. Getting up from the couch turns into a near maximum effort squat, going up the stairs becomes a hard set of lunges, picking things up from the ground becomes a hard set of deadlifts. If you are constantly living around your maximum capacity, you are more likely to feel pain and experience injury, so as a result you end up doing less to avoid the pain which ultimately lowers your capacity more.

The measures that we took were hand grip strength, sit to stand, and knee extension strength. These three are easy to implement and give great information about the strength and potential frailty status of patients.^1-4 I will list their initial scores below.

Hand grip strength

• Right: 54.4lbs
• Left: 52.0lbs

Sit to stand

• 5 reps completed in 13s
• 10 reps completed in 30s

Knee extension strength

• R: 52.2lbs
• L: 48.6lbs

These values are on the low end which put this patient at a higher risk for falls and raised suspicion of physical frailty and developing sarcopenia.^2-4

We had to break the cycle of doing less because of pain which started by educating them on pain. I have a video explaining the system I use here. After that, we got to work strengthening them. It has been shown that older individuals DEFINITELY have the ability to get stronger.^5,6 They did squats, step ups, bench push-ups, rows, calf raises, you name it! Exercising is safe for older individuals and it turns out that they respond fairly similarly to hard sets^5,6so after a few weeks of getting familiar and comfortable with the exercises, they worked hard!

After 8 weeks of treatment, they no longer have back pain that puts them out of commission after going for a walk, they are able to enjoy their life more and they have their life back. Here are their results from their strength tests after 8 weeks - keep in mind that these first 8 weeks had a heavier focus on the lower body:

Hand grip strength

• Right: 64.6lbs
• Left: 55.8lbs

Sit to stand

• 5 reps completed in 9s
• 14 reps completed in 30s

Knee extension strength

• Right: N/A (had pain where they have a metal plate in their leg so we terminated the test)
• Left: 74.8lbs!!

Those increases are HUGE and have been the explanation for why they are able to do so much more and live with less pain! A 54% increase in leg extension strength is astronomically high and it has now put them outside of the at risk category! One thing that can't be measured with these numbers is the confidence to do things that they did not think they could do. That mental aspect often goes understated but it has a huge impact.

Sure, focusing on some short term pain relief can feel good, but like I said earlier most of the time all that is needed is some education around pain, a mindset shift, and to GET STRONGER! The root issue more often than not is because living up to your capacity is tough and an increase in that capacity not only will help to decrease pain in the long run, but open up your life to be able to do more of the things that you love. I hope that this patient example has shown just how important building some strength can be for decreasing pain and increasing your life.

As always, go out there and move!

*This is an informational resource and not medical advice, please consult your healthcare practitioner for diagnosis, treatment, and guidance.

References

1. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M; Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019 Jan 1;48(1):16-31. doi: 10.1093/ageing/afy169. Erratum in: Age Ageing. 2019 Jul 1;48(4):601. PMID: 30312372; PMCID: PMC6322506.
2. Bohannon RW. Reference values for the five-repetition sit-to-stand test: a descriptive meta-analysis of data from elders. Percept Mot Skills. 2006 Aug;103(1):215-22. doi: 10.2466/pms.103.1.215-222. PMID: 17037663.
3. Goldberg A, Chavis M, Watkins J, Wilson T. The five-times-sit-to-stand test: validity, reliability and detectable change in older females. Aging Clin Exp Res. 2012 Aug;24(4):339-44. doi: 10.1007/BF03325265. PMID: 23238309.
4. https://www.sralab.org/rehabilitation-measures/30-second-sit-stand-test
5. de Santana DA, Castro A, Cavaglieri CR. Strength Training Volume to Increase Muscle Mass Responsiveness in Older Individuals: Weekly Sets Based Approach. Front Physiol. 2021 Sep 30;12:759677. doi: 10.3389/fphys.2021.759677. PMID: 34658936; PMCID: PMC8514686.
6. Borde R, Hortobágyi T, Granacher U. Dose-Response Relationships of Resistance Training in Healthy Old Adults: A Systematic Review and Meta-Analysis. Sports Med. 2015 Dec;45(12):1693-720. doi: 10.1007/s40279-015-0385-9. PMID: 26420238; PMCID: PMC4656698.

Other papers related to the topic:

• https://pubmed.ncbi.nlm.nih.gov/36098156/
• https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31138-9/fulltext
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818450/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241367/