Pain is an evergreen topic when talking about musculoskeletal (MSK) conditions. Although every person sees and feels pain differently, it plays a starring role in their daily life. But pain can be demoted to a lesser, supporting role.

How?

By understanding pain, what it entails, and how we should behave towards pain, recovery won’t seem as difficult and unattainable as before.

Pain is not just pain

Pain is the way our body responds to a threat by prompting protective behaviors, which includes focusing attention on pain sources and avoidance. However, these protective behaviors may persist beyond the healing time, and this is when pain turns chronic, leading to pain-related disability.

So, pain is more than just pain. It's the fear of pain and movement, the loss of function, and the inability to do the things we used to do out of the fear of them being harmful — even though most times they are not. However, feeling pain does not mean we have serious damage, nor does it mean we are doing further damage. The same applies to exercise therapy.

Exercise-induced pain is common and to be expected

When people struggling with an MSK condition are about to start their treatment, they often fear that physical therapy will be painful. The answer is quite straightforward; yes, it is painful – at first. But this pain is normal, bearable, and nothing to be worried about.

As the body gets used to the therapeutic exercises, the higher loads patients can tolerate, the less and less pain they feel. In other words, there's a dose-response to exercise for MSK pain. Over time, people learn to expect increasingly challenging exercises while knowing they can tolerate them.

Moderately painful exercises are actually beneficial

Research has shown that doing moderately painful exercises offers better outcomes than doing exercises with no pain at all. It has also proved that exercising into pain has no apparent adverse effect when the aim is to manage chronic musculoskeletal pain. One of the discussed reasons for this response to exercise into pain was the positive impact on central pain processes, the immune system, and affective aspects of pain. In short, moderately painful exercises challenge the body’s threat response to pain, helping “reconceptualize” pain as safe and non-threatening.

Consequently, people no longer perceive pain as equal to harm, being then able to reintroduce the same movements they were avoiding before. They learn how to cope with pain — and conquer it.

Being a coper, not an avoider, is the best way to conquer pain

During a painful event, it’s better to cope with pain and not give in to paralyzing pain-related fear.

Changing the perception about pain is a tipping point between having a coping instead of an avoidance behavior. It includes challenging the attention bias, which happens when we focus our attention on how painful a particular movement is and end up feeling it more strongly. In other words, we end up catastrophizing pain.

Exercising, as mentioned before, is a way of challenging this bias and reframing pain as not harmful. Another one is making a valued life goal a priority over pain.

Focusing our attention on what really matters to us outweighs our pain-related fear. When we set goals and are optimistic about them, it becomes easier to hold back our fear-related protective behaviors.

After the pain, the recovery

The Sword Health team took all critical aspects of pain management into account when developing our solution for MSK care by:

• Promoting exercise as the first-line approach to MSK management
• Making goal-setting a priority, enabling participants to divert their attention from pain to their more objective, valued goals
• Fostering continuous education as a way of empowering people to put pain into perspective and go through with the program despite it

At the end of the day, our Digital Therapist yields undisputed results, with a reported 74% decrease in pain after only eight weeks — all while helping people stay away from opioids and surgeries, too.

After we understand pain, the path to recovery becomes clearer. Pain is no longer a barrier to therapy, so people can set their minds to a more relevant goal — getting better, faster.