Karen M. Pechman, M.D.

Medical Director of Physical Medicine and RehabilitationBurke Rehabilitation Hospital

White Plains HospitalWhite Plains, New York

Clinical Assistant Professor of Rehabilitation MedicineCornell University Medical College

New York, New York

Analgesic Exercise:Conclusive Proof or Just Common Sense?

Therapeutic exercise for chronic musculoskeletal pain:

Can therapeutic exercise really alleviate pain?

FINANCIAL DISCLOSURES

Please note:

There are no financial

disclosers applicable to this

presentation.

• To understand the role of exercise in controlling chronic musculoskeletal pain

• To understand how improving musculoskeletal function and balance can alleviate pain

• To be able to prescribe appropriate exercise programs for your patients with pain

OBJECTIVES

• What are the mechanisms by which exercise can help to relieve chronic musculoskeletal pain?

• What are some examples of how improving musculoskeletal function and balance can alleviate pain?

• What are some examples of appropriate exercise programs for your patients with chronic pain?

PRE-TEST QUESTIONS

• Psychological factors involved—being proactive, empathy, attention¹

• Enhancing skeletal and joint stability²

• Exercise to alter acquired protective (movement-related) pain memory⁶

• Carefully progressive exercise programs to address pain-related fear and avoidance⁷

THE ROLE OF EXERCISE IN CONTROLLING CHRONIC MUSCULOSKELETAL PAIN

THE ROLE OF EXERCISE IN CONTROLLING CHRONIC MUSCULOSKELETAL PAIN

Source: Fear-avoidance and its consequences in chronic

musculoskeletal pain: a state of the art Johan W.S.

Vlaeyena, Steven J. Linton, Pain 85 (2000) 317-332

• Equalize length and strength

• Improve spinal and joint stability

• Assess for and correct/improve musculoskeletal imbalances or dysfunction

• Walking programs are associated with improvements in musculoskeletal pain³

• Resistance and aquatic exercise in chronic pain conditions such as fibromyalgia⁴˒⁵

IMPROVEMENT OF MUSCULOSKELETAL FUNCTION AND

BALANCE IN THE TREATMENT OF PAIN

IMPROVEMENT OF MUSCULOSKELETAL FUNCTION

AND BALANCE IN THE TREATMENT OF PAIN

Source: Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis, O'Connor SR, Tully MA, Ryan B, Bleakley CM, Baxter GD, Bradley JM, McDonough SM, Arch Phys Med Rehabilitation, 2015 Apr;96(4):724-734.

IMPROVEMENT OF MUSCULOSKELETAL FUNCTION AND

BALANCE IN THE TREATMENT OF PAIN

Source: Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis, O'Connor SR, Tully MA, Ryan B, Bleakley CM, Baxter GD, Bradley JM, McDonough SM, Arch Phys Med Rehabilitation, 2015 Apr;96(4):724-734.

• Progressive strengthening/PRE’s⁸˒¹º

• Progressive stretching/ROM⁸˒⁹

• Aerobic Exercise¹³˒¹⁴

• Aquatic Exercise⁵˒¹¹˒¹³

• Walking programs³

• Postural Exercise¹⁵

• Supervision and follow-up¹º

EXERCISE PROGRAMS FOR YOUR PATIENTS WITH CHRONIC

MUSCULOSKELETAL PAIN

EXERCISE PROGRAMS FOR YOUR PATIENTS WITH

CHRONIC MUSCULOSKELETAL PAIN

Source: Dysfunctional Endogenous Analgesia During Exercise in Patients with Chronic Pain: To Exercise or Not to Exercise? Narrative Review. Eva Kosek, MD, PhD, Jessica VanOosterwijck, PhD, Mira Meeus, PhD, and Jo Nijs, PhD., 2012;15;ES205-ES213

• What are the mechanisms by which exercise can help to relieve chronic musculoskeletal pain?

• What are some examples of how improving musculoskeletal function and balance can alleviate pain?

• What are some examples of appropriate exercise programs for your patients with chronic pain?

POST-TEST QUESTIONS

QUESTIONS?

Karen M. Pechman, M.D.

Medical Director of Physical Medicine and RehabilitationBurke Rehabilitation Hospital

White Plains HospitalWhite Plains, New York

Clinical Assistant Professor of Rehabilitation MedicineCornell University Medical College

New York, New York

• (1) An assessment of the efficacy of physical therapy and physical modalities for the control of chronic musculoskeletal pain, Jocelyne S Feinea,James P Lund, Pain, Volume 71, Issue 1, May 1997, Pages 5–23

• (2) Muscle control–pain control. What exercises would you prescribe?, C.A. Richardson, G.A. Jull, Manual Therapy, Volume 1, Issue 1, November 1995, Pages 2–10

• (3) Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis, O'Connor SR, Tully MA, Ryan B, Bleakley CM, Baxter GD, Bradley JM, McDonough SM, Arch Phys Med Rehabilitation, 2015 Apr;96(4):724-734.

• (4) Resistance exercise training for fibromyalgia, Busch AJ1, Webber SC, Richards RS, Bidonde J, Schachter CL, Schafer LA, Danyliw A, Sawant A, Dal Bello-Haas V, Rader T, Overend TJ, Cochrane Database Syst Rev. 2013 Dec 20;12:CD010884. doi: 10.1002/14651858 CD010884

BIBLIOGRAPHY

• (5) Aquatic exercise training for fibromyalgia, Bidonde J1, Busch AJ, Webber SC, Schachter CL, Danyliw A, Overend TJ, Richards RS, Rader T, Cochrane Database Syst Rev. 2014 Oct 28;10:CD011336. doi: 10.1002/14651858.CD011336.

• (6) Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories, Jo Nijs, Enrique Lluch Girbes, Mari Lundberg, Anneleen Malfliet, Michele Sterling, Manual Therapy 20 (2015) 216-220

• (7) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art Johan W.S. Vlaeyena, Steven J. Linton, Pain 85 (2000) 317-332

• (8) Exercise Therapy for Low Back Pain A Systematic Review, Maurits van Tulder, PhD, Antti Malmivaara, MD, PhD, Rosmin Esmail, MSc,and Bart Koes, PhD , SPINE Volume 25, Number 21, pp 2784–2796, 2000

BIBLIOGRAPHY (CONT)

• (9) Exercise as a treatment for chronic low back pain, Rainville J, Hartigan C, artinez E, Limke J, Jouve C, Finno M, Spine J. 2004;4(1):106.

• (10) Exercise and chronic low back pain: what works?, Liddle SD, Baxter GD, Gracey JH, Pain. 2004;107(1-2):176.

• (11) Therapeutic aquatic exercise in the treatment of low back pain: a systematic review, Waller B, Lambeck J, Daly D, Clin Rehabil. 2009;23(1):3.

• (12) Exercise-based therapy for low back pain, UpToDate, Authors:Carol Hartigan, MD, James Rainville, MD, Section Editor: Steven J Atlas, MD, MPH, Deputy Editor;Lee Park, MD, MPH, Literature review current through: Jul 2015.

• (13) Effects of Pool-Based and Land-Based Aerobic Exercise on Women With Fibromyalgia/Chronic Widespread Muscle Pain, EVA SALTSKAR JENTOFT, ANNE GRIMSTVEDT KVALVIK, ANNE MARIT MENGSHOEL, ARTHRITIS CARE & RESEARCH 45:42–47, 2001

BIBLIOGRAPHY (CONT)

• (14) Physical activity and exercise in older adults, UpToDate, Author: Miriam C Morey, PhD, Section Editor:Kenneth E Schmader, MD: Deputy Editor: Nancy Sokol, MD, Literature review current through: Jul 2015. 

• (15) Effect of global posture reeducation and of static stretching on pain, range of motion, and quality of life in women with chronic neck pain: a randomized clinical trial, Ana Cláudia Violino Cunha, Thomaz Nogueira Burke, Fábio Jorge Renovato França, Amélia Pasqual Marques, Clinics vol.63 no.6 São Paulo  2008

• (16) Nonpharmacologic therapy of osteoarthritis, UpToDate, Author: Kenneth C Kalunian, MD, Section Editor:, Peter Tugwell, MD, Deputy Editor: Monica Ramirez Curtis, MD, MPH, Literature review current through: Jul 2015.

• (17) Dysfunctional Endogenous Analgesia During Exercise in Patients with Chronic Pain: To Exercise or Not to Exercise? Narrative Review. Eva Kosek, MD, PhD, Jessica VanOosterwijck, PhD, Mira Meeus, PhD, and Jo Nijs, PhD., 2012;15;ES205-ES213

BIBLIOGRAPHY (CONT)