Exercise therapy is one of the most important and effective treatments for reducing and preventing pain. Exercise causes the body to release chemicals such as endorphins and enkephalins, which block pain signals from reaching the brain. Exercise also offers general health benefits for people, regardless of whether or not they are suffering from pain.

Patients who exercise strengthen muscles and increase the range of motion in joints. Exercise programs can have special benefits for those suffering from various types of pain, such as back pain, neck pain, arthritis, fibromyalgia and lupus.

Most exercises fit into one of three categories:

• Flexibility. These include range-of-motion and stretching exercises that help ease movement in the joints.
  
  
• Aerobic capacity. Exercise that helps strengthen the heart, lungs and muscles associated with the cardiovascular system.
  
  
• Strength. Exercises that help build strong muscles.

Regular exercise can also:

• Promote weight loss, which can reduce stress in joints and help prevent osteoarthritis
  
  
• Improve sleeping and energy levels while awake
  
  
• Increase bone mass, which reduces the risk of injury and osteoporosis
  
  
• Help prevent heart conditions, diabetes and other diseases
  
  
• Enhance healing of wounds

People are advised not to begin an exercise program without first consulting a physician or other expert, such as a physical therapist, occupational therapist or certified exercise therapist.

Exercise therapy is one of the best methods for helping patients to reduce or eliminate many forms of acute pain or chronic pain. It can help patients strengthen muscles, increase the range of motion in joints and achieve a state of physical fitness that allows them to perform everyday activities without pain or discomfort.

For many years, experts warned pain patients to rest and avoid exercise. At the time, the consensus was that too much physical activity would further damage joints and muscles, causing pain to worsen. However, experts now understand that exercise actually helps relieve chronic pain by strengthening muscles and other tissue and increasing a patient’s flexibility and stamina.

Exercise also causes the body to release chemicals such as endorphins and enkephalins, which block pain signals from reaching the brain and can help alleviate anxiety and depression. These emotions can make pain more difficult to manage.

Exercise gives pain patients increased energy and helps them sleep and reduce fatigue. It also helps patients maintain a healthy weight, which reduces the stress on joints and increases bone mass, which leaves patients less susceptible to injury and conditions such as osteoporosis. Scientists also credit exercise with reducing blood pressure and inflammation and helping to prevent cardiovascular diseases, diabetes and some types of cancer.

Most experts recommend that people engage in some kind of activity on most or all days of the week – even if some bedrest is also recommended. This is also true for most pain patients. Patients are never too old to begin an exercise program. Studies have shown that it is possible to add muscle mass, increase aerobic capacity and increase flexibility as late as a person’s 90s. However, patients are advised not to start an exercise program without first consulting their physician.

Although the type of exercise will vary depending on the type of pain and a patient’s complications, some low–intensity exercises commonly used to treat different types of pain include:

• Stationary bicycling
• Swimming
• Walking
• Using an exercise ball
• Stretching, flexibility and range-of-motion exercises such as yoga, tai chi and Pilates

Exercise offers health benefits for people regardless of whether or not they are suffering from pain. However, exercise programs can have special benefits for those suffering from various types of pain, including:

• Back pain. Exercise can help speed recovery from back problems and increase flexibility and strength so that injuries do not recur in the future. Exercise may also reduce back muscle spasms and hydrate intervertebral discs that become painful when they lose fluid. Back pain is usually treated by non-weightbearing exercises. For conditions ranging from herniated discs to scoliosis, exercise therapy may be prescribed to improve posture, flexibility and strength.

• Headaches. Exercises such as regular swimming can reduce the frequency and severity of migraines and tension headaches.

• Neck pain. Flexibility and strength exercises can increase the fitness of neck muscles and reduce or help prevent pain in that area. Range-of-motion exercises are often recommended to improve mobility and function after whiplash.
  
  
• Shoulder pain. Many causes of shoulder trauma, such as fractures, dislocation, separation or a torn rotator cuff, require short-term immobilization, followed by exercise to regain mobility and strength. Joint-restricting chronic conditions such as frozen shoulder or tendinitis often benefit from range-of-motion activities.
  
  
• Pelvic pain and sexual pain. General exercise may help relieve conditions including benign prostatic hyperplasia, prostatitis, prostatodynia, interstitial cystitis and chronic pelvic pain syndrome. Kegel exercises, which strengthen the pelvic floor muscles through repeated contraction and relaxation, can help prevent urinary incontinence and vaginal or uterine prolapse.
  
  
• Leg pain. Exercise is often recommended to ease circulatory or nerve problems that cause leg pain, such as peripheral artery disease or neuropathy.

• Arthritis. Exercise strengthens muscles around joints, which allows the joints to pull apart and reduce the grinding that leads to further joint deterioration and pain. Exercise for arthritis often includes range-of-motion exercises to reduce stiffness and endurance exercises to reduce inflammation in joints.
  
  
• Carpal tunnel syndrome. Stretching and strengthening exercises may be part of the treatment plan for this source of wrist and arm pain.

• Osteoporosis. Weight-bearing exercises such as walking and aerobics help prevent this bone-thinning disorder, and moderate exercise can help people who already have osteoporosis maximize their balance, mobility, strength and daily functioning.
  
  
• TMJ disorder. Treatment of this cause of orofacial pain may include special exercises.
  
  
• Fibromyalgia. Studies show that aerobic exercise, such as swimming, walking or running, improves muscle fitness and reduces muscle pain and tenderness. Exercise can also improve muscle endurance.
  
  
• Fatigue and chronic fatigue syndrome. Moderate exercise can reduce fatigue by enhancing mood, energy, endurance and appetite.
  
  
• Myofascial pain syndrome. Treatment of this musculoskeletal disorder may include physical therapy to stretch and strengthen affected muscles.
  
  
• Systemic lupus erythematosus. Rest may be required during flare-ups of this autoimmune disease, but physical activity during remissions can help patients cope.
  
  
• Myositis. Patients with this muscle disease who are at risk of joint contractures can benefit from low-impact exercises and active or passive range of motion.
  
  
• Polymyalgia rheumatica. Stretching and low-impact exercises are typically emphasized to promote flexibility in people with this muscle-stiffening disorder.
  
  
• Other sources of joint pain. For conditions ranging from sickle cell anemia to late-stage Lyme disease, a physician may suggest exercise therapy to reduce stress and maximize function.

Regular physical activity can help prevent many conditions, including cardiovascular diseases, diabetes and some cancers. Routine moderate physical activity including adequate warm-ups and stretching may also help prevent athletic injuries common in underconditioned "weekend warriors," such as strains, sprains, plantar fasciitis, shin splints and Achilles tendon injuries.

Most exercises designed to relieve pain and boost general health fall into one of three categories:

• Flexibility. These include range-of-motion and stretching exercises that help ease movement in the joints. This can help patients move and perform daily activities without experiencing pain. In addition, these exercises prevent muscles from shortening and tightening. This can help decrease the risk of future injuries that might cause pain.
  
  Range-of-motion exercises include moving the joints in various parts of the body as much as they can be moved in a certain direction. Such body areas include the jaw, shoulders, elbows, wrists, fingers, thumbs, hips, trunk, ankles and feet. Stretching exercises usually involve extending various muscles and holding the stretch for 30 to 60 seconds before releasing the stretch. Patients should not bounce or overstretch. Patients can benefit from stretching the heel, hamstrings, quadriceps, hips and low back.
  
  
• Aerobic capacity. Exercise that helps strengthen the heart, lungs and muscles associated with the cardiovascular system. This can help reduce the risk of cardiovascular disorders (such as heart attacks, high blood pressure and high cholesterol), increase stamina and energy and reduce fatigue. Experts usually advise patients to get 20 to 40 minutes of moderate intense aerobic activity on most days of the week. Aerobic activities include running, hiking, bicycling, cross-country skiing and aerobic dance.
  
  People with arthritis and other sources of joint pain may find particular benefit from water aerobics. The buoyancy of the water reduces the stress on a person’s joints while at the same time providing resistance that aids aerobic conditioning.

• Strength. Exercises that help build strong muscles. This increases overall fitness and reduces fatigue, making it easier to carry out daily activities. To build strength, patients may incorporate a weight-training program into their workout routine. For each muscle group exercised, patients are generally advised to allow at least 48 hours between sessions to allow recovery.

In addition, people with chronic pain should try to improve their posture. Good posture helps to minimize pressure on a person’s joints and muscles. On the other hand, poor posture stresses muscles and may cause them to stretch or shorten. Stretched muscles are weakened, and shortened muscles are more prone to injury and pain.

People are advised not to begin an exercise program without first consulting a physician or other expert. This is especially true of people suffering from pain, as it is crucial to design a program that helps relieve a patient’s pain and is safe enough to prevent additional injury.

A physician may want to review the medical history, perform a physical examination and possibly conduct blood tests, an exercise stress test or other diagnostic tests before clearing a patient for exercise.

In addition, people with certain conditions may need precautionary exercise routines that take into account their condition, such as:

• High blood pressure (greater than 160/100 mm Hg)
  
  
• Diabetes or disease of the heart, lung or kidneys

• Family history of cardiovascular problems before the age of 55
  
  
• Previous exercise symptoms that include chest pain, shortness of breath or dizziness
  

Exercise routines often include a flexibility component, a cardiovascular component and a strength-training component. Flexibility exercises typically involve various stretching techniques. Cardiovascular exercise includes activities such as running, aerobics, biking, swimming or sports activities that allow the patient to strengthen the heart and lungs. Strength-training exercises allow patients to improve muscle strength and tone and to increase flexibility. They usually involve use of free weights or resistance machines.

Aside from a physician, other experts who can help design an appropriate exercise program include:

• Physical therapist (PT). These experts are trained and licensed in ways to use exercise and other treatments to achieve physical health. Physical therapists can help choose the most appropriate exercises to address a patient’s particular type of pain. They often have certain specialties, such as pediatrics, orthopedics, sports medicine or rehabilitation.
  
  
• Occupational therapist. These therapists help teach patients to perform daily tasks in ways that will not aggravate injuries or place extra stress on the joints.

PTs and OTs hold college degrees, have completed internships and have received certification from their national organization. In physical therapy and occupational therapy, exercise or other physical activity often follows use of modalities (physical agents) such as thermotherapy, ultrasound therapy, hydrotherapy or electrical therapy. These modalities help maximize the joints’ range of motion and function.

• Exercise therapist. Most commonly known as a personal trainer, these are experts trained in helping people to exercise safely and effectively. Most health clubs have trainers available to help club members design and execute an exercise program.
  
  

  There is a wide range of exercise therapists, such as certified personal trainer, certified exercise therapist, certified athletic trainer or exercise physiologist. Depending on the designation, qualifications can range from a home study course to an advanced university degree. Certifications are available through a range of organizations, such as American College of Sports Medicine, National Athletic Trainers Association, American Council on Exercise, National Exercise Therapy Association or National Federation of Personal Trainers. Patients are advised to ask about an exercise therapist’s qualifications and experience.

Exercise may also be part of complementary and alternative pain management such as chiropractic or other manipulation therapy.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about exercise therapy:

1. Which of my pain conditions can be helped by exercise therapy?
   
   
2. Which exercises will best control my pain?
   
   
3. Are there any exercises I should avoid?
   
   
4. How can exercise reduce my pain?
   
   
5. Won’t the strain and stresses of exercise make my pain worse?
   
   
6. At what level of exercise should I begin? How long should my sessions be, and how many times a week?
   
   
7. At what rate should I increase intensity, frequency and duration?
   
   
8. How can I tell when I should exercise and when I need to rest?
   
   
9. Which experts can help me design an appropriate exercise program? What are the various qualifications and certifications of the professionals who offer exercise therapy?
   
   
10. What should I look for in choosing an exercise therapist?
    
    
11. Do you recommend a particular facility or therapist?