Should exercises be painful in the management of chronic MKS pain? A SR with MA

(Smith, Hendrick, O Smith, & Al., 2017)

Aims: To compare the effect of exercises where pain is allowed / encouraged compared with non-painful exercises on pain, function or disability in patients with chronic musculoskeletal pain within randomised controlled trials.

Method: Systematic review on exercises into pain vs non-pain exercises on pain, function or disability. 9 papers included, total of 385 participants with pain > 3 months (chronic).

Results: Small but significant difference favouring exercises into pain in the short-term, moderate quality evidence, small effect size (-0,27) on patient reported pain.

Appears to be no difference in patient reported pain on medium and long-term due to moderate to low quality evidence. The instructions regarding pain were different, not clear if that had an effect.

Limitations: None of the studies recorded levels of pain during exercise.
The framing of pain vs no pain can potentially affect the outcome, the effects are unclear.
Studies included different areas, LBP, shoulder pain, Achilles pain, plantar heel pain.

In practice: Affects advice / conversations with patients. Pain during exercises in chronic pain not harmful, does not prevent improvements.

Smith, B., Hendrick, P., O Smith, T., & Al., E. (2017). Should Exercises be painful in the management of chronic msk pain. BJSM, 1–10.

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