Should rehab be painful?

A very recent article in press has caught my eye because it is so topical in relation to pain issues and how these fold into the rehab process.

Historically we have always viewed pain as a counterproductive signal, but is that really the case?

Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Benjamin E Smith, Paul Hendrick, Toby O Smith, Marcus Batema, Fiona Moffatt3, Michael S Rathleff, James Selfe, Pip Logan, British Journal of Sports Medicine 2017, Article in press.

Well, this is an intriguing question and attention grabbing headline, which for me raises a few questions.

What is pain, and how much pain is acceptable?

The paper may be read in its entirety here, however, here is the abstract:


Background Chronic musculoskeletal disorders are a prevalent and costly global health issue. A new form of exercise therapy focused on loading and resistance programmes that temporarily aggravates a patient’s pain has been proposed. The object of this review was 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.

Simon Bartold
Director of Bartold Clinical