I have pain. Should I rest or exercise?

If you’re in pain, it can be difficult to know whether to rest or exercise. While rest can be helpful in the short term to allow the body to calm down, too much rest can actually weaken the muscles and make it more difficult to manage pain in the long term. On the other hand, regular exercise, including strength training or resistance training in particular, can help to improve or maintain muscle strength and endurance, which can in turn help to reduce pain and improve function.

Why strength training, though? Can’t I just stretch regularly?

Some people do find good pain relief with resting and stretching every now and then. And if that works well for you, keep it up. However, you can get even more out of your improvement journey by adding strength training to the mix. The many benefits of strength training include:

Reduced pain and disability

First and foremost, we can address the pain itself. Exercise training has been shown to be an effective treatment strategy for reducing pain and disability for adults with chronic pain (Belavy et al., 2021). As well as improving strength and endurance, one suggested mechanism of pain reduction is via increasing a person’s pain threshold. Exercise training was more effective than non-exercise at improving pain sensitivity. Now this doesn’t mean to push through and ignore your pain to do exercise. Work with your healthcare professional to find exercises and variations that work for you specifically.

Reduced risk of future injury

Aside from decreasing pain, we want to decrease the chance of the injury or condition recurring in the future. Strength training affects the structural makeup of the body in many ways including bone, connective tissue, as well as the muscles (Hoffman, 2017). The most well-known change with strength training is muscle gain. There is a notable decrease in function as muscle mass decreases. This includes balance, strength, coordination. Decreases in any of these traits can result in falls, rolled ankles, muscle tears, or even unsafe compensatory movements.

Bone density is an important consideration as we age, especially for women who have larger bone density loss with age. Bones with lower density are more brittle and prone to breaking, even with minor trauma. This can be particularly problematic for people with osteoporosis, as they may be at risk of fractures from everyday activities such as lifting a heavy object or falling from a standing position. Osteoporosis is often referred to as a "silent disease" because it can progress without any symptoms until a fracture occurs. In addition to increasing the risk of fractures, lower bone density can also lead to other problems such as loss of height, a hunched posture, and chronic pain. Subjecting the body to increasing loads through a strength training program can increase/maintain bone density and prevent these effects.

The connective tissues in the body include tendons and ligaments that support or connect different tissues in the body. Resistance training can help to increase the loading capacity of tendons and ligaments, which can in turn help to improve joint stability and reduce the risk of injury. Strength training can also help to improve the overall health and function of connective tissue by increasing blood flow and the delivery of nutrients to these structures. It is important to note, however, that connective tissue has a limited capacity for remodeling and strengthening, so it is important to progress slowly and carefully with strength training to avoid overloading the connective tissue and causing injury.

While exercise in general has been shown to reduce injury risk, recent research by Lauersen et al. (2014) compared strength training, stretching, proprioception training and combinations of these and their ability to reduce acute and overuse injury risk. Strengthening was found to be best by a good margin, followed by proprioceptive training, and closely followed by a combination of all three. Interestingly, stretching showed little to no benefit in reducing injury risk. This goes against the traditional wisdom of stretching to prevent injuries.

Increased functional performance 

Whether your goal is to get back to sport or back to walking around the home safely, function is key. Most people do not consider going to seek professional help when pain first develops. They come in when their pain has gotten so bad that they cannot do a certain thing. They rolled their ankles and now they can’t play basketball. Or their back hurts and now they can’t drive. Pain is important because it decreases your ability to function, usually by restricting your range of motion or by reducing your strength or endurance. Strength training will, obviously, increase your strength, but a lesser known fact is that it also increases your range of motion. Recent research has shown that the gains you get in range of motion or flexibility from stretching regularly compared to a strength training program did not differ (Afonso et al., 2021). This means you could be developing strength and flexibility at the same time instead of doing separate resistance and stretching routines.

Reduced mortality risk 

As we age, many become more aware of the fact that our bodies become more easily affected by things and we do not recover as easily. Increasing overall health and longevity becomes more important. 

A systematic review and meta-analysis was performed by Shailendra et al. (2022), looking at resistance training and its effects on mortality risk. The study compared those who did no resistance training to those with any resistance at all. They found that the risk of mortality by cardiovascular disease, cancer, and mortality by any cause was reduced by up to 27% with 60 minutes of strength training per week. This tells us that going from no strength training to any amount of strength training can have a large effect on a person’s health and longevity.

Builds resilience (physical and psychological)

In addition to all of these physical benefits, strength training has also been shown to decrease anxiety, depression, stress, improve mood, memory and cognition, and increase overall confidence levels. All of these factors have been shown to affect pain levels as well and by controlling them, you control your pain.

To get started on the benefits of guided strength training, book in with our physiotherapists by using the button below. You can find our clinics in Markham and Toronto.

Conclusion

So yes, you could just stretch and reduce some pain. But why not spend the exact same amount of time doing some strength training and reduce your pain, reduce your injury risk, reduce risk of disease, increase your strength and flexibility, become more physically and psychologically resilient, and become more confident all at once. 

It is important to consult with a healthcare professional to determine the best course of action for your individual situation. They can help to develop a pain management plan that includes strength training that is appropriate for your needs and goals.

References

Afonso J, Ramirez-Campillo R, Moscão J, et al. Strength training versus stretching for improving range of motion: a systematic review and meta-analysis. Healthcare (Basel). 2021;9(4):427.

Belavy DL, Van Oosterwijck J, Clarkson M, Dhondt E, Mundell NL, Miller CT, Owen PJ. Pain sensitivity is reduced by exercise training: Evidence from a systematic review and meta-analysis. Neurosci Biobehav Rev. 2021 Jan;120:100-108. doi: 10.1016/j.neubiorev.2020.11.012. Epub 2020 Nov 27. PMID: 33253748.

Hoffman, J. Resistance Training and Injury Prevention. Indianapolis, IN: American College of Sports Medicine; 2017.

Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2014;48(11):871-877.

Shailendra P, Baldock KL, Li LSK, Bennie JA, Boyle T. Resistance training and mortality risk: a systematic review and meta-analysis. Am J Prev Med. 2022;63(2):277-285.

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