My Top Article in 2017
Simple guidelines for clinicians
The article that I appreciated the most in 2017 is the following:
“Exercise for chronic musculoskeletal pain: A biopsychosocial approach”[1]
I could have mentioned other high quality papers covering more specific topics such as Rate of Force Development (RFD)[2], training specificity [3], altered kinetics in DVJ [4], Exercise Induced Hypoalgesia (EIH)[5] etc. but I would like to report some parts of the brilliant review by Booth et al. because it contains simple basic fundamentals that should be the cornerstones in 2018 of any clinician involved in Musculoskeletal and Sports Medicine.
The general guidelines for aerobic and resistance exercises are depicted in the following table:
Short nuggets:
COMMENCING TREATMENT AND EXPLAINING PAIN
Explaining pain refers to a range of educational techniques that aim to change how the patient makes sense of their pain (Moseley &Butler, 2015)
Goal setting should also be completed before commencing exercise and involve a collaborative approach with the clinician assisting the patient to identify meaningful goals not only related to exercise, physical activity and function but other biopsychosocial aspects (Gardner et al., 2015). Patient‐centred goal setting promotes informed, individualized exercise interventions that are more meaningful and engaging to the patient. Clinicians should emphasize that exercising in itself is not the final treatment goal but regular exercise can help patients to enhance life quality through improvements in physical function and performance of activities of daily living
AEROBIC EXERCISE
Aerobic exercise performed between 20 and 60 min, ≥2 days/week for 6 weeks or longer can be sufficient to positively impact on symptoms and function (Busch et al., 2011; O’Connor et al., 2015). The benefits of aerobic training also include improved psychological well‐being and better cognitive and metabolic function, which holds promise for CMP patients who often have co‐morbidities. Aerobic exercise has also been shown to decrease pain perception and pain sensitivity in healthy individuals and CMP cohorts (Naugle, Fillingim, & Riley,2012). Performed at an intensity to improve cardiovascular fitness, aerobic training might also augment pain tolerance (Soriano‐Maldonado, Ortega, & Munguía‐Izquierdo, 2015).
RESISTANCE EXERCISE
Resistance training that engages non‐painful body parts can have a positive global impact on pain (Burrows, Booth, Sturnieks, & Barry, 2014; Vaegter, Handberg, & Graven‐Nielsen, 2014) offering alternative exercise strategies for patients experiencing flare‐ups.
Low‐ to moderate‐intensity resistance exercise (40–60% 1RM) has shown to be sufficient to evoke positive changes (Bennell & Hinman,2011; Busch et al., 2013; Kristensen & Franklyn‐Miller, 2012). While most exercise interventions for CMP will involve low‐ to moderate intensity exercise, higher intensity training (≥70% HRmax/1RM) can improve pain and function without adverse effects (Bennell & Hinman, 2011; Kristensen & Franklyn‐Miller, 2012; Limke,Rainville,Peña, & Childs, 2008) and should be prescribed when the goal is a return to more physically demanding work, sport or recreation. Clinicians should aim to gradually increase exercise intensity and apply the principles of progressive overload as the patient’s confidence and exercise tolerance improve.
References:
1. Booth, J., et al., Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal Care, 2017.
2. Rodríguez-Rosell, D., et al., Physiological and methodological aspects of rate of force development assessment in human skeletal muscle. Clinical Physiology and Functional Imaging: p. n/a-n/a.
3. Balshaw, T.G., et al., Training-specific functional, neural, and hypertrophic adaptations to explosive- vs. sustained-contraction strength training. J Appl Physiol (1985), 2016. 120(11): p. 1364-73.
4. Powell, H.C., et al., Individuals Post-Achilles Tendon Rupture Exhibit Asymmetrical Knee and Ankle Kinetics and Loading Rates During a Drop Countermovement Jump. J Orthop Sports Phys Ther, 2017: p. 1-37.
5. Lima, L.V. and T.S.S. Abner, Does exercise increase or decrease pain? Central mechanisms underlying these two phenomena. 2017. 595(13): p. 4141-4150.