It is not all about strength: rethinking mechanistic assumptions in exercise-based rehabilitation for musculoskeletal pain relief

Key Points

1. Current research challenges the assumption that strength gains directly mediate pain relief in musculoskeletal rehabilitation.

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BACKGROUND & OBJECTIVE

Exercise therapy has been found to be modestly effective in reducing pain in musculoskeletal conditions and is therefore a mainstay of rehabilitation (1). However, the evidence for how exercise improves pain is sparse leading to explanations that are reliant on outdated biomechanical beliefs. This editorial piece aimed to challenge what the authors consider an outdated biomechanical assumption amongst therapists, that strength gains are the primary driver of pain reduction and clinical improvement.

Alternative bio-psycho-social mechanisms are proposed that form a multi-dimensional framework which has stronger empirical support than the general assumption that strength gains mediate recovery and pain relief. The authors argue that understanding how an intervention works matters for scientific rigour, clinical integrity and conducting responsible research.

The evidence for how exercise improves pain is sparse leading to explanations that are reliant on outdated biomechanical beliefs.

Psychosocial factors, metabolic health and movement confidence should all be considered and acted upon within scope of practice.

METHODS

The authors provided 19 references of related current research to support their argument that “a chasm between belief and data warrants attention’. They extrapolate the framework and go on to make clinical suggestions. The following research findings were used to

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