Exercise & Pain: Exploring a complex relationship

Ben Cormack

C LAS S OV E RV I E W
Exercise can be a powerful tool to help manage many conditions seen in the clinic. However, there is
currently a lot of misunderstanding surrounding exercise therapy – When is a specific type of exercise
needed versus more general exercise? Is it ok for exercise to be painful? What is the right dosage of
exercise? And perhaps most importantly, how do we get our patients on board with exercise? This
Masterclass answers all these questions and more, empowering you to use exercise in the most
effective way possible to enhance patient outcomes.

1 Copyright © Physio Network

P RESENTER bi o
Ben Cormack is a musculoskeletal therapist with a clinical background in
sports therapy, rehabilitation, pain science and exercise. He specialises
in a movement and exercise based approach with a strong patient
centred focus. Ben is a popular international presenter who has delivered
presentations and courses all over the world.

Module Summaries Learning objectives:

• Understand the relationship of posture to
Module 1: Lower back pain pain
Lower back pain is a huge worldwide • Understand the relationship of strength
problem. This lecture looks at what we do to movement
and don’t know around back, its contributory
• Understand more about muscle firing and
factors and current best practice for
relationship to pain
treatment. It also explores how we use
exercise in the treatment process.
Module 3: Exercise dosing
Learning objectives: Exercise dosing is still one of the most
unknown areas in rehabilitation. The same
• Understand best practice for LBP
dosage can different effects on different
• What exercise is best for LBP people. How do we get better at applying
• Exercise case study for LBP the ”right” dose? And what does that mean
anyway?

Module 2: Movement myths

Learning objectives:
This lecture dives into the many of the myths
that we have around movement that shape • Explore what ‘dosage’ is
the way we work with people. Using an • Clinical reasoning around dosage
evidence based framework around popular
• Case study on application of dosage
therapeutic targets we ask are these factors
important and what to do with them.

2 Copyright © Physio Network

Module 4: Painful exercise Module 6: Exercise specificity
Painful exercise is an important and hot When do you need to be specific with the
topic in today’s rehab world. As it is often application of exercise and when less so?
unavoidable we need to know how to navigate This lecture explores different case studies,
using painful exercise and what to look out for. guided by current evidence, to ask and
answer this complex question.

Learning objectives:
• Understand Research around painful exercise Learning objectives:

• Use clinical reasoning with painful exercise • To understand when exercise specificity is
required
• Know when and when not to use painful
exercise • Understand what are the parameters
around exercise specificity
• Explore case study examples of the
Module 5: Selling exercise application
The biggest problem in rehab is not which exercise
to choose. It’s how to actually get patients to do
it. This lecture looks at some of the beliefs that Progress Checklist
limit adherence and also information that might 1. Review all learning objectives
persuade them to do more. 2. Complete all Masterclass video lectures
3. Take the quiz to test your knowledge
Learning objectives: 4. Print or save your certificate to record your
• What are the benefits? professional development.
• What are the problems?
• Learning the data around exercise

3 Copyright © Physio Network

 REFERENCES

MODULE 1 3. Relationship between Hip Extension Range of

Motion and Postural Alignment. Heino J et al J
1. Diagnostic triage for low back pain: a practical
Orthop Sports Phys Ther. 1990
approach for primary care. Med J Aust.  2017;
206(6):268-273 4. Variation in Pelvic Morphology May Prevent
the Identification of Anterior Pelvic Tilt –
2. Individualized Low-Load Motor Control
Preece. J Man Manip Ther. 2008; 16(2):
Exercises and Education Versus a High-
113–117.
Load Lifting Exercise and Education to
Improve Activity, Pain Intensity, and Physical 5. Subacromial impingement syndrome: The
Performance in Patients With Low Back role of posture and muscle imbalance. Lewis
Pain: A Randomized Controlled Trial. Journal et al. Journal of Shoulder and Elbow Surgery
of Orthopaedic & Sports Physical Therapy, 14(4):385-92 • July 2005
2015 Volume:45 Issue:2 Pages:77–85.  6. Dynamic testing of the motor stereotype in
https://www.nice.org.uk/guidance/ prone hip extension from neutral position
conditions-and-diseases/musculoskeletal- Clinical Biomechanics. Vogt et al. Vol 12, Issue
conditions/low-back-pain 2, March 1997, P 122-127
3. Prevention and treatment of low back 7. Muscle firing order during active prone hip
pain: evidence, challenges, and promising extension. Nygren Pierce M, Lee WA. J Orthop
directions Lancet, Foster et al, Volume 391, Sports Phys Ther. 1990;12(1):2-9.
Issue 10137, 9–15 June 2018, Pages 2368- 8. The activity pattern of the lumbo pelvic
2383 muscles during prone hip extension in
4. Exercise interventions for the treatment of athletes with and without hamstring strain
chronic low back pain: a systematic review injury Int J Sports Phys Ther. 2014 May; 9(3):
and meta-analysis of randomised controlled 312–319.
trials – Searle et al, Clinical rehabilitation. 2015 9. Corset hypothesis rebutted--transversus
abdominis does not co-contract in unison
prior to rapid arm movements. Morris et
MODULE 2
al. Clinical Biomechanics ,Volume 27, Issue
1. Spinal curves and health: a systematic 3, March 2012, Pages 249-254
critical review of the epidemiological
10. Willey et al, The effect of a hip-strengthening
literature dealing with associations
program on mechanics during running and
between sagittal spinal curves and health.
during a single-leg squat, J Orthop Sports Phys
Christensen et al J Manipulative Physiol
Ther. 2011
Ther.  2008; 31(9):690-714
11. Frontal plane kinematics of the hip during
2. Lumbar lordosis: study of patients with and
running: Are they related to hip anatomy and
without low back pain. Murrie VL et al Clin
strength? Baggaley et al 2015 Gait & Posture
Anat. 2003 Mar;16

4 Copyright © Physio Network

 REFERENCES

12. Moreside & Mcgill, Improvements in hip MODULE 4

flexibility do not transfer to mobility in 1. Should exercises be painful in the
functional movement patterns. J Strength management of chronic musculoskeletal
Cond Res. 2013 pain? A systematic review and meta-analysis.
13. The influence of load and speed on Smith BE, Hendrick P, Smith TO, et al. Br J
individuals' movement behavior. J Strength Sports Med 2017;51:1679-1687.
Cond Res. 2013. Frost D. 2. Musculoskeletal pain and
exercise—challenging existing
paradigms and introducing new.
MODULE 3
Smith BE, Hendrick P, Bateman M, et al. Br J
1. Acute sensory and motor response to 45-s Sports Med Published Online First: 20 June
heavy isometric holds for the plantar flexors 2018. doi: 10.1136/bjsports-2017-098983
in patients with Achilles tendinopathy. O neill
et al. Knee Surg Sports Traumatol Arthrosc
(2018).  MODULE 5
2. Chronic Psychological Stress Impairs 1. Effective treatment options for
Recovery of Muscular Function and Somatic musculoskeletal pain in primary care: A
Sensations Over a 96-Hour Period. Stults- systematic overview of current evidence.
Kolehmainen et al. Journal of Strength Babatunde et al. PLoS One. 2017 Jun
and Conditioning Research: July 2014 - 22;12(6):e0178621
Volume 28 - Issue 7 - p 2007–2017 2. 2013 Neer Award: predictors of failure
3. Strength Gains after Resistance Training: of nonoperative treatment of chronic,
The Effect of Stressful, Negative Life Events. symptomatic, full-thickness rotator cuff tears.
Bartholomew et al. The Journal of Strength Dunn et al. Journal of Shoulder and Elbow
and Conditioning Research 22(4):1215- Surgery Volume 25, Issue 8, August 2016,
21 • August 2008 Pages 1303-1311
4. Triathletes Lose Their Advantageous Pain 3. What does best practice care for
Modulation under Acute Psychosocial Stress. musculoskeletal pain look like? Eleven
Geva et al. Medicine & Science in Sports & consistent recommendations from
Exercise 49(2):1 • September 2016 high-quality clinical practice guidelines:
systematic review. Lin I, Wiles L, Waller R,
et al. Br J Sports Med  2019. doi:10.1136/
bjsports-2018-099878

5 Copyright © Physio Network

 REFERENCES

4. Bowden, J. A., Bowden, A. E., Wang, H. , 6. Knee osteoarthritis has doubled in

Hager, R. L., LeCheminant, J. D. and Mitchell, prevalence since the mid-20th century.
U. H. (2018), In vivo correlates between daily Ian J. Wallace, Steven Worthington, 
physical activity and intervertebral disc health. Daniel E. Lieberman et al.
J. Orthop. Res., 36: 1313-1323.  PNAS August 29, 2017 114 (35) 9332-9336
5. Booth, Frank W et al. “Lack of exercise
is a major cause of chronic diseases”
Comprehensive Physiology vol. 2,2 (2012):
1143-211.

6 Copyright © Physio Network