Exercising for Pain

Regarding corrective exercise…. is it counter productive to prescribe exercises in patterns that are DP if the exercise itself does not provoke pain for purpose of muscle activation. Are we supposed to be completely avoiding exercise at all costs in painiful patterns even if the exercise is not provoking pain?

For example, MSF is DN and MSE is DP. The MSF is found to be a Hip JMD and after hip joint mobilization/ hip flexion patterning correctives one also prescribes bridges (a hip extension pattern)for glute max activation performed in pain-free ranges.

1. It is NEVER wrong to do something to get someone out of pain. That is the artful nature of this and other systems. There are definitely varying levels of right in terms of approaching the Painful pattern.  Whatever muscle activation means as the question asks is up for debate, but what can not be denied is that exercising in the presence of pain may yield the appropriate deep stabilization pattern, or it may not.  Names such ranging from Hodges and Jull to more recently Kiesel and Moseley suggest that in the presence of pain, there is not a predictable explanation for what is happening, or whether we are hurting or the helping.

So if you are following some rubric such that only focuses on auditing the FP or FN, that is totally okay, but it is incomplete.  Remember that the big money is in the DN, which should be training concurrently with the FP or FN if you so choose.  One complication you may run into is that the DN can change if you change the pain, so recheck the whole SFMA to make sure you are seeing things authentically.

2. The SFMA was originally taught with minimal attention to intervening into the painful pattern. This was not the literal intent, just a principle-based focus. Some messages were grandly misinterpreted that improving t-spine rotation was all you needed to get back knee ROM after a TKR because it was all about the DN and “not chasing pain.”  This is obviously nonsense in many cases. You still have to do something that gets at the pain. No matter how exciting regional interdependence and overthrowing the government is, it is still imperative to treat the local lesion and kill the insurgents.

3. Exercising through or in pain is different than exercising for pain.

4. Gentle or graded movement may be semantics for certain “exercises.” Active shoulder ROM in a pain-free range, self-SNAGS, or REIL are all “exercises” that I would consider gentle or graded movement.
The foolishness of using rubber bands or 2# scaption when the shoulder hurts doing the movement is where we should steer clear.

  • March 18, 2012

Leave a Reply 4 comments

Tim Ward Reply

Could you give a quick glossary of all the abbreviations?

Charlie Reply

SFMA = Selective Functional Movement Assessment
FN = Functional Non-Painful
DN = Dysfunctional Non-Painful
FP = Functional Painful
DP = Dysfunctional Painful
ROM = Range of Motion
TKR = Total Knee Replacement
SNAGS = Sustained Natural Apophyseal Glides
REIL = Repeated Extension In Lying
# = pounds

Tim Ward Reply


Dr. E Reply

Great q&a Charlie! Love how your recent schedule includes The Avengers on 5/4! I’m waiting til the crowds clear a bit.

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