Living with pain can be a complex journey, but the good news is that a variety of strategies exist to help manage and alleviate discomfort. In this comprehensive guide, we’ll explore a range of approaches, from physical activity to medical interventions, PT-led care, and home-based techniques.

Physical Activity: Tailored for Your Body

One of the most important things you can do for your pain is to be physically active. Research repeatedly shows bed rest does not work for treating pain and medical clinical practice guidelines specifically state to avoid bed rest. This is often easier said than done. If you have severe pain, how do prioritize physical activity? You don’t need to complete formal workouts in the gym. You can start with basic activities at home.

Graded exposure for musculoskeletal pain is like a step-by-step way to help you get used to activities that might be a bit uncomfortable. Instead of completely avoiding those activities, you start with easier versions and slowly work up to more challenging ones. Let’s use low back pain as an example.

If you have pain in your lower back while bending at the waist to pick up groceries off of the floor, you may start by taking a knee to avoid any back bending. Once that is easy, you squat low and barely bend your back, relying more on your legs. Next, you use a wide stance so you don’t need to bend your knees or back as much, but you’re starting to get some waist bending. Once you can fully bend without pain, you gradually pick up more bags and heavier with each trip until you no longer have to restrict your activity.

It’s a bit like taking small steps to become okay with movements that might feel a bit uneasy at first. This helps you gain confidence and get back to doing things without too much discomfort. Even little activities such as getting the mail or standing for 30 minutes to bake can be powerful steps in the right direction, especially if you have anxiety or fear of some movements. You may fear pain, re-injury, or a fall. All are normal responses that you can work through.

As your fear and anxiety around movement reduces, pain becomes the primary limiting factor. That pain can be a result of tissue damage (acute pain) or a learned experience (chronic pain). In both cases, pain is your guide for gradually progressing activity, using a method known as graded activity.

If you have tissue damage and acute pain, you want to limit activity to prevent further damage and to support healing. After an injury, the body uses inflammation to trigger healing. During healing, new tissue is formed but it is weak initially and cannot handle the same amount of stress as it could before the injury. For example, you may limp after a hamstring strain. That is a normal response that limits strain on the hamstring. Pain will let you know how fast you can walk. If you try walking too fast too soon, the pain will be sharp and severe. A little pain is ok.

For graded activity, pain levels of 1-4 are typically OK. You don’t want to fear all pain, which may lead you to be completely inactive, which is terrible for healing and overall health. You also don’t want to push through severe pain which may delay healing or cause more damage. If there is no damage and the pain is more driven by learned experiences (remember pain is complex and is affected by biological, social, and psychological factors), then you still want to gradually increase your activity level, but you don’t need to fear delaying healing.

The Pain Willingness Dial is like a tool to help you decide what activities you feel okay doing when tissue healing is not a concern. It’s a visual guide that lets you show how comfortable you are with different tasks or movements. By using the dial, you can find a balance between avoiding everything because of pain and doing too much, which might make things worse. It helps you make thoughtful choices about what activities to do based on your pain tolerance and overall well-being.

For example, your pain may normally be a 4 out of 10, which you can manage during basic activities. You have a big golf outing planned with friends and you know that your pain will jump to the 7-8/10 range by the end of the round. Since you love golf and have been looking forward to the event for months, you are willing to endure the added pain. Conversely, if your flower bed needs a few hours of weeding and mulch laying, which would result in the same spike in pain, you may push the activity off a few weeks, as your pain willingness dial is lower.

When it comes to treating pain through exercise, not all types are created equal. Both aerobic and strengthening exercises have a pain-relieving effect while stretching and proprioceptive exercises are found to be less effective. Aerobic exercise, involving continuous movement of major muscle groups, is particularly beneficial when done at a low-to-moderate intensity (50–60% of maximum heart rate) for managing chronic pain. Strengthening exercises, where muscles work against resistance, are well-tolerated and more effective when done on solid ground. Stretching aims to improve flexibility, and proprioceptive exercises focus on neuromuscular training for posture and coordination. Though these latter exercises may not directly ease pain, they can have positive emotional effects, making them valuable additions to comprehensive training programs.

When it comes to exercise intensity, vigorous aerobic activities tend to have a higher pain-relieving effect compared to moderate exercise. However, the response to exercise intensity can vary among individuals. In strengthening exercises, even isometric contractions with loads as low as 10–30% can be sufficient for pain relief, especially when held until failure. Short exercises like a 3-minute wall squat program can also have a pain-relieving effect.

Considering the timing and duration of exercise, a recent study suggests that for an optimal pain-relieving effect, physical exercise programs should not exceed 120 minutes per week. The duration of exercise in chronic pain should ideally fall between 7 to 15 weeks, with the pain-relieving benefits beginning to decline after this period. The response to physical exercise is variable among patients with chronic pain, emphasizing the importance of personalized prescriptions by professionals with expertise in musculoskeletal health, exercise, and pain management.

Understanding how exercise can make a difference in managing your pain is essential for creating a plan that works for you. Striking the right balance is key—doing too little exercise may not help while doing too much can lead to discomfort and make you want to stop. Personalizing your exercise plan is important to avoid issues and get the most benefits in the long run. The way you exercise matters; moderate-intensity exercises before or after a pain episode tend to be most effective. For chronic musculoskeletal pain, it’s recommended to stay within safe pain limits, starting with easier exercises and gradually increasing intensity. Consider water-based exercises like swimming or treadmill walking, as they can reduce body weight and provide thermal benefits. Remember, chronic pain doesn’t always mean damage, and your mindset plays a big role in how you feel during exercise. Integrating coping strategies linked to your pain perception is crucial for making exercise enjoyable and safe. This not only helps with pain but also boosts your mood, making it easier to stick to your exercise routine and make positive lifestyle changes. You’re in control, and understanding the importance of factors like exercise equipment and support from experienced professionals can make your exercise journey more successful.

Medical Interventions: Tailored to Your Diagnosis

Medical interventions may be necessary, but they often should not be the first line of treatment.

Injections

Studies suggest that injections ( might not work well for pain relief in the long run. Even though they can help a bit in the short term, especially for things like long-lasting back pain, their benefits don’t seem to last for a very long time. Those short-term benefits may help you get over the hump and complete a rehabilitation program. Understand an injection won’t fix damaged tissue or resolve the root causes of pain.

Some research also talks about possible risks and side effects that can happen if you get these injections too often, particularly corticosteroids. So, when thinking about ways to manage pain, it’s important to know that injections may not be a perfect solution for a lasting effect, and it’s good to talk to doctors about what might work best for your pain.

Medications

Research on medications for musculoskeletal pain suggests that while prescription drugs, such as opioids and muscle relaxers, can offer short-term relief, their effectiveness over the long term might be limited, and the side effects can be very harmful. Opioids may induce side effects such as drowsiness, constipation, nausea, and potential respiratory depression, particularly in high doses. Additionally, opioids carry risks of tolerance, physical dependence, and addiction. Muscle relaxers may cause drowsiness, dizziness, dry mouth, and blurred vision. These medications can also lead to urinary retention and gastrointestinal discomfort. Both opioids and muscle relaxers should be used cautiously, strictly as prescribed, due to the potential for adverse effects and the risk of developing tolerance or dependence over time.

As with injections, pain medications do not address the root cause and will not enhance the body or facilitate healing. Studies often highlight that relying solely on medications for managing MSK pain does not lead to lasting improvements. It’s important to understand why you are prescribed a medication and to have a clear plan with your physician about the timeline for taking it. There are some situations, such as post-surgical, when pain medication is appropriate. Speak with your physician about all of your options and make sure you have a comprehensive rehabilitation plan to fully address your pain.

Surgery

In many cases, surgery is the wrong first option. A review of 25 trials in the journal Pain Medicine found surgery is ineffective for chronic pain. Another review in the British Journal of Medicine assessed the clinical effectiveness of the 10 most common orthopedic procedures in the US. Only two of the 10 were superior to conservative care alone: total knee replacement and carpal tunnel release.

Other Conservative Care Options

While your physical therapy plan of care focuses primarily on physical activity, another tool will be used to help treat your pain. Some of these are provided by your PT, such as manual therapy while others can be done in the clinic or at home, such as icing.

Manual Therapy

Manual therapy is a hands-on approach to treating musculoskeletal and orthopedic conditions, typically performed by trained physical therapists, chiropractors, or osteopathic physicians. This therapeutic technique involves skilled manipulation and mobilization of joints, soft tissues, and muscles to alleviate pain and improve range of motion. Manual therapy can be applied to any region of the body and research shows it is effective for reducing pain.

Ice

In essence, icing, or cryotherapy, offers short-term pain relief and can reduce swelling, particularly beneficial after surgery or acute injuries, though it doesn’t alter recovery timelines significantly. Whether using a high-end ice pack or a simple bag of frozen peas, a 10–20 minute application of something very cold can be effective. Though the pain relief is temporary, it can aid in better sleep, reduced reliance on pain medication, improved focus at work, or enhanced daily enjoyment, making it a valuable intervention despite its limited duration.

Heat

Heat application, whether through hot packs or warm baths, can provide short-term pain relief, similar to ice. For chronic pain, one is not universally superior to the other. Choose the modality that provides the most relief for you. For heat, use 20-30 minute applications over the area that is painful.

Stretching

Stretching can provide short-term pain relief. Along with pain and discomfort, you may feel tightness and the urge to stretch the area that hurts. The perceived tightness does not mean you have impaired flexibility and need to “loosen” your body. The perception of tightness often improves with any physical activity, including low-intensity cardiovascular exercise that increases muscle temperature and blood flow. If you want to use stretching to relieve some pain, discomfort, or tightness, keep it at a low or moderate intensity (max 7 out of 10 stretch intensity) and hold the stretch for 30-60 seconds.

You may receive other treatments for pain as well, including, e-stim, ultrasound, dry needling, or cupping. Ask your PT to learn more about them.