Why Does Physical Activity Take Pain Away?
By Norman A. Deitch, D.C.

In my last article, I discussed the process of nonsurgical spinal decompression therapy and the concept of how and why the therapy works.  I thought that this article should focus on some of our unique clinical experiences with patients.
 
Recently, Richard, a fit 58-year-old surfer from Oceanside came into my office for a consultation regarding his lower back and radiating leg pain. He had suffered with this condition for more than 25 years. Richard explained that he began to have pain once in a while and it would clear up in a few days. He has always been physically active and the few episodes of back pain were not too troublesome. Richard has been going to various chiropractors for many years and has recently tried acupuncture with various degrees of success.

About three months ago, he woke up one morning and couldn’t move. He said that the pain was so bad that it brought tears to his eyes.  Eventually he was able to get into a hot shower, do some stretching and get on with his day. The puzzling thing was that once he got on his feet and started vigorous exercise, the pain went away completely. The pain resumed the next morning. Richard went to his chiropractor, who suggested he get an MRI. The report came back showing a 6 mm disc bulge at L5/S1 compressing the central spinal cord and his right sciatic nerve and a 5 mm disc bulge at L4/5 on the left, compressing his peripheral nerve. In addition, Richard had a mild spondylolisthesis (when a vertebra shifts sideways) of L4 on L5 that added to the spinal stenosis (narrowing of the spinal canal) that the discs were creating.  His chiropractor referred him to me for evaluation, to see whether Richard could avoid surgery.

When Richard came into the office he could hardly walk and couldn’t sit comfortably.  He could only pace around so that the pain wouldn’t be so overwhelming. After reviewing his MRI findings, taking a history and doing some neurological and orthopedic tests, I told him that I thought our treatment would be of great benefit and he could avoid back surgery. He was very skeptical because he had been to so many doctors and chiropractors, had physical therapy and some injections, none of which brought more than temporary relief.  I took him for a tour of our facility where he met patients undergoing active treatment. After meeting several patients and hearing of their results, Richard began his program of nonsurgical spinal decompression therapy, horizontal electrotherapy, active therapeutic movement and pelvic stabilization.
 
In the first two weeks, Richard was nearly pain free all the time. He was amazed, and frankly so was I, at such rapid progress. Today, three months after he began treatment, he is completely pain free and fully functional.

Richard’s case was very interesting as his bulging disc and degenerative disc disease was also accompanied by a grade 1-2 spondylolisthesis. A “spondy” can be caused by trauma, such as a sports injury; continuous compressive pounding, such as running; a motor vehicle accident; or stepping off a curb the wrong way. It also can occur when the body, in an attempt to avoid pain and further injury, develops compensating postural positions that place unnatural loading on the spine. Compensatory posture can cause lateral curves (scoliosis), an increase or decrease of normal curves and cause unleveling and rotation of the hips, creating a short and long leg. Over time, this condition causes abnormal joint motion that sets off a process of joint degeneration.

Another interesting aspect of this case was that Richard’s pain would completely disappear during vigorous activity, only to return with a vengeance when he rested. Because this phenomenon is not common, I researched it. I discovered this may be due to several mechanisms:  Vigorous physical activity activates a bombardment of endorphins that create a natural “high” that can block pain signals. This is the body’s natural “morphine.”  Vigorous physical activity also will produce joint lubrication that hydrates cartilage, reducing irritation of the highly innervated joint capsule.  Vigorous physical activity produces a fusillade of proprioceptive signals, special cells within joints that tell the brain where you are in space, to the sensory cortex that can overshadow pain signals. 

Indeed, the notion of strenuous activity to relieve pain is controversial among physicians managing pain while dealing with underlying conditions. Generally, the medical community relies on chemical mediators, drugs, to manage pain. Other therapies that mediate pain include various forms of electrotherapy, meditation, acupuncture and, if it can be tolerated, a program of well-thought-out exercise. However, without addressing Richard’s underlying condition, his problems would have worsened. Recent research suggests that specifically targeted motion does indeed reduce pain and improve joint function when used in conjunction with therapeutic procedures addressing the underlying cause of the pain.

Norman A. Deitch, D.C., is clinic director at Non-Surgical Spine Center, a division of Health-Link Medical Center in Oceanside, Calif. See www.nonsurgicalspinesolution.com.