As physical therapists, we frequently hear this question: “I have this ache or pain, what should I do?” While specific aches & pains need a bit more assessment, there are general strategies that you can implement for musculoskeletal pain. In this blog post, we’ll be focusing on some strategies that are efficient in terms of both time & money and which have minimal side effects.
1. Improve Sleep Hygiene
Sleep not only influences our body’s ability to recover after injury, but it also influences our perception of pain. Studies demonstrate a connection between poor sleep & perception of pain [1, 2]. In addition, sleep disturbances are considered a risk factor for developing chronic pain . Here are a few simple tips from the Centers for Disease Control & Prevention (CDC) which require minimal up front investment:
- Avoid caffeine, large meals, alcohol or excessive fluid intake before going to bed
- Have a consistent bedtime & a consistent wake up time
- Keep your bedroom dark, relaxing, quiet and at a cool, comfortable temperature
- Exercise each day
- Don’t use electronic devices in the bedroom – keep your bedroom only for sleep & sex
If you still have sleep difficulties after implementing these steps, consult a licensed practitioner who can help through further evaluation such as testing for sleep apnea.
2. Exercise Daily, Emphasizing Aerobic Exercise
Research shows that aerobic exercise performed at least 75% of VO2 Max  (or roughly at an intensity where you can talk but not sing) decreases sensitivity to pain. Aerobic exercise has been recommended as part of a treatment approach for chronic pain . This can take a variety of forms such as walking, biking, swimming, dancing, rowing and more.
3. Manage Levels of Stress
Both stress & our emotional state influence our perception of pain and our response to it. Research shows that cognitive stressors can significantly impact our perception of physical pain . Beyond that, stress has real physiological effects (such as elevating cortisol levels & increasing inflammatory markers) that directly affect whatever tissue may be irritated .
Ideally, we want to remove chronic stressors, however, this is often not possible. Fortunately, there are tools recommended by the American Psychological Association (APA) which you can implement to help mitigate the effects of chronic stress:
- Eat a well-balanced diet
- Perform mindfulness based meditation
- Perform muscle relaxation exercises
- Get regular physical activity
- Sleep well
- Take time for pleasurable leisure activities
- Spend time in nature
If you chronically struggle to manage stress, even after incorporating interventions like the ones described above, then consult a licensed practitioner for further guidance.
4. Try Thermal Modalities Including Ice Packs, Hot Packs, Heating Pads & Hot Baths
For acute injuries, I recommend the updated guidelines of “PEACE & LOVE” (the updated version of “RICE”), which include protection, elevation, compression, and pain free movement to promote blood flow to the injured site. However, after the acute injury phase, the response to hot or cold often varies by individual. Some people swear by ice packs. Others love hot Epsom salt baths. Overall, I feel comfortable recommending people try either hot or cold, since both routes typically have no adverse side effects and are highly accessible by most people.
5. See a Qualified Physical Therapist or Other Musculoskeletal Provider
If the general recommendations listed above don’t work, I’d advise seeking a formal consultation with a clinician for more customized advice. Many factors such as your stress levels, sleep quality, emotional state, and what is happening at the tissue level play a role in your individual experience of pain and your body’s response to it. A good clinician can help you determine what factors to focus on in order to maximize your recovery.
*This post was originally posted by Jahan at his blog.
1. Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The association of sleep and pain: an update and a path forward. The journal of pain, 14(12), 1539–1552. https://doi.org/10.1016/j.jpain.2013.08.007
2. Wei Y, Blanken TF, Van Someren EJW. Insomnia Really Hurts: Effect of a Bad Night’s Sleep on Pain Increases With Insomnia Severity. Frontiers in Psychiatry. 2018 ;9:377. DOI: 10.3389/fpsyt.2018.00377. PMID: 30210367; PMCID: PMC6121188.
3. Generaal, E., Vogelzangs, N., Penninx, B. W., & Dekker, J. (2017). Insomnia, Sleep Duration, Depressive Symptoms, and the Onset of Chronic Multisite Musculoskeletal Pain. Sleep, 40(1), 10.1093/sleep/zsw030. https://doi.org/10.1093/sleep/zsw030
4. Jones, M. D., Booth, J., Taylor, J. L., & Barry, B. K. (2014). Aerobic training increases pain tolerance in healthy individuals. Medicine and science in sports and exercise, 46(8), 1640–1647. https://doi.org/10.1249/MSS.0000000000000273
5. García-Correa, H. R., Sánchez-Montoya, L. J., Daza-Arana, J. E., & Ordoñez-Mora, L. T. (2021). Aerobic Physical Exercise for Pain Intensity, Aerobic Capacity, and Quality of Life in Patients With Chronic Pain: A Systematic Review and Meta-Analysis. Journal of physical activity & health, 18(9), 1126–1142. https://doi.org/10.1123/jpah.2020-0806
6. Marie Hoeger Bement, Andy Weyer, Manda Keller, April L. Harkins, Sandra K. Hunter, Anxiety and stress can predict pain perception following a cognitive stress, Physiology & Behavior, Volume 101, Issue 1, 2010, Pages 87-92, ISSN 0031-9384, https://doi.org/10.1016/j.physbeh.2010.04.021.
7. Hannibal, K. E., & Bishop, M. D. (2014). Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Physical therapy, 94(12), 1816–1825. https://doi.org/10.2522/ptj.20130597