Medicine or Movement?

You may have seen big headlines last week telling you to ditch the painkillers and get to your local Pilates class.  

So where has all this come from?

A high quality study from Australia published last week * has looked at the evidence from 6000 spinal pain sufferers and found that anti-inflammatory painkillers offer little or no benefit when compared to placebo.  The benefits of other pain relief such as Paracetamol has long been questioned for spinal pain and therefore led the study to conclude that there is currently no simple pain medicine available that can offer management for spinal pain.  The study also noted the issue of side effects, as those who were regularly taking anti-inflammatory medicines were more than twice as likely to have gastrointestinal changes.

So where does that leave you if you have spinal pain?

Of the estimated 28 million people living with back pain in the UK, the majority will resolve themselves after a few weeks, and whilst these headlines can be concerning, it is important to know that anti-inflammatory pain relief is still recommended by the National Institute of Clinical Excellence to help manage pain in the short term.  The time to question the use of these drugs is more relevant when they are intended to manage a long term condition.  

Long term Pain

When pain lasts longer than 12 weeks; that is, longer than the time the tissues should have needed to heal, it is called chronic pain.  Recent neuroscience has helped us to understand that chronic pain is often actually the brains way of protecting the body after a bout of pain.  Activities and movements that were not a problem before an injury can understandably be sore when you are recovering from something recent. Knowing this, the brain ramps up its pain response, making you likely to avoid certain movements during this time.   If all is well, the brain should readjust its perception of these movements again as you get better.  However, we now know that sometimes the brain can continue to feel normal movements as dangerous and so continues to warn the body off them even when there is no danger present long down the line.  Over time this process can understandably lead to fear and avoidance of certain movements and you may find yourself becoming stiffer and so less able to continue with the activities you enjoy.  

Why painkillers aren't the only answer.

Whilst painkillers may still have a role here if prescribed by a professional, it is certain that they are not a cure, they cannot change any of the underlying reasons for the discomfort, and most importantly, pain medicine cannot offer any reduction in the likelihood of pain returning.  For that to happen, the brain needs a chance to re-calibrate and reestablish safe, comfortable movement patterns.  Therefore, to offer any longer term benefit, pain relief needs to be prescribed together with an increase in activity and strengthening.

How do I get moving again?

If you have had your spinal pain for a long time it can feel difficult to tell the difference between safe and dangerous movements.  In this case, it is often advisable to visit a local physiotherapist who can guide you with simple and safe exercises to get you started.  Importantly, they will assess the way you currently move and help identify any changes that could help you reduce pain.  As you practice more and more gentle activity, the  brain has an opportunity to realise that no harm has come, and so it is able to dampen down its pain response.  

Yoga and Pilates

Another brilliant way to get back into activity is to start Pilates or Yoga.  Several research articles have recently shown that the combination of mindful movement, breath control, strengthening and relaxation offered by yoga and Pilates can help with dampening down the pain response in the brain.  This improved comfort then allows you to explore the huge variety of movements offered in class, so reducing stiffness and the resulting relaxation can offer better sleep and pain management.  

An experienced teacher will be able to adjust classes and poses to your particular body requirements and ensure you are moving safely helping you build confidence in your body again.

Whichever activity you choose, with some initial guidance and regular practice of safe activity you are truly able to change the way your brain interprets pain without any side effects and understanding where pain comes from goes a long way to explaining why painkillers alone aren’t a solution.


Hayley is a physiotherapist specialising in using yoga and Pilates as rehabilitation. She has a masters in neuropsychology and is passionate about improving the movement of her clients and classes. If you have any comments or questions on anything raised in this article, Hayley would love to hear from you.,

This article is intended as reference only.  It is always advised to seek and follow medical advice where required.