Background & Aims
Exercise-induced hypoalgesia (EIH) is characterized by a diminished sensitivity to noxious stimulation or a decrease in pain perception because of exercise. Available evidence on the remote effects of isometric exercise-induced hypoalgesia (EIH) in patients with chronic low back pain is limited. Furthermore, there is controversy regarding the most appropriate intensity (% of the maximal isometric voluntary contraction – MIVC) of work (high vs. low) to trigger EIH when applying isometric exercise. This study aimed to determine the immediate effect (one session) of a series of isometric contractions of the dominant quadriceps at 25% of a maximum voluntary contraction, on the symptoms in patients with nonspecific chronic low back pain.
Methods
In this case series study, eleven subjects between 18-65 years of age with chronic low back pain with mild to moderate to severe disability (0-60%) on the “Oswestry Disability Index” scale (ODI); a pain intensity score between 2 and 8 points on the Pain Numerical Rating Scale (PI-NRS), performed a single series of five isometric quadriceps contractions at 20% MVIC dominant (20% FIMV). The series of IC was done until exhaustion or up to a maximum of 5 minutes. The outcome measures
included muscle pain sensitivity, through the pressure pain thresholds (PPT), assessed locally and distally. Also, the intensity of pain (PI-NRS) and the level of expectations (CEQ) reported by the patients were considered. Outcomes were assessed before (M1) and after (M2) the intervention.
Results
The average age of the participants was 39.5 years (SD= 7.9 ranging between 26 to 49 years). Pressure pain thresholds in the lumbar area increased significantly after the intervention (p= 0.016), however, these changes were not considered clinically relevant (mean differences 0.96 kg/cm2/sec); in the thenar area, there were no significant changes (p= 0.131) (mean differences -0.58 kg/cm2/sec). Pain intensity decreased significantly (p= 0.011) and this change was deemed to be clinically meaningful (2 points). The average differences between M1 and M2 in the expectations (CEQ) were 2 points and were statistically significant (p= 0.007).
Conclusions
The results of the study suggest that isometric contractions of a remote muscle can produce hypoalgesic effects in chronic low back pain patients. These results suggest a systemic effect of the HIE phenomenon.
References
Deyo R, Dworkin S, Amtmann D, Andersson G, Borenstein D, Carragee E, Carrino J, Chou R, Cook K, Delitto A, Goertz C, Khalsa P, Loeser J, Mackey S, Panagis J, Rainville J, Tosteson T, Turk D, Von Korff M, Weiner D. Report of the NIH task force on research standards for chronic low back pain. PHYS THER [internet]; 2015; 95:e1-e18.
Sterling M, Sluka K.A, Grace P. Physical Activity, and Exercise for Pain. Gold M.S, Pogatzki-Zahn E.M, Wallace M.S, editores. Pain 2018: Refresher Courses 17th World Congress on Pain. Washington, D.C: IASP Press; 2018. 245-52
Koltyn K. Analgesia following exercise. Sports Med. 2000; 29(85-98)
Naugle K.M, Fillingim R.B, Riley J.L. A meta-analytic review of the hypoalgesic effects of exercise. The Journal of Pain [internet]; 2012. Vol 13, No 12 pp 1139-1150
Mogil J, Sternberg W, Balian H, Liebeskind J, Sadowski B. Opioid and nonopioid swim stress-induced analgesia: a parametric analysis in mice. Physiol Behav.. 1996; 59(123-132)
Lemley KJ. Mechanisms of Isometric Exercise-Induced Hypoalgesia in Young and Older Adults. ; 2014
Bement M.H, Sluka K.A. Exercise-induced hypoalgesia: an evidence-based review. Sluka K.A. Mechanisms and management of pain for the physical therapist. Second edition. Philadelphia. IASP press; 2016. 177-201
Fuentes C JP, Armijo-Olivo S, Magee DJ, Gross DP. Effects of Exercise Therapy on Enogenous Pain-relieving Peptides in Musculoskeletal Pain. A Systematic Review. Clin J Pain. 2011; May;27(4):365-74.
Rio E, Kidgell D, Purdam C, Gaida J, Lorimer Moseley G,Pearce A.J, Cook J. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med [Internet] 2015; 0: 1-8.
Gajsar H, Titze C, Hasenbring M, Vaegter H.B. Isometric back exercise has different effects on pressure pain thresholds in healthy men and women. Pain Medicine [Internet]; 2016; 0: 1–7.
Van der Roer et al. Minimal Clinically Important Change for Pain Intensity, Functional Status, and General Health Status in Patients with Nonspecific Low Back Pain. Spine [Internet] 2006; 31: 578(82).
Nock MK, Ferriter C, Holmberg E. Parent beliefs about treatment credibility and effectiveness: Assessment and relation to subsequent treatment participation. Journal of Child and Family Studies. 2007;16(1):27-38)
Rio E, al e. Isometric Contractions Are More Analgesic Than Isotonic Contractions for Patellar Tendon Pain: An In-Season Randomized Clinical Trial.. Clin J Sport Med. 2017; 27(3):253-259
Rice et al. Exercise-Induced Hypoalgesia in Pain-Free and Chronic Pain Populations: State of the Art and Future Directions, The Journal of Pain. 2019; 20 (11): 1249?1266
Van Ark M et al. Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomised clinical trial. Journal of Science and Medicine in Sport. 2016; 19 (9): 702–706
Crombie, KM, Angelique G. Brellenthin, Cecilia J. Hillard, and Kelli F. Koltyn. Endocannabinoid and Opioid System Interactions in Exercise-Induced Hypoalgesia. Pain Medicine 2018; 19: 118–123
Sokunbi O, Watt P, Moore A. Changes in plasma concentration of serotonin in response to spinal stabilization exercises in chronic low back pain patient.. Nig Qt J Hosp Med.. 2007; 17(108–111)
Koltyn K, Umeda M. Exercise, hypoalgesia and blood pressure. Sports Med. 2006; 36(207–214)
Umeda M, Newcomb L, Koltyn K. Influence of blood pressure elevations by isometric exercise on pain perception in women. Int J Psychophysiol. 2009; 74(45–52)
Ossipov M, Morimura K, Porreca F. Descending pain modulation and chronification of pain. Curr Opin Support Palliat Care. 2014 June; 8(2): 143–151
Bannister K. Descending pain modulation: influence and impact. Current Opinion in Physiology 2019, 11:62–66
Lannersten L, Kosek E. Dysfunction of endogenous pain inhibition during exercise with painful muscles in patients with shoulder myalgia and fibromyalgia. Pain. 2010; 151(77-86)
Fingleton C, Smart KM, Doody CM. Exercise-induced Hypoalgesia in People with Knee Osteoarthritis with Normal and Abnormal Conditioned Pain Modulation. Clin J Pain. 2017 May; 33(395-404)
Stetler C. Adherence, expectations, and the placebo response: why is good adherence to an inert treatment beneficial? Psychol Health. 2014; 29(2):127-40.
Alsouhibani A, Bjarke Vaegter H, Hoeger Bement M. Systemic Exercise-Induced Hypoalgesia Following Isometric Exercise Reduces Conditioned Pain Modulation Pain Medicine 2019; 20: 180–190
Kosek E, Lundberg L. Segmental and plurisegmental modulation of pressure pain thresholds during static muscle contractions in healthy individuals. Eur J Pain 2003; 7(3):251–8
Senarath ID, Chen KK, Weerasekara I, de Zoete RMJ. Exercise-induced hypoalgesic effects of different types of physical exercise in individuals with neck pain: A systematic review and meta-analysis. Pain Pract. 2023 Jan;23(1):110-122
Bannister K. Descending pain modulation: influence and impact. Current Opinion in Physiology. 2019; 11: p. 62-66.
Cinnamon S. Adherence, Expectations, and the Placebo Response: Why is Good Adherence to an Inert Treatment Beneficial? Psychol Health. 2014 Feb; 29(2): p. 127-140.
Rief W, Stefan G H, Nestoriuc Y. The Power of Expectation – Understanding the Placebo and Nocebo Phenomenon. Social and Personality Psychology Compass. 2008; 2(4): p. 1624–1637.
Presenting Author
Jorge Fuentes
Poster Authors
Topics
- Treatment/Management: Interventional Therapies – Other