In the 1990s, it began to be widely accepted to prescribe opioids to people recovering from surgery or injury, as well as to people suffering from moderate to severe musculoskeletal pain (such as back pain and osteoarthritis). While effective for pain management, we would soon discover how highly addictive these drugs are. Statistics show that one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid dependence.
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And once you’re addicted, it’s very hard to stop. The Centers for Disease Control and Prevention (CDC), in their 2018 annual survey report on drug-related risks and outcomes, found that in 2016, more than 11.5 million Americans reported abusing prescription opioids. And despite efforts to curb these statistics, this number started to rise again during the pandemic.
In response, the medical community has tightened controls on the prescription of opioids, with many avoiding prescribing them all together. For example, for patients with severe back pain and arthritis, injections and minor procedures are much more common and recommended. While this approach will prevent you from becoming addicted to opioids, there are still inherent risks when you receive an injection or undergo a procedure.
So what’s the alternative?
Prescribed movement strategies are the alternative. Specialized, custom “exercises” designed to have a very specific (and noticeable) effect on your pain. But what’s the difference between general exercises that make you feel good and prescribed movements that also make you feel good? Well, the differentiator is in both 1) how your pain responds to the movement while you’re doing it, and more importantly, 2) how it behaves afterward. Many exercises feel good when you do them, but not all exercises give you the long-lasting effect you are really looking for.
For example, let’s say you have back pain. Stretching your back a certain way may make you feel good and relieve your pain temporarily, but an hour or two later, or when you’re doing an activity that usually aggravates your back, your pain comes right back . The stretch will make you feel better, but it’s not good enough to make you stay better. Over time, you will find that your back pain often comes and goes, and while this stretch always helps, nothing really takes your problem away completely. Instead, you get stuck in that vicious cycle of stopping all activities every time you hurt your back — or worse — start avoiding certain activities altogether for fear of hurting your back. This is not a way of life and it is not an example of a well-prescribed exercise strategy.
So what would a prescribed exercise strategy look like? Let’s take the same example above, but this time you notice that a particular stretch not only makes your back pain go away in that moment, but it stays away the more you do it. Plus, fast forward in time, when your back pain returns, you can reliably use this piece to take your back pain away every time. This is an example of a prescriptive movement strategy. You know exactly what to do, how often to do it, when to do it, and it works flawlessly every time. And once you know what your prescribed movement is, you can use it to avoid pain as well. The good news is that 70-80% of all musculoskeletal pain responds to a prescribed exercise strategy. It works in all joints and muscles. You just have to work with someone who knows how to help you find it and then use it over time. I can’t tell you how often I meet people who have the right movement, they just didn’t apply it correctly to get the long-lasting relief they were looking for.
Too good to be true?
It’s not – I promise. The problem is, there’s a lot of misinformation out there, and not every healthcare provider or fitness professional is trained to discover the prescribed exercise you need — or teach you how to use it properly. The second problem – to be fair – is that hospitals make a lot of money from procedures and surgeries. There is no real incentive for them to support conservative, natural treatments that you can do on your own at home. With procedures and surgeries, the results are faster, which makes for happier patients (in the short term). But studies show that 2-3 years after surgery, your results are no better or worse than if you were getting exercise as your treatment. And after 10 years, those who managed to avoid surgery for the same problem have much better results than those who went under the knife. The biggest benefit of taking the time to go slow at first and find a prescription exercise strategy that works is that you always have this exercise drug at your disposal. It’s always in your “medicine cabinet” and you never need a prescription or pharmacy to refill it.
I hope I got you thinking. And encouraged you to at least explore whether exercise can really be your medicine. If you’ve already tried this and didn’t succeed, it’s very possible that you just didn’t have the right approach. Find someone who stays up to date with the latest movement research and who is trained to help you detect if a prescribed movement strategy is going to work for you. Remember that 70-80% of the time it will. There is no reason to risk becoming addicted to opioids, or undergoing unnecessary procedures or surgeries if not necessary.
dr. Physiotherapist and Pilates expert, Carrie Jose owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch or request a free copy of her guide to back pain, email info@cjphysicaltherapy.com or call 603-605-0402.