Can stretching increase your pain tolerance?

Analysis: It has long been accepted that stretching provides pain relief, but this is rarely found to be directly associated with pain reduction

By Hugo Massé-Alarie, Laval University

To stretch or not to stretch? Should it be done before or after exercise? Does it prevent or heal wounds? Stretching is always a hot topic. However, although it is effective in improving flexibility, its usefulness in reducing pain is questioned.

Back ache is one of the most prevalent health problems in our society. Until 80% of the population could suffer from it at least once in their life. Many patients do not improve after treatment. What makes treatments work or not? Answering this question could improve the quality of life for millions of people.

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From RTÉ Brainstorm, everything you need to know about back pain management

Health professionals, including physical therapists, often prescribe exercises such as stretching to reduce pain. It has long been accepted that stretching relieves pain by increasing range of motion and decreasing muscle tone, making it feel like there is less pain.

However, this perceived pain relief is rarely directly associated with pain reduction. Indeed, a recent study watch this increased flexibility was actually associated with a greater tolerance for pain, which occurs during stretching. Stretching may impact pain perception by activating areas of our central nervous system that modulate pain.

I am professor in the physiotherapy program at Laval University and researcher at Cirris, the university’s interdisciplinary research center in rehabilitation and social integration. In collaboration with students from Laval University and McGill University, I have just published new research on the effect of stretching on pain sensitivity: “Stretch-induced hypoalgesia: a pilot study” in the scientific journal Scandinavian Diary of Pain.

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From RTÉ Radio 1’s Today With Claire Byrne, Registered Physiotherapist Jenny Brannigan discusses back pain

For the study, we recruited 22 healthy adults who did not suffer from back pain. Each participant was asked to perform a stretch of the lumbar region (lower back), followed by a stretch of the forearm muscles. Participants had to hold each stretch for three minutes to produce a moderate stretch sensation.

Stretching produces hypoalgesia

Before and after each exercise, we measured the pain threshold of a lower back muscle (lumbar spine erectors) and a forearm muscle (wrist flexors) using of an algometer.

An algometer is a measuring instrument equipped with a sensor that calculates the pressure needed to produce a sensation called a pain threshold. This way we can measure the modulation of pain sensitivity, or the change that stretching has on a pain threshold.

A man with a back rests his hand on the lumbar region.
Back stretches may not benefit everyone with back pain. Photo: Shutterstock

We calculated the modulation of each stretch over the extended area and over an area away from the stretched muscles. A change recorded in an area away from the stretch would suggest that regions of the central nervous system that involve pain control have been activated, and therefore the stretch has had a systemic effect.

We observed that both stretches produced hypoalgesia, an increase in the threshold of pain sensitivity. In other words, after the participants performed the stretches, the experimenter had to apply greater pressure to produce pain.

After wrist extension, stretch-induced hypoalgesia was limited to the stretched area itself, while after back flexion, hypoalgesia was also present away from the stretched area (the front -arm).

Does the brain play a role?

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According to RTÉ Brainstorm, our thoughts about stress, anxiety and worry can make us more prone to back pain and less likely to recover from it

Stretching is not the only type of exercise that produces hypoalgesia. Several studies have shown that aerobic exercise and exercise involving sustained muscle contractions also induce hypoalgesia.

These forms of exercise have received far more attention from the scientific community than stretching, with some groups of researchers attempting to determine what mechanisms are at work. For example, exercise-induced hypoalgesia has been suggested to involve the activation of – and interaction between – the opioid and endocannabinoid systems, which control pain.

In a recent review or research, the authors suggested that exercise-induced hypoalgesia could be explained by the unpleasant and sometimes even painful effect of these exercises. Indeed, we know that the activation of nociceptors (pain receptors) induces hypoalgesia by triggering systems that modulate pain, including opioids.

Back stretches may not benefit everyone with back pain

For example, holding a hand in a bucket filled with cold water produces intense pain which induces systemic hypoalgesia. It is possible that similar mechanisms could also explain our results, since stretching sometimes produces an unpleasant or even painful sensation.

Distant, and therefore potentially systemic, effects were only present following back stretching. We believe that stretching the back might involve stretching a greater mass of structures (muscles, ligaments, tendons, skin) than stretching the wrist, and therefore might produce a greater effect. These hypotheses should be tested in future studies.

Stretching is not a panacea

The immediate benefits of stretching in people with back pain could be explained by the fact that the regions of the body involved in the modulation of pain were stimulated. However, many people with chronic back pain benefit less from hypoalgesia which is usually induced by exercise. This could be explained by differences in the functioning of regions of the central nervous system involved in pain control.

Back stretches may not benefit everyone with back pain. Severe back pain that persists over time is usually multifactorial, so general management by a medical professional, such as a physical therapist, may be needed to reduce or control the pain. Stretching is only one of the treatment tools available to improve one’s condition and it is not a panacea!The conversation

Hugo Massé-Alarie is an assistant professor of physiotherapy at Laval University. This article was originally published by The conversation.


The views expressed here are those of the author and do not represent or reflect the views of RTÉ


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