EXERCISE THERAPY FOR PAIN MANAGEMENT

Abstract

Chronic musculoskeletal pain is a leading cause of disability worldwide, prompting a shift in physiotherapy from symptom-based treatment toward comprehensive, patient-centred, biopsychosocial care. Within this model, exercise therapy is a cornerstone of evidence-based pain management. This chapter reviews the physiological mechanisms underlying exercise-induced pain relief, including exercise-induced hypoalgesia, activation of the endogenous opioid and endocannabinoid systems, enhanced descending pain inhibition, and modulation of inflammatory and neuroplastic processes. It outlines major exercise modalities — aerobic, resistance, flexibility, balance/proprioceptive, and mind–body exercise — and examines their clinical application across five common conditions: chronic low back pain, neck pain, knee osteoarthritis, rheumatoid arthritis, and fibromyalgia. The FITT principle (Frequency, Intensity, Time, Type) is presented as a practical framework for individualised prescription, alongside key considerations for patient education and adherence. Future directions, including wearable technology and multidisciplinary integration, are also discussed. The chapter argues that individualised, mechanism-informed exercise programmes are essential for reducing pain, restoring function, and supporting long-term self-management.