Take Home Points

  1. Aerobic exercise improves pain tolerance in healthy individuals. 
Pain tolerance is a fascinating characteristic. Ninety percent of the patients I treat in physical therapy state they have a high pain tolerance, which is not often the case. Now, having a high pain tolerance for sport is helpful, but it isn’t likely needed in the general population, other than impairing the bodies system for regulating damage.
Exercise is believed to provide a small pain modulating effect. Also, exercise training is believed to decrease pain levels in those with chronic pain. Unfortunately, the effect of exercise and pain tolerance in healthy individuals is not well documented. Only one previous study analyzed the effects of exercise and pain tolerance in a healthy population. Anshel (1994) aerobic exercise increased pain tolerance, but resistance training did not. 

Jones (2014) split twenty-four (M=3, F=21; ~23 years of age) subjects into a control or exercise group. The exercise group completed eighteen training sessions, while the control group did not exercise. The exercise training consisted of cycle ergometer exercise performed 3 times per week for 30 min at 75% of heart rate reserve. Age-predicted maximum heart rate was determined using the prediction equation HRmax = 207 – 0.7 x age.

Pressure pain threshold was assessed over four muscular sites (trapezius, biceps brachii, rectus femoris and tibialis anterior). This test pushes a muscle with an increasing force until the subjects tells the tester to stop (sounds fun!). 

Ischemic pain tolerance was performed with the participant performing a hand grip test while their blood was constricted with a sphygmomanometer (blood pressure cuff). The participant was asked to maintain a specific pressure until it was no longer tolerable. 

After the training, the ischemic pain tolerance improved in ten of the twelve exercise group subjects, but only five of the control subjects. There was not significant improvements in pressure pain threshold in the exercise group, compared to the control group. 

The exact mechanism/s of increasing ischemic pain tolerance is not well understood. This increase could have occurred from an adaptation in psychology or physiology. Nonetheless, this improvement in pain tolerance with ischemia is one reason why athletes likely have a greater training capacity for pain. However, this improvement may expose athletes to greater muscular injury/harm.

Monitoring pain and injury is essential with elite athletes. AC Milan reportedly performs scrupulous bi-weekly exams on their soccer players, looking for early signs of injury. This frequent monitoring is essential for elite success, as prevent elite performance. All of our COR sports team training involves monthly screening, as well as our physical therapy clients. Ensure your team and self are monitored frequently and correctly! 

References
  1. Jones MD, Booth J, Taylor JL, Barry BK. Aerobic Training Increases Pain Tolerance in Healthy Individuals. Med Sci Sports Exerc. 2014 Feb 5. [Epub ahead of print]
  2. Anshel MH, Russell KG. Effect of aerobic and strength training on pain tolerance, pain appraisal and mood of unfit males as a function of pain location. J Sports Sci. 1994;12(6):535- 47.
Written by Dr. John, DPT, CSCS