Exercise Without Injury by Dr. Buller

“I want to start exercising, but it hurts when I try.”  This is something that I regularly hear from patients.  What’s interesting is that I ultimately guide these patients through their recovery process to get them out of pain with exercise.  Both acute and chronic pain are associated with alterations in natural body movements (1).  A fresh ankle sprain and that old, nagging, back stiffness you may feel are great examples of each, respectively.  Imagine you just twisted your ankle.  Maybe you were staring at your phone and missed the last step, or perhaps your latest attempt at a hot new dance move in that pair of stilettos didn’t play out as you had envisioned it.  Regardless, your ankle is going to slowly morph into a ripe eggplant, and you’ll have to find a new way to get around.  In the case of long-standing low back stiffness, you just don’t have quite the same movement variability you once had; maybe your “worm” dance now looks like a log roll. 

Both instances involve a threat response by your central nervous system (CNS), which is comprised of your brain and spinal cord.  Your body’s primary objective is self-preservation.  The alarm of an injury or pain can trigger a response (limping or stiffness) as an attempt to avoid further injury or, in the worst-case scenario, a life-ending event.  Keep in mind that these bodily systems developed at a time when an injury could mean that you would soon transition from the hunter to the hunted.  Though pain is a very complex subject and process, the progression of recovery and return to normal activity has an underlying tenet:  threat mitigation.  A well-guided exercise regimen has the potential to decrease pain perception through threat mitigation within the central nervous system via graded exposure to movement and activity (2). 

Graded exposure is the process of slowly introducing a stimulus (e.g. a new movement-based activity) so that we may progressively increase the body’s tolerance (2).  My default method of seasoning food is a perfect example of what we don’t want to do.  When I season food I am preparing, I tend to shoot first and ask questions later.  The ultimate result is food that is too salty or spicy to ingest (though I will generally choke it down because I hate wasting).  Rather, if we add a small amount, let it simmer, then taste and repeat, we are more likely to achieve the optimal results of a balanced flavor profile.  The same holds true for exercise:  add a small dose of activity, see how it feels, then repeat the process.  The best part about movement-based activity is that you can always adjust.  If you have a favorable response, you can add more over time.  If you overdo it one day, take it is as lesson learned and decrease your dosage. 

We all know that exercise is an important part of general health and well being for things such as obesity, diabetes, and cardiovascular disease, however, exercise is also integral for mental health.  A wide gamut ranging from mood disorders such as anxiety and depression to cognitive decline associated with Alzheimer’s and Parkinson’s disease can all be positively impacted by physical activity (3).  Another noteworthy finding is the significant association between psychological problems such as anxiety and depression and musculoskeletal disorders such as neck and low back pain (4).  Regular physical exercise is as important and necessary for nourishing the brain as it is for the rest of the body and is thus a critical part of feeling your absolute best

If you are ever unsure of where to begin, start with exercise that can be scaled to your ability while also enjoyable and accessible for proper adherence.  If you do not know if you should start exercising based on any pain or discomfort, seek advice from a knowledgeable healthcare provider, preferably one with experience in treating musculoskeletal problems. 

As always, this information provided is not meant to be used for self-diagnosis or to replace the services of licensed medical professionals, and you should always consult your physician before beginning any exercise program. 


  1. Laird RA, Gilbert J, Kent P, Keating JL. Comparing lumbo-pelvic kinematics in people with and without back pain:  a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2014;15:229
  2. Hargrove TR. 2014. A guide to better movement. Seattle (WA): Better Movement.
  3. Ruegsegger GN, Booth FW. Health benefits of exercise. Cold Spring Harb Perspect Med doi: 10.1101/cshperspect.a029694.
  4. Yazdi et al. Association of derived patterns of musculoskeletal disorders with psychological problems: a latent class analysis. Environmental Health and Preventive Medicine. (2019) 24:34. doi: 10.1186/s12199-019-0784-x.
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