Supplementary blog to “Musculoskeletal pain and exercise—challenging existing paradigms and introducing new”

This is a supplementary blog and dummies’ guide to a paper first published online in the BJSM in 2018. Smith BE, Hendrick P, Bateman M, et al. Musculoskeletal pain and exercise—challenging existing paradigms and introducing new British Journal of Sports Medicine 2019;53:907-912. 

It formed part of a chapter in my recent PhD that looked at the assessment and management of patellofemoral pain. As such, my work is a product of supervision and collaboration.  So I would like to start by acknowledging and thanking my supervisors Pip Logan and Paul Hendrick, and collaborators Marcus BatemanSinead HoldenChris LittlewoodFiona MoffattMichael Rathleff, James Selfe and Toby Smith.

The aim of the published education review was to provide an understanding on the potential mechanisms behind exercise, and to build on this into discussing the additional theoretical mechanisms of painful exercises.

  • Central and peripheral pain mechanisms,
  • the immune system, and
  • affective aspects of pain

are all described in detail.

What follows over the following three blogs is a dummies’ guide to these three mechanisms.

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What is central sensitisation? A dummies’ guide to what it is and why might exercise help. 


blood smallDummies’ guide to the immune system in persistent pain. And why might exercise help?


knee smallAffective aspects of pain. A dummies’ guide to what it is and how might exercise help. 


The original review focuses on these three mechanisms as these systems appear to respond differently to painful stimulus, compared with pain-free exercises.

They are discussed in relation to the biological effect of exercise for people with chronic pain.


This additional mechanistic consideration could be used to help clinicians in the prescription of therapeutic exercise and for researchers to advance knowledge for such a globally burdensome condition.

I hope you’ve found this supplementary blog and dummy guides helpful.