SynthesisBritish journal of sports medicine2017
Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis.
Synthesis in British journal of sports medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 55 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Effect of Isometric Exercise on Pain Perception in Subjects With Rotator Cuff Related Shoulder Pain
Development of a Tele-Physiotherapy Tool for the Early Management of Muskuloskeletal Pain in People With Visual Impairement (TeleEDxPhysio)
A Feasibility Study of a Combination of Graded Pain Exposure and Graded Motor Imagery in People With Complex Regional Pain Syndrome Type 1
Who cites it
55 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Efficacy on pain and knee function of Kinesio taping among patients with patellofemoral pain syndrome: a systematic review and meta-analysis.BMC musculoskeletal disorders · 2025Pooled it
- Effect of gardening activities on domains of health: a systematic review and meta-analysis.BMC public health · 2025Pooled it
- Efficacy of different analgesic strategies combined with conventional physiotherapy program for treating chronic shoulder pain: a systematic review and network meta-analysis.Journal of orthopaedic surgery and research · 2024Pooled it
- Effects of resistance training on quality of life, fatigue, and pain in patients undergoing cancer treatment: A systematic review and dose-response meta-analysis.Brazilian journal of physical therapyPooled it
- Association of Pain During Exercise With Exercise-Induced Hypoalgesia in People With Knee Osteoarthritis.Arthritis care & research · 2025Trial
- Exercise into Pain in Chronic Rotator Cuff-Related Shoulder Pain: A Randomized Controlled Trial with 6-Month Follow-Up.Open access journal of sports medicine · 2024Trial
- Hypoalgesia after exercises with painful vs. non-painful muscles in healthy subjects - a randomized cross-over study.Scandinavian journal of pain · 2022Trial
- A loaded self-managed exercise programme for patellofemoral pain: a mixed methods feasibility study.BMC musculoskeletal disorders · 2019Trial
- Rehabilitation and return to activity after platelet-rich plasma injections in chronic tendinopathies: Consensus from international experts.PM & R : the journal of injury, function, and rehabilitation · 2026Review
- Review
- Resistance Exercise as a Dual-Target Strategy in Physical Therapy: Reducing Depressive Symptoms to Improve Rehabilitation Participation and Outcomes.Archives of rehabilitation research and clinical translation · 2026Article
- Rotator Cuff-Related Shoulder Pain: A Survey of Current Physiotherapy Practice in Cyprus.Clinics and practice · 2026Article
- Exercise-Induced Hypoalgesia Following Blood Flow Restriction in Rotator Cuff Repair Rehabilitation: A Randomized Crossover Clinical Trial.Translational sports medicine · 2026Article
- Nociplastic pain: an introduction.The Journal of the Canadian Chiropractic Association · 2025Article
- Painful considerations in exercise-management for rotator cuff related shoulder pain: a scoping review on pain-related prescription parameters.BMC musculoskeletal disorders · 2025Article
- Credibility of Blood Flow Restriction Training in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis.Orthopaedic journal of sports medicine · 2025Review
- Current status and factors influencing kinesiophobia in patients with meniscus injury: a cross-sectional study.Journal of orthopaedic surgery and research · 2025Article
- Predicting Pain Response to a Remote Musculoskeletal Care Program for Low Back Pain Management: Development of a Prediction Tool.JMIR medical informatics · 2024Article
- Survey of Confidence and Knowledge in Managing Patellofemoral Pain among Physical Therapists in Saudi Arabia.Healthcare (Basel, Switzerland) · 2024Article
- Development and feasibility of a conceptual model for planning individualised physical exercise training (BMJ open · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundChronic musculoskeletal disorders are a prevalent and costly global health issue. A new form of exercise therapy focused on loading and resistance programmes that temporarily aggravates a patient's pain has been proposed. The object of this review was to compare the effect of exercises where pain is allowed/encouraged compared with non-painful exercises on pain, function or disability in patients with chronic musculoskeletal pain within randomised controlled trials.
methodsTwo authors independently selected studies and appraised risk of bias. Methodological quality was evaluated using the Cochrane risk of bias tool, and the Grading of Recommendations Assessment system was used to evaluate the quality of evidence.
resultsThe literature search identified 9081 potentially eligible studies. Nine papers (from seven trials) with 385 participants met the inclusion criteria. There was short- term significant difference in pain, with moderate quality evidence for a small effect size of -0.27 (-0.54 to -0.05) in favour of painful exercises. For pain in the medium and long term, and function and disability in the short, medium and long term, there was no significant difference.
conclusionProtocols using painful exercises offer a small but significant benefit over pain-free exercises in the short term, with moderate quality of evidence. In the medium and long term there is no clear superiority of one treatment over another. Pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes. Further research is warranted to fully evaluate the effectiveness of loading and resistance programmes into pain for chronic musculoskeletal disorders. PROSPERO REGISTRATION: CRD42016038882.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.