Our Words Affect Pain

Picture from Coregymball

It may be just words you think. Perhaps not. Recently published fascinating research suggest that how healthcare providers describe an injury can have a direct impact on a patient's pain. 

Not only were the patients blinded (a technique used to minimise bias), the patients also did not know they were part of a study.

Picture from article

50 recreational runners with Achilles tedinopathy took part in the radomized trial (pictured above). They ran 3 times a week. Runners in the experimental group received diagnostic information of tendon pain that highlighted reversible changes in muscle function as their primary problem. They did not hear any reference to tendon pathology.

The control group received an explanation of tendon pain that prioritised irreversible structural tendon pathology as the cause of pain.

The primary outcome measure was how much pain the runners had during a standardised hopping task measured on a scale of 0-100. Secondary outcomes were how stiff the lower limbs were hopping and time in seconds for pain to ease after completing the hopping task.

The diagnostic information immediately affected pain intensity during the hopping task. The average pain score was 25.4 in the experimental group versus 36.7 in the control group.

Time to ease (no pain) after hopping was near identical in both groups. Lower limb stiffness was higher in the experimental group. Note that higher leg stiffness is better for leg hopping because increased leg stiffness allows for greater force production and more efficient energy transfer. This leads to higher jump heights and faster movement.

This is a really intriguing area of research. We now have data showing that information from healthcare providers during the first visit has an immediate effect on pain. The language we use during clinical interactions can be powerful, shaping our perceptions and pain responses. This knowledge should change how we interact with our patients. 

However, we need to also be able to do this in our clinics without compromising the accuracy and necessary medical information.

Reference

Travers NJ, Travers MJ, Gibson W et al (2025). The Content Of Diagnostic Information Has An Immediate Effect On Pain With Loading In People With Morportion Achilles Tendinopathy: A Randomized Clinical Experiment. Bra J PT. 29(5). DOI: 10.1016/j.bjbt.2025.101244

Simple Hopping Exercise Improves Running Performance

Last week's topic was on when to change your running shoes, with a key finding showing that energy consumption while running with newer PEBA midsoles was 1.8 percent less compared to EVA misoles. And using less energy means we can run further and faster. Running performance is thus dependent of how efficiently we move, which is defined as running economy  (RE).

In case some of you are not willing to shell out a few hundred dollars for a new pair of PEBA midsole running shoes, let me suggest another way to improve your RE without spending any money.

Here is what authors who investigated the effects of spending just 5 minutes daily doing double leg hopping (similar to plyometrics) over 6 weeks (Engeroff et al, 2023). 

34 amateur runners (29±7 years, 27 males) were assigned to a control group or a hopping exercise group. Those in the control group did not do the hopping exercises but continued with their own exercise. 

Those in the hopping exercise group did the regular exercises plus the hopping. The hopping bouts lasted 10 seconds each initially, (they did 5 times with 50 seconds rest) with the bouts gradually increasing and the rest periods shortening (pictured above). Each week after, they added an additional set of hops and reduced the rest times by 10 seconds to have a total training time of 5 minutes.

RE, peak oxygen uptake (VO2 peak) and respiratory exchange ratio (RER) were measured at 3 running speeds (10, 12 and 14 kmh) before and after the hopping program.

The authors found that the simple double legged hopping exercise can enhance running economy (RE) at higher speeds (12 and 14 km/h) in the subjects. The benefits are pronounced even when the hopping regimen is kept simple and done for 5 minutes daily. Maximum aerobic capacity was unchanged if their regular running and exercise habits were maintained.

The authors sugested that the increase in Achilles tendon stiffness improved RE since stiffer tendons are more capable of transferring energy to help movement. Their data showed significant improvements in RE while the subjects were running at 12 and 14 km/h but not at 10 km/h which provides support that Achilles tendon stretch and recoil increases with running speed (Lai et al, 2014).

What I felt was important was that there were no reported injuries nor side effects from the hopping exercise protocol. It is also not known if the hopping can be done in a fatigued state? Would that then lead to possible injuries? 

The hopping described in this study is really simple. The subjects hopped as high as they could using both legs with both legs either straight or slightly bent. So no need to do box or squat jumps! Other than packing my skipping rope with me when I'm traveling later this month, I'm going to try this as well.

References

Engeroff T, Kalo K, Merrifield R et al (2023). Progressive Daily Hopping Exercises Improves Running Economy In Amateur Runners: A Randomized And Controlled Trial. Sci Rep 13, 4167. DOI: 10.1038/s41598-023-30798-3

Lai A, Schache AG, Lin YC et al (2014). Tendon Elastic Strain Energy In The Human Ankle Plantar-Flexors And Its Role With Increased Running Speed. J Exp Biol. 17: 3159-3168. DOI: 10.1242/jeb.100826