2) Strengthening--Strengthening muscles can "unload" injured structures. For example, strengthening muscles surrounding an arthritic joint reduces the stresses on the joint. Although the joint may remain arthritic, strengthening muscles surrounding the joint will increase stability, reduce abnormal joint motion, and result in decreased pain. Similarly, people who are stronger are less likely to experience pain from doing the same activity than are people whose muscles are "straining" to complete the task.

3) Endurance-Exercises which promote aerobic metabolism and increase the heart rate are beneficial, possibly because they promote better circulation through injured tissues which can help to promote healing. In addition, it has been shown that aerobic exercise increases the body's level of endorphins, (a chemical which the body produces naturally) which relieves pain. This is probably the reason for "the runner's high" in marathon runners. People who exercise aerobically have less depression and anxiety, uniformly report less pain despite no apparent change in their condition, and function at a much higher level in their daily lives.

What is biofeedback?

Technology has made it possible for the therapist and the patient to receive signals about electrical activity in their muscles, temperature in their extremities, and pulse rate. Receiving "feedback" about these parameters helps the patient to "learn" to promote better relaxation in muscular tissues, better circulation through injures tissues, and a greater sense of calm and control. Learning to use these techniques can result in decreased pain and decreased tension, in people in whom muscular tension is a significant component of their ongoing chronic pain.

What is cognitive behavioral therapy?

Imagine two people who both sprained their ankles. One person sprained his ankle just after being fired from his job and tripping on the way out of his office. The other person sprained his ankle just after being notified that he had won the 10 million dollar lottery. The mechanical injury might be the same in these two people but the perception and level of pain and the impact of the injury on these two people's lives may be worlds apart. Cognitive behavioral therapy teaches people "mental exercises" and tactics for reducing negative emotions and responses to our pain and increasing positive and coping responses so that the patient with chronic pain can go on and function despite his condition. A special by-product of cognitive therapy is that aside from functioning better despite the pain, ,it has been shown in research studies that the amount of pain which is reported actually decreases. There are psychometric tests which can be administered to evaluate and plan cognitive therapy and to assess its benefits.