02/04/2026
Does slow and steady always win the race?
Our growing understanding of persistent pain has expanded how we think about treatment and clinical reasoning.
Causal mediation analyses suggest that improvements in pain and disability are more closely related to changes in:
Beliefs about pain
Pain catastrophising
Pain self-efficacy
This helps explain why someone can improve in objective measures like strength or range of motion, yet still experience pain.
So, what does that mean for how we prescribe exercise?
For some people, gradual, graded exposure is helpful.
For others, going too slow or too light may inadvertently reinforce the idea that they are fragile or need protecting.
In those cases, a more meaningful increase in load or engagement with the feared activity might be more helpful.
If someone is worried that lifting heavy will cause harm, then lifting something meaningfully heavy, and being okay, can provide credible evidence that challenges that belief.
Not as a rule. Not for everyone. But as an option worth considering.
How deliberate are we in using movement, exercise, and behavioural experiments to actually target these mediators?
