Adaptation, Allostasis, Pain Management and Exercise Dosage

Tissues adapt as long as load stays within their capacity, and Paul extends this to people adapting to social and economic stress. Allostatic load, the cumulative strain on the body over time, reduces adaptive capacity and can contribute to chronic disease. Pain management needs a working knowledge of neuroscience, attention to psychological, social, vocational and cultural context, careful listening and a clear sense of where scope of practice ends. A 2017 systematic overview by Babatunde found clinically significant gains in pain, function and quality of life from exercise for the shoulder, knee, back and multi-site pain, with no clear winner among exercise types. Yet one size does not fit all, and the idea that more is better fails to specify dose. Tracking volume through frequency, intensity and duration, alongside RPE and distress scales, can shift attention from pain to progress. For knee osteoarthritis, running is not shown to cause wear and tear, aerobic exercise has been compared with corticosteroid injection, and resistance training with acupuncture.