Something I teach and bring to my research reading is the ‘so what’ question. So what is about bringing home the implications, the rationale, the WHY in all that I do.
I’m reflecting on this as I consider my blog.
When I started writing in 2007, I wanted to get information out to people just tiptoeing into pain practice and who might not have access to research. At the time research was hidden behind paywalls, while today there are many open access papers, and they’re distributed widely.
And yet there is so much research to wade through: so much published, so many authors and researchers competing for attention, grant money, and publication space. It’s difficult to know what to read, what the studies mean in practice, and in the excitement of new! shiny! it’s still easy to be carried away by a study that attracts attention.
Theory and why it’s important
I studied theory development and methodology in my MSc when I studied under Professor Brian Haig. Theory underpins the hypotheses we test in experimental studies, even if the theory isn’t specified. Assumptions underpin theories and research methods, even if these aren’t specified. Paul Thagard (1950 – present) argues that strong theory is characterised by its ability to explain a wide range of phenomena (explanatory breadth), to create testable predictions, and ultimately to be supported by empirical evidence. It should be parsimonious, have few assumptions, good predictive power and be coherent. Testing strong theory requires testing at least two strong hypotheses – the winner adds to the developing theory.
As a pragmatist, Brian considers that a theory should be judged by its ability to explain, and not just be ‘logically entailed.’ (Inference to the best explanation). This is the “so what” of a theory. Not just logically connected, but that each proposition (hypothesised relationship) should hold together because of their explanatory relations of breadth, simplicity and analogy (Thagard, 1978). In other words, theories should work.
As I read through the many, many papers published daily, I wonder at how well theory development measure against these principles. How many are fairly weak hypotheses pitted against a null hypothesis? How many will push the explanatory and predictive envelope – particularly when it comes to pain and pain management?
Exercise – and theory
A brief example: we know that ‘exercise’ in its many forms is a good thing for people in general and I don’t deny the value of regular movement practices. We have a heap of studies showing that it has an effect, largely positive, for people experiencing various pains.
Exercise provides small effects on pain intensity and disability (Hayden et al., 2021 defining a reduction in pain intensity of 15 on a scale of 0 – 100 and 10 on a scale of 0 – 100 for disability as clinically significant – see figure below), has a relatively modest impact on risk of future episodes (de Campos et al., 2021 – but note the relatively small sample size and follow-up periods, and most 18 months), and we still don’t know the most useful frequency, intensity, duration, or form. The studies I’ve cited are only for chronic low back pain.

Fig 4 from Hayden et al., 2021. Dotted line represents clinically important difference. Note how few actually reach clinically important difference despite statistical significance.
BUT we don’t yet know why movement helps – and many theories have been proposed. Some people believe it’s good because it ‘corrects movement dysfunction’, some think it’s great because it reduces inflammation, others think it’s awesome because endorphins, Google AI tells me it’s good for reducing ‘pain sensitivity’, improving mood, and boosting physical function.
While there might be a lot of empirical data on exercise (volumes of it!), a coherent explanatory theory is missing. Existing theories don’t explain why the effect sizes are so modest, especially with respect to reducing disability. In other words, the ‘so what’ hasn’t yet been answered in a way that has explanatory breadth, is simple and analogous.
My so what is about how relevant all the research into exercise is in terms of the daily lives of people with pain, particularly weird pains like neuropathic and nociplastic pain. Do these studies translate into ways people with pain can live everyday life? Do they allow us to know what people with pain can do as they go through life stages? Do they give us sufficient information to be flexible with movement practices so they get done (See Heisig et al., 2025)?
For all this research to be relevant, to make a difference in the lives of people who live with persistent pain, is it time to stop spending vast amounts of precious research funding on what we already know (that exercise/movement practices are kinda good) and to think outside the box to develop a theory that does more? Explains more? Helps us more?
de Campos, T. F., Maher, C. G., Fuller, J. T., Steffens, D., Attwell, S., & Hancock, M. J. (2021). Prevention strategies to reduce future impact of low back pain: a systematic review and meta-analysis. Br J Sports Med, 55(9), 468-476. https://doi.org/10.1136/bjsports-2019-101436
Harré, R. (2002). Cognitive science: A philosophical introduction. SAGE Publications Ltd, https://doi.org/10.4135/9781446216330
Hayden, J. A., Ellis, J., Ogilvie, R., Malmivaara, A., & van Tulder, M. W. (2021). Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews, 9(9), CD009790. https://doi.org/10.1002/14651858.CD009790.pub2
Heisig, J., Lindner, N., Kornder, N., Reichert, W., Becker, A., Haasenritter, J., Viniol, A., & van der Wardt, V. (2025). Adherence Support Strategies for Physical Activity Interventions in People With Chronic Musculoskeletal Pain-A Systematic Review and Meta-Analysis. J Phys Act Health, 22(1), 4-52. https://doi.org/10.1123/jpah.2024-0099
Thagard, P. (1993). Conceptual Revolutions. Princeton. ISBN: 9780691024905