Exercising for Persistent Pain
This article is for people who struggle with nerve, joint or muscle pain that has persisted for a long time. The goal of it is to learn to become more active, so that your mind and body are as healthy and resilient as they can be, despite your aches and pains.
Why exercise?
We constantly hear about the many benefits of exercise. For example, it improves cardiovascular and mental health, increases bone and muscle strength, longer life expectancy and so forth. I prefer to look at it on an individual level. Perhaps it means you are able to walk around in the shops without leaning on a trolley, picking up your kids without fear, or do a long shift at work without feeling like death at the end of it.
Exercise increases your tolerance to do activities that are important to you.
What would you do today if you didn’t have pain? Or, what did you used to enjoy doing before your pain set in?
Will exercise help my pain?
Typically people find that their pain decreases with movement and exercise when they find the right thing for them, at the right amount, and once they have managed to string along a few weeks of it. This is not guaranteed though, as it depends on a variety of factors. Luckily all the other benefits are guaranteed!
The first step is to ask the key question: “Am I safe to move?”
Usually we consult our medical practitioners with the hope of getting a label (diagnosis) for our pain and to get the best treatment for it. It is important that you do that, but I am assuming that if your pain persisted for a long period of time and you are reading this, you already have done that and are still in pain and without any clear solution on how to get better.
By the end of your physio or doctor’s appointment, you should know whether you have a condition that means you should avoid exercise and or movement. There are very few of these. For most joint, nerve and muscle pain, exercise done right is not only safe but recommended as one of the best treatment strategies by health practitioners. This includes conditions like arthritis, spondylosis, disc herniations and sciatica.
Next is to understand that pain does not necessarily mean damage or harm.
Pain is a protector. It is useful and it helps us survive. If you touch a hot stove, you feel pain and you quickly remove your hand. Pain is like an alarm that warns you of impending danger.
Unfortunately, chronic pain is much less useful. It is out of proportion to any damage in the body and the alarm that is usually so useful becomes completely over-protective. This means that if a particular activity or movement you do causes you pain, and has done so for a while, it is very likely that the pain is not indicating you are doing any harm. You ache, but are safe. This is critical to understand because otherwise exercise makes no sense and you will remain feeling the same.
So how do you know if your pain system is over-protective?
There are many signs to look out for. Your body starts to feel more sensitive than it did. Activities that used to cause a little pain now cause a lot of pain. Activities that were usually not painful, start to become painful. Your pain might spread, or it might move from one side of your body to the other, or from one location to another, or new spots become sore. Your movement system starts to get in on the act. Remember that movement is another great way to protect. You might find some movements become more difficult. You might feel stiff. You might have muscle spasms. They can be really frightening, particularly if you don’t understand them or know what caused them. They are another way your body protects a painful area. They are almost never a sign that you have damaged something. You might even find you become more sensitive to things that don’t seem related to your body – loud noises, unusual smells - slightly annoying people can become very annoying people. All these things show that your system is ‘on alert’. Pain can actually be turned up and down by your thoughts, feelings and other things going on in your life – things that actually have nothing to do with the painful body part!
This is why the first step is seeing your health professional and asking, “Am I safe to move?”. You are asking if your pain system is being over-protective.
After this, you need to decide which exercise to do. The best exercise is the one you enjoy as this is the one you will stick to in the long run. If you have never enjoyed exercise, try to think of a time when even if you didn’t like the activity it at least made you feel a bit better after. It does not have to be the gym or a sport, but it needs to be more demanding than your normal day to day life. Make sure there is going to be minimal resistance to your option. If you choose to start swimming regularly but the pool is far away or only open at inconvenient times for you, you might be setting yourself up for failure.
Stop wasting time and get started! You can’t expect any results without action. Get used to how your body feels and reacts and don’t be too hard on yourself, just show up. There’s no need to push yourself to complete exhaustion.
“But what about the pain?”
On the one side we know pain is like an over-sensitive alarm and does not mean you are doing any damage, so you don’t need to avoid pain. And some discomfort might be needed for a proper workout. But, you don’t want too much pain because it can be horrible, like pain that flares up after activity or exercise and stops you from working or sleeping properly
To solve this conundrum, stick to this golden rule for exercise and pain:
Exercise within a level of tolerable pain, that does not increase whilst exercising and that gradually decreases once you have finished.
“Tolerable pain” is very individual. For some it will be 1/10 and for others 4/10. A different way to think of tolerable pain is something you can cope with and feel is manageable. It should make you feel anxious and you should still feel in control. This may take a bit of trial and error to find this specific level. Think of a flare up as a learning process. You now know what level is “too much”. The great thing is that as you continue to exercise, it is very likely that what was once too much will become manageable.
As you start to build consistency with your exercise habit, keep pushing yourself one step at a time. Earlier, I said the best exercise is one that you enjoy, because you will stick to it. This is true, but it is also true that part of your exercise should be quite hard. Not all of it, but maybe just the last few minutes or the last couple of repetitions. Remember, “What doesn’t challenge you, will not change you.”
That concludes my guide to exercising with longstanding pain. It can be a long road, with setbacks along the way, but at the end it’s always worth it!
