Exercise and chronic pain – Debunking myths
Being physically active has a positive influence on both our physical and mental health. Living with chronic pain can make trying to achieve your weekly quota of physical activity extremely challenging. This challenge arises due to the unpredictable nature of pain, one day you can complete all your physical activities (walking the dog, going to the gym, doing some home exercises or playing your favourite sport) and the next you may be unable to complete half or even none of your planned activities. During a flare of pain walking from one room to the next may be a struggle, let alone trying to leave the house for exercise. For that reason, exercise consistency can be hard to achieve for many pain conditions. There are times where pain conditions may need reduced activity and sometimes rest however, by not engaging in any physical activity or by choosing complete rest for long periods, secondary health issues can arise. These secondary problems include decreased fitness, increased bodyweight, decreased muscle and bone health and decreased mental health, all of which can make simple daily tasks become very taxing. The World Health Organisation recommends that we aim to achieve 30-minutes of moderate activity per day (or 150 minutes collectively per week) in order to maintain our health. Depending on your starting point 150 minutes per week while living with pain may seem daunting but remember any exercise will have a positive impact on your health, even if 10 minutes of activity is your starting point. Below we discuss 3 common myths about exercise and pain that might be preventing you from getting the movement your body needs.
Myth 1: One specific exercise type is superior to another. There have been many heated debates by healthcare professionals and researchers over what the best exercise for resolving pain might be, but the fact is research repeatedly shows no one exercise is superior to another. For example, if we consider the research on low back pain we will find that there is strong evidence to show that strength training (with or without weights), Yoga, Tai chi, Pilates and even simple walking programs can all have positive impacts on both low back pain and function. In some ways this is unsurprising when you consider how different we all are as humans. Despite being diagnosed with the same condition (such as arthritis, pelvic pain, fibromyalgia) our pain conditions will affect us all in different ways and consequently we all have different requirements from exercise. Decide what exercise is for you by identifying what exercise can support you to achieve your personal goals, that is accessible and most importantly that you enjoy.
Myth 2: Hurt means harm (or damage). Exercising with pain is complex because each person’s pain is individual and effects them in a variety of ways. With chronic pain it is safe to exercise and important to remember hurt does not mean harm. Living with chronic pain you may always have some pain present, and that pain will be present while you exercise but that hurt during exercise does not mean you are damaging your body. To increase our strength and fitness we often do need to push into a ‘zone of discomfort’. For example if trying to increase my cardiovascular (lung and heart) fitness I would need to exercise to the point of breathlessness or if trying to increase the strength of my legs I would need to exercise them to the point of fatigue (a tired ache). It is normal for your body to respond to physical exercise with varying levels of fatigue, stiffness and perhaps a muscle ache. These are expected consequences of activity and will likely resolve in 2-3 days. If the exercise you engaged in leaves you unable to function, with severe fatigue or a significant exacerbation of your pain then it needs to be adjusted and you should seek support from a healthcare professional to find the right adjustments to make the ‘exercise dose’ work for you.
Myth 3. A flare of pain means I should stop activity and completely rest. Often during a flare of pain we are advised to stop all activity and rest. When taking a new medication if the initial dose is not effective for your needs there will be a discussion with your doctor or pharmacist and most likely the dose will be adjusted until the right level is found for you. The same approach should be made with exercise. Each individual requires a dose of movement that fits both their current physical capacity and their current pain status and this dose will vary and need to be adjusted regularly depending on your pain levels. Listen to your body and begin to learn when it needs to engage in lighter workloads and when you are able to push into more challenging activities. Remember pain often does not follow a linear pattern and so it makes sense that neither will your exercise program. For most pain conditions it helps to have a variety of physical activities you can choose from depending on your symptoms. On a flare day some people may choose to do some light stretching or a slow 5 to15-minute walk and on a lower pain day they might complete a hike or some taxing strength exercises. Remember you know your body best and you are the expert in picking what movement feels good and what doesn’t on individual days but some movement is better than no movement.
Reengaging with physical activity after a diagnosis of chronic pain can be daunting. The benefits of exercise are many and include improvements in muscle and bone strength, enhanced mental health and opportunities for social engagement (meeting friends and family) to name but a few. Keep in mind that physical activity is defined as all movements you complete in a given day. Movement is for everyone and any movement is better for your mind and body than no movement at all. Physical activity does not need to be in a gym or with fancy equipment, getting out gardening, doing some DIY, housework or even light walking in a nearby park all counts as physical activity.
The take home message, find movement that works for you! Movement should be fun, social, and add a sense of achievement to your day. Check out local clubs, community facilities, walking groups close to you that might offer opportunities to engage in more movement. Considering we are all individuals and have different needs, interests and abilities finding the right physical activity fit for you is essential in order to find a long-term movement program that works for you.
