Should You Exercise If You Have Chronic Pain?
We're in a lot of pain. Pain affects more Americans than diabetes, heart disease, and cancer combined — that's 100 million of us — and many people say they "can't" exercise because of pain. That's counter to current science that says instead of resting, we really should keep moving.
In fact, an April 2017 report on Cochrane finds 21 reviews with evidence that physical activity reduces pain severity, improves physical function, and has a "variable effect" on both psychological function and quality of life, meaning results were mixed.
Just what is pain? The International Association for the Study of Pain defines it as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage."
You know what it is, and you want more control over it.
When life's a pain
You have options to reduce pain, move better, and be more productive. Anthony Carey, M.A., certified strength and condition specialist and American Council on Exercise (ACE)-certified medical exercise specialist, has co-developed special programs designed for athletic and fitness trainers and physical, occupational, and massage therapists who help clients like you.
Carey, of Function First in San Diego, is an expert in biomechanics or the study of human movement, in corrective exercise, and in musculoskeletal pain that affects bones, muscles, ligaments, tendons, and nerves. The work for clients in pain is designed to be "smart and strategic, efficient and non-provocative, as well as confidence-building," he says.
He spoke to HealthCentral in a telephone interview. "To regain a sense of control, brain working positively with body is at the center of pain-free movement," he says. Carey is very familiar with the cycle.
"Let's say you've got chronic knee pain, but you know you need to move, so you go for a walk," he says. "Then when your knee hurts, you start modifying your gait and in doing so, you stress other parts of your body, which can cause them pain, and all that reduces your confidence."
He works to rewire your nervous system and the brain's interpretation of the "threat," and also to change how it responds to pain.
Brain over pain
"With pain, your body receives messages or inputs from joints, tissues and other pressure centers that create a predictable response and continually produce avoidance," he says. "This response directs how you perceive your ability to move, adding stress and anxiety as you prepare to climb those stairs."
It's called confirmation bias: "Everything you look for and all that you perceive has a way of proving whatever you believe," he says.
Consider the "haunted-house" effect. "People in the house approach a corner where they think something will scare them," he says. "Even if that doesn't happen, many will actually experience fright even if no one is there."
People with chronic pain feel the same when they approach what they believe is a threat, such as simply trying to complete a movement. Remember that pain is an experience, says Carey, not a sensation. And it is real.
Easy does it
There's a predictable cycle to exercise-induced hyperalgesia or the body's response to pain. It postulates that:
Inappropriate beliefs lead to
Fear which leads to
Reduced exercise tolerance
This bio-psycho-social paradigm confirms that movement is dangerous and is going to hurt you. You can change the paradigm and change your mind. You'll begin with subtle, restorative, and corrective exercises, Carey says, and you won't rush.
"Initially, exercises aren't 'knee specific,'" he says. "They influence mechanics related to the knee and how your entire body moves and feels." You do movements in a strategic sequence that encourages your body's motor system to react in certain ways to create a new response — think "nervous-system training."
"It helps change your brain's interpretation about what is actually happening," Carey says. "Accomplishing pain-free-movement provides the brain new information and new, non-threatening options."
How to reduce your pain
A pain-free movement specialist should spend significant time discussing your medical history, as well as your pain history, Carey says.
"Share your fears and discuss what you've done in the past that hasn't worked."
Ideally, your plan will initially include preparing your muscles and connective tissue — "support" for the body — nervous system, and psyche for more advanced movements with:
Positions you assume and then hold for a designated period of time
Gentle, isometric exercises
Yoga, with modifications as necessary
Traditional rehabilitative exercise
The goal is to place a functional demand on the body that meets your long-term objectives, he says. Before you undertake an exercise, your fitness professional will determine whether that exercise is:
Negative: increasing pain, apprehension and/or compensation
Neutral: allowing you to feel safe doing it; it neither increases or decreases symptoms
Positive: it feels good, you like doing it, and it moves you toward your objectives
Step-by-step pain control
It's important to prevent what Carey calls "the cascading effect."
"Once pain gets bad, you may put on body weight, which can lead to depression, high blood pressure, and other secondary morbidities," he says. "You feel less and less healthy and start to go downhill."
There is also an opposite scenario which can occur — all good. You start to move more, your mood improves, you're more social with friends, and more engaged in life in general. Moving more burns more calories. You may even eschew that cheeseburger for healthier protein and some vegetables, along with more water, because now you have the vibe.
"Positive things start to happen, one after another," Carey says. Here's how:
You may begin with a walk that's pain-free. (Whew.) Then you add 10 minutes on a stationary bike because soft tissues in your legs are warmed up and working with you and prepared to do more. (Yay!) Now your brain produces more dopamine, a neurotransmitter that helps control its reward and pleasure centers. You've got this. (Success!)
"You create good feelings about how you're functioning," he says. "The record is playing differently. Remember, too, that you are not your diagnosis and that imaging studies don't correlate exactly with the pain experience. To cope and manage, remember that chronic pain is a comprehensive experience beyond what your doctor may have labeled you."
To find this cutting-edge help, you have to look a bit harder. Your healthcare provider or YMCA may recommend a trainer or physical therapist specializing in exercise with pain — important —from a bio-psycho-social perspective, which is newer. For Carey's program, find ACE-certified trainers in your area here. Their profile page lists their certifications and areas of focus, in this case, pain-free movement.
Now, go have fun. You're ready.