Essential Knowledge About Pain
“How can I exercise with pain?”
Important Facts About Exercise and Pain: True or False?
‘No pain, no gain’
‘Pain indicates I am damaging my body, so I should not exercise with pain’
‘Swimming will fix my back’
‘Pain requires rest, not exercise’
‘A strong core will stop my back hurting’
‘Exercises can change my neck posture, and thereby stop my neck pain’
‘I am on my feet all day at work, so I don’t need to exercise’
‘Pilates will fix my hip pain’
‘I should be able to exercise like I was before I had pain’
What are your beliefs about exercise and pain?
Important Facts About Exercise and Pain: Exercise and Pain
The evidence is clear that exercise is one of the most beneficial strategies for managing pain. This is reflected in clinical guidelines that universally recommend exercise as a front-line management for almost every single pain problem. Exercise equals movement, and movement is good for your wellbeing and the health of your body, even if that part of your body is experiencing pain.
Important Facts About Exercise and Pain: Knowing What Exercise Is Best For You
The evidence is overwhelmingly in favour of exercise for pain.
BUT, NO ONE TYPE OF EXERCISE HAS REALLY PROVEN TO BE SUPERIOR TO ANY OTHER FOR PAIN PROBLEMS.
That’s right, no exercise has really proven to be better than any other exercise for pain problems. BUT, the exercise one person needs might be very different to what is good for another person. What follows are some steps to help you decide which exercises might be best suited to you and your problem. This information can help you work out an exercise plan with your health care practitioner.
STEP 1: What Exercise Do You Want to Do?
Perhaps the most important concept in working out what exercise will be best for you is finding something that you will stick with. You may need to take steps to get to this, but having a structured plan will help.
12 Tips to Help You Stick With Exercise. Click Here
26 Ways to Actually Stick to Your Workout Click Here
14 Tips for Starting and Sticking with a Workout Routine Click Here
5 Reasons You Can’t Stick to An Exercise Program Click Here
7 Simple Ways to Motivate Yourself to Exercise (Video) Click Here
STEP 2: How Might The Type Of Pain I Have Influence The Exercise I Need To Do?
Not all pain is the same. Understanding that ‘your pain does not necessarily equal damage’ is often necessary, so you don’t become avoidant or fearful of movement and exercise. Your health care professional can help you understand the relationship between the source of your pain and what this means for exercise. While movement, exercise and physical activity are all good, modification in relationship to the type of pain you have may be necessary. Here are some broad guidelines.
TENDON PAIN: Some pain with exercises targeting tendons can be acceptable. As a broad guideline, it has been suggested that pain up to 4 or 5/10 that lasts up to 24 hours might be acceptable.
NERVE PAIN: Pushing into nerve pain generally leads to further irritation of the nerve. Pain causing stretching of a nerve is not advised, but other exercise that doesn’t irritate the nerve is important.
PAIN SENSITIVITY/NEUROPATHIC PAIN: Pushing into pain sensitivity or neuropathic pain generally leads to further sensitisation of the nervous system, called wind-up or temporal summation. Gentle, relaxing movement and exercise is generally a better way to build up activity tolerance. Cardio exercise is good – puffing without excess pain usually helps.
MUSCLE PAINS: A feeling of stretching should be expected when trying to lengthen tight/tense muscles. Some people perceive this as pain, or worry about this type of pain, and need to learn that it is a normal, expected experience. Some muscle soreness is often desirable after working muscles. Again, you may need to learn to distinguish this as a normal, expected experience.
SHOULDER IMPINGEMENT PAIN: Trying to force an impinging shoulder further into range is likely to aggravate impingement further. Stretching the shoulder may not be desirable in this circumstance.
When you start a new routine, some pain might be expected. This should not be a reason to stop. You need to continue and give your body and nervous system time to adjust. Some adjustments in your program may be helpful. This might include adjusting how far you move, changing the repetitions, changing the routine of the exercises you perform, or altering the load.
STEP 3: Do You Need Specific or General Exercise?
Broadly speaking, you may be able to consider exercise under these 2 general categories. Some exercises may have elements of both (eg hydrotherapy may have a general exercise component with very specific components added in). Most pain problems require an element of both, but getting the balance right can take time and skill.
This could be considered exercise that gets your whole body moving, works your cardiovascular system or leads to general strengthening. It might target your overall endurance and tolerance to activity.
Resource: Australia’s Physical Activity and Sedentary Behaviour Guidelines
These exercises are usually highly targeted to your problem. This might include:
- Exercise to maintain or restore limitations in specific movements.
- Targeted strengthening of specifically weakened muscles (as opposed to just general strengthening).
- Muscle relaxation exercises to reduce unhelpful protective habits.
- Very specific changes to the way you posture yourself or perform specific movements patterns This often involves trying to create ‘new habits’.
- Graduated loading to improve tolerance to loading. Sometime this may involve unloading first (eg hydrotherapy).
- Exercise targeting functional tasks related to work, sport or recreational activities.
STEP 4: Strategies to help
As well as prescribing different types of exercise, your health care professional can help you with strategies to assist with integration
Having a goal can be a strong motivator for sticking with exercise. You may find useful guides on the internet, such as this one. Click Here
SPECIAL NOTE FOR CHRONIC PAIN: Many people with chronic pain will have a goal to have less pain (or even no pain), which is very understandable. When it comes to exercise, exercise can assist with pain, but for chronic pain it is usually better to have a goal related to function and activity rather than to just pain. These goals are usually more achievable, and once achieved, the pain will frequently become less of an issue also.
Often, attaining your goal will take multiple steps, not one big leap. Graded exposure may be necessary, which is essentially building steps to you goal. This might include breaking down the overall goal into components and working on these individually. Or it may mean building up the amount of activity/exercise you perform slowly, until reach the goal. Graded exposure allows your body tissues and nervous system to adapt to new challenges in a controlled manner. It can also help you regain your confidence to be active.
Pacing. Download PDF
Some people try to push through pain, which results in a boom-bust cycle. Others become avoidant due to worry about pain or trying to avoid aggravating the pain. Neither situation may be ideal, and can result in a downward spiral of physical capacity and tolerance. Pacing strategies attempt to break this downward spiral. Pacing strategies you need may differ depending on the type of pain you have.
Summary: Pain and exercise
All clinical guidelines for the management of pain problems recommend exercise and remaining active. But there are no ‘magical’ exercises that will suit everyone who has pain. Your health care practitioner can help you establish what is going to be the best exercise for you, and work out the best dosage depending on your needs at that time, and the type of pain you are experiencing.
Evidence Informed Information Compiled By Dr Darren Beales, PhD and Dr Tim Mitchell, PhD