Exercising when it hurts

Tom Jesson
Feb 24, 2019 · 11 min read

A step by step guide

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This post is for people who have muscle, joint and/or nerve pain, perhaps in more than one place, that has gone on for a long time and doesn’t seem to be going away. It is meant to help you become more fit and active, so that your body and mind are as healthy and capable as they can be, despite your pain.

Why exercise?

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Ask yourself, “what would I do today if I didn’t have my pain”, or, “what did I used to enjoy before my pain came on?”

Will exercise help my pain?

Step 1: Ask The Key Question

“Am I safe to move?”

What you want to know from your doctor or physiotherapist is whether you have a condition that means you should avoid exercise and movement. There are really very few of these.

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In fact, for most muscle, joint and nerve pain, exercise (done right) is not only safe but strongly recommended by health professionals. This includes joint pain like hip and knee arthritis, and neck and back pain, including spondylosis, sciatica and disc problems.

Step 2: Understand that “hurt doesn’t necessarily equal harm”

Unfortunately, persistent pain is much less useful. It is almost always well out of proportion to any damage going on in the body, and people can feel terrible pain when moving even when it is not dangerous. The alarm that is usually so useful becomes “over-protective”.

This means that if there is a particular movement you do that causes you pain, and has done for some time, it is very likely that that pain is not indicating you are doing any harm. You are sore, but safe. This is important to understand because otherwise exercise makes no sense and you will just be miserable!

Another way to think of this is like a lowering of the pain threshold. A certain part of the body — or many parts — becomes over-sensitive to movement and feels more painful than it needs to be.

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via noigroup

This is why step 1 is seeing your doctor or physio and asking, “Am I safe to move?”. You are asking a medical professional if your pain system is being over-protective.

There are some links at the end of this post that explain this step in more detail.

Step 3: Decide which exercise

Exercise doesn’t have to be a sport or the gym. For our purposes, exercise is anything that is more demanding than your usual day to day life. For some people, this could be walking, gardening, dancing, lifting and carrying... At the end of the post, I have put a list of different exercises that you might want to start with.

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Avoid the trap of choosing something you think you “should” do. If you have back pain, you don’t have to do pilates. That will help, but it will help because it’s exercise, not because it’s pilates. If you have knee pain, don’t think you have to do exercise in the swimming pool.

Make sure there is going to be as little “resistance” as possible to your choice. If you choose to go swimming regularly with a friend but the pool is a long drive away, only open for free swim at awkward times and your friend is very busy and likely to cancel, you might be setting yourself up for failure. On the other hand, if the pool is near your house, affordable, and your friend is reliable, that would be a perfect situation. So, try to choose something that will fit in as easily as possible with your existing routine.

Step 4: Get started and get into the swing of it

When you know what you want to do and when you want to do it, do it! And for now, don’t worry about anything more than doing it. The details don’t matter, we are just keeping it simple at this stage. The key is to “just show up” — at the gym, in the park, in front of your TV with an exercise DVD on.

Explore the movements involved in whatever you are doing. Get used to how your body feels, see how it reacts, see how your pain reacts. Enjoy moving your body again. Don’t feel you have to work yourself to exhaustion.

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If you miss a workout, don’t beat yourself up. There is no value to doing this. Just try again next time.

What about the pain? The golden rule

To solve this, I recommend sticking to the golden rule of exercise and pain. The golden rule is this:

Exercise within tolerable pain, that plateaus during exercise and does not continue to rise significantly, and gradually decreases once you have finished.

“Tolerable pain” is a funny phrase. This is very individual. For some it will be a mild discomfort, for others it will be more. Another way of thinking of tolerable pain is something you can cope with and feel is manageable. It should not feel frightening and you should feel in control.

It will take some trial and error to find this level. At first, you might do too much and flare up your pain. Take time to let it ease off then try again, doing a little less. Think of a flare up as a learning process — you now know what is “too much” for you. As you continue to exercise, it is likely that what was once too much will become achievable.

Be ready for DOMS!

Step 5: pushing on for maximum benefit

Once you are in the habit of exercise, you might find that you end up doing the same thing each time. For example, walking the same route, lifting the same weights, dancing along to the same DVDs. Unfortunately, the body quickly adapts to this and you will stop getting as much benefit. You are ‘maintaining’ things, but not getting fitter. To get the most from exercise, you have to keep moving out of your “comfort zone”, a little bit at a time.

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Each time you push out of your comfort zone, your body adapts and gets stronger for next time. Over time, the benefit adds up.

To make sure you are doing this, it helps to keep track of what you are doing. Then, you can make sure you progress over time. For example, try to walk a bit further, or do the same distance in a shorter time. If you are doing home exercise or weights at the gym, try to do a few more “repetitions” or lift heavier weights. There are some tools to help this at the end of the post.

As you start to build the exercise habit, this becomes key. 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. A good rule of thumb is:

“What doesn’t challenge you, won’t change you”.

Give yourself some tough love. Are you out of breath? Sweating? Are your muscles tired? If not, you may not be getting the benefit you want.

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The power of doing a bit more over time — Milo of Croton carried a newborn calf on his shoulders every day. As the calf grew bigger, Milo grew stronger.

Another benefit of keeping track of what you are doing is that it helps you to follow your exercise programme based on what you plan to do that day, rather than based on your pain. Allowing your pain to ‘dictate’ what you do often leads back into the spiral of doing less and less.

Step 6 and beyond: becoming an exercise expert

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Once you are in (or back in) the world of exercise, your confidence will be higher and it is time to try new things. For example, if you mostly do things like walking and swimming, you would benefit from adding in some strength training — shorter, high intensity movements often using weights. It is good to have a variety of endurance, strengthening and mobility exercises, if you can.

It might also be a good idea flip the “best exercise is the one you enjoy” rule and actively try things that you are worried about. If you are worried about something it is likely a weakness of yours that you might benefit from confronting. You might surprise yourself!

That concludes my six step guide to exercising when it hurts. It can be a tough road, with setbacks along the way, but always worth it!

Thank you to Tina, Chris and Bernadette for their advice on this post!

My personal website.


Links and extra stuff

Step 1: ask The Key Question

Once you have spoken to your physiotherapist to ask if you are safe to move, you might want to ask them to support and advise you through your exercise journey, too. They will be happy to help you with the process — that’s our job! Don’t feel like you need a physio though. As long as you have medical approval, a personal trainer or fitness instructor would be a great idea too.

Step 2: Understand that “hurt doesn’t equal harm”

Step 3: Decide which exercise

  • Walking
  • Running, for example Couch to 5k or Parkrun
  • Cycling or an exercise bike
  • Lifting weights at the gym
  • Walking up and down the stairs
  • Carrying heavy bags
  • Racquet sports
  • Dance classes
  • Gardening
  • Home stretches or yoga
  • Exercise class at your local health centre
  • Rock climbing
  • Escape Pain app or local class
  • Youtube/DVD workouts, or NHS fitness studio
  • Youtube/DVD dance tutorials
  • High intensity interval training
  • Home strength exercises

For more tips about approaching exercise I recommend this great list of “common sense exercise and movement guidelines”.

Step 4: Get started and get in the swing of it!

Step 5: pushing on for maximum benefit

For things like lifting weights or doing bodyweight movements, this exercise diary is good for keeping track of sets and reps. Here is an instructional video on how to fill it out.

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