Living in pain, how exercise can be your way out of chronic pain

You are not alone. 6.9 million people in Australia live with chronic musculoskeletal conditions (27% of all Australians). The most common conditions are back pain, arthritis and osteoporosis.

Pain can impact your mood and quality of life tremendously. It can be extremely frightening and socially isolating.

In my 20 years as a physiotherapist specialising in chronic pain, I have seen one common denominator. Fear of movement. It is understandable when movement hurts. Many people stop moving because they are frightened of damaging themselves and making things worse.

But is rest the right thing to do? Will resting relieve pain and make you feel better?

In acute injuries, rest is an essential part of the healing process. In chronic conditions, healing is usually completed (while pain can persist), so rest is generally not helpful. It often leaves you moving less frequently over time. This reduces your overall load tolerance, which can mean low load — like daily activities — can now cause pain. It can isolate sufferers as they can no longer participate in usual social activities.

Consider load tolerance as the threshold your body reacts to with pain as a warning before tissues are damaged (usually long before injury). This mechanism usually keeps us safe and alive. This warning occurs too early in chronic pain as the nervous system has become overprotective; your tissue is not in danger of injury. Your system has become overly sensitive to load. If you are in chronic pain and decide to move less, you will decrease your overall load tolerance further. That can mean the pain will come on with even minimal load (e.g. sitting).

You might now think this does not apply to you because you have been diagnosed with a or herniation, in the knee or hip or osteoporosis. Our body is a great healing machine; for the above diagnoses, exercise is often the best treatment to reduce pain and regain quality of life. I have linked reliable resources for evidence-based information on each condition if you need more convincing. Click on them to find out more.

This is commonly known as the “cycle of disability”. You move less because you are in pain, but that causes you to be in more pain, which makes it even more scary to move.

If moving less worsens chronic pain, does moving more improve it?

Ignoring your pain and pushing through it will most likely lead to a flare-up (pain increases without tissue damage being present). The solution is graded exposure to exercise. You push the threshold gradually over time, so you will have some pain when moving but it won’t flare up.

Choose something you think you can manage. That can mean some pain (even an hour or two after), but choose something that will not increase your pain for days.

To feel safe with this approach, it is essential to understand that pain comes far before tissue damage/injury. You are usually safe to perform movements even with some mild discomfort.

This could be any movement done in bed, pool, or gym. It could be dancing, walking, beginners’ Pilates or some Yoga. Anything you feel confident to do, even rolling around on the floor, can signal your subconscious that moving is safe and will increase your load tolerance.

Movement helps to down-regulate your nervous system and not see it as a threat. Things become less scary if we expose ourselves to them.

By teaching our system gradually to accept the load, the pain will reduce.

Over time you need to increase the load, time and demand on the system to increase your load tolerance further. Repeat the same load for 3–4 sessions before increasing one of these parameters. Little by little is a good approach here.

Should you not feel confident, seek out the help of a physiotherapist. We can guide and support you on this journey.

I believe that with this approach, many can help themselves on the journey to a better quality of life.

Originally published at https://www.myhealthscript.com on August 16, 2023.