How and Why to Exercise with Chronic Pain

Every type of sensation or feeling a person experiences such as heat, cold, touch, and even pain is controlled by the nervous system in the human body. The nervous system is a network of nerves that connects the brain to the rest of the body to allow for the input of information. For example, if someone stubs their big toe, the nerves in the big toe get “excited” and send messages to the brain to tell the person that their toe is injured.
How Does This Relate to Chronic Pain?
Normally, pain lets a person know that they have injured themselves and need to protect that area while it heals. Once the body part has healed, the nerves in that area “calm down” and stop sending messages to the brain. In this example nerves in the toe would stop sending messages to the brain that the toe is injured. However, with chronic pain, the nerves in the painful area are constantly in that “excited” mode even though there is no injury.
How Chronic Pain Begins
There are many reasons that chronic pain may be present. Various disorders and illnesses, as well as injuries from years ago, can lead to chronic pain. With chronic pain, we know the nervous system never quiets down. In fact, the brain and its various parts are still paying attention to the injured area, even though the injury is healed. In fact, an injury isn’t even needed for chronic pain to develop. An example of this is the development of chronic pain in those who are witnesses to trauma.
Pain Does Not Always Mean You Are Not Fully Healed 
In the human body, it normally takes 6-9 months, at most, for the natural healing process to occur. This means that chronic pain that has lasted longer than that window of healing time likely is no longer protecting an injured body part. Instead, the nerves are in that “excited” mode. For people with chronic pain, this means that movement and exercise, although may be painful at the time, are likely not going to cause any injury to them. In other words, Hurt does not always equal Harm!
Benefits of Movement and Exercise
Lifestyles that do not involve movement and exercise have been shown to increase health risks for people across all populations, especially for those with chronic pain. In fact, increased movement and exercise actually work to help “calm down” those overactive, or “excited” nerves that are causing the chronic pain. Also, while movement and exercise can, of course, lead to things like increased heart health, increased aerobic capacity, and greater strength, it also relates to increased community participation, greater social involvement, and increased ability to complete household tasks. It has been shown that people who have chronic pain find an increase in their quality of life after they begin to increase movement and exercise.
Scared Afraid Man Wrapped in Red Fear Tape
The “Fear Avoidance” Principle
For many with chronic pain, they tend to stay away from movements that they find painful or movement altogether. This is known as “Fear Avoidance” because the person is concerned that by increasing movement or trying to exercise they will harm themselves. Therefore, they avoid it all together. As it turns out, fear avoidance is actually a main contributor to the continuation of chronic pain. Limiting motion and exercise reduces all the beneficial effects that are mentioned above. It is important to remember that hurt does not equal harm to break the cycle of fear avoidance and to get moving again.
How to Reengage with Healthy Movement
Start simply with more motion…
It would be unfair to expect someone who has had chronic pain for years to jump right back into an exercise regimen. If you are completely unsure you can see a physical therapist or… simply start with more motion. There are many ways throughout everyday life to simply choose to move more. Some examples may include:

  • Take the stairs instead of the elevator
  • Get up from your desk at the top of each hour and walk around
  • Ride a bike to work if your commute allows it
  • Park farther from the front door or your workplace
  • Use a Fitbit or other activity tracker to set goals for yourself and track motion trying to slowly increase each day

When you are ready to start a more regular, regimented exercise program, it’s good to start with a structured walking program. One such program may look something like this:

  • Start by walking 5 minutes per day for the first week. Remember to take breaks as often as necessary throughout the walking program.
  • Week 2: walk 5 minutes at a comfortable pace, and 5 minutes at a brisk pace. The next day, walk for 10-15 minutes. Alternate these two exercises for Week 2
  • Week 3: walk 15-20 minutes total alternating a brisk pace and comfortable pace every 5 minutes. The next day, walk for 15-20 minutes. Alternate these two exercises for week 3.
  • Week 4: Walk 25-30 minutes total alternating brisk and comfortable paces every 5-10 minutes. The next day, walk for 25-30 minutes total. Alternate these two exercises for week 4.
  • Continue with a progression such as this until walking has become a comfortable exercise and you are no longer feeling the benefits
  • Remember, these are guidelines. If after a week or two you do not feel comfortable progressing, then repeat that week of the program.

Slow and Steady Wins the Race
Chronic pain does not start overnight, so it will likely not disappear overnight either. Increase movement and exercise step by step trying to make small progress over a long period of time. Start with a walk around the block instead of trying to run a marathon right off the bat. Remember, “hurt does not equal harm” so although increasing motion or beginning to exercise may be uncomfortable, your body will eventually help those overactive nerves to “calm down”.
Do something you enjoy…
Increasing motion and exercise should not be a chore. By starting an activity you enjoy, it is much more likely you will continue with it. You can choose one of many methods to increase motion, it does not have to be going to a gym or going for a run. Some other examples are:

  • Yoga
  • Pilates
  • Recreational sports
  • Tai chi
  • Spin classes
  • Cycling
  • Swimming

Different Types of Exercise
Strength Training
Weight training for strength is a good way for many people to stay active and increase function. When using weights there are two general ways to structure your exercise

  • If your goal is to grow muscle and get larger muscles, it is important to use higher weight but lower the number of repetitions. Such as 3 sets of 8 reps, or 4 sets of 6 reps with a weight that is very challenging to complete the motion by the last rep of each set.
  • If your goal is to increase muscle endurance and stability, use lower weight but increase repetitions. Such as 4 sets of 12 reps, or 3 sets of 15 reps with a weight that creates a muscle burn sensation by the end of the set.

The body can be broken down into different types of muscle groups based on the motion they produce, such as:

  • Pushing/Chest (Pectorals, Shoulders, Parts of upper arm, and more)
  • Pulling/Back (Trapezius, Shoulders, Latissimus Dorsi, Rhomboids, Parts of upper arm, and more)
  • Overhead motion (Mainly shoulders)
  • Legs (Quadriceps, Hamstrings, Glutes, Calves, and more)

In general schedule your weight training days to prevent back to back days of the same motion or muscle group.
Endurance Training
The main way to measure an endurance workout would be to track your heart rate, or how many times your heart beats per minute. An easy way to figure out what your heart rate needs to be at to increase endurance is to follow this simple formula: 220 – your age, then take 80% of that number or multiply it by .8. For example, for a 50-year-old the target heart-rate would be found like this.
220 – (50) = 170
170 x .8 = 136
Target heart rate = 136 heartbeats/minute
Endurance workouts can take many forms. Someone may find that they reach their target heart-rate just by walking, others may need to jog at various paces. Others may choose to join spin classes, bike on the road or in a gym, or go hiking. The main point is to reach each individual’s own target heart rate.
Remember…You Can Feel a Bit Sore But  Be Safe!
It is common after an increase in activity to feel muscle soreness the next day or even two days after the activity. It is helpful to stretch and perform a 10-minute warm-up before starting, and a 10-minute cool-down after exercise. Stretches should be held for 10-20 seconds at a time

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