This blog was provoked by comments I have seen online recently – someone with a chronic condition, fibromyalgia, was really distressed by colleagues making comments about how she was coping with her condition. They were suggesting she go to the gym – the implication being that this would “cure” her pain. This woman just couldn’t get people to understand how exhausting living with this pain was, and how gym exercise would completely wipe her out, with no long-term benefit. She was doing an active job, in the veterinary practice, on her feet all day. and certainly wasn’t sedentary. She just didn’t go to the gym.
So, are her colleagues right?
I’m sure these suggestions were well meant. It can be very hard to understand why someone doesn’t just do the thing that you find helpful. Maybe for you it is the gym, for someone else it’s pilates, or yoga, or some special back exercise they were given by the physio.
If you tell people you have a pain problem, the variety of advice you receive is staggering!
This tells you there isn’t one solution to pain.
Everyone is unique.
Everyone’s experience of pain is unique.
So that means your solution to your pain is going to be unique to you. It might be just exercise of one type or another, but more likely it will be several types of changes in lifestyle. Some small, some maybe bigger. Some additions, some subtractions.
What’s the evidence (from large, controlled trials)? Will exercise be a solution to my pain?
Exercise is one of the most useful things you can do to help your pain.
i.e. it has a mild to moderate effect. This means it helps some people a lot, others less so, but on average, most peoples pain will be improved somewhat by being more active.
It also means there will be some people for whom exercise doesn’t make much difference, and some for whom it can make things worse (at least if they are not very careful with the dose and type)
This makes exercise one of the most effective interventions for pain of anything (of those interventions that have been well tested). But hardly a panacea.
So, I would say – if you aren’t very active (and that’s most of us, if we’re honest!) and you have pain, then doing more activity is likely to help. If you are already active, but still have pain, see below for what might help you.
So, how does exercise help pain?
The weird thing they have found from these trials on large numbers of people in pain : the improvement in pain is NOT associated with increased strength or stamina or flexibility.
It certainly is not associated with increased core strength (or more active glutes, or whatever muscle is fashionable at the time.) It seems that it is more about how it changes the nervous system and peoples’ emotional state. ( see why core strength to help back pain is a myth here )
Exercise for pain is more about your nervous system and general body/mental health
If done appropriately, it can train your nervous system that movements are “safe” and there is no need to be guarded (more about muscle guarding here). This “safety” message to the nervous system can reduce its state of high alert, and moderate your pain.
It can increase capacity – i.e. with a higher level of fitness more activity is within your comfort zone. However, fitness is quite activity specific, so I find this applies less than you think. But its still very useful to build resilience with a variety of exercise, especially if you are unfit.
Exercise can be social and fun – and is more likely to help your pain if that is the case (for many and various reasons, but in summary: happy and relaxed = less pain!)
And of course, exercise has lots of side benefits that can feed into helping pain e.g. lowering inflammation, releasing endorphins and other pain reducing chemicals, increasing self-esteem, giving you a feeling of taking control over your pain etc.
I wouldn’t ever discourage anyone from exercise or activity…. nearly all of us need to do more!
What I disagree with is this idea that any exercise is automatically going to be a cure for someone’s pain. And I definitely disagree with shaming someone who is trying to cope with chronic pain or other condition because they don’t go to the gym.
There are lots of reasons to keep active which apply whether you are in pain or not. A little more short- term pain with exercise might sometimes be the trade- off for these benefits. But in general, we should be looking for exercise that helps us settle our pain over the long term and makes us happy and healthy.
What exercise should I be doing?
What you enjoy!
Studies don’t show any advantage of one type of exercise over another in terms of pain, so do what you find fun, or is easy to keep up, or that comes with a nice social side.
Don’t make yourself miserable slogging at the gym thinking that if you just get a bit fitter your pain will reduce. But if going to the gym makes you feel good, then go!
Make movement a part of your life as much as possible in a way that works for you. Walking works.
What if I’m active and I still have pain?
There are 3 things to consider in this case:
1. Do you need to concentrate on calming your nervous system down instead?
If you are already active then doing more and more is unlikely to make a difference. It may be you even need to row back for a while, and work on your pain in other ways before you build up again. When pain becomes persistent we can become very sensitised. Then activity that in theory should be helpful might just be winding your pain up and getting it more and more engrained. For many of the people I work with being inactive is not the issue. They need the tools to calm an over sensitive system rather than to keep pushing at exercise as a solution.
Read more about this and your pain puzzle here.
2. Are you working too hard at your exercise – and probably everyday life too – because you are too tense and “ switched on”?
Having pain is a stimulus – an alarm bell going off in our nervous system telling us of “danger”. There may be no danger anymore e.g. with an injury that has healed, but the alarm still goes off, making us permanently on high alert, tense and prone to guarding the painful area with excessive muscle tension. This may have become so normal for us we don’t even notice we are doing it.
This guarding can make movement tense and effortful and can be very tiring.
Sometimes doing gentle, calming kinds of movement can help this e.g. tai chi, or a gentle yoga class.
However, for some people this way of moving and being has become ingrained and they will be tense and guarded in all movement, however gentle. This can be changed, but needs a detailed approach. This is what Alexander Technique excels at – helping you to undo habits of excessive tension and guarding to help you move more easily and freely. We can often be using excessive effort when just sitting or standing too, so everything is a bit tiring! Learning to change this can help give you more energy overall.
If you learn to move more easily and freely, you can then enjoy activities more and get more benefit from them. You can even get back to doing sports or hobbies that were previously too pain-provoking.
3. Are you getting the dose right?
So often we do exercise in the chunks of time it is presented to us in, like 1 hour classes. Or we feel the convention that exercise is 30 mins as a minimum, and anything less is somehow worthless. We forget to listen to our bodies. With exercise for pain the goal isn’t to avoid discomfort, but it does need to not cause flare ups constantly, and it needs us to be progressing towards more confidence and consistency, which might mean micro doses at first.
So, just because a yoga class is an hour long, it doesn’t mean an hour is the right amount for you. Maybe too many of the movements are too provoking for you. But if you enjoy it, why not do a few minutes of the exercises you tolerate well using a online video. Or attend the class but explain to the teacher and opt out of all your problematic exercises (for now – calm things down and you can get back to the rest later).
Often the same goes for those exercises the physio gave you. They might be the right ones to do, but the number of sets and reps are aggravating to your pain, so you can’t keep them up. It’s ok to scale right back, pay attention to doing a tiny amount accurately, with ease and helping your nervous system to calm down. Then you can start to increase the volume and get more into the strengthening and conditioning aspect of the exercise.
Think about why and how you exercise (this means anything that gets you moving, not just ‘formal’ exercise)
If the exercise you are doing is a chore you have to grit your teeth to do (perhaps literally?), then its probably NOT helping your pain. It might be the time to find something more fun, gentle or sociable.
If the exercise you do is consistently making your pain worse over the long term, then perhaps change to something gentle and symmetrical like walking or cycling for now, and think about retraining how you move to make movement more comfortable again.
If you are inactive and in pain, then doing more movement is likely to help you (check with your Doctor if you aren’t sure, but most conditions, including arthritis for instance, benefit from more activity). It doesn’t have to be something others would call exercise – you just have to move. Choose fun and easy, and start small and build up very slowly, you don’t need to chase strength and fitness to get improvements in pain: its more about ease, confidence in movement and happiness.
If you think your movement may benefit from some retraining, to help with pain or discomfort, or to give you more coordination and confidence in movement, then I would love to help.
Want to talk through how movement could help your pain? You can book a chat with me here