Can I exercise myself out of pain?

Can I exercise myself out of pain?

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, and certainly wasn’t sedentary, but 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 it’s 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!

And 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 lots of changes in lifestyle and thinking, some small, some maybe bigger (more on this in future blogs….)

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.

This makes it the 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. But what if you are already active? Then doing lots more is unlikely to make a difference. But maybe have a look at what you are doing, and how you are doing it (more later)

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.

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 can give you a feeling of taking control of your condition

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 also make you realise that a bit more pain isn’t causing you damage, so you might then choose to do something fun or fulfilling despite it causing a bit more pain short term, because overall that makes your life better.

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 capacity 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. weight loss ( therefore decreasing inflammation), endorphins, increasing self-esteem 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 – be it squats and deadlifts, yoga, or pilates 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 to it.

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!

Be active and make movement a part of your life as much as possible.

What if I’m active and I still have pain?

There’s a few things to consider in this case:

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.

Think about why and how you exercise (this means anything that gets you moving, not just going to the gym)

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 formal exercise. 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.

Contact me to book a lesson in Alexander Technique to find out more