Chronic Pain

Exercise and Chronic Pain

Significant research shows that exercise is a critical tool in the treatment of chronic pain. Too often, we avoid activity in an attempt to decrease flare ups. But gradually over time the less we do, the less we feel capable of doing before hurting. This spirals down until even completing daily activities is too much. Therapeutic exercises are the primary choice of non-pharmacological treatment for chronic pain. There are known benefits of exercise and regular physical activity. The CDC list includes: controlling weight, reduced risk of cardiovascular disease and metabolic disease, reduced risk of some cancers, strengthens bones and muscles, improved mental health and mood, improved ability to perform daily activities and prevent falls, and increased chances of living longer.

Exercise and physical activity have proven benefits for pain control. This may be due to exercise induced hypoalgesia- a decreased sensitivity to painful stimuli. It occurs when nociceptive (painful) stimuli are interrupted or decreased somewhere along the path between the input (nociceptors), and the places where they are processed and recognized as pain in the conscious mind. EIH, (exercise induced hypoalgesia) is a phenomenon which has been extensively studied. Although poorly understood, EIH seems to increase pain tolerance and reduce pain intensity ratings during and after exercise. The most commonly accepted hypothesis behind EIH is that natural central opioid systems in the brain are activated by increased discharges from skeletal muscles secondary to rhythmic muscle contractions, as seen with exercise. This seems to be through two mechanisms. One is by increasing our own blood endorphin concentrations. The principal function of endorphins is to inhibit the communication of pain signals; this may produce a feeling of euphoria very similar to that produced by opioids. Another proposed mechanism for EIH is endocannabinoids- these are involved in mediating some of the physiological and cognitive effects thought to control the transmission of pain. Concentrations of certain endocannabinoids have been found to rise during physical activity.  Since they penetrate the blood-brain barrier, they also contribute to the development of an all natural exercise-induced euphoria colloquially referred to as a “runners high.”

Pain control is achieved differently with different types of exercises, i.e. aerobic exercise, endurance training, and resistive exercise and strength training.  It’s important to make sure the appropriate intensity and frequency of exercise is achieved in order to get the desired effects of hypoalgesia. That’s why supervision from a healthcare provider, physical therapists, or specialists is required to ensure the proper balance is prescribed. Too little exercise is not beneficial, whereas too much can aggravate symptoms. A study in the British Journal of Sports Medicine concluded even one session of resistance exercise can achieve a hypoalgesic response. Regardless of the type of exercise performed, the EIH response was larger in an exercising body part compared to a non-exercising one.

The best program to help chronic pain is one that incorporates multiple forms of exercise, including:

Stretching exercises:

It’s important to stretch at least once a day to help increase flexibility, loosen tight/stiff muscles, and improve your range of motion. Stretching daily will help ease your everyday movements and improve range of motion.

Strengthening exercises:

Strengthening exercise such as: squats, wall push ups, or bicep curls help build strong muscles. Heavier weights are unnecessary. We are looking to tone, lengthen and strengthen, not produce bulk.

Cardiovascular exercises:

Walking, hiking, swimming or biking provide light aerobic exercise, which results in a host of healing benefits. All are activities that can be done anywhere. If working out in a gym, make sure you are trained to use the equipment and initially supervised to prevent injuries. Walk on a treadmill or switch to an elliptical trainer for a lower impact workout. After my neck surgeries, I had to give up my beloved running sessions because the impact could further harm me. It took a while, but now the elliptical provides the same “rush” I used to feel when lightly jogging.

Supervised exercise therapy, which is individually designed for your specific needs, improves pain and function. There’s no question that lack of physical activity is detrimental. Regular physical activity helps prevents joint stiffness, muscle tightness and helps increase blood circulation. Remember that exercise is just like a medicine, and like a pill, it is an important strategy to incorporate daily. Be safe and start slowly with short bursts of exercise, not long stretches, until you acclimate. As I’ve said before, the body sees everything you do throughout the day so a few minutes at a time, several times a day, adds up. Avoid pushing too hard and monitor pain levels while exercising as on a scale from 1-10,  1 being no pain, 10 extreme pain. If levels increase by more than 2 points from baseline, you should stop and modify that exercise, or seek professional advice.

The bottom line is: get active! I’ll be showing a different exercise every Tuesday to give an idea of the type I’m recommending. In fact, these are all exercises I actually use. Because I have both neck and low back issues, it’s imperative to use exercises that will only stress one area at a time. That’s why I isolate the muscles involved so only a specific area is affected. For example, with bicep curls, I place one arm on a table and my back against a chair or wall. This way only the bicep is stressed on that side. Otherwise, I’m tempted to use other muscles to “help me lift” such as swinging with both arms or recruiting my back. Doing this is also a sign the weight is too heavy and unable to be lifted alone. Try each one for a week and see how it feels- ask questions is there’s a concern and soon you’ll have a safe, comprehensive routine too.

    -Dr. Courtney

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