Chronic Pain and Exercise

Why it Hurts! Understanding Chronic Pain

Chronic pain refers to pain that extends beyond the expected healing time and includes conditions such as:

• Spinal pain
• Knee Pain
• Shoulder Pain
• Hip Pain
• Elbow pain
• Neck pain
• Wrist pain
• Post-Operative pain
• Neuropathic pain

20% of Australians suffer chronic pain to the point that the pain significantly impacts their daily life. Too often clinicians view chronic pain the same as acute (short-term) pain; seeing pain as a reliable indicator of the severity of the injury, the worse the injury the worse the pain. In this instance, the factors besides injury to the joints, muscles tendons and ligaments and tissues become very important in how much it hurts.

If the pain isn’t treated early then the non-tissue related factors, such as you muscles, tendons or ligaments become the driving cycle of pain and disability.

Examples of chronic pain conditions include:

• Fibromyalgia
• Chronic regional pain syndrome

With these conditions there is high level of pain with no known cause identified. Often it is very difficult for clinicians to work out how much of the patient’s pain is caused by tissue injury (eg: disc injury or degenerative joint) and how much it is caused by other factors.

The key for the clinicians and patients is to not focus on finding and fixing a problem with the tissues or a structure when treating chronic pain.

It is not uncommon to have tried multiple treatments that have failed to deliver adequate pain relief. The ongoing treatment can definitely foster some negative thoughts for the client. However it is very important that the clinician continues to try different exercise to treat and minimise the pain in the client. Unlike acute pain which is helpful to aid recovery allowing inflammation to promote healing; chronic pain is much less helpful. Chronic can impose significant stress on all the body’s structure.

The way to focus on chronic pain is best done through getting the patient to move more rather than passive treatment (stretching, massage).

Exercise and Chronic Pain

Motion is Lotion! Movement is key to chronic pain and managing the symptoms. The benefits include:

• Lubricating the joints
• The discs in your back and ligaments get the nutrients and minerals to help them become healthier
• The nervous system relaxes and reduces flare-ups
• The body also releases hormones known as endorphins which work as pain relievers during exercise
• The pain tolerance will improve over time and post-exercise you normal levels of pain may not re-appear until at least 60mins after

Exercise tips for chronic pain

Reassurance for the patient is very important to reduce any additional stress or anxiety. The clinician needs to tell the patient that pain felt during exercise does not necessary equal further injury. It is normal for people with chronic pain to experience discomfort/increased symptoms as they gradually become more active.

There is no optimal type of exercise for chronic pain however exercise programs should be specific for the patient and to be fun. As the Exercise Physiology sessions are generally longer than other allied health professionals, this will help the patient-clinician communication and exercise programming, which promotes better outcomes.

Exercises for Chronic Pain

Choose exercises you enjoy, just make sure you move.

Aerobic exercises will be included in all programs

It is important that any exercise that increases the normal level of pain will need to be cut out or dropped in intensity.

Start of slow with the exercises and make it consistent in terms of volume from day to day, until the you become accustomed to a particular intensity.

The volume of the exercise program will increase before the intensity.