What is pain?
The first step in managing you pain is understanding exactly what pain is. Pain is the body’s way of alerting you of danger.Pain, as defined by the International Association for the Study of Pain is an unpleasant experience that involves both sensory and emotional factors. Pain is associated with potential or actual damage to body tissue. That being said, pain does not necessarily mean there is damage.

Acute Pain and Chronic Pain:
Pain can be further categorized into chronic pain and acute pain. Chronic pain is used to describe a pain that continues, even after the danger has passed. And example of chronic pain would be back pain that lasts six months or more.
Acute pain is used to describe pain related to an immediate threat or danger. Acute pain is usually short lived and will often resolve with treatment. An example of an acute pain would be a broken bone.

The Nervous System and Pain:
Chronic pain can also be associated with the nervous system. When the nerve fibers are easily stimulated, they can send a message to the brain that the brain will then perceive as pain, although there is no actual damage to the never itself. The intensity of nerve related pain can vary as well as the pain sensation itself. Nerve related pain or neuropathic pain is often a result of a highly sensitive nerve rather than an immediate threat or danger.
Neuropathic pain can be managed with slow, gradual and consistent stimulation. This can help teach the nervous system not to over react and therefore, ease neuropathic pain.

Exercise and Chronic Pain:
Often times, people who suffer with chronic pain will fear being physically active because they are worried about the pain becoming worse. Many people feel an increase in pain after being physically active, especially if they had not been active for a long time prior. Some may fear re-injuring themselves and so, they avoid exercise altogether.
When dealing with chronic pain, it is important to know that an increase in pain following physical activity does not necessarily mean there has been an increase in tissue damage. In fact, it is not uncommon for those who are just becoming more physically active to have some aches and soreness after exercise. This is because muscles that may not have been used in this way before are now being put to work. The aches and pains associated with exercise are usually temporary and will often improve with continued physical activity as muscles are made stronger.
Always speak with your primary care physician before starting a new exercise regimen. Not all exercises are suited for everyone. Know your own physical limits and stay well within them.

Inactivity and Chronic Pain:
Chronic pain can make us believe that the less physical activity we take part in, the better we will be able to control our pain levels. You may feel as though limiting your activity is providing you with some level of control over your pain, but inactivity can have negative long term physical effects. A loss of muscle mass and bone mass is associated with inactivity. This puts the body at risk of further injury and increased pain. Muscles and joints can become stiff with inactivity, making movements difficult and often times painful. The level of pain experienced when you are not actively in motion, such as when you are sleeping, can be increase with physical inactivity. Inactivity has also been linked to difficulty sleeping, fatigue and depression.

The Benefits of Exercise:
Regular exercise holds many benefits for people everywhere. For those dealing with chronic pain, regular exercise can improve muscle mass and strengthen the body. This allows your muscles to better support your body, putting less pressure on sore joints. When you strengthen your core muscles, you are improving your posture, and alleviating the weight in your mid and low back which can also decrease back pain. Regular exercise also decreases body fat, which will take any additional weight off of your joints and decrease pain levels. Increased flexibility can also be achieved through regular exercise making day to day tasks easier to complete and less painful.
Regular exercise also prompts your brain to release endorphins, which can reduce pain levels, reduce anxiety and help with depression. Regular exercise also improves overall quality of sleep.

Types of Exercise:
Various exercises can be divided into three categories: Aerobic exercises which increase heart rate (Think jogging), muscle strengthening and endurance (such as lifting hand weights) as well as stretching to increase flexibility.

Aerobic Exercise:
The term aerobic means that oxygen is present. Aerobic exercises increase heart rate which improves the blood flow and oxygen to the tissue of the body. This form of exercise requires the movement of the larger muscles such as the legs and arms. Low impact aerobic exercises are excellent for those dealing with chronic pain. Some low impact exercises include walking, swimming and riding a bike.
Canadian guidelines state that adults require 150 minutes of aerobic exercise per week. That can be broken up into 20-30 minutes per day.

Muscle strengthening and endurance:
Muscle strengthening and endurance encourages the use of isolated groups of muscles in the body. This is usually achieved through weight and resistance training. Muscle strengthening provides an increase in support and protection of your joints. Muscle strengthening also makes muscles less susceptible to injury and therefore, less prone to pain. Free weights, stretching bands and body weights are just a few of the items that can be used for muscle strengthening and endurance exercises.
You should always keep at least one day in between sessions of muscle strengthening. Muscle strengthening should be done 1-2 days per week depending on your physical capabilities. Always consult with your primary care physician before starting a new exercise regimen.

Stretching:
Stretching is simply lengthening your muscles to increase flexibility. Stretching relieves pressure on the joints and nerves of the body. Stretching can also increase blood supply to the body tissue. Taking part in stretching before and after exercise regularly can decrease the amount of soreness associated with exercise and it can also decrease the risk of an exercise related injury.
The correct way to stretch would be in a slow and controlled fashion. Stretching should not be done at a fast pace nor should stretching involve jumping, bouncing or sudden movements. You should feel very mild tension when stretching and you should be able to hold the stretch for 30 seconds at a time.
Stretching should be done daily, before and after exercise, as well as anytime you feel tension throughout your body.

Duration of Exercise:
To begin with, find the level and duration of exercise that you are comfortable with. Any activity is better than no activity. Once you have found a comfortable level of activity, you can make very gradual increases either in the duration or the intensity of the exercise. Keep your physical limits in mind and do not exceed those limits. Drink plenty of fluids when exercising and keep cool.

Pain with Exercise:
If you experience pain either during or after exercise, you may need to modify your exercise regimen. This can mean either changing the duration of your exercise, the frequency or the style of exercise you have chosen. It is easy to push ourselves too hard when trying to regain our health. Try exercises that are gentler on the joints such as walking and swimming rather that jogging or muscle strengthening if you are experiencing pain from exercising. It is important to do a thorough warm-up involving stretching before exercising. A cool-down is also important post exercise.

Tips:

  • If you are having difficulty committing to an exercise regimen try using positive self talk to keep yourself motivated and on schedule.
  • Start slow. Pushing yourself from day one will not help you build endurance and may cause more harm than good.
  • Exercise is more enjoyable when you have a friend or a group with you. Go for walks within your community with neighbors and friends.
  • If possible, avoid driving from destination to destination. Try walking instead.
  • Keep a diary of your exercise program and watch the gains in your physical activity.
  • Set exercise goals for yourself. Set short term and long term goals to keep you motivated.
  • Set up a baseline for yourself. Know your physical limits and stop yourself before the pain starts or before you become exhausted.
  • Don’t forget to breathe throughout your workout.
  • Remember that it is okay to have a bad day when you cannot be as active, as long as you don’t lose track of your fitness goals.
  • Make time for physical rest in between workouts.
  • Listen to your body.

Performing all exercises with the proper body mechanics is vital to your exercise program. Performing all daily tasks in the proper way that uses the least amount of effort is important when working around chronic pain. Body posture, body positioning and balance are all key when performing the proper body mechanics to avoid further injury.