Chronic Pain and Exercise
By Ashley Osier
MA, HHE, CPS, CSMT, CAMT, CAYT, CWHP
Currently chronic pain impacts 100 million Americans, more than diabetes, coronary heart disease and cancer combined, each year.
~ John Hopkins Medical Center and the American Academy of Pain Medicine
This article is written for those who are struggling with chronic pain, for my clients and students who are in process with countering their own chronic pain, and for those who love someone who suffers from chronic pain. Part of my intention in putting this together is to provide a safety check for chronic pain sufferers in the current sea of fitness videos, practices, approaches and expectations in attaining the perfect body and fitness level. It is imperative then that those who suffer from chronic pain exercise safely and with people who have knowledge of chronic pain.
Many years ago I wrote my master's thesis on alternative therapies that effectively treat chronic pain. These treatments are still seen as being useful means to decrease chronic pain and address other aspects of one's life that is affected by living with chronic pain. I have listed them in the latter part of this article. Exercise was one of the solutions I addressed in my thesis. More studies over the years have found depression to be a major side effect with chronic pain and exercise is proven to effectively counter depression. Exercise then is one means to reduce chronic pain by boosting seratonin levels and reducing depressive symptoms, but it can also improve strength, flexibility, function, circulation, and bone density, when done wisely.
So what is exercising wisely look like? Well it will depend upon a number of factors that each person needs to take into consideration prior to beginning. Age, previous injuries/sprains/strains, resolution of the same, general health and fitness level, diet, sleep and time to exercise. Level of chronic pain is also a major factor. Checking in with your doctor to make sure all of your general vitals are stable is a great start. If you see an exercise, gym, trainer, video, etc, that interests you, you can talk to your doctor about whether your health history and current status is a good fit. Make sure to be realistic about your exercising goals. Start small, light and slow and work your way up.
Those who have lived with chronic pain know that it impacts every area of a person's life and every relationship is affected. It is a physiological response that cannot be measured, diagnosed or cured and it depletes physical, emotional and mental energy from the constant bombardment of pain messages. Recommended treatments often include pain and psychiatric medication and surgery. Many people are left feeling hopeless and helpless with little explanation or understanding of what is really going on. On a positive note, chronic pain requires greater attention to body posture, mechanics, details, breathing, activity, overall function and ability and modification thereof. As a result, body awareness can lead to knowing one's body better in all areas having to do with health, which can result in a healthier lifestyle and longer life.
In working with my own chronic pain in the past, I found it useful to understand what pain was and the difference between acute pain and chronic pain. I have spoken to a number of people over the years who wonder why pain goes away with some injuries but then lingers with others. Often times chronic pain sufferers who try to exercise will experience increased pain symptoms and will need to stop exercising. Most of the time it is due to exercising with the idea that they can workout the same way as they did prior to the chronic pain. But most often chronic pain sufferers need to start at square one and work their way up to what will keep them fit and functional without increasing symptoms. The time commitment and process can be frustrating. But when chronic pain is able to be better understood, sufferers can approach exercise more realistically and effectively.
One of my clients, for example, is a 30-year old man who is fit and lean. He works out regularly, but also has a desk job that requires 8-12 hours of sitting every day. He has an unresolved sledding injury to his low back (from college), but he is able to work out hard and when he strains a muscle, to recover well enough within a couple of weeks to continue working out without having to stop his exercise. However, one day he bent over to pick up a piece of paper that fell on the floor and his back went into spasm. He has had dull intermittent pain ever since and has not returned to any kind of regular exercise routine. When he tries to exercise, the pain increases and other functions become challenging. Married with another baby on the way, he is caught in a very frustrating pain cycle that is impacting work, personal function and relationships with wife and children.
This is a perfect example of the difference between acute and chronic pain. When you are injured and the pain is acute pain, the pain will usually last 2-3 weeks and there is a right side of the brain correlation that receives the sharp localized pain associated with acute pain. On the other hand, if the pain is associated with chronic pain, it will last a minimum of a few months to one's lifetime, can be constant and/or intermittent, and it is the left side of the brain that receives the dull, aching or throbbing sensations. It goes even further than that. At the opening of the base of the neck (referred to as the "gate") are nerve-fiber clusters and these clusters are called "gatekeepers." There are large nerve-fiber clusters that close the gate and there are small nerve-fiber clusters that keep the gate open. Can you guess which cluster is associated with chronic pain? Yep, the one that keeps the gate open. So the messages for chronic pain move markedly slower and with more consistency while the acute pain cluster move quickly so the sensation of pain can be minimized. In the animal kingdom, acute pain provides a quick escape from predator function with recovery time being a few days to a few weeks. So what is the function of chronic pain?
At the time of my thesis, a study in 1989 by Curl, D. D. and Shapiro, C. S. found that "chronic pain serves no self-preservation function and rarely warns the patient against any impeding biological threat…" It cannot be detected, effectively measured or diagnosed by doctors, and it is impossible to treat or cure. Unfortunately my findings still hold true today. But on a more positive note, at minimum, chronic pain can serve as a means to slow us down, make us more thoughtful and intentional with how we use our body, help us to become more careful, and often our ability to consider others and be more empathic will result. This becomes useful when working on posture, good body mechanics and correct lifting, proper ergonomics at work and home, and safe exercise. Though frustrating, chronic pain can actually make us smarter with our body and even healthier. I will address this more in the exercise section.
Since taking the "chronic pain is a wonderful teacher" route is not a popular path, most doctors offer many creative options to treat chronic pain. Health centers provide classes on pain management, physical therapy, cortisone shots, nerve blocks, surgery, pain medications, and recommendations for time off of work and any activities that increase pain symptoms. Acupuncture is now being offered and recommended by a number of doctors as well. Many doctors when they are unable to find a causal factor will diagnose their patients with a psychosomatic disorder and recommend psychological counseling and meds. But it doesn't address the physiological reality of chronic pain.
In doing my research on chronic pain, I found that the speed in which chronic pain sends the pain message through gate is 3mph as opposed to 40mph with acute pain. Pain that travels that slow and is repetitive is difficult to stop. So chronic pain that is increased by bad posture will not go away by correcting posture for thirty seconds a couple times in a day. Nor will it go away by taking a stretching class once or twice a week, getting massage once a month, or taking a relaxing bath for 20 minutes every night. When people go to a massage therapist expecting chronic pain to be relieved, it is completely unrealistic specifically because of this 3mph message output. At 3mph, one needs to counter the pain with multiple solutions multiple times per day and on an ongoing basis to address the physiological reality of chronic pain. Does that make sense?
When I start to get tendonitis in my forearm, for example, I am working on LI 11 consistently throughout the day, wearing an arm support throughout the day, using ice or Biofreeze multiple times in a day, stretching throughout the day, having good use of body mechanics, etc. This multiple countering technique counters the pain message output, blood and energy are promoted for better healing, inflammation is decreased, tightness is stretched, stiffness is moved, soreness/damaged tissue is rested, etc. I want to be in solution with a pain symptom more than I am experiencing the pain to shift the pain message output itself.
This is where the Point Release™ Technique comes into the picture.
Remembering that I am not a doctor but a health educator and therapeutic bodyworker that specializes in pain management, I focus on reducing the pain messages by stimulating the PRT points regularly. My experience is that it is an effective counter to the three second message output most of the time. Does it stop it? I am not sure. Studies on acupuncture points used for chronic pain present how the stimulation of acupuncture points releases endorphin, encephalin, and dynorphin, natural pain relievers in the body. Stimulating acupuncture points also works on the limbic system and the nervous system to effectively block pain. Since chronic pain is associated with the limbic system and acupuncture points affect the limbic system, naturally releasing pain relieving hormones, it is likely that stimulating PRT points regularly will indeed effectively counter the three second message output. With continued practice and by incorporating other counter measures with consistency, I have experienced myself and seen it in clients and students, pain recognition decreases significantly so that exercise is possible. There have also been times when it completely disappears and routine function, sometimes modified, is restored.
So what about exercise? While countering chronic pain messages with consistent practice of effective techniques, slowly adding safe exercises that engage the muscles at a micro level will build healthy muscle development from the core out. When the foundation is established added exercises for the bigger muscle groups can be tried one at a time, to test efficacy without increasing symptoms. For some people, like myself, this process has taken years. For some of my clients whose chronic pain comes from a less severe cause, the restored function and strength can take a year or less. For those whose chronic pain has a more severe cause, such as a result of a surgical procedure that went wrong, it can be slow and arduous. Realistic thinking and empathic planning with commitment to appropriate goals are essential. Finding the right therapists can be a challenge but worth the time.
Below are some alternatives to relieving chronic pain, safe and repeatable exercises and things that increase pain symptoms. The more you can focus on using chronic pain to increase your body awareness and health the less the chronic pain will be a negative influence in your life. There are many ways to befriend chronic pain and make it a powerful ally in your life. You can contact me to set up a few sessions to explore some of these options and experience them for yourself. The key is to find the combination of pain countering solutions that will be useful for you in your process to reduce and manage the pain. Exercise is essential and should not be cut out completely unless recommended by your physician. And as a note of caution, never go to the gym in pain and lift free weights, machines with weights, or work with a personal trainer without letting them know you are in pain. Always go to your personal physician and let him or her know what you are experiencing and ask what exercises will be safe and repeatable without getting injured. Then make sure you follow directions so you don't make symptoms worse.
Effective Alternatives in Relieving Chronic Pain
*RICE (rest, ice, compression, elevation)
*Maintaining appropriate weight
*Proper sleep
*Posture therapy
*Safe and repeatable exercises such as tai chi, conscious posture, walking, swimming
*Gentle stretching
*Therapeutic movement such as Alexander Technique and Feldenkrais Method
*Relaxation techniques such as deep breathing and relaxing specific areas of the body
*Aromatherapy - lavandula augustifolia essential oil
*Distraction therapies such as art, therapeutic dance and movment, creative writing, singing/sound therapy
*Self-acupressure/Point Release™ Technique
*Massage/Acupressure/Acupuncture/Reflexology
*Maintaining efficient elimination process
Additional alternatives from my thesis include: autogenic training, biofeedback, guided imagery, hypnotherapy, magnetic therapy, and nutrition therapy.
Safe and Repeatable Exercise
(always consult your physician before you practice any exercise)
Tai chi
Conscious posture
Walking
Swimming
Things that Increase Pain Symptoms
Being overweight
Increased stress
Inadequate sleep
Poor posture
Sedentary lifestyle
Negative thinking
Exercises that are not appropriate for your body
In returning to the example of my 30-year old client, it is important to highlight that he has a previous injury that was never resolved. Unresolved injuries or even strain to muscle that is severe or is repeated can set the body up for a chronic pain scenario. If you consider the animals in the wild who have to run away from predators repeatedly, they eventually end up exhausted and may even give up running due to repetitive stress and overwhelm. The body has a similar response. With repeated strain or injury to a single area without resolution and proper care, the area or muscle can become weakened, exhausted and challenged to naturally heal or bounce back. More solutions may be needed to assist the healing process and more time may be required to address chronic symptoms. I have found that a quick response to injuries and strain to an area of the body results in the body kicking in more quickly and responding likewise. There is an automatic healing response that takes place in the body naturally, but this automatic response can be impacted by repeated stress, injury or strain and awareness of this point is important to remember. So know your limits and be responsible with your body.
For more information on chronic pain facts, figures, treatment options and other interesting information, you can check out the following sites. The American Academy of Pain Medicine has an website of facts and figures on pain in America at http://www.painmed.org/patientcenter/facts_on_pain.aspx detailing more facts about pain and chronic pain and what options are available for sufferers. John Hopkins Medicine Health Library has additional information at http://www.hopkinsmedicine.org/healthlibrary/conditions/spine_shoulder_and_pelvis_disorders/chronic_pain_85,P01366/. Additional information about the Gate Control Theory of chronic pain can be viewed at: http://www.spine-health.com/conditions/chronic-pain/modern-ideas-gate-control-theory-chronic-pain
Curl, D.D., Shapiro, C.S. (1989). Head/neck pain. The need to identify the patient with acute vs. chronic pain. [20 paragraphs}. Chiropractic Technique. 1 (3), 101-105. Retrieved April 5, 2001, from Alt-Health Watch: http://ehostvgw13epnet.com
To set up a pain management counseling session, therapeutic bodywork session, or private instruction session in therapeutic stretching, Point Release™ Technique, therapeutic exercise, contact me at ewsomatherapy@gmail.com.
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