17 Jul Does Exercise Make Pain Better or Worse?

This article was contributed and written by Accredited Exercise Physiologist, Biara Webster.  

Ongoing pain, sometimes referred to as chronic pain or persisting pain, impacts every part of our lives.  Similarly, every part of our lives can also impact pain. In other words, pain, although felt in the body, is influenced by a mixture of biological, psychological and social factors all pulling on the pain volume knob.

This means chronic pain can be complex and confusing.

Adding exercise to the mix can add a whole new layer of complexity, but it can also bring relief and hope. We can end up with questions like,

Why are doctors telling me to exercise?

How does exercise help pain?

What is the best exercise to do?

If it’s safe, why does exercise increase my pain?

CHRONIC PAIN AWARENESS 

Chronic pain affects approximately 3.6 million Australians and is characterised as pain that persists longer than the expected healing time of the injury. Chronic or persisting pain occurs when the signal between the site of pain and your brain is delayed, disrupted, or abnormal due to misfiring nerves.

National Pain Week was established by Chronic Pain Australia to create social awareness and get people talking about chronic pain.

Although exercise is recommended by most health and medical practitioners for pain management, there are some stigmas regarding both the tool (exercise) and the service (health practitioner choice).

Physical activity is essential for human health, and it can also be a powerful tool to help manage pain. There should be no barriers to accessing something as free as exercise.

So, let’s go through some common questions around pain and exercise so we can push down some of these barriers!

QUESTION 1: WHY ARE DOCTORS TELLING ME TO EXERCISE? 

Exercise can be beneficial for pain 

Physical activity is important for those suffering from chronic pain for the same reasons it’s important for everyone else:

• It’s proven to protect against the development, or worsening, of many health conditions such heart disease, type 2 diabetes, lung diseases, osteoporosis, dementia, depression, anxiety and some cancers.
• Increases and maintains fitness and strength to continue enjoyment and independence of everyday activities.
• Improves longevity and quality of life.

But, exercise is also proven to help manage pain.

So, if your medical practitioner or allied health professional advises you to exercise, it’s because it’s an evidence-backed recommendation and it can make a big difference to your chronic pain or injury.

QUESTION 2: HOW DOES EXERCISE HELP PAIN? 

The cool thing about exercise is that it can be used to address many factors that contribute to pain, like sleep, mental health and general muscle tension.

• Researchers suspect there may be a protective role of exercise against developing persisting pain due to the effects on the nervous and immune systems.
• Exercise gets your heart rate up and releases endorphins, commonly known as “happy chemicals.” They are our natural pain killers; in fact they share their cell receptor with the strong and infamous opioid pain medications!
• Other bio-chemicals released with exercise that can block “potential-pain” messages include dopamine, serotonin, adrenaline and nitric oxide.
• Exercise can also improve your sleep. Although pain often impacts sleep, sleep quality can also impact pain.
• Stress has biological mechanisms that can exacerbate pain. Exercise can help manage stress.
• Some exercises can directly and immediately assist in pain due to load changes through the body, as well as increasing awareness of different sensations.
• Exercise adaptations can lead to increased load tolerance through muscles and joints strengthening and increased psychological tolerance of discomfort.

QUESTION 3: WHAT IS THE BEST EXERCISE TO DO FOR PAIN?

There is no ‘one size fits all’ exercise for people with chronic pain.

Exercise for pain relief

The best thing to do is to find what works for you.

Most commonly, stretching and mobility movements (such as yoga) are relieving as they relax the tension of the muscle and provide a different sensation.

Other common options are walking, walking in water, or swimming, but a strength exercise can be just as effective. For example, if we are looking purely through a biomechanical lens, acutely contracting a certain muscle may decrease pressure that is activating nerves in the sore area. Again, it may help by providing different sensations to direct our attention to as well.

Exercise for your best self

When it comes to exercise for persisting pain, it’s important not to get stuck in a pain-relief loop. We also want to consider what you enjoy and what your goals are.

Therefore, exercises should be focused on specific movements you need to get back to your activity. These might not provide pain relief initially but will have long term benefits for your quality of life.

The best exercises are:

• Exercises you enjoy
• Exercises that make you feel strong and confident
• Exercises specific to your goals
• The activity (your goal) itself, modified if needed, e.g. for a shorter time, less load, or adjusted posture.

You can also consider exercising in a group or with a friend. Bonus: pick people you really get along with or those with a sense of humour so you can get some laughter too (double endorphins, proven to help manage pain!).

QUESTION 4: IF IT’S SAFE, WHY DOES EXERCISE INCREASE MY PAIN? 

Flare ups can be frustrating and scary. There are a few ways exercise can increase pain and it’s important to be mindful of these when exercising with chronic pain:

• Doing too much exercise. If you haven’t exercised for a while, or if any of the below apply, it can be easy to do too much. Find a tolerable amount and build from there.
• Placebo and nocebo effects. Our beliefs impact how we respond. If you do not believe you are safe, your whole being will rally against it. Learning about pain and the body can help update our beliefs and help us feel safe.
• Fear of movements causing more injury or fear of pain itself. Annoyingly, fear and stress increase power to pain pathways! Reducing our fear of pain or our fear of exercising with pain can help manage our pain.
• In some people with chronic pain, the endorphin response is not functioning normally, leading to the endorphins released during exercise not working properly.
• Changes in the nervous system. Some people have altered features in the nervous system which result in increased sensory information. Our bodies do adapt, so there is a lot of potential to downregulate these pathways.
• Humans are the original AI. A part of learning is through association, which doesn’t require conscious thoughts. It is too easy to develop unconscious negative associations with pain, but to break this association we have to use our consciousness.
• Changes in the signal processing. Normal sensory information can be interpreted as pain! We do have the capacity to change this through practice.
• Some pain is normal and expected and can even be a good thing. If it’s a new pain, seek help from your health practitioner.
• Consider other aspects of your life, not just the most recent exercise. How is your stress, mood, sleep, diet?

EXERCISE AND PAIN: WHERE TO START 

The best exercises to start with will be what you can tolerate, this includes specific movements as well as how many repetitions and for how long. Two things that will make a huge difference are to relax and breathe! Pain can cause conscious and unconscious movement compensations including excessive bracing and muscle tension which are actually perpetuating pain.

You can try starting with exercises that are nowhere near your site of pain. Check out this article by exercise physiologists for some more great tips.

Consider working with an Accredited Exercise Physiologist who can:

• • Teach you the science of pain and injury, different ways to manage pain, and how to manage activity through pacing.
  • Help you start and progress your exercise routine to manage and reduce your pain.

Ready to get started in your pain improvement journey? Find your local Accredited Exercise Physiologist here. 

To learn more about exercise for persisting pain, you can download our FREE eBook here.

Written by Biara Webster, Accredited Exercise Physiologist (AEP) since 2011.
Biara works at Sydney Spine Institute, specialising in the biopsychosocial management of chronic pain. She has completed numerous courses in pain management including the Professional Certificate in Pain Sciences (University of South Australia) and is enrolled in a Higher Degree by Research with UTS conducting further study into pain sciences.