How to exercise right with complex regional pain syndrome (CRPS)

Anyone who has experienced chronic pain will know how debilitating it can be. Many people living with pain will avoid exercise for fear of making their symptoms work. Complex regional pain syndrome (CRPS) is a form of chronic pain that usually affects a limb, typically after injury. In this blog, we take a look at how someone living with CRPS can reintroduce exercise safely and how exercise can be used to manage symptoms of this condition.

What is CPRS?

Complex regional pain syndrome (CRPS) is a severely debilitating and widely misunderstood syndrome. It usually develops after an injury however the symptoms are disproportionate to the original injury and can continue even once healing process has occurred. The symptoms also extend beyond pain and have significant impact on overall health and wellness.

The International Association for the Study of Pain outlined specific criteria for the diagnosis chronic regional pain syndrome. To meet the criteria, patients must display at least one symptom in three of four categories explained below:

Sensory symptoms: for instance, pain from a trigger that would not normally cause pain or increased pain for something that would previously been minor. This can often present as a burning sensation and/ or numbness.

Symptoms involving blood vessel: like a change in skin temperature or change in skin colour.

Symptoms affecting sweat glands: for example, swelling or sweating changes.

Motor symptoms or changes to hair/skin: i.e., decreased range, weakness, tremor, muscle contractions and/ or change in hair or nail growth.

It’s important to note that part of the diagnosis is that there is no alternative diagnosis or injury that could better explain signs and symptoms.

How to treat and manage CRPS

The exact cause of CRPS is unknown but it’s widely recognised that this syndrome is more than a severe pain response to injury and involves the peripheral and central neuroimmune system. The practical implications of this are that treatment needs to be multidisciplinary (combining several professional specialisations to work together), thorough and address any secondary symptoms. These symptoms include things like stress, fatigue, anxiety, depression, reduced concentration, fear, gastrointestinal changes and motor control changes.

There’s no gold standard of treatment for CRPS. Rehabilitation will most likely require focus and changes to lifestyle habits to include basic skills of pacing, stress management, sleep hygiene and goal setting. These changes are unlikely to have a rapid effect, rather they require persistence, patience and to be layered together.

The role of exercise

People with CRPS can and should exercise. Aerobic exercise and strength training both play a large role in the accepted holistic model for treating CRPS. General exercise should complement other therapy options, including appropriately timed rehabilitation exercises, tactile discrimination, graded motor imagery, self- management strategies and pharmacology.

Exercise can help to:

  • Reduced pain
  • increase function
  • Manage depression
  • Assist in management of recurrent pain attacks
  • Decrease fatigue
  • Decrease social isolation. (The effect of upper-extremity aerobic exercise on complex regional pain syndrome type I: a randomized controlled study on subacute stroke)


What types of exercise are best?

Aerobic and strength exercises are typically commenced on the nonaffected areas of the body and progressed as tolerated. As exercise is progressed to include more of the affected limb, the likelihood of triggering symptoms is increased. Goals typically focus on increasing function, coordination, range of motion and strength whilst decreasing fear of movement. More research is required to determine optimal prescription. Current recommendations are simply to do as much exercise as can be tolerated. It’s also recommended that exercise should be included alongside typical pharmacological and rehabilitation.

It’s important to note that a temporary flare of symptoms may occur due to exercise. This is not a sign of any damage or negative consequences – simply that in the current moment the volume or load was too much. Individual capacity can change daily, and activities should be revisited or attempted over time. Whilst a flare of symptoms is ok and not harmful, it can sometimes be distressing for the individual. For this reason, symptoms should be used as a threshold to guide exercise prescription.

Where to get help

Typically, a CRPS diagnosis is surrounded with delayed diagnosis, mixed messaging, and unknowns, often resulting in fear and uncertainty. Patients will commonly develope a significant fear of movement from previous flare ups. This feeds a disability cycle (reduced activity > increased pain > increased disability > reduced activity and the cycle spirals down).

An Accredited Exercise Physiologist (AEP) can help people prevent and upend this cycle. They can also help to regain movement and function with less fear, educate and reduce uncertainty if flare ups happen, and can assist with multiple aspects of holistic treatment (including exercise prescription, self-management strategies and graded motor imagery).

No two individuals with CRPS will have exact same presentation and therefore exercise prescription will vary. An AEP can help individualise exercise and help you stay active regardless of severity or where symptoms are occurring. To find an AEP near you, click here.

Written by Heather Martin. Heather is an Accredited Exercise Physiologist and manager at Club Active.