Exercise and the Chronic Pain Pattient

Exercise is an important aspect of chronic pain management. However, the notion of movement to manage chronic pain seems counter-intuitive for many patients as movement typically leads to increased pain. Encouraging a person with chronic pain to increase their activity level is usually met with some level of resistance. This may be due to fear of increased pain, fear of re-injury, being unsure of what type of activity is appropriate for them, or perhaps the person is not sure where to start. These concerns are valid; therefore it is important that the patient be provided proper guidance. Physical therapy with a therapist that has pain management experience can provide education and instruction to assist in over-coming these barriers, allow the patient to progress their activity level safely and provide instruction on activity progression and active pain management skills. 

Chronic pain often leads to physical inactivity, and physical inactivity in turn leads to loss of strength and endurance, decreased physical function, decreased health, muscular dysfunction, low tolerance to activity and increased sensitivity to pain. The only way to counteract the effects of physical inactivity is to engage in exercise. Therefore, it is important for people with chronic pain to engage in a regular exercise routine. 

Where to start? 

A common question that individuals with chronic pain often have is, is it safe for me to exercise? The answer is yes, exercise is safe for people with chronic pain. What is an appropriate starting point for someone who is inactive and has chronic pain? A person should use their current level of daily activity as their baseline and then begin by adding a small amount of activity throughout the week. For example, if someone is sedentary the majority of the day but will get up and do light household activities such as cooking, cleaning and other activities of daily living (ADLs), they can begin by adding another activity such as going for a short walk, doing some light stretching or spending a little extra time performing each daily task. The initial goal is to gradually increase one’s overall activity level throughout the day by either introducing new activities or increasing the amount of time spent performing each current activity. 

Importance of progression 

Once someone has begun to engage in regular activity including household tasks and/or light walking, the will also need to participate in a regular exercise program to continue to make physical improvements. Our bodies adapt fairly quickly to activity, therefore it is very important to routinely make incremental changes to those activities. This means that exercises must be progressed in some fashion over time. Appropriate overload requires making adjustment to an exercise program by either increasing the frequency, intensity or time spent performing each task. In essence, this means gradually increasing the workload over time as the body adapts to a specific task. For example, if a person is able to walk 5 minutes with moderate effort, the next step is to increase the walking time to 7 minutes. After a few walking sessions, the body will adapt to walking 7 minutes, and at that point, the walking time is increased by another two minutes for a total of 9 minutes. If an increment of two minutes is too much, then 1 minute might be more appropriate. The purpose of progression is to increase strength, endurance, physical capacity and fitness level. A person’s physical and functional level will remain the same if the activity level is not progressed in some way.

What to expect when someone starts to exercise

When someone makes a change to his or her regular routine, it is very common that the individual will have an increase in pain. However, usually within a week the person should begin to notice a slight increase in his or her tolerance to activity. Over time, the body will adapt to a higher level of activity, which may result in a decrease in pain symptoms. However, the ultimate goal of exercise is not to get rid of pain but to allow the body to function at a higher level even if pain symptoms persist.

Types of activities

What types of exercises are appropriate for people with chronic pain? Patients should engage in cardiovascular activities, strengthening exercises, functional tasks, flexibility exercises and physical activity. 

• Cardiovascular activities include walking, swimming or riding a stationary bicycle   

• Strengthening exercises include upper and lower extremity resistance exercises with the use either bands, weights, exercise machines and/or body weight movements 

• Functional tasks include lifting and carrying activities or activities that simulate work related tasks 

• Flexibility refers to stretching and ROM exercises 

• Physical activity includes daily tasks such as cleaning, doing laundry, grocery shopping, doing yard work or going for a leisurely walk.

All of these activities work in conjunction and are important to help enhance one’s physical capacity. As the body becomes stronger and more tolerant to activity, greater benefits can be seen in regards to functional capacity and improved ADL ability. Patients should be encouraged to begin participating in an exercise program regardless of their current physical level. Although pain is a limiting factor, most people can safely begin by adding a small amount of activity to their daily routine. As their bodies adapt, they can introduce new activities gradually. They key is to continuously challenge the body to adapt to a new level of physical capacity.    

Feinberg Medical Group is known for its expertise in pain management. We provide individualized work conditioning and functional restoration programs to assist patients in increasing their physical and functional activity that leads to return to work, increased independence in ADLs and a higher quality of life.