Pain is defined as an unpleasant sensory and emotional experience as described by the International Association for Study of Pain (IASP). Acute pain has the purpose to remove your body from a noxious stimulus. For instance, pain associated with acute injury from an ankle twist tells your body to stop weight-bearing. However, once the pain becomes chronic, over months or years, that pain signal is no longer effective for preventing further injury in most cases and actually can get in the way of healing and decreasing the chronic pain by resulting in fear of movement.
Today for most people suffering from chronic pain, their initial response is to avoid activity and instead seek rest. However, exercise actually results in increased blood flow to the painful soft tissues bringing healing mediators into the tissues as well as breaking up scar tissue which can contribute to the pain because of the increased nerve endings in scar tissue. In addition, as exercise increases, psychological well-being increases and sleep improves. With improving mood and sleep, there is an additive effect on reducing chronic pain as pain is exacerbated by anxiety, depression, and poor sleep.
In addition, regular physical activity helps to control weight, lower the risk of cardiovascular diseases, strengthens bones, muscles, improves balance and stability and reduces the risk of inflammatory and chronic diseases. Daily exercise improves a person's ability to do work and prevent illnesses, helping us to live longer.
The two most important exercises are resistance and strength exercises, and aerobic training. When these exercises are prescribed appropriately, they can help achieve pain control without exacerbating the injury.
Endurance Training and Aerobic Exercises
Over the past twenty years, the effects of aerobic exercises on managing pain have been extensively studied. Exercise intensity needs to be tolerated by the individual for the exercise to continue being effective. Aerobic exercises should be designed to target all the large muscle groups involved in repetitive movements; with each movement, the muscle contracts, which elevates heart rate until the target heart rate can be maintained for around 20 minutes. The optimal amount of moderate to vigorous exercise is universally accepted to be 150-300 minutes per week.
Various studies involving people complaining of moderate chronic pain, performing aerobic exercises like running and walking for 25 minutes at 70% of their heart rate, suggest that vigorous and moderate exercises can help reduce pain perception. However, every person is different and exercise regimens should be tailored to the individual.
If one is very sedentary or has many chronic illnesses, we would recommend starting slow with respect to frequency, duration, and intensity of exercise to avoid injury. A gradual increase to the recommended amount of exercise can be achieved safely this way.
Exercise should also be goal-oriented so that you are as successful as possible in implementing it into your life. Everyone’s ability, desire, resources, and enjoyment of exercise is different. Finding the optimal mix that brings you joy is the key.
Strength or Resistance Training
Over the past couple of years, very few studies have examined the relationship between resistance training and natural pain modulation. A study done by Koltyn and Arbogast concluded that a bout of resistance exercise or training could help achieve decreased pain sensation. The exercise consisted of lifting for 45 minutes, with 3 sets of 10 reps at the subject's 75% one rep max; these included pull-downs, leg presses, arm extensions, and the bench press. All of these exercises can be performed at your neighbourhood gym or a home gym.
While the EIH response was larger in the exercising body part than the one that was not exercised, the subject reported feeling overall relief. Some studies have had subjects perform 2 isometric contractions of their dominant biceps brachii and their quadriceps at both 30 and 60% MVC. They concluded that these isometric contractions by the biceps and quadriceps could produce a larger EIH than any low-intensity contraction.
Other benefits of resistance training include increased bone density and muscle strength as well as decreased muscle, joint, and tendon pain over time. Universally, it is accepted that the optimal amount of resistance training is 2 times per week.
Condition Specific Exercises
Condition-specific exercises also referred to as therapeutic exercises, are the main choices for a non-pharmacological approach to treating chronic pain in the low back, neck, and complex regional pain syndrome. Exercises can also be used to seek relief from conditions such as osteoarthritis and fibromyalgia, in addition to others.
In patients suffering from neck pain for the past three months, exercises have been shown to trigger a mechanical hypoalgesic response. A few specific exercises consist of 10-second contractions for a total of 10 repetitions and a 10-second hold in between them. There are also cervical flexion endurance exercises where you lift the head supine for three sets and ten repetitions each.
Exercise has also been found to halt the progression of muscle weakness leading to imbalance, unsteady gait, and fall risk in patients with neuropathy.
Supervised exercise therapy involves lots of stretching and strengthening, which is designed to improve function and relieve pain. Over the years, doctors and physical therapists have developed many exercise programs that, when performed under their supervision multiple times a week, can help patients experience relief.
When people say that they are resting on the bed to recover from pain, that does not work if they continue to stay on the bed for over 2 days. There is absolutely no benefit to being bedridden. Instead, you might as well get involved in physical activities like Yoga, Tai Chi, or Qi Gong. These forms of exercise have shown to have a significant positive benefit for those suffering from pain and preventing pain in the aging population.
In people over age 65, it is important to include exercises, such as Yoga, Tai Chi, and Qi Gong, that result in improved balance, coordination, gait, agility, and proprioception to reduce the risk of falls.
Tai chi and Qi Gong, for instance, are ancient practices that have been around for hundreds of years. They are highly effective interventions in osteoarthritis, fibromyalgia, and low back pain. The same goes for Yoga, which dates back to 500 BCE. It is an effective adjunctive treatment and excellent for treating low back pain.
The American College of Physicians recommends that people suffering from chronic low back pain include Yoga in their daily exercise routine. A study showed that taking 2 classes a week for 8 weeks resulted in a decrease in the intensity of chronic back pain. The same study showed that Yoga was instrumental in helping relieve tendon pain, painful joints, etc. In addition, progressive resistance training resulted in strengthening weak muscles and reducing pain.
Regular activity can help to prevent a multitude of ill effects caused by immobility. It can prevent muscle tightness, joint stiffness and assist with blood circulation. Work in some kind of movement throughout your day especially if you are prone to sitting. Set your watch to get up and move around intermittently. Other known physical activities like walking and swimming are effective at decreasing pain and also improving function. That's why rehabilitation programs have over the years been shown to have positive long-term effects on people suffering from chronic pain.
Exercising is Free
Exercise is the best long-term solution for anyone who is suffering from chronic pain. It does not take a lot of time to do and comes with a laundry list of numerous other unrelated benefits. It makes you feel more confident, for instance, and regular resistance training can help you look good too.
Many doctors will prescribe a shortlist of drugs, including painkillers that offer temporary relief but can't be a long-term solution and can cost a lot of money. Exercise is free and has the added benefit of potentially engaging in an exercise in nature as well as in a group, increasing social interaction, both of which have also been implicated in treating chronic pain successfully.
If you have no idea how to do Yoga or Tai Chi, for that matter, numerous gyms offer classes or you can do it at home or with a group of friends following a free YouTube class. You can start with the beginner's class and work your way up. People with joint and muscular pain should let the instructor know of their physical issues and limitations. Remember, all of these exercises, including Yoga, are individualized. Listen to your body and only do what does not cause sharp pain. Yoga can be beneficial for relieving your chronic pain and preventing further injury if you individualize your practice to you and not what others are doing.
It is essential to take the time out to engage in something even as simple as brisk walking. Walking outside can be immensely beneficial. However, walking on a treadmill if it's too cold outside is the next best thing. The idea, though, is to keep your body moving and continue to challenge it. That way, you're not giving chronic pain a chance to take over your life.
Physical exercise and activity is a proven treatment for chronic pain. If your pain is unbearable and ruining your quality of life, consulting with a professional who evaluates and treats chronic pain is important. Determining that you will not injure yourself further by engaging in physical movement is the first step. Then, developing an optimal exercise/movement regimen individually suited to you is important. Everyone’s ability, desire, resources, and enjoyment of exercise are different. Finding the optimal mix that brings you joy is the key.