5 tips for exercising with pain

1. Is it safe for me to exercise when i have pain ?

This is probably the first question you want to ask. To begin with there are very few incidences when complete rest is recommended or that exercise is not advised for helping in the recovery of musculoskeletal or nerve related pain.  Even in an acute injury like a hamstring tear or a sprained ankle we almost always get people “loading it” as soon as reasonable.

Why do we do this ? the body heals and adapts when we put a load through it with exercise.

In fact, a recent study into the best way to treat musculoskeletal injuries highlighted that “Patients should receive management that addresses physical activity and/or exercise is often a vital part of recovery“. This is true  in conditions such as low back and neck pain, osteoarthritis, sciatica, painful tendons and ligament injuries to name but a few.

In the event where you can’t directly exercise the affected area  you can probably  still train around the injury. This keeps the other tissues fit and healthy and you will have a far better result in the long term.

Just because you are hurting does not mean you are harming the area.

For most individuals whose pain has become more persistent, their symptoms are more an indication of how angry or sensitive the system is rather than an indication of doing in further damage.

Think of pain as  your alarm system and in an  acute pain situation it stops us from doing more damage, after a few days the pain should subside or resolve .

 

However in more persistent pain states  this alarm  system won’t switch off and often it is disproportionate to the problem. I often liken it to a child having a tantrum or the volume turned up to 11 on a radio, ( spinal tap anyone ?). In this situation your pain is not a reliable witness to the affected area.

In the words of David Butler and Louis Gifford, ” hurt does not equal harm”. This doesn’t mean we ignore what it  telling us but neither do we want it to dictate to us what we do. Maybe we use it to gauge our response to activity and how we adjust  that activity to improve.

If you want further explanation this is a brilliant summary by Greg Lehman

2. So how hard should I exercise when in pain ?

Here are a  few “rules” or guidelines to get you started;

• In the early days we want to establish good activity habits. I like to find movements that are relatively comfortable to do but are related or specific to the problem. In this stage  I prefer to work within limits that don’t provoke the injury or the pain to a level that impacts your next few days.
• In more longstanding or  persistent  problems we want to build confidence with movement and good habits.  With  acute injuries, like a newly sprained ankle,  we want to  achieve the same thing but also create the ideal environment for tissue repair.
• Incorporate general exercises that are not targeting the affected area and whole body or some simple aerobic work to keep the rest of the body fit and healthy. The healthier you are the better your recovery.
• For general exercise try and do things you enjoy if you can, the more engaged you are with an activity  or the more it means to you there is possibly more benefit in it.

3. Flare ups of pain  and how to manage them

You will have flare ups along the way, its inevitable and its entirely normal.  Sometimes flare ups are a result of pushing too far, which I see as a good thing as it demonstrates confidence in your ability. I’d much rather that scenario than somebody that is fearful of movement.

However think of a flare up as a learning process — you now know what is “too much” for you.  From there you can establish a baseline of activity  that shouldn’t set you back as bad then you can gradually progress  towards that “flare up point” and beyond as the tissue becomes less sensitive and painful.

Progressing exercises can take the form of:

• Increasing the amount of exercises you do.
• Number of days you do exercises.
• Length of time you do them.
• Complexity of the exercise.
• Range of movement.
• Weight or load lifted.
• Type of equipment that you use.

There are endless combinations available to you , but its good to work with your physio to guide you.

Sometimes you need to “Rattle the snake”.

When the pain settles down and becomes easier to predict then its time to challenge it and give it a nudge.

Remember that flare ups are more a reflection of the sensitivity of the tissue rather than an indication of the physical state of the tissue.

This is especially true of more long term aches and pains rather than the acute pain associated with a traumatic injury e.g an ankle sprain.

 

 

Giving the pain a “nudge” is sometimes a useful way to help desensitize the condition. I often tell those with nerve pain that they will flare up again on their way back to full fitness and often they come out of the flare up a lot better than when they went into it.

4. So how much pain is acceptable from a flare up?

This is very individual but its like goldilocks and the three bears, not too little, not too much its about getting it just right.

I try to work on the premise that the pain should settle within 24 hours  and should not really get to more than 4-5 out of 10.

As your symptoms become more stable / predictable you will be able to “rattle the snake” more and you may need to to keep progressing..

5. What exercise should I do for pain ?

That all depends on what your problem is and what is required to get you back to full fitness.

This may involve having better movement, improving strength or control, a better aerobic fitness or a combination of all of these factors. So it is important to make a plan with your physio that will help you achieve your desired outcome.

Do stuff you enjoy and love to do ?

Its also important that you include activities you like to do or in environments that you enjoy. In the early stages this may need to be modified but  it can make a huge difference in your long term outcome.

Whatever you do  be consistent and remember ,What doesn’t challenge you doesn’t change you!

If you would like more information on this topic check out this resource from Greg Lehaman: Recovery strategies workbook 

If you want to get started on exercise to help with your aches and pains please feel free to contact us here