Exercising with Pain

By Coralie Wales and Matthew Craig, member of the Chronic Pain Australia National Advisory Panel

If you have experienced long-term pain you may also have experienced the "turning off" of certain stabilizing muscles as a result of the experience of long-term pain. It is thought that the experience of pain gives rise to hyperactivity of the long muscles (engaged during stress), at the expense of the short muscles that are required to stabilise the skeleton. This situation can develop to the extent that sometimes you feel uncertain on your feet, feel dizzy and unstable.

Many people experience upper body problems, and this might relate to inappropriate stabilisation of the shoulders and spine, leading to other problems. It is helpful to aim to normalise your skeletal muscle behaviours - thus restoring a more normal demand on the nervous system to reduce central sensitisation.

"The assistance of a highly skilled physiotherapist knowledgeable about Central Nervous System Sensitisation may be required in order to help you learn the best exercise strategies to calm down the nervous system"

When you live with pain, exercising to keep your body healthy can be challenging, but it can be done. Here are a few ideas that might help you.

Matthew Craig, physiotherapist at Bounce Rehab says: "I think it is important that people with long term pain are aware that there is much that they can do themselves each and every minute of the day to make for a more conducive and comfortable environment. People in pain need to identify their limitations and discover that by doing too much too soon they are not going to get to the finishing line any quicker".

Another tip is about muscle soreness after exercise: "The experience of soreness that occurs with starting exercise programs is a crucial point. I often ask my patients to perform 1 to 2 home exercises with low repetitions and taking hours in between sets. This helps greatly determine the effects of this new loading pattern (or irritability). Emphasis on recovery from activity and exercise is often overlooked. The importance of recovery from activity/exercise should never be forgotten. Normal muscle soreness may last 24-72 hours in healthy non-injured populations. I often see long-term pain sufferers take 5-7 days to overcome new loading patterns. So highly skilled and structured exercise programs are best given once to maximum twice per week for the first 4-6 weeks with encouragement of a basic daily home program incorporating ADL's".

"Muscle soreness is usually equal on both sides, it is widespread in nature and is resistant to treatments such as heat, ice, medications, stretching or further bouts of exercise as per Evidence Based Medicine. Mechanical ‘flare-up' typically is consistent and localised to the regions that have hurt previously (i.e. there are aggravating and easing movements, heat is often effective and pain may follow it's usual pathway)"