Why Exercise For Chronic Pain Is A Complicated Relationship

Jessica Bento, Physical Therapist (Creator DVRT Rx Low Back Course, DVRT Restoration Certification, Knees Over Toes Course, DVRT Rx Shoulder, Knees, Pelvic Control, & Gait Course)

Is was the driving motivation for me to become a physical therapist. After seeing my own dream of becoming an Olympic swimmer ruined because of injury and pain, I could think of nothing more motivational than trying to help those in the same situation. Every physical therapist and health professional in general would love nothing more than to help people in pain.

Not only because it really messes with your daily life, but because we know the impact can be far more severe.

Yes, depression can be a major outcome of chronic pain. There is research that up to 85% of people with chronic pain develop depression (you can read HERE). There becomes a vicious cycle with chronic pain of managing emotional distress as well as physical. That is why any health professional would LOVE to decrease pain. However, that is a VERY tricky subject.

Why?

For one, everyone’s perception of pain is quite different. While we often use scales of one’s pain in a clinical setting, that perception of a “5” for one person may be an “8” or “3” for another. In other words, pain doesn’t always tell us what is happening with the actual problem and can be complicated by lifestyle and emotional factors. For example, research tells us that there are 44 areas of the brain that are involved with pain processing (that’s A LOT) and there can even become issues in how one’s nervous system interprets pain signals (this is the foundation of studying neuroplastic pain).

What am I REALLY getting at? Mostly using a broad recommendation to become more active to a person with chronic pain isn’t really much of a solution based approach. We know overall that physical activity is better than not doing anything, but put yourself in a chronic pain person’s shoes.

Your life is pretty much turned upside down. The things you want and enjoy doing are being limited by your pain. You start to feel bad about yourself, you become concerned with how you are going to go to work while in pain, take care of your family while you are hurting, and interact with a world that is becoming less accessible to you because your pain interferes with so many different aspects of relationships, work, and hobbies. A health care practitioner tells you that you should try to raise your activity because that will be good for your chronic pain (let’s keep it to low back pain for the sake of this post).

That doesn’t seem to make a lot of sense to you at first because just basic things like sitting in a chair, walking around your house trying to do chores, and so forth is already increasing your pain or making it difficult to tolerate. However, let’s say you have that break through and that person is willing to be more active. What is the first thing they should do? Where should they start? How much should they do in order not to increase their pain levels?

These are ALL very complex questions that take truly an individualistic approach to helping issues like chronic low back pain. After all, not everyone that has an issue like chronic low back pain has to the same experience with pain.

This means telling people that have chronic pain of a 3 to be as active or do the same things as someone with a 6 is obviously problematic. That is why I get so cynical when people show things like “the 5 best exercises to solve low back pain.” What an incredibly vague and non nuanced discussion of a complicated issue.

So, what CAN you do and help support people or yourself who are struggling with issues like chronic low back pain?

Start Small

Most people with pain are nervous to do any activity because they are afraid of increasing their pain levels. Beginning with very small bouts (maybe 10 minutes) but with greater frequency (maybe aiming for twice a day 4-5 days a week is better) to help establish a baseline that isn’t scary or problematic is a great start.

What activity can that be? Of course this depends on a variety of considerations such as…

-What does the person enjoy?

-What environments do they thrive in (do they like groups or more individual practice)?

-What do they have relatively easy access to (this can be from a time, money, travel, and any resource perspective)?

-What is their pain level and any diagnosed conditions that have specific contraindications?

In other words, if we really want to help people, we have to be REALLY thoughtful about all aspects of the issue they are facing. What are some practical ideas for people that we can use?

Movement That Reduces Anxiety

I really admire what Josh has committed to in his own recovery as most people wouldn’t have gone outside of the traditional box of dealing with chronic low back pain as Josh has. Even I was rather unfamiliar with how practices like Qigong and Tai Chi can help chronic low back pain.

NO! You do not have to become a martial arts expert or devote life to any specific practice. These types of results are very common and why even Harvard recommends these types of practices for people with chronic pain.

Yes, NONE of this material has to do with DVRT in an obvious way. I will in future posts help make the connection, but the point is that we need to have a large toolbox if we are going to meet people with chronic pain where they are at currently. These types of practice don’t require intensive training, they can be easily assigned as homework, and addresses not just the physical, but mental side of issues that chronic pain bring up. They can easily be modified (as I will share below) and combine powerful elements of movement, mediation, and breath ALL at once (sounds pretty good). There are forms of yoga that do this as well so if you have found a style or practice you enjoy that can work as well.

The point is that if our goal is to help try to reduce pain, then we have to be open in all the areas that we have to consider of the person, not just the pain. These types of practice can be a great starting point for many because the movements aren’t complicated, they don’t increase fear in most cases, they are very easy to modify, and they can be done slowly so that people learn to not fear movement.

These are topics and in depth conversations we will go over and demonstrate in our 12 week DVRT Rx Low Back Pain course that will begin NEXT week! This week you can save $100 on our program and gain an educational experience like you have never had before! Just go HERE

Meditative practice be extremely helpful and there are great apps like Headspace, Calm, Breethe and others that can help, but you can also practice some simple guided practice like that below. You don’t have to be going through chronic pain to benefit from these practices they can help with general well being as well as a host of other health issues.

In order to better understand chronic pain, we have to do a better job of understanding people first! This is a great presentation of JUST that below: