Module Four - Move with Joy
Session 1 - Exercise for Pain Management
How we may stop normal fluid movement
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Reduce activity due to symptoms.
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How we may stop natural fluid movement.
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Stop moving, bed rest or prolonged sitting.
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How we may stop natural fluid movement.
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Limp or begin to favour a limb or body part.
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Become guarded alter movement to stop bringing on pain.
Exercise – A Central Component of Chronic Pain Treatment
In multidisciplinary clinics one of the key clinicians is a physiotherapist, who provides front line treatment with exercise, advice and also prescribes exercise for homework to help reduce and recover from chronic pain.
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This can be a difficult job; patients are in pain.
The exercises patients are asked to do cause pain and compliance with doing exercises at home between appointments can be poor. I can attest to that from my own experience, keen at first until a busy life or lack of motivation get in the way.
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If you have chronic musculoskeletal pain it is important to move!
Physiotherapists generally have short appointments that don't allow them time to educate their chronic pain patients. Education about chronic pain is a key starting point to understanding this complex issue. Chronic pain is very different to acute pain caused by an injury or an operation. Tissues heal, acute pain heals and the pain goes away.
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Over my twenty years as a therapist, I devised ways to encourage movement that can help your body recover and reduce the level of chronic pain and its impact on your everyday life.
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As this is module four in the pain support program there will be a range of readiness for including movement in your activities.
"If you have found an improvement in your pain levels and already you have returned to normal movement or to regular exercise, some parts of this module may be more useful."
Although there is useful new knowledge throughout especially about lifestyle and the brain you will enjoy your time on this section of the program.
Client story:
Gemma (not her real name) was struggling with chronic pelvic pain even to the extent that walking was painful. She had been in a treatment program for over 2 years – her problem was she was too tired going to seemingly endless therapy appointments.
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However being intent on feeling better and returning to normal life she was doing all the ‘homework’ prescribed.
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One was regular daily exercises given her by a physiotherapist. When we discussed these it became obvious that some of the exercises were painful – but she continued to do them.
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My advice was to stop painful exercises immediately. Because as you now know she was developing such negative neural networks that would make her overall pain worse.
I also asked her to be honest with her physiotherapist telling her about how painful the exercises were.
Great result – she had a total re-assessment and was given a new physiotherapist.
Important message here.
If you are in a pain management program or regularly having treatment with doctors and therapist, it’s important to inform them of what is happening with you (even if they don’t ask). Be sure to include the positive aspects as well as the negative information about your progress towards recovery.
Movement Self-Assessment
Get a notepad and spend 10 minutes asking your body to move (gently) to have a record of what you are able to do without any pain and what movements cause pain, adding a description to your notes describing the pain sensation and level.
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What movement you find difficult and /or painful?
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Are there body parts that hurt?
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Is there a difference between the left and right side of your body?
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Are there limitations in your movements?
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Once you add weight (e.g. lifting) to a movement is it painful?
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Any other notes needed to describe your pain, sensations, feelings or emotions.
NEED a imagining pain video here.
Session 2 - Can Exercise Fix your Pain?
Florence's story – why a daily gym workout was not the answer.
This is a familiar approach to exercise if you have persistent pain. There is nothing physically wrong so you are told exercise is going to help your pain.
Florence, not her real name, had chronic pain due to a lifetime of nursing.
She went to a women's gym most days thinking exercise would be good for her pain. At the gym she used fixed exercise machines that work muscles in a specific manner not always applicable to the natural movements of everyday life.
Her future plans were to travel around Australia in a caravan with her husband.
Presently impossible, as sitting in the car for any length of time was unbearably painful.
Taking Care of Everyone Else
At our first meeting she and I discussed the time and energy she spent looking after several generations of family members.
However, being a health professional herself, and after a lifetime of nursing, the penny quickly dropped as she understood the effects of stress and brain neurology that had become enmeshed together to facilitate her ongoing pain.
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Too many visits to the gym were not helping her pain - in fact making it worse. Each visit her workouts embedded guarding and a distorted body shape.
She was shocked to see her body alignment in the way she stood and walked in the photos and videos that I'd just taken of her movement and posture.
How Can Chronic Pain Develop?
Florence's problem developed over a long period of time, through a combination of: -
Ø guarding - body response to protect the injured, or painful, area by tightening surrounding muscles
Ø compensation - using an alternative muscle to do the work, not the correct one
Ø favouring - being careful with a part of your body and treating it gently
Ø pushing through - ignoring the pain and 'grin and bear it'
Ø hiding her chronic pain - not able to discuss her pain and worries (alone in pain)
At this stage of the program you understand that chronic pain is complex and pain stays for many different reasons. This applied to Florence as her loss of fluidity and movement increased over the years?
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You may notice the last two tricky items on the list: -
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Pushing through the pain – fighting and forcing the pain is contraindicated (see later)
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Hiding her chronic pain – social support, care and understanding matter.
Chronic pain thoughts - Frustration
The next time I saw Florence, two weeks later, she had made a lot of changes: -
Ø reduced gym visits to once a week,
Ø dropped the intensity of her workouts,
Ø just enjoying her visits,
Ø and socialising with the other ladies at the gym,
Ø let go of some family responsibilities,
Ø learnt how to say "no"!
She looked happier, had more energy and her pain was already decreasing.
And another positive aspect that really helped, the prospect of the travel around Australia was now a joyful future vision.
A vision that she could now work towards and at the same time continue to make changes she needed to her lifestyle and her thinking.