Why do Physiotherapists ask Chronic Pain Patients to Exercise?
Updated: May 17
Exercise is 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.
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.
If you have chronic musculoskeletal pain - it's important to move!
Also physiotherapists generally have short appointments that don't allow them time to education their chronic pain patients. Education about chronic pain is a key starting place to understanding this complex issue - so different to acute pain, caused by an injury or operation, that heals and the pain goes away.
Time to talk about your pain and it's impact of your life
I'm fortunate in my own pain clinic that I see clients for at least an hour for their initial consultation. Over my twenty years as a therapist, I have devised ways to encourage movement that can help your body recovery and reduce the level of chronic pain and its impact on your everyday life.
Sit back and come on a journey with me - time to start learning about your pain.
Here’s an example of developing self-awareness and self-care.
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 particular specific manner not always applicable to 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.
What she and I discussed at our first meeting was 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.
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.
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.
How Could Chronic Pain Develop?
Florence's problem developed over a long period of time, becoming 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)
How can this loss of fluidity and movement increase over the years?
Here's a scenario to think about.
Pain developing from a weak muscle in the hip
I've made up a story to illustrate how favouring and guarding can happen naturally and often without noticing the changes that are happening, to your movement, and how you hold your body.
If you have a weak muscle in your left hip the muscles of the right hip will have to work harder to keep the body balanced. And the extra tension of muscles in your right hip will affect the rest of the right leg.
This puts a strain on your foot, and with the foot in a different position strain will be placed on other sets of muscles.
This in turn changes overall posture and can challenge the positions of your internal organs. Your body needs to have clear communication and circulation between all its organs. Imbalances in muscle, ligaments can affect this communication and circulation, in turn, influencing how they work.
Hence, the chemical, physiological and psychological balance of your body can be changed, impacting on everything from your individual cells to your overall mood.
As your body and mind are affected, the way you think, feel and perceive events differently and consequently you assume a posture reflecting these changes.
This new posture may result in additional tension and imbalance amongst muscles, which again affects your overall wellbeing, and can increase pain levels, decrease mobility, and increase anxiety or stress. It effectively can become a ‘downward spiral’ as cause and effect work together by layering upon each successive layer and worsening the situation.
Now time to assess your own posture
Your turn-get a piece of paper and pen and record your pain development. Here's some questions to get you started.
o When did you first notice your pain, ache or discomfort?
o Where was this on your body?
o How did this effect how you moved, did your work or pastime?
Remember to add in the stress or pressure at work or from family, add in a pinch of trauma and a good dollop of unexpected events!!
Why You Must Exercise If You Have Chronic Pain
I found this definition of exercise –
"Planned, structured, and repetitive bodily movements that are performed to improve or maintain one or more components of physical fitness."
Whereas I think a better priority, especially if you have chronic pain, is to move. Movement helps our bodies in many ways, in fact we all know it's what we all need to do, to be healthy and to stay healthy.
In pain management programmes the emphasis tends to be on functional movement, that is everyday movement. Therefore treatment goals are set around everyday tasks, such as
o Get in and out of the car
o Unload the dishwasher
o Walk to the end of the driveway
Of course these are part of living our lives and something it would be good to do without having pain. However, they are painful to do, even when they are broken down into smaller steps called graded exercise.
Why I use photos and videos of pain patients
What often arises with my chronic pain clients after they see their posture and how they move, their more holistic goals are to have:
o "fluid movement",
o "muscles working in harmony"
o or something as simple as "I have my natural movement back".
These type of what may be classified, holistic goals are different to goals that may be set by pain management clinicians. The emphasis is on functional movement such as doing an everyday activity. But I think the idea of working on functional movements can lack interest and instils more fear of movement. Even graded exercises may be seen by patients as a small spoonful of nasty tasting medicine, but it still tastes nasty however much you have to take?
Start A Pain Reduction Journey – Start With Awareness
I'd like to take a moment to go into more detail about the posture photos and videos I take when I first meet a new client. When I'm working in my clinic these have been very useful for client awareness and education, as with Florence's case study above.
I ask for a relaxed normal posture without shoes, socks are okay.
To help to get their 'normal' posture of how they hold their body when having chronic pain, I start this visual information collecting with a walking video. Clients walk from one end of my clinic to the other, the speed and movement to be as natural as possible.
You've seen Florence's phots above, now here's a video one of my client recorded at our first meeting.
Over the years of using these visuals, clients have found them intriguing, discovering for themselves and then pointing out the impact of constant pain has had on their posture and movement.
How to Do Your Own Videos And Photographs.
Your turn - Now it's time for a friend to take some natural posture photos of you. Don't try to stand "good". Take four different views for the photos, front, back and two sides.
For the video you need to be able to take about 10 or 12 steps to be able to walk naturally, walking towards your friend then turn around and walk back to the start. You rarely see what you look like from behind!
Aren't mobile phones great!
I generally then line up the photos on a word document to help check out the posture. We are not looking for perfection - none of us are that - but you will find it interesting, especially when you consider where you chronic pain happens to be in body.
The next time you visit your doctor or pain specialist you'll have heaps to discuss with them, show them your photos and the thoughts that arose during the activities above.
Check out Jean's pain-less journey
If you find your visuals give you cause for thought or would like to speak with me about your chronic pain, here's where to find out more
Self-awareness Of Poor Posture In Chronic Pain
The posture photos are what Florence found so useful and helped start her pain-less journey. Clients are able to see for themselves how pain impacts their body and the effects of guarding, compensation etc., has on the whole of their body and mind.
Many clients seem to recognise or even feel emotional when they view the effects of living with pain. They see the change in their physical appearance. It is one thing to feel pain, from inside but another to see and feel pain from the outside. And as in Florence's case she learnt that she had to make changes, and she did!
A Final Thought About Muscles
In some cases, I believe that you may need muscle releasing and muscle relaxing as opposed to building up and strengthening painful muscles with repetitive exercises. To have strengthened, tight, switched-on muscles that can exacerbate pain, may not be the answer for all people who have chronic pain. How we hold our bodies and how this changes with chronic pain over time, is important to take into consideration in any treatment plan especially involving exercise.
NOTE: If you have pain it's important to contact your doctor and have it checked. Always ask your pain clinician if exercise is suitable for you before doing a any exercise.
This article is the personal opinion of the author, Jean Jordan who is a natural therapist who works online with people who have chronic pain and related stress and anxiety.
Want to find simple effective ways to reduce your chronic pain and increase more movement into your life without increasing your stress and overwhelm? This is where I can help! Ideas can be found in the articles on my website. You can sign-up to regular updates or spend time using some of the collection of self-help techniques. After over 20 years of having my own pain clinics pain I started Natural Pain Solutions online business to reach more people, rather than one person at a time. Therefore when I completed my postgraduate pain management studies I wanted to spread the word about holistic self-help techniques that people can use at home.