“According to research, exercise can be very helpful to reduce pain and improve function. Moreover, for people with musculoskeletal pain, movement and exercise are a key component of your recovery.”
Movement and pain
Physical activity and movement are vital to helping you manage your pain so you can complete your everyday activities. When we experience acute pain, for example when we roll an ankle or experience a lower back injury, one of the body’s natural responses is to tense up and limit as much our movement, to protect our body. That initial protective response usually lasts 24-48 hours, but it can be unhelpful in the long term if it persists. According to research, exercise can be very helpful to reduce pain and improve function. Moreover, for people with musculoskeletal pain, movement and exercise are a key component of your recovery. One of the examples are recent research on lower limb osteoarthritis, showing that exercise-based program has significantly helped reduce pain, in comparison to paracetamol use. One of the most beneficial effects of the movement and exercise is an improvement in overall function, which in turn reduce disability, depression and improve the quality of life.
What if it hurts when I move? Quite often movement will cause discomfort or pain and we may respond with either stopping the activity, moving differently (compensation with surrounding muscle groups, tensing up), or with exacerbation of the movement (‘overdo’). I would like to share some facts with you about a decision-making process that can influence your decision to move and exercise when you have pain: 1. Your belief system. If you believe that your movement is causing additional damage to your tissue your recovery is likely to be slower then for a person that has a more helpful belief, that pain is part of recovery and does not mean more damage. This belief system can cause you to stop moving which can have a slowing impact on your recovery. Remember that having some discomfort and pain is normal in recovery, and the movement itself is not causing additional damage. If you have doubts about what movement is safe for you, contact your physiotherapist for advice. In some pain conditions, persistent pain can be associated with disruption or distortion of our perception of where our body is in space. Your physiotherapist will work on the body and mind re-integration as this is a very important process in helping to treat persistent pain. 2. Advice from your health professional. Clear and consistent advice and instructions from your health professional team to start moving in a paced way will get you underway to recovery. 3. Catastrophizing. Negative thinking, thinking that the worst will happen and mood responses (anxiety/ depression) to actual or anticipated pain tend to magnify the threat value of pain and often makes us feel helpless in the context of pain. Do not be afraid to talk to your doctor or therapist about it and get some help. Often talking to someone about the actual pathology of your pain can help you change the perception of pain and it is very helpful in pain management. Now we know that pain usually leads to changes in activity level. Finding the right balance in your recovery is the key. It is important that you don’t push through the pain and push yourself to the limits as this will cause a flare-up. On the opposite, avoiding activity and choosing to give up on activities, may lead to more pain and disability. Using a ‘paced’ approach gives you the best chance of successful recovery. This gives you a way to break everyday activities and exercises into smaller bits. Pacing helps you stay active throughout the day and allows you to do things that you care about. Having a clear plan on how you can incorporate a short exercise routine into your schedule will give you peace of mind and a routine. Pacing will give you control over your recovery and wellbeing. Pacing will also help you to build up endurance and the ability to tolerate more activities during the day. You will quickly notice how well you understand your body and you will establish an effective exercise routine that won’t flare up your pain. The current best research shows that grading your activity and using measurements like the number of repetitions or time that you need to complete an exercise, gives you the best chance of successfully progressing in your recovery.
How do I pace myself? Firstly, establish your therapy goals. Usually, it is an activity that you would like to get back into doing, like fishing, running, walking your dog, playing with your grandchildren, etc. 1. Set the baseline Work out how long can you do a certain task without pain flare-up (that doesn’t mean that you won’t experience any pain during the activity). · write the time, distance or number of times that you can do the activity or task without a pain flare · taking 3 measures over 3 days often gives the best guide · Now add the 3 numbers together, then divide by 3. You should then reduce this number by 20% (or multiple by 0.8) to give yourself a buffer. This is your first-week baseline for activity “one”. Repeat for other activities. 2. Repeat the task daily Using your baseline number, do this activity daily for the first week. 3. Increase by 10% per week Slowly increase the time, distance, or number of repetitions each week by 10%. This becomes your baseline for the second week. Repeat that every week until recovery. 4. Do small bits often Make sure you break your activities into smaller chunks as this will often help you maintain the range of your activities and your tolerance. 5. Rest is important During a recovery, rest is very important. Take time to have a small break in-between your tasks, especially when you know that a certain activity will be stressful. Practice mindfulness and deep breathing throughout the day for nervous system recovery. It is very important to have a group of people who support you in your recovery. Involve your family members, friends, and health professionals in your journey, and don’t be afraid to ask for help.
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