MOVING THROUGH CHRONIC PAIN
How Exercise Can Heal What Hurts
by Julie Peterson
When our body keeps hurting, especially if it’s been that way for a long time, it’s natural to want to snuggle into pillows with a good movie and move as little as possible. And for many years, that’s the kind of rest that doctors recommended for the 20 percent of American adults suffering from chronic pain. But with a plethora of studies showing that exercise can reduce pain severity, enable better physical functioning and boost morale with virtually no adverse side effects, that advice is fast changing. “Exercise helps to release endorphins, which are the body’s natural painkiller chemicals,” explains Rumki Banerjee, M.D., medical director of Apex MD, in Glen Allen, Virginia.
For those suffering from conditions like rheumatoid arthritis, fibromyalgia and low back pain, the thought of moving may be uncomfortable, and even the sight of stairs may trigger pain signals. But walking up just one step can give the brain new information. “If it’s possible to do a movement one time without pain, the brain starts to change, the door to movement reopens and we begin to end the chronic pain cycle,” says Annie Forest, a fitness trainer who specializes in the neurology of pain at Forest Coaching Studios, in Madison, Wisconsin.
A good first step is to consult an expert. “If your doctor approves, take advantage of the knowledge and expertise of a movement expert. Physical therapists, occupational therapists, Pilates trainers and yoga teachers are trained to help others move safely and more effectively,” says Peter Abaci, M.D., medical director of the Bay Area Pain and Wellness Center, in Los Gatos, California, and author of Conquer Your Chronic Pain: A Life-Changing Drug-Free Approach for Relief, Recovery, and Restoration.
The muscle pain that occurs in everyone starting a new exercise regime—known as delayed onset muscle soreness—typically lasts only a day or two, and is a sign the body is slowly gathering strength, say physical therapists.
It’s best—and probably the only thing possible for those in chronic pain—to start slow. “Walking is one exercise that gets your body moving, blood and fluids circulating, and if done outdoors, can take you out into nature to offset the amount of time spent indoors,” says physical therapist Karena Wu, owner of ActiveCare Physical Therapy, in New York City and Mumbai.
Slow stretching, especially if it involves holding positions up to one minute, and gentle versions of yoga, including chair yoga, have also proven helpful. A study of 228 people with chronic back pain published in the Internal Archives of Medicine found that both approaches reduced symptoms within 12 weeks and lowered the use of pain medications, and that results lasted at least six months.
Tai chi, an ancient Chinese practice that involves breath control combined with slow, fluid movements, has been shown to benefit people with osteoarthritis, rheumatoid arthritis and tension headaches, among other chronic conditions. In a study in the New England Journal of Medicine, people with fibromyalgia taking tai chi classes twice a week for 12 weeks reported less pain and depression and better sleep than another group taking wellness classes and stretching sessions. Chi kung (qigong), another slow-moving, mind-body exercise, supplies similar benefits, concluded a February study published in the journal Holistic Nursing Practice.
Compared to aerobics, especially for older people with lower back pain, “Pilates may be more effective for pain and disability because exercises are more targeted to the muscles of the pelvis and trunk,” concludes a recent Brazilian study.
Aqua therapy, also known as water aerobics, reduces pressure on aching joints while still providing enough gentle resistance to build strength, plus a heated pool can relax the whole body. Swimming was shown in a 2013 study in Clinical Rehabilitation to ease the lingering pain of cancer survivors better than land exercises; studies of arthritis and fibromyalgia patients showed similar results.
It’s also key to have goals—even as simple as cooking a meal without pain. “I ask people to envision a pain-free life and imagine what that would look like, what they would do if they didn’t hurt,” says Forest. “If you say, 'I’m a softball player and a mom who picks up her kids,’ then your brain wants to head in that direction. Having a target is really important.”