Exercise & Chronic Pain

EXERCISE AND PAIN: Complimentary Roommates 
by Celeste Cooper

What is exercise?

Exercise can be classified as passive, active, anaerobic or aerobic.  An example of passive and active exercise: let your left arm go totally limp and relaxed, use your right hand and arm to lift your left arm as far as you can without using any muscles in the left arm.  Your left arm is under passive exercise (not using any muscle action) and your right arm, the one doing the work, is under active exercise.  Examples of anaerobic exercise are isometrics, light weight-lifting, and stretching, basically movement that does not significantly increase your heart rate. So it naturally follows that aerobic exercise is any type of movement that increases your heart rate.

When to exercise

Exercising when you have chronic pain or illness is the epitome of the right kind, the right amount, the right time, and the right patient. So, what is too much, what is enough and what do we expect? 

Certain times of the day have been identified; generally, the best time for us is late morning through early afternoon. It could be different for you, but the goal is to move during our peak hours and avoid exercise at least two hours before going to bed.  Exercising causes the release of the feel good chemicals, endorphins, which can interfere with sleep.  It is also important not to exercise just after eating, because the blood in our body is shunted to our stomach and bowel to aid in digestion, thereby, decreasing the blood supply to other parts of our body such as brain, heart and muscles.  

“If you drain your car battery completely, you cannot get enough energy to recharge it. The body, mind, and spirit work much the same way.” (Cooper and Miller, 2010).

Chronic pain patients may have a co-existing condition called myofascial pain syndrome (MPS).  Myofascial pain syndrome is seen in some patients with chronic fatigue syndrome, fibromyalgia, chronic migraine, interstitial cystitis, restless leg syndrome, post surgical syndromes, post sports injury, musculoskeletal deformity, and a host of other painful conditions.  If this is the case for you, identifying the tell tale myofascial trigger points and treating them prior to any weight load exercise is imperative. Trying to exercise a muscle riddled with myofascial trigger points will only set you back, give you feelings of defeat and most likely cause you to quit. 

Remember, you are not in a marathon; doing more on Monday to make up for a Sunday can be catastrophic. 

Types of exercise

Stretching is a must to keep muscles supple and yielding, and aerobic exercise, the kind that gets your heart rate up, is important for general health.  However, in patients with autonomic nervous system dysfunction, such as that seen in a certain subset of FM and ME/CFS patients, aerobic exercise may not be well tolerated. (see neurally mediated hypotension) If you have difficulty reaching your target heart rate or experience extreme fatigue post exercise, you could be one of those patients.  

Having joint disease, including the spine and certain connective tissue restricting conditions may limit the type of exercise for physical reasons, so finding the therapy that gives us the biggest bang for our buck is important. Imagine stiff muscles and joints as a rusty hinge and movement as a means of providing lubrication, allowing them to flow freely, instead of jerking and resisting like a sputtering car nearly on empty. We should pay attention to any new sounds that indicate our engine is about to blow. 

Some chronic illnesses affect our proprioception, the unconscious awareness of where our body is in the environment.  We walk into things, or simply fall over for no apparent reason.  This could be due to the presence of myofascial trigger points or the nature of the illness such as autonomic or metabolic disruption, or dysfunctional sleep patterns, so use care.  

If you have a chronic pain condition directly linked to a neurologic, immune, metabolic or autonomic disorder such as diabetes, systemic lupus erythematosus, multiple schlerosis, scleroderma, ankylosing spondylitis, complex regional pain syndrome, hypothyroidism, hypometabolism, or musculoskeletal immobility and neuropathy, identify perpetuating factors, and avoid over doing, particularly if you are in a flare. Everyone with chronic pain problems understands that some days aren't as good as others so try not to start a routine on a physically or emotionally challenging day. Heed the warning signs, and once they have passed get back on the yellow brick road.

Try different types of exercise until you find something you enjoy so you will stick to it. T’ai Chi, Qi Gong, Yoga, stretching, Feldenkrais, Hellerwork, walking, swimming, riding a bike, rocking, or bouncing on a yoga ball are all good ways to increase movement unless you have a condition that dictates otherwise. (These are all covered in detail in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: the Mind Body Connection.)

Movement and tolerance

As with anything related to chronic pain or illness, we must focus on what we CAN do. Movement should be based on tolerance. Know your body and its experiences from previous flares, move when you can to prevent atrophy of your muscles. There are many exercises that can be done in bed or with the assistance of a care giver, so there is no excuse not to do some form of movement.

On days when you have to force yourself to get out, use that handicap sticker, minimize your time doing only what must be done, but on other days, park as far away from your destination as possible and walk.  There are ways of getting exercise without making it like work.  As you are walking down the parking row, assistive devices in hand if need be, smile at the people you pass, it could make their day, and I guarantee it will make yours. 

Finding your target heart rate(THR)

The effect of aerobic exercise is measured by target heart rate.  There are precautions and a rule of thumb is if you are unable to speak a complete sentence, it is too much.  Should you experience any extreme shortness of breath or chest pain, stop immediately, see if resting helps.  If your symptoms do not subside immediately, seek emergency help. Your doctor should be aware if you are starting an exercise program so you can discuss any precautions you need to take.

Low impact
220 - (minus) age x (times) 60% = THR

If your age is 50, your aerobic exercise THR is:
220 - 50 = 170; 170 x 60% = 102 beats per minute

Moderate impact
220 - (minus) age x (times) 70–80% = THR

If your age is 40, your aerobic exercise THR is:
220 – 40 = 180; 180 x 70% = 126 beats per minute
to 220 – 40 = 180; 180 x 80% = 136 beats per minute

High-impact exercise is strenuous and should be reserved for athletes with properly conditioned bodies.

The motto is always start low and go slow then build from there. 

Effects of exercise

Moving or exercise, whatever you want to call it, improves blood flow, getting it where it needs to go.  When we breathe we take oxygen into our lungs which is then taken into the blood stream.  Think of oxygen as food for our cells; visualize breathing through movement as providing a feast for the body.  Deep breathing is important too, as aerobic exercise is to improving heart function and circulation; deep breathing is to improving lung function. Maximize this free, nearly effortless, exercise to stretch the muscles between the ribs, keeping them healthy, preventing restriction and increasing capacity to exchange oxygen rich blood. 

Weight bearing exercise is known to improve bone density, and physical movement is the ONLY thing that circulates the clear yellow fluid called lymph throughout our body.  Lymph fluid moves through body tissues picking up bacteria, and other unwanted toxins filtering them through the lymph nodes. It is the backbone of our immune system.  In essence, if we don’t move, we become a toxic blob.

Movin’ on down the road with big wheels turning, maintaining forward momentum in the face of pain as we follow the yellow brick road together, we will…..

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This website receives no revenue. Income generated from book sales is used to provide a free blog, reimbursement for expenses related to advocacy, and volunteer education pieces as health expert for Sharecare.com. Celeste Cooper hopes you find the content of this website, her blog, her answers on Sharecare, links to her advocacy work through PAINSproject.org, and her books helpful in your journey.
Read more about the books:

Broken Body Wounded Spirit, Balancing the See-Saw of Chronic PainSpring Devotions 

Broken Body Wounded Spirit, Balancing the See-Saw of Chronic Pain
Winter Devotions

Broken Body Wounded Spirit, Balancing the See-Saw of Chronic Pain, Summer Devotions (here).

Broken Body Wounded Spirit, Balancing the See-Saw of Chronic Pain, Fall Devotions (here).

Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body Connection (here).

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