Exercise Recommendations For Chronic Pain
Recently, there has been several debate on social media regarding the topic of exercise for people with persistent pain. Few debate what kind of exercise we should use and whereas others debate whether or not exercise is even beneficial.
However, if you’ve worked with people with persistent pain or/and followed the research on it, you would come to the know that exercise, while being helpful, is by no means a panacea and often (both in anecdotally and in the research) results in a smaller improvement in pain and a little to moderate improvement in function.
More so, it seems a bit hypocritical that we spend so much time debating on the effectiveness for pain yet we are the same people that want our patients to emphasize functional improvements over pain improvements.
In addition, we absolutely need to scrutinize our thought processes, biases and evolve them based on the scientific literature but few times, by paying attention just on pain improvement and not on all the other health and functional importance of exercise, we “miss the forest for the trees.”
Furthermore, there are various benefits of exercise ranging from muscle mass, improved heart health, strength, power, bone strength and endurance that looking solely at pain outcomes is rather shortsighted IMO.
It’s important that we include exercise, however with a few caveats:
1) Pain is a complex and multifactorial experience and simply saying that it can be “exercised away” isn’t appropriate or in line with the literature. It could however be very disheartening for a few patients who are diligent with exercise but are not experiencing the improvements they need. Patients need to be enlightened on the risks and benefits of active exercise therapy just as we would expect them to be with pills, injections or even surgery.
2) As Greg Lehman has written about and discussed few persons; specifically those with high psychosocial factors; might not tolerate much exercise very well and will need an emphasis on managing psychosocial factors, lifestyle and beliefs factors so as to maximize the benefits from physical rehab.
What Types Of Exercises Should We Recommend?
Few persons would say “we should just let people do what they want and let that be their activity.” Capitahealth doesn’t disagree with that, and while valued activities promote greater adherence the problems with that approach include the following:
1) The activities might not get consistently done, that’s walking outside or gardening during rainy, snowy or hot weather
2) The activities might not promote bone density, heart health, muscle mass or strength to an extent that can overcome the effects of aging. For instance, swimmers and cyclists are very physically fit but have higher osteoporosis risk and low bone density.
3) These tasks might not give people adequate fitness to do more strenuous ADLs with an adequate reserve afterwards.
Inasmuch as exercise isn’t a panacea for chronic pain, there are different health and functional benefits to exercise that should be accounted for and an ideal program directs a client towards goal activities while addressing potential physical deficits that hinder the performance of those activities. In a nutshell, exercise needs to be dosed appropriately and incorporate individual factors.
We believe that this article offers a different perspective on the ol’ “exercise and chronic pain” debate.