EXERCISING WITH CHRONIC PAIN: HOW TO ALLEVIATE STRESS ON THE BODY

By

NICOLE GOLDEN

Chronic pain is defined as any pain from an injury or condition lasting more than 12 weeks. Many potential clients seeking a certified personal trainer, yoga class, or corrective exercise specialist do so in hopes of using exercise to mitigate chronic pain. It is estimated that as much as 25 per cent of adults in the United States suffer from some form of chronic pain (Dahlhamer et al., 2018), meaning there needs to be a bigger emphasis on how to ease those pains. Likewise, the prevalence of chronic pain increases with advancing age and obesity (Okifuji & Hare, 2015). Physical activity may not necessarily be a definite cure-all for chronic pain, however, exercise does increase flexibility, conditioning, independence, and strength, and optimize movement patterns with the correct combination of exercise modalities and programming. Similarly, physical activity is an important piece of a weight management plan which can reduce the health complications (and pain associated with) obesity.

Becoming a Corrective Exercise Specialist (NASM-CES) will equip you with the knowledge you need to deal with chronic pain through corrective exercise. 

WHAT ARE THE DIFFERENT TYPES OF CHRONIC PAIN?

There are several types of chronic pain though the most common types of pain seen in a personal training practice are neuropathic, musculoskeletal, and inflammatory in nature. Here are a few examples:

NEUROPATHIC PAIN

This type of pain is caused by damage to the nerves and is often described as burning, tingling or numbness. This type of pain can be seen in diabetics (diabetic neuropathy), in individuals with a history of Alcohol Use Disorder, and in some cases, the result of chemotherapy.

MUSCULOSKELETAL PAIN

This classification refers to pain stemming from either the muscles, connective tissue (tendons, ligaments), joints, or fascia. Some examples of musculoskeletal pain could be low back pain, plantar fasciitis, and osteoarthritis.

INFLAMMATORY PAIN

This type of pain arises from chemicals released from immunocytes invading bodily tissues. It can affect the entire body or certain parts. Inflammatory pain can result from chronic conditions such as autoimmune disease, chronic oxidative stress, and low levels of chronic inflammation (Pahwa & Jialal, 2019).

WHAT IS THE LINK BETWEEN OBESITY AND CHRONIC PAIN?

Obesity can directly or indirectly cause all three of these types of pain. First, obesity is a significant risk factor for the development of diabetes and subsequently diabetic neuropathy. Comparably, increased loading on the spine and other joints (i.e., knees and hips) can lead to increased compression forces, degeneration of connective tissue, and closing of joint space leading to conditions such as osteoarthritis and degenerative disc disorder.

Singh et al. (2015) conducted a study measuring the compressive forces on labourers with a BMI over 35 kg/m2. The compressive forces on the spine from lifting moderate loads in these individuals exceeded the Occupational Safety and Health Administration (OSHA) safe limit. The researchers concluded that excess body weight can in fact lead to chronic pain from musculoskeletal dysfunction.

Similarly, obesity can lead to endocrine changes which creates a chronic low level of inflammation in the body such as macrophage accumulation in fat tissue in addition to increased levels of C-reactive protein (CRP) and interleukin-6 which are both markers of chronic inflammation. Likewise, it is common for individuals affected by obesity to also suffer from sleep apnea reducing the likelihood of achieving restorative sleep. This can further predispose someone to chronic pain (Okifuji & Hare, 2015).

WHAT TYPES OF EXERCISE CAN HELP WITH CHRONIC PAIN?

Exercise has been frequently studied as an alternative to pharmacologic therapy in treating chronic pain. First, exercise is often part of a weight management program to treat obesity. The achievement of healthy body weight may reverse a chronic inflammatory state, increased mechanical loading on the joints, and sleep disturbances associated with chronic pain disorders.

Similarly, physical activity alone (without weight loss) can improve sleep and reduce chronic inflammation in the. In fact, avoiding movement, even in those dealing with chronic pain, may lead to loss of strength, range of motion, and independence of body (Ambrose & Golightly, 2015).

STRETCHING/SELF-MYOFASCIAL RELEASE (SMR)

Stretching is often looked at as the first line of defence so-to-speak when using exercise to treat chronic pain. In general, regular flexibility training can improve range of motion, increase circulation to the muscles, and activate the parasympathetic nervous system.

All these factors will allow for greater movement. Additionally, many chronic pain syndromes can be the result of improper length-tension relationships of various muscle groups. For instance, shortening of the back extensor and hip flexor muscles can lead to lordosis (abnormal spinal curvature) due to increased mechanical stress on the spine.

Likewise, shortening of the hamstrings can alter the range of motion in the hips, possibly leading to back pain (Gordon & Bloxham, 2016). Regular stretching combined with SMR or “foam rolling” can help to restore appropriate length-tension relationships thereby decreasing the potential for pain.

YOGA

Yoga is a practice that began in India more than 4,000 years ago. The practice includes components of balance/flexibility through various postures, control over breathing, and meditation. The breathing and relaxation techniques taught through yoga have been demonstrated to increase relaxation and help individuals with chronic pain syndromes deal with the emotional aspects of these conditions.

The balance/flexibility portion of yoga can help an individual with chronic pain improve range of motion and circulation to the muscles and reduce the potential for disability associated with chronic pain (Vallath, 2010).

Holtzman & Beggs (2013) conducted a meta-analysis of randomized controlled trials examining the effect of regular yoga practice on chronic low back pain. The researchers determined that regular yoga practice can significantly improve low back pain, especially in the short term and reduce markers of functional disability in these patients. Based on these findings regular yoga practice may be a great first step in exercising to reduce chronic pain.

RESISTANCE TRAINING

Resistance training can help to reduce chronic pain in a few ways. First, strength training can be used as a tool for strengthening muscles that are relatively weak which could be a potential source of pain or as part of a constellation of muscle imbalances leading to painful movement. For example, clients with chronic low back pain may have a history of sitting for long periods of time.

This position shortens the hip flexors, lengthens the gluteals and causes a persistent anterior pelvic tilt altering the position of the spine (Clark et al., 2014). A corrective exercise program that helps to inhibit/lengthen the hip flexors and activate/strengthen the gluteals and transverse abdominis (TVA) can help to relieve this pain.

To elaborate, researchers identified 30 patients with chronic low back pain of 3-12 months and more than 12 months. Both groups were given a core/gluteal strengthening coupled with a lumbar flexibility program and pain was reassessed after a six-week intervention period. The results showed that nearly all the participants had significant improvement in low back pain regardless of how long the back pain had persisted prior to the intervention (Kumar et al., 2015).

The benefits of resistance training are not limited to just alleviating low back pain. Engaging in a regular resistance training program can also help strengthen muscles surrounding joints affected by osteoarthritis or other conditions. Several studies have demonstrated that even in older adults with osteoarthritis received significant benefits in pain reduction and functionality when engaged in a regular and progressive resistance training program (Latham & Liu, 2010). Overall, regular resistance training can improve many conditions causing chronic pain.

WATER AEROBICS

Water aerobics can be an excellent choice of exercise modality for individuals who have conditions causing chronic pain. There are several reasons why this is the case. First, water provides buoyancy which helps to provide some offloading of stress on the joints while simultaneously providing resistance for exercise. Second, the hydrostatic pressure experienced during a water aerobics session can help to increase the load on the respiratory system as fluids are driven towards the trunk in addition to providing additional support allowing the client to gain better postural control.

Last, hydrodynamic drag forces allow for resistance to increase as the participant increases their speed, yet, as soon as movement is stopped, the resistance is also stopped. This allows the participant complete control over how much resistance feels safe to them (Zamunér et al., 2019).

(Baena-Beato et al. (2013) conducted a randomized controlled trial to evaluate the effectiveness of a water aerobics program on low back pain in 49 sedentary adults. The results demonstrated that in the cohort that engaged in water aerobics 5 times per week over the two-month study period, there was a significant reduction in low back pain as compared to the control group which did not participate in an exercise program. The researchers concluded that water aerobics is an effective non-pharmacologic treatment for low back pain.

BIKING AND WALKING

Low-intensity activities such as walking, and biking are generally very easy on the joints and are considered a very safe and effective exercise modality for those living with chronic pain. Likewise, cycling and biking are good introductions to physical activity that can help chronic pain sufferers break the cycle of inactivity which leads to further pain and disability.

These activities can help reduce chronic pain caused by generalized inflammation by assisting with weight loss, improving circulation, and in the case of pain caused by osteoarthritis, helping to move synovial fluid through the joints allowing for less pain and increased range of motion (Milosavljevic et al., 2015). It is also important to note that walking can be incorporated into other activities (i.e., yard work, house cleaning, etc.) which will increase overall daily step counts.

CONCLUSION

There are many choices for exercise which are safe and beneficial for individuals struggling with chronic pain. A well-rounded exercise program which combines several of these exercise modalities (i.e., resistance training, yoga, walking/cycling, and water aerobics) can provide the most benefit as each addresses different aspects of conditions or movement imbalances leading to chronic pain.

Check out the sample weekly schedule for some ideas on how to structure an exercise schedule to aid with chronic pain.

Incorporating even a few of these exercise modalities in your or a client’s weekly schedule can go a long way to helping them feel better and keep moving.

NICOLE GOLDEN

Nicole Golden has been a health/fitness professional since 2014 when she left the field of education to pursue a full-time career in fitness. Nicole holds a Master of Science degree from Concordia University Chicago in Applied Exercise Science with a concentration in Sports Nutrition. She is a NASM Master Trainer, CES, FNS, BCS, CSCS (NSCA) and AFAA-certified group fitness instructor. Nicole is a sports nutritionist (CISSN) certified through the International Society of Sports Nutrition. She is the owner of FWF Wellness where she specializes in corrective exercise, nutrition coaching, and training special populations. She has a great deal of experience working with a wide variety of clients including female athletes, cancer survivors, older adults with medical comorbidities, and clients who have undergone bariatric surgery. She also has a special interest in coaching clients in recovery from Substance Use Disorders. Nicole enjoys spending time with her husband and five children when she is not training clients or teaching fitness classes.