Exercise and activity
Gentle exercise, for example stretching, swimming, walking, yoga etc., is now recommended as part of a plan for managing chronic pain. People we talked to recommended exercise for the mental as well as physical benefits, since it can be a great distraction from the pain.
Several people told us that they had found it difficult to start exercising. Some had never really exercised and didn't know where to start, while others had taken part in very vigorous exercise before their pain started and knew they couldn't go back to their old routines.
People were sometimes frightened of moving, or protected the painful part of their body and found the prospect of exercising terrifying. A few were concerned about exercising when taking medication in case they unknowingly injured themselves, although some had been taught that these concerns are unfounded (see also 'What is chronic pain?').
- Age at interview:
- Age at diagnosis:
- Medically retired care officer; married; 3 children.
When I first had the pain I did, I drew back from everything, I wasn't going for walks, I wasn't doing anything, I was feared to lift a teapot, feared to do anything because it was hurting my pain. But when I went to the Pain Association and things like that and doctors appointments and hospital appointments, everybody's said the same thing, 'You should try and do some gentle exercise'.
Now gentle exercise means like, you could even do the Mexican wave, that's a gentle exercise, you can do it with one hand, as long as you're moving, its an exercise.
So when, when you've been in chronic pain for so long and you do tend to, you don't try and do it all in the one day, that would kill you. So yes, you might be apprehensive about doing exercising, but its not the exercising that you think its going to be. Its... You're not going to row down the Clyde, you're not going to run a marathon, all you're going to do is gentle exercise that won't aggravate your pain, but it could help and yes I did.
I still don't do an awful lot of exercising but I do exercises. It's what we call a gentle movement, because it really is just gentle movement, and it's a case of the better you can be at you're gentle movement the better it gets. But you don't rush into it, you can't rush in to it.
- Age at interview:
- Care home manager; single.
You said that you, you tended to protect yourself when you had an injury?
What were you worried about when you were protecting that?
It is the fear that it would get worse and then it becomes a habit. You clutch an arm and I find myself involuntarily doing it, it becomes as I say a habit. If my right arm's sore then I'll put my left one out and that carries on beyond when I should be doing that.
There's really no reason why I'm going to further injure it or even if I have an injury while the use of it, it's necessarily going to make that any worse. In fact non use, again I know this rationally, makes things worse because it stiffens more than using it but nevertheless that's what I believe and what my habits are. So that's what happens with that...
Is that something that you've learnt on the pain management?
I knew it before but there's a difference between rationally knowing and being convinced, in actuality I think that pain management clearly helped me a lot in that this was an irrational thought and that movement in fact would be better for it than non-movement because it's just going to atrophy it if I leave it.
Also I know from my experience that I'm going to strain the other side. I think probably why I have problems on the left hand side because I protected the right much longer than I should have done. Yes, the movement might have been painful with the right side but I think my gnawing worry was that I would injure it further, to what extent I don't know, but I don't think that figured in it. It was just that you know this is sore I'm going to protect this from getting any worse. So the way to do it is not to use it.
Is that something you've changed now?
- Age at interview:
- Age at diagnosis:
- Writer/driver; married; 2 children.
One of the first things they teach you at the Pain Management Clinic is that doing and acting is not going to make you worse. There's a natural assumption if you hurt that there's an underlying injury but the pain mechanisms of the human body are basically designed as warning systems, so that when you first feel pain, yes you should do something about it.
But when pain becomes chronic it's no longer giving you any useful information. It's useless pain. That's how they described in the pain clinic. It's useless pain.
And it's... chronic pain is usually caused by some damage to the pain system itself so that it's giving false signals and basically once an injury or an illness has been diagnosed, treated, if pain persists six months or a year after the problem has been resolved, say you had your appendix out, it's resolved, but if you get chronic pain as a result of that and I know people for example who have had chronic pain as a result of a hernia operation.
What's happened is something has gone wrong with your pain system itself and that pain is not a warning. It's an unfortunate residue and so what you're taught is that you are not going to cause yourself injury by exercise, moving etc., setting goals and achieving them.
Often people were introduced to exercise by a physiotherapist, who gave them an individual programme. Some attended a special physiotherapy exercise class or learnt how to exercise safely on a Pain Management Programme (see also 'Physical therapies'; 'NHS pain management programmes').
Others had found useful books or videos on exercises for people with chronic pain (see 'Resources' section).
In the past, some people, particularly those with back pain, had been told to take bed rest until their pain eased. One woman said that she was not told when to start moving again and so ended up spending months resting, during which time she became very stiff. Another person who was advised to rest said he found lying down uncomfortable and started to walk and do stretching exercises instead, which helped.
- Age at interview:
- Unemployed; divorced; 2 children.
You mentioned that you think you were given some wrong advice?
Well, I was actually, well I thought I was given advice anyway. At the time I didn't because apparently that was the thing to do was rest and the more I rested the worse the pain got. I mean I couldn't sit down for any length of time, I had to move about a lot.
When I was lying down I got relief from the pain but it seemed to come back with a bit of a vengeance and I found that actually lying down made it worse. I was lying on my side... I was lying on the side where the pain was, I was lying on my back. Couldn't lie on my stomach at the time because I was nearly 16 stone. I was quite a big guy at the time like. And I didn't seem to be able to get any relief at all. I mean having to lie in your bed with a pillow between your legs feeling like your bladder is going to burst any minute, just the pain was causing a lot of associated pain as well like.
I started doing my own exercises because I noticed that being static all the time, being immobile seemed to cause a lot more pain than I should have had and I noticed sometimes that when I was walking just about the house, sometimes I got a bit of relief with the pain so I thought 'Ooh maybe this will work' so I started doing a few things and I made a few enquiries as well.
I had a lot of physiotherapy right from the very start but the first physiotherapists were actually scared to touch me because every time they did something it caused me a lot of pain. Second physiotherapist was actually down on this area and he was really good. He was actually amazing, he made me do things that I thought I'd never be able to do again.
The stretching, the bending... and I found my mobility was actually really sort of relief your pain. Not too much. Too much can actually cause a lot of pain as well. Just within bounds. When the pain starts, stop doing the exercises, and at first I was a bit on the impatient side. I probably caused myself more harm than good. I kept on going till the pain got too bad that I couldn't do anything. So I found out that's not the way to go. I have to pace myself. So I found out that way.
We now know that prolonged periods of rest lead to muscle wastage and stiffening of joints and tendons, which can actually make the pain worse.
One man, who was a nurse, said he was aware that medical understanding changes from time to time so understood why he had been advised to rest. Medical professionals and therapists now agree that rest combined with gentle activity, for example gentle pottering, is the best course of action for a flare-up of pain (see also 'Coping with flare-up').
- Age at interview:
- Nurse; married; 2 children.
You were told to rest in bed at the time, what are your feelings about that now?
I suppose, I don't know really. Medicine changes all the time and nowadays they don't advise bed rest, not for two weeks, because it's not going to do any good, it'll just make, it doesn't make matters worse but I think your back just stiffens up.
They recommend now sort of a small amount of bed rest and then to get back exercising. I don't tend to look back and think 'Oh well they told me' what they told me to do was wrong' because at that time that was what the treatment was. So you don't look back and tend to blame anyone for what they did or didn't do. That was the treatment at that time so you tend to go along with it.
Several people found that exercise relieved their pain through the release of endorphins, natural pain relieving chemicals. Others did not experience noticeable pain relief but felt that they were physically fitter, had more strength and had reduced their weight by being more active.
Different types of exercise suited different people. The important thing with all types of exercise is to set yourself goals and build up to them gradually staying within your limitations (see also 'Pain management: pacing and goal setting'). It was pointed out that it is important to remember that you are not training to run a marathon or to be an Olympic athlete.
- Age at interview:
- Medically retired horse breaker; divorced; 3 children.
As I mean I'm not a person who has taken exercise because I don't need exercise if you have got a dozen horses, you don't need exercise. You're gonna get all the exercise you want, like it or not. But after the accident I couldn't really come up with a kind of exercise that I could do without really hurting me.
I did things like setting myself a walking target. I was like, if I could meet the walking target, you know. Like halfway down the track first and back and then three quarters of the way down the track and back and then to the first bend in the track and back and that was, that was more like it, you know achievements sounds silly, but those were like achievements and there were days you couldn't do it.
Tomorrow will be better, but I've got a gun dog and we both put an amazing amount of weight on because when you go from working a 12, 15 sometimes 18 hour day to doing nothing. I mean eating habits didn't change, it had nothing to do with that but I've been at 11 and a half stone for years and all of a sudden I went up to 15. And I thought, well I've got to do something and walking would at least keep the legs moving and it's a thing you can actually see the achievements. If you reach a point and manage to walk back, you can extend it and slowly things did get better. I mean I could walk the whole length of the track and back now.
I would take a stick but I could still do it but if I like walk to the car no problem. The sticks in the car when I go out because I had to go somewhere, I mean I don't go anywhere without the stick. Where as I could walk down to the bottom of the track now with a stick and that would be just under the half mile. On day 1, I mean 25 yards was a major, major struggle, you know.
But I have, after I had a couple or three diets, some of which have worked, some haven't and I'm on a diet now and it is working, I mean I'm down to under 14 stone like. Which is a long way from 11 and a half but I don't see myself getting back to 11 and a half unless I start mucking horses out again and riding and that's not going to be, that's not going to happen. But I mean the first time I managed the bottom of the track, I thought that was a great day, you know. Prior to that you wouldn't even have thought about that, would you.
Several people attended hydrotherapy with a physiotherapist and were shown exercises in a special heated pool. Hydrotherapy is usually only available for a limited number of sessions, but several people had continued to exercise at a public swimming baths. Swimming was seen as an excellent exercise because the joints are supported.
Several people said that gentle Aquafit exercise or even walking in water was beneficial. Public baths could be busy, although many have adult only and women only sessions. A man suggested going during the day to avoid the children and a woman had attended a special session reserved for people with disabilities.
- Age at interview:
- Retired lecturer; married; 2 children.
Well I was very keen to undertake some exercise that would maintain mobility, because I was told that every joint should be put through it's full range once a day and I came across this book by a chap who'd been an Olympic swimmer and as he got older he developed Arthritis and worked out a set of exercises for Arthritic's that was based on Yoga and it was stretching rather than leaping about to music.
I mean I couldn't do aerobics. Now I started off with one exercise once and built up to about thirty five exercises that I did five times a day. If I tried to double them up to ten repetitions, I should have said five repetitions once a day, I tried to double up to ten repetitions, it was too much.
But I kept it up for a number of years and, when I couldn't do the standing exercises and I had to do the lying exercises on the bed, I could still do the hand and foot exercises and the physio said 'Well it's nearly nothing, but it's not nothing, so do the hand and foot exercises' and I did and sometimes, if I'm having trouble with my feet, I lie on my back in bed and hold each foot in turn in the air for a minute or two to try and stimulate the circulations but bed-socks do help.
And the, I mean you get endorphins from exercise, and I have tried to go swimming once or twice. The local swimming pool has a special time on a Sunday evening for disabled and they have a chair hoist that will let you down into the water and lift you up and deposit you on a trolley and someone can wheel you to the showers and they don't just have tiny little cubicles, which I hate because I'm too big and unwieldy, they have big family rooms. So [husband's name] and I can go in together and he can help me.
Yoga, Tai chi, Chi Gong, Pilates or exercises that focus on core stability muscles were popular. Classes vary considerably and some warned that it is important to find a teacher who understands your limitations.
Some people had joined a gym. They recognised that others might think that this was impossible and stressed that they stayed within their limits and didn't use equipment that made their pain worse. One woman who had joined a local council gym said that it made her feel part of society again.
- Age at interview:
- Medically retired project manager; married; 4 children.
That's the other thing which I probably never mentioned, when I finished my Pain Management Programme, as I say and I really hadn't ever exercised in my life apart from my short spell of physio when I had that last operation but when I came back from the Pain Management Programme, I hadn't made the video then and I used to sort of lie on my floor and think 'Oooh look at that same bit of ceiling' and I got quite bored with doing this routine exercise all the time and the whole thing about pain management is self management so it's, to, for you to empower yourself to deal with your pain and, and take you know, control of your own life.
And because I was in that period where I had three months before I went back for my last assessment, I thought I'm going to join the gym and I did feel a bit intimated because most gyms have got a few poseurs in there and I thought 'Well, no. If I go early in the morning, you know, it won't be busy'.
Anyway I went to the gym and I told them about my back, etc., etc., and I was quite clued up on what not to use and what to use and they were really nice and I actually did go to a gym for quite a long time and it was, and that was another thing that was beneficial to me.
I went to the local what do you call it, you know, the local, the cheap one, the ooh, like the local community, say, I can't think what you call it, local run, council one or whatever it was, so it was a lot cheaper. And I went early in the morning and there were people there obviously probably business people but again I felt 'Yes, I'm part of society again' and I, and that really boosted my morale.
Okay, I couldn't go on the rowing machine and I couldn't do this and I couldn't do that but I felt quite good and then when I moved I joined, I did join the one across the road and you know okay there are a lot of young people in there and I think, you know, the trainers probably prefer the young people but it doesn't matter because you've got all the machinery there and the equipment and they are genned up on how to tell you what to do and I, you know, it would be better to spend your money on something like that where you are really benefiting from it and meeting other people and they've got classes in there and things like that.
Some gyms had specially qualified staff who could help people with chronic pain to develop a programme of exercise. One woman had been referred to a local fitness centre on a scheme funded by Primary healthcare.
- Age at interview:
- Age at diagnosis:
- Retired government officer/nursing; married; 2 children, 3 stepchildren.
I try, on a day to day basis, to get some exercise and we've got a new scheme in this area called Terms, it's a combination thing between Primary Healthcare and Leisure Services, and the physio at the neurological hospital asked my GP to refer me for this and I actually got referred for... they decided the best thing for me was Aquafit and I had to agree to do two sessions a week for 10 weeks.
I've just completed it and it has helped in that it strengthened my muscles and I had my assessment this morning, as a matter of fact, and my cardio vascular performance has doubled, so that's good. Hasn't done anything for the pain, but when you're in water, it's not so bad, so swimming is a really, really good thing to do.
So it does help the pain when you're in the water?
It helps the pain, yes. Being in warmish water, being in any water. I mean, in Spain I would swim, I've been in Christmas day in the sea. Just being in water seems to have the affect of dulling the pain. But, then it's a funny pain, it's not the same as other pains.
Exercise didn't suit everyone, some thought it made them feel worse and others found it difficult to do and preferred to include exercise in their everyday routine. It was emphasised that any movement is beneficial.
Everyday physical activity included; playing with children, gardening, working in the garage, cycling, doing general housework, walking the dog, walking up stairs, getting off the bus a stop earlier or walking to a friend's house.
One woman recommended buying a pair of trainers and had been pleasantly surprised to find that she gained 'a real spring in your step'. A woman who had been having her groceries delivered started to use the supermarket again - even loading and unloading a shallow shopping trolley could help with mobility.
Trying to maintain as normal a life as possible by continuing with activities and social contact can help to regulate peoples’ mood and stop them feeling isolated and depressed and this in turn can help with how people experience levels of pain.
Last reviewed May 2015.
Last updated May 2015.