Exercise pages for pain management

What’s the right type of exercise for me?

The best type of physical activity for you is one that does not exacerbate your pain, and one that you enjoy, so that you will perform it regularly enough to reap benefits. Experiment with different types of exercise to find what works for you. If you suffer from joint pain, such as arthritis, a sports injury or back pain, mobility exercises are essential in helping you regain comfortable movement. But if you can, combine these with strength training and aerobic exercise to safeguard your health, strengthen muscles, increase calorie expenditure and relieve stress.

1. Getting mobile

   Gentle mobility or ‘range of motion’ exercises, such as bending, extending and rotating, enhances the flow of the sticky liquid called synovial fluid that coats joint surfaces, making movement easier and less uncomfortable (3) Keep your movements smooth and controlled – don’t jerk or overstretch. Try to do mobility exercises at least once a day – ideally mobilising every joint from head to toe, although you could start just with your ‘problem areas’. Repeat each movement 3-10 times, depending on how it feels.

2. Raising your pulse

   Aerobic activity means low to moderate exercise that gets your heart rate up and leaves you feeling slightly breathless and warm. It doesn’t mean donning Lycra tights to work out to music in an aerobics class (although that is an option!). If you have painful joints, activities in which your body weight is partly supported – for example, swimming or aqua aerobics, in which the water provides support, or cycling, in which the bike takes some of your weight – are good choices. If you don’t currently do any aerobic exercise, start by gradually increasing the amount of activity you do as part of your daily routine. See below for 5 ways to inject more activity into a typical day. The aim is to build up to 30 minutes per day, 5 days per week. Don’t worry if you can’t achieve 30 minutes straight away – start with 10 minutes, twice a day and build it up when you feel ready. Every little helps. You should always consult your doctor or your practice nurse, if you've never exercised before, or have any concerns. Top tip: Always warm up before exercising. This involves mobilising the joints with gentle bending, extending and rotating movements and raising the heart rate and body temperature through easy-paced aerobic activity. (Marching on the spot will do fine.) If you are very stiff, a warm shower or bath can help start the process.

5 ways to inject more activity into a typical day

• Hide the remote control and get up to change TV channels
• Stand up, and walk around if possible, when you are on the phone
• If you drive to the supermarket, park as far from the store as possible
• Take on a household or garden chore that needs doing, such as cleaning windows or mowing the lawn
• Place items you use regularly somewhere that you have to stretch up or bend down for them, rather than in easy reach

Be strong

Strengthening the muscles through regular physical activity (particularly strength or ‘resistance’ training) takes the pressure of the joints, and helps to maintain good posture. It also makes day-to-day activities easier, enabling you to do more without fatigue. While strength training entails ‘overloading’ muscles by getting them to exert or resist a force greater than they are accustomed to it certainly doesn’t have to mean going to a gym and hoisting dumbbells around! You can use just your own bodyweight, or items such as resistance bands, bottles or cans as weights. Start with simple movements and little or no resistance – and only take the joints through a range that does not cause further discomfort or pain.

Building muscle has another benefit: a higher level of muscle mass increases energy demand, contributing to weight control. When you train to increase your strength, remember that it is specific to each area. (In other words, training your arms won’t help your legs!) A full body programme, performed 2-3 times a week, is the best approach. If you need to start with no weights at all, that’s fine. Just work up to using light weights when you feel able.

Tops tip: Ask your GP or healthcare provider for advice on specific exercises that could help your condition and reduce pain. You may be referred to a physiotherapist or osteopath, who can use physical therapy (such as massage and gentle stretching) and provide you with exercises to do at home.

Taking it further

If you already exercise regularly, don’t rest on your laurels! The body is very good at adapting to the physical demands you place upon it – and it’s only by moving the goalposts a little further away every now and again that you can make further fitness gains. There are three ways you can progress, nicely summed up by the acronym FIT.

F for frequency: you can exercise more often.

I for intensity: you can push yourself harder during exercise.

T for time: you can increase the duration of your workouts.

Top tip: Pick just one letter at a time to work on! Don’t try to increase the duration and intensity of an exercise activity all at once.

Making exercise happen

• Pick a ‘best’ time to exercise. Some people prefer mornings, others find they are in less pain later in the day.
• Take your time and don’t push through pain – pace yourself.
• Start with small, manageable goals and work up, bit by bit.
• Commit to exercising regularly for at least 6 weeks before giving up – it may take time to feel and see the benefits.
• Vary your activities.
• Be aware that while movement may be uncomfortable – or even painful – that doesn’t necessarily mean it is making your condition worse, or causing further damage.

Top tip: Try to distinguish between ‘good’ pain and ‘bad’ pain. We all suffer a little when we first exercise after being inactive for a long period, but there’s a difference between discomfort – as a result of unaccustomed effort – and actual pain.

Excuses - What’s stopping you?

You know that exercise is beneficial, but you just can’t get started… Here are five of the top excuses, quashed!

• ‘I’m scared it’ll make my pain worse’. All the evidence suggests that physical activity is an important part of your overall pain management strategy – both mentally and physically. Provided you approach exercise sensibly – checking with your health professional and following the advice here – you are likely to make things better, not worse.
• I’m self-conscious’ It’s natural to feel a little self conscious about exercise, but there are plenty of ways you can reduce those feelings. Perhaps you can exercise with a friend or partner instead of going it alone? That way, it’ll be more fun as well as providing moral support. Choose clothes you feel comfortable in – you don’t have to dress up in Lycra! If you are exercising in a public place, such as a gym or local park, you could choose quieter times of day when there are fewer people about, or why not exercise at home? There are plenty of inexpensive pieces of home exercise equipment, and your local library should have a range of exercise DVDs and books to browse.
• ‘I haven’t got time.’ Many of us leave busy, active lives with work and family commitments, household chores, getting around and social activities filling our diaries. But as far as exercise is concerned, it’s about taking time, not making time. Exercise can help maintain and improve your health, enhance your wellbeing and maximize your quality of life. You owe it to yourself to take time each day to commit to activity. See 5 ways to inject more activity into a typical day for some ideas of how to weave activity into your day, rather than needing to put a specific block of time aside.
• ‘I don’t enjoy it.’ If you dread exercise, it’s because you have picked the wrong type – or perhaps, you have tried to achieve too much too soon and overstretched yourself. The absolute key to lifelong exercise is to find an activity that you enjoy. Didn’t like swimming? Try cycling. Found the gym boring? Try a group class. Felt humiliated in that dance class? Sign up for yoga. Once you’ve found an activity you like, make haste slowly. That means progressing at a slow and sensible rate, rather than pushing yourself too hard. That way, you’ll reap the gain, without the pain. 

7 ways to stay motivated

Half the battle with exercise is getting started – the other half is sticking with it! There are some key things to think about.

• Make it fun – If exercise is boring or unpleasant, you will do your utmost to avoid it. That’s why it’s so important to make it as enjoyable as possible. Why not put on your favourite music while doing household chores, to encourage you to move your body, or work out with a friend or partner?
• Make it varied – Varying your activities not only helps prevent boredom, it also gives your body a better challenge, by using a greater range of muscles and movement patterns. For example, you could take a walk every weekday, swim on Wednesday evenings and go for a long bike ride on Sundays.
• Set goals – Every journey needs a destination – and knowing what you are aiming to achieve through physical activity makes it easier to stick with it, particularly when exercise feels tough. You may want to lose a stone, or simply be able to walk to the local shop and back without pain. Once you’ve set your goal, decide on a deadline by which you want to achieve it – one that is realistic but challenging – and then start your journey. Remember the golden rule: make haste slowly!
• Look for support – Get some support for your new regime. Ideally, recruit an exercise buddy to do your activities with you – which provides both a social element and some competition! Or you might consider joining a class or group – or becoming a member of a gym.
• Fit it in – Exercise – like any appointment – has to be fitted in to your lifestyle. So rather than pledging to exercise ‘every day’, think about where and when you can fit in the different forms of activity and then schedule them in. It’s also a great idea to keep an exercise diary in which you record what you did and how it felt. This could prove really helpful – indicating whether certain types of activity made your pain better or worse, for example. And looking back at how much you’ve done can be very motivating.
• Stay positive – If things don’t go quite to plan, don’t be discouraged. Stick with it and remember that many of the benefits of exercise go far beyond what we can immediately see. OK so you may not be pain-free, but perhaps your blood pressure has dropped, and you are feeling more relaxed.  Be patient – changes take time. It’s inevitable that you will occasionally miss the odd session, or not achieve what you set out to – but as long as you keep focused on the ultimate goal and exercise regularly and consistently, you are doing fine.
• Reward yourself.  Make sure that you reward yourself for your fitness achievements. Why not try keeping an ‘exercise jar’, in which you put a small sum of money each time you complete a workout. After a month, empty your jar and spend the money on something just for you.

Dealing with stress

Living with chronic pain can be very stressful. The good news is that regular physical activity can help dissipate stress and anxiety and, longer term, can help you cope with stress more effectively. But there are other actions you can take to address these negative states of mind, too. Some have an immediate short-term effect (ideal for when you are about to lose your rag!) while others, practised long-term, can have a lasting effect on mood and stress levels.

Relaxing

Try this! Calming breath.

When we are feeling stressed, our breathing often becomes more shallow and rapid. Sometimes, we even hold our breath. A few deep breaths can make you feel instantly calmer. Here’s how to do it:

Lying, standing or sitting, start by letting all the air out of your lungs, breathing out through the mouth (a big sigh). Now place your hands just below your ribcage on your tummy and breathe in through your nose, pushing your hands out with your tummy. Imagine you are inflating your stomach! Pause for at least a second, a little longer if possible, and then slowly and steadily let the air out through your mouth, feeling your tummy subside beneath your fingers. Try to make the exhalation last longer than the inhalation. Repeat 3-5 times and then breathe normally for a few moments before resuming what you were doing.


Meditation

Meditation is the practice of quietening the mind, in order to reach a deep sense of calm and relaxation. Some types of meditation involve focusing on an external object (such as a candle flame), others focus inwardly, on the rhythm of the breath or on a word or phrase (a ‘mantra’) repeated over and over again; still others simply involve sitting quietly while you allow your thoughts to float away.

So how do you get started? Well, you need at least 5 minutes in which you won’t be disturbed – ideally twice a day. Find a quiet, comfortable place and sit down (crossed legs are not essential – a comfortable chair is fine). Don’t lie down – you want to be relaxed but not asleep!

Close your eyes and spend the next few minutes doing, thinking and saying nothing. Try to completely empty your head. As thoughts come in, acknowledge them and then let them go. Don’t worry or get frustrated if you feel you aren’t getting it ‘right’ – just carry on relaxing and freeing your mind. As you get more adept, you’ll be able to meditate for longer.

Progressive muscle relaxation (PMR)

This is a relaxation technique used to release stress and muscular tension. All you do is tense and release each muscle group of the body, one at a time – often starting at the toes and working up to the head. The whole process is done slowly, so that by the end you feel completely relaxed.

Get your ZZZs in

It’s no secret that a lack of sleep leaves you less able to deal with the challenges of the day – but did you know that it is associated with weight gain? While experts still haven’t agreed on a definitive figure for how much sleep we need, (and it does vary from person to person), the guidelines generally fall between 7-8 hours. Here’s how to make sure you get a good night’s sleep.

•  Establish a regular routine of what time you go to sleep and get up – the body likes consistency

•  Sleep in a completely dark and well-ventilated room

•  Avoid stimulants such as caffeine in the latter part of the day. Caffeine taken within 6 hours of bedtime can affect your sleep

•  Keep the bedroom clear of clutter and don’t watch TV in bed!

•  Take a warm (not hot) shower or bath to help you relax

•  A milky drink can help make you feel sleepy

If you do only one thing: Don’t let pain stop you from being active. Start right now to take small steps towards a more active lifestyle.