No one wants to be physically active when they’re hurting. For the 116 million Americans suffering with chronic pain, it’s often more tempting to lie down than move. But the right exercise program can provide effective chronic pain treatment, pain experts say. The trick is to find a workout that makes you feel better rather than worse. Here’s how...
Chronic pain isn’t an equal-opportunity affliction. It strikes women more frequently than men, and leaves them hurting with low back, neck and hip aches from arthritis; severe headaches; fibromyalgia; and irritable bowel syndrome (IBS).
It's enough to make you head to bed.
“My patients are reluctant to exercise because they’re afraid it will increase their pain,” says Jennifer Kelly, Ph.D., a clinical psychologist and director of the Atlanta Center for Behavioral Medicine.
“The less you do, the more difficult it is to do anything,” says Kelly, who has specialized in treating women with chronic pain for 24 years.
That's why movement – especially exercise – is an "excellent way to suppress pain,” says rheumatologist David Borenstein, M.D., a clinical professor at George Washington University School of Medicine and author of Heal Your Back: Your Complete Prescription for Preventing, Treating, and Eliminating Back Pain (M. Evans & Company).
That's because active women generate endorphins, natural chemicals that inhibit pain signals to the brain, he explains.
“If you’re breaking into perspiration, you’re making your own opioids,” or natural painkillers, Borenstein adds.
But no one – and especially chronic pain patients – should just go from being a horizontal spud on the couch to running a triathlon.
First, check with your doctor before starting aprogram to ensure that the type and intensity of exercise you’re planning to do won't worsen your condition.
Don't stop exercising if you have slight discomfort at the beginning – a little soreness is to be expected if you haven’t been active for a while, says Marie Hoeger Bement, Ph.D., an assistant professor of physical therapy at Marquette University.
“You also can expect mild fatigue and a light brush of perspiration,” adds Elaine Larson, a physical therapist at University of Utah Chronic Pain Center.
“You want to build slowly and use the activity for your benefit,” she says.
Read on for 10 chronic pain treatment exercises for top complaints.
1. Chronic Pain Treatment: Walking, Hiking and Treadmills
Walking helps nearly everyone with chronic pain. Walks can even ease stress-triggered headaches.
By stimulating fluid and blood flow to joints, walking promotes joint repair and eases pain, says Larson.
Start with a few minutes on flat surfaces every other day, building gradually.
Special considerations: Women with osteoarthritis or rheumatoid arthritis should avoid walking on concrete, cautions physical therapist Shannon Wilson of Peace Health Southwest Medical Center in Vancouver, Wash. Hard surfaces stress joints.
Hiking sharp hills or on uneven terrain in the wilderness can also worsen knee pain, she adds.
Women with fibromyalgia should use Nordic walking poles, which provide balance and prevent falls, says Kim Dupree Jones, Ph.D., of Oregon Health & Science University.
2. Chronic Pain Treatment: Running
Running can relieve stress, which may ease headaches, says Seymour Diamond, M.D., executive chairman of the National Headache Foundation.
It also may lessen discomfort for women suffering from IBS, suggests a preliminary study of IBS patients published in 2011 in the American Journal of Gastroenterology.
Special considerations: Avoid running if you have arthritis in your legs or hips because it pounds lower joints, exacerbating pain in those regions.
It also aggravates lower back disc pain, says Dana Dailey, a physical therapist at Genesis Medical Center in Moline, Ill.
To avoid knee injuries – a problem common to dedicated runners – wear knee braces, suggests Wilson.
3. Chronic Pain Treatment: Outdoor Bicycling
Biking increases blood supply to muscles and joints. It also can spur the release of endorphins which lift mood and reduce pain, says Dailey.
Special considerations: Adjust the seat and handlebars so that you’re not hunching over or extending your legs uncomfortably far while pedaling. Low handlebars can worsen neck or back pain, cautions Bement.
Heavy resistance or steep hills strain knees, an issue for women with joint pain.
Biking in colder weather can increase pain for women with fibromyalgia or arthritis, says Wilson.
4. Chronic Pain Treatment: Water Sports
Water sports are the safest physical activity for chronic pain patients, and water aerobics benefit those with fibromyalgia, says Jones.
Both swimming and pool aerobics ease overweight, deconditioned women into an exercise program.
Plus, the water’s buoyancy can help swimmers with arthritis or even serious spinal and range-of-motion pain to get back in shape, says Wilson.
Flotation devices may make exercising easier at the start, she advises.
Special considerations: Overhead arm strokes, such as those used in the front crawl or back stroke, may increase pain for women with shoulder or arm stiffness. Try the breast stroke instead.
Warm water is better for those with arthritis because cold temperatures can increase pain, notes Wilson.
Start slowly, because the ease of moving in water can prompt women to overdo exercises at first, Larson advises.
“Your body isn’t giving you the instant feedback of soreness you get on land,” she says.
5. Chronic Pain Treatment: Pilates
Pilates, a system of exercises that stretches muscles, strengthens a woman’s back and abdominals, which helps to support aching joints, says Wilson.
Women with IBS, as well as neck, shoulder, back and knee pain, have reported the exercise helps reduce their discomfort, says Risa Sheppard, a Pilates teacher for 36 years in Los Angeles.
Special considerations: Women with back and shoulder pain may need to skip or modify Pilates positions that extend the arms overhead or far out in front of the body, says Jones.
Also, avoid large classes that can't accommodate modifications for your condition, Dailey says.
6. Chronic Pain Treatment: Yoga
Yoga postures and breathing exercises relieve stress, a big pain culprit. Typically, as her chronic pain patients ease into an exercise program, pain decreases along with depression and anxiety, Kelly says.
Regular practice can help those with headaches, backaches and fibromyalgia, says Kelly McGonigal, Ph.D., who teaches yoga in a Stanford University School of Medicine class and wrote the book, Yoga for Pain Relief: Simple Practices to Calm Your Mind and Heal Your Pain (New Harbinger Publications).
Restorative yoga, which uses props to support poses, is tailored to chronic pain patients, modifying positions that otherwise may be too difficult or dangerous.
Special considerations: Be careful with deep squats and extreme forward or backward stretches, which could worsen joint pain and create new injuries, says Wilson.
As with Pilates, stay away from large classes that don’t allow a routine that accommodates your condition, experts say.
Also, don’t pressure yourself to keep up with others in a class if it’s not comfortable. If you're holding your breath or straining to breathe, you’re pushing beyond the safety point, McGonigal cautions.
7. Chronic Pain Treatment: Zumba
This Latin-inspired, fast-moving dance and movement activity is fun, and women are more motivated to stick with it. Zumba can strengthen muscles and unleash a surge of endorphins that blunt pain, Wilson says.
Special considerations: Zumba's twisting movements and lunges can sharpen neck, back or knee pain for women with arthritis.
Be careful if you have fibromyalgia, which can impair balance. It’s easy to fall when you’re doing fast foot movements, Jones warns.
Plus, Larson adds, because time flies when you’re enjoying an activity, watch that you don't overtax your body.
“Fifteen minutes at your own pace could be fun,” he says. “An hour of too much could be a disaster.”
8. Chronic Pain Treatment: Tennis
Tennis can take the sting out of headaches by lowering stress, especially for women who are long-time players and enjoy the sport, says Diamond.
Special considerations: Twists, sudden direction changes and sharp arm movements can hurt women with shoulder, elbow and knee pain, as well as back injuries.
A wider grip and larger racket can prevent pain for women with arthritis in their hands.
Also, briefer, more frequent sessions are best, suggests Larson.
9. Chronic Pain Treatment: Gym Machines (Ellipticals, Steppers, Recumbent Bikes)
Ex-runners with chronic pain like elliptical machines because they produce the same “endorphin high” as running, without endangering joints.
Ellipticals also are a good choice for women with joint injuries because they can control the intensity and direction of the pulleys, says Bement.
Steppers can strengthen leg muscles.
Recumbent bikes, which have seats with backs and sit low to the ground, take pressure off lower backs and necks.
Special considerations: Ellipticals adjusted into a deep incline can place tremendous pressure on the knees, worsening arthritis or knee injuries. So can the repetitive motions of a stepper. For women with limited range of motion, recumbent bikes may be difficult to mount and dismount says Wilson.
10. Chronic Pain Treatment: Weight-lifting
With careful supervision of form, weight-training can bring relief for women with fibromyalgia and other types of chronic pain.
Start slowly: Using light weights with few repetitions is safest, experts say. And programs should be balanced, so all parts of the body gain strength at the same time, Jones adds.
Special considerations: Lifting heavy weights above the waist can aggravate back pain, Dailey warns.
Also, holding weights over the head or doing bicep curls fully extended can create more shoulder and arm discomfort, she says.
Women with arthritis should never lift weights on days with active inflammation of joints (redness, warmth and swelling) or they risk greater injury, she adds.
What’s Your Fitness Style?
Some people find it easy to wake up at 4:30 a.m. and go for a five-mile run, while others simply hit the snooze button. Aspects of your personality determine the kind of exerciser you are, so if you're in a fitness rut, it's time to put your unique interests back into the workout equation.
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