Step 3: Become Physically Fit – Use it or lose it!
Often individuals with chronic pain stop being active and proactive; they let pain rule their lives. This leads to loss of independence, loss of self esteem, and loss of self confidence. Inactivity leads to weakening of muscles, loss of flexibility, loss of stamina, and weight gain. These symptoms are known as physical deconditioning and disuse syndrome.
The following are consequences of prolonged physical inactivity:
- Muscle deterioration or atrophy
- Reduced joint flexibility
- Increase body fat in proportion to muscle mass
- Decrease resistance to infection
- Decrease in sex hormones and sex drive
- Reduction of brain chemicals, leading to increased depression
Exercise is one of the most important ways to fight back against chronic pain. The following body chemicals are changed by regular exercise.
Walking, swimming, stretching, yoga, Pilates, and gentle aerobics cause the release of endorphins which help lessen pain, fight depression, and improve self esteem.
Pain relief from exercise, in part, comes from the release of endorphins from the pituitary gland in the brain. Endorphins are ten times stronger than morphine. Even better yet, your body does not build up a tolerance to them as it would if you were taking pain pills. These natural opioids not only flood the brain, creating physical and psychological relief, but also work on closing the pain gates in your spine.
Exercise also increases the brain’s supply of serotonin. Serotonin, one the brains neurotransmitters, is one of pain’s worse enemies. In fact the mental exhilaration or “runners high” usually attributed to endorphin release, is probably more a result of increased serotonin release. Many researchers believe this because they know that serotonin has far greater effect on the mind than do endorphins which mainly affect the body.
Although excess norepinerphrine release by the adrenal gland during extreme physical or psychological stress can actually jam the pain gates open, lesser amounts released during exercise will boost mood and energy. The net result is that norepinerphrine released during exercise will help fight pain.
As a patient with chronic pain, you may think there is no way you can safely exercise. But in reality, you can and should do some form of exercise to help yourself improve. There are some basic principles you must understand and incorporate into your exercise program.
Physical Exercise Programs: basic principles
- Find out your true physical limitations
- Live within your limitations
- Improve your activity tolerance/ Set Goals
- Improve self-acceptance
A. Recognizing True Physical Limitations
Discuss physical limitations with your health care provider. Ask for a referral for physical therapy. Take the time to learn your true limitations and the reasons behind them.
Many chronic pain sufferers limit themselves needlessly for a number of reasons.
- Fear and Avoidance. Learning about your condition and its limitations on your activities should alleviate unnecessary fear. As a chronic pain sufferer you must understand that hurt does not necessarily mean harm. Reasonable exercise will not break your spine or put you in a wheelchair.
- Distorted Thinking. You do not need to view activities as ‘all or none’. Thinking that “If I can’t do it the way I used to, I won’t do it at all” is self defeating. You need to make compromises in your approach to activities-pace yourself, take frequent breaks and find short cuts if necessary. Don’t give in or up!
- Secondary Gains. This is when you use pain as an excuse to avoid (or to gain) something based on your desires, not your true needs or limitations. An example of this is using pain as an excuse not to return to a job that you did not like in the first place. (Or avoiding exercise because you never did like it.) Stopping this behavior requires honest self examination.
- Physical Compensation or Overuse Syndrome. A natural reaction to pain is to overuse one body part to compensate for limited use of the painful body part. Limping, or using crutches because of pain may result in overuse of other body parts, resulting in additional pain. Excessive use of braces like those for the low back or neck will cause weakening of supporting muscles, thus leading to more pain. It is important to try to use as normal body movements as possible.
B. Improve Your Activity Tolerance
Take control by setting goals. First, establish a baseline for a particular activity. For example, measure how long you can walk or ride an exercise bike before provoking too much pain; be honest with yourself regarding how much is too much. Gradually and systematically increase your activity. Set small goals and keep a log to ensure success. For example, increase your walk or ride by one minute every 3 days or so as your tolerance improves.
Accomplishing your goal is extremely important. Do not stop every time you feel a small twinge of pain. If you know that the activity is not going to harm you, there is no reason to surrender to the pain. Admitting defeat is not the easy way out. You only succeed in opening the pain gates wider. You, in essence, allow your subconscious the approval to let pain through. Although it may be a struggle, you must take control and prove you are in charge by consistently improving your activity tolerance.
C. Living within Your Limitations
Learning your physical limitations is one thing but practicing them on a daily basis is another. Although some individuals know how far they can push themselves, they frequently find themselves doing too much and suffering afterwards. It is important to follow these principles:
- Strike a balance in activity; avoid too much and too little.
- Pace yourself.
- Use good body mechanics.
- Do warm up and cool down exercises
- Don’t let good days, enjoyable activities, or competition with others trick you into becoming careless and overzealous.
D. Improving self-acceptance
Regrettably, many individuals with chronic pain conditions suffer from low self-esteem. Inability to accept yourself and your limitations can lead to frustration, anger, stress, and depression. The following are some rules to help improve self esteem:
- A person with a physical limitation or disability is not less valuable than an able bodied individual.
- Think positively. Be thankful for what you have and what you can do.
- Channel your energy into skills that are not overly physically demanding.
- Do your best and be satisfied that you did so.
Accepting true physical limitations as defined by your healthcare provider and still challenging your body to improve its exercise tolerance is just one way you that can improve your condition and quality of life.