Pain is often a criterion to stop exercising. Or at least until that pain subsides. But, what if that pain has no intention of disappearing anytime soon. Should we just become sedentary? As fitness professionals, we know the importance of physical activity. So, how should we prescribe exercise to those with chronic pain? That’s the question we’ll be answering in this article.

What Is Chronic Pain?

Pain is typically associated with injury or trauma. After appropriate treatment, this pain usually subsides. Yet, sometimes this pain continues. Chronic pain is defined as pain that continues past typical tissue healing time, despite medication or treatment. This is generally accepted to be 12 weeks. 

Chronic pain may also arise without injury or trauma. Chronic pain may also be a byproduct of other conditions such as diabetes, arthritis, fibromyalgia, irritable bowel syndrome, and back pain. Sometimes chronic pain arises without medical detection. 

Chronic pain affects 34% of people in England and 20% Scotland. Whilst some may be aware of the cause of their chronic pain, many others have no identified cause of pain.

Chronic pain has negative implications for an individual’s quality of life. Chronic pain contributes to disability, anxiety, depression, poor sleep, and increased medical costs. While exercise might not cure pain, it can reduce its debilitating effects on life.    

Prescribing Exercise To Those With Chronic Pain

Gone are the days where rest is the prescription for chronic pain. More and more health professionals are encouraging their clients to incorporate exercise into their daily routines. But, we must remember clients with chronic pain possess a whole set of challenges that make exercise prescription particularly tricky. We also need to ensure our programs are sustainable yet effective. 

As exercise professionals, we need to find a balance between physical activity, exercise, and relaxation. Notice the difference between physical activity and exercise. Physical activity refers to movement throughout our day. This may be as simple as a walk or doing chores. Exercise refers to structured exercise in the form of a workout or playing a sport. 

Physical Activity

As mentioned, physical activity refers to movement throughout the day. Without frequent movement, our muscles and joints stiffen up and stop working properly. For those with chronic pain, we want to stimulate our muscles and joints throughout the day to offer acute pain relief. Prolonged periods of sedentary behaviour can also be mentally draining and disruptive. Chronic pain is linked to stress and sadness. Regular movement helps clear our minds and releases happy hormones to help us deal with our pain.

Encourage clients to incorporate movement into their day to day lives. Ideally, work with your client to identify where activity can be placed into their routine. This might be walking to and from work, or during their lunch break. Encourage clients to make small changes such as taking the stairs, or performing a couple of stretches every time they take a bathroom break. 

Exercise 

A common fear among those with chronic pain is exercise will increase their pain. We need to ensure our clients aren’t put off by exercise by ensuring workouts aren’t overstimulating. Clients with chronic pain won’t benefit from burnout sets of weight training. Instead, we should focus on lower-intensity exercise that is going to provide benefits without causing too much fatigue. 

Work with your client to find what intensity and type of activity suits them. Make it enjoyable so your client isn’t put off by the prospect of exercise. Swimming is a suitable form of exercise for people with chronic pain. The buoyancy of the water can make exercise feel easier on the muscles and joints. If your client isn’t keen on swimming, fitness classes can also be performed in and out of the water. 

Communicate frequently with your client to find out what is and isn’t working. From here, adapt as necessary. Find that balance between motivating and challenging your client, and keeping them determined and motivated. 

Relaxation 

Recovery and relaxation are just as important as the exercise itself. When the body feels stressed it releases hormones that cause tension and anxiety. For those with chronic pain, this is physically and mentally less than desirable. The additional tension can make the pain worse and the added anxiety can reduce motivation to exercise. 

Targeting these underlying problems may help with the cause of chronic pain. It is suggested that a person’s psychological perspective to pain can also play a large role in their ongoing physical ability levels. To encourage relaxation, prompt clients to follow the five steps to mental wellbeing; connect with others, be physically active, learn new skills, give to others, and practise mindfulness. Similar to physical exercise, these steps to mental wellbeing might not cure the problem, but they can reduce its debilitating effects on life.    

Referrals 

While we try our best to assist our clients, there’s a time we might have to refer. It’s our job to keep an eye on our clients mental, physical, and social well-being. If our clients’ health deteriorates beyond our control or they aren’t managing their condition in the way we both are hoping, we should encourage our clients to speak to their GP or seek further support from other health professionals such as Physiotherapists, Osteopaths and Psychologists. They can assist with potential medical, physical, or mental health.

Conclusion 

Chronic pain can be a debilitating condition affecting 20% of the population. Chronic pain might not have an underlying cause, thus making it difficult to treat. Exercise has been shown to effectively help relieve symptoms associated with chronic pain. Alongside structured exercise, clients should also be encouraged to add movement to their day to day routine. Regular exercise and movement can help reduce pain and improve your client’s quality of life and mental wellbeing.

Work with your client to create a program that is both challenging and sustainable. We don’t need to prescribe an Olympian-style training plan to reap the benefits of exercise. We just need something that’s going to increase the heart rate, stimulate the muscles, move the joints, and release those feel-good hormones.

To assist with mental wellbeing, encourage clients to follow the five steps to mental wellbeing; connect with others, be physically active, learn new skills, give to others, and practise mindfulness. Chronic pain doesn’t have to have a negative effect on your client’s life. 

Read more about Chronic Pain from Versus Arthritis here.