Chronic Pain and Exercise - We've got your back!

Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. There are many different types of pain, the two most common being acute and chronic pain. 

  • ACUTE PAIN – generally occurs due to a sudden onset or incident. Often a sharp, severe pain that is directly related to tissue damage such as a sprained ankle or a paper cut. Acute pain is often short-lived (less than 3months) and gradually resolves as the injured tissues heal. 

  • CHRONIC PAIN – A persistent pain lasting more than 3 months, where the pain can become progressively worse and reoccur intermittently, usually occurring after injuries have healed. Chronic pain can cause significant psychological and emotional trauma and often limits an individual’s ability to fully function. 1 in 5 individuals are affected by chronic pain, to the point that pain significantly impacts on their daily life. 

Lower back pain is the most common area for chronic pain, affecting 70% of adults. Some patients particularly focus on finding or fixing a problem, yet it’s not as simple as that. Unless experienced a traumatic event or an acute incident, many cases of back pain are considered non-specific, meaning back pain can occur for a number of reasons including; individual characteristics (age, weight, fitness levels), psychosocial factors (stress, anxiety, depression), occupational factors (heavy lifting, excessive bending, twisting and vibrations) and physiological factors including impairments to muscle activation patterns and weakness in both trunk and extremity muscles. All of which can lead to loss of lumbar stability and recurring lumbar spine injuries. 

The treatment of back pain is often a combination of many modalities and developing coping strategies to manage symptoms of lower back pain. Most individuals use passive treatments such as osteopathy, physiotherapy, remedial massage, and medications prescribed by their GP and see great results. However, if your doctor or allied health professional is recommending exercise as a treatment method, they are doing their job really well! Some may even refer you onto an exercise physiologist, whom specialise in developing and prescribing exercises for those with chronic condition and injuries such as lower back pain. 

More often than not, when we have chronic pain we don’t want to move. There is this fear of movement and the perception that pain means further damage. However, it is important to remember pain does not necessarily equal injury and not moving can actually be detrimental to your health and worsen your pain overtime. 

There have been many studies regarding pain and exercise as a treatment method. The main conclusion from research is exercise does not increase the risk of back pain or degeneration and may actually have a slight protective effect against back pain. In addition, those with a history of back pain have found regular exercise can reduce the risk of future episodes and reduce back pain intensity. The body loves movement and gradually being more active is an essential component to managing and treating lower back pain. 

Exercise can also be an effective tool to confront fears, reshape mindset and alter behavioural responses to pain. The saying “take control of your health and don’t let your health take control of you” is particularly appropriate for this topic. People with lower back pain may believe their pain may never go away so why bother trying. When in fact, exercise can help to improve trunk/core strength, flexibility, range of motion and overall fitness levels. Studies have found there is a higher rate of medication dependence and anxiety for those with chronic back pain. However, exercise can assist with mood and improve confidence, where research has identified exercise has been more effective in treating depression and anxiety than psychotherapy and antidepressant medication. In fact, your body produces its own pain relieving medication otherwise known as endorphins that work like the pain medication doctors prescribe. 

With that being said, it is important to remember each individual’s back pain is different, it’s subjective and there is no one size fits all approach. There is a difference between pain and muscle fatigue or muscles feeling the ‘burn.’ If there is one-side joint pressure, discomfort or  a sharp, sudden pain, that is a red flag and exercise should be modified or ceased. However, if you are pushing your muscles to fatigue, this is where the transformation of strength develops. To assist in recovery post exercise, stretch, stay hydrated and maintain a healthy diet. Research has provided some exercise recommendations for those with chronic lower back pain, these include:

  • Resistance Training – two days per week, where stabilisation and strengthening exercises of lower limbs and trunk are encouraged. A specific exercise program or Pilates are equally effective at improving strength and reducing chronic lower back pain. 

  • Cardiovascular Activities – It is known that people who are in pain have reduced aerobic capacities, compared to those with no pain. This is often due to pain restricting movement or fear of movement. Trying to complete some form of activity that gets the heart rate up such as walking, running, dancing, cycling, swimming at least 3 days per week for 15minutes. 

  • Mobility/Flexibility Exercises – minimum three sessions per week, greater results are seen from stretching five times per week. These sessions can be as simple as completing trunk and lower limb stretches morning and night. 

Here are some tips to think about;

  • Choose exercises you enjoy!

  • Try a range of aerobic activities – walking, cycling, swimming, hydrotherapy

  • Supervised sessions are encouraged during initial stages of exercise

  • Passive treatments work in conjunction with exercise and shouldn’t replace movement as the only form of pain relief/treatment

  • It is normal to experience discomfort/increased symptoms as they gradually become more active

  • Delayed onset muscle soreness (DOMS) peaks 1-2 days after exercise and can often be interpreted as exacerbation of back pain

  • Avoid exercises that increase pain down legs or arms

  • Don’t do more on good days and less on bad days – consistency is key

  • Start slow, start low and aim to grow

  • Consider talking to your doctor or allied health professional (exercise physiologist, physiotherapist or osteopath) in regards to an appropriate exercise program

References:

Exercise is Medicine Australia (2014). Chronic Pain and Exercise. Retrieved from http://exerciseismedicine.com.au/wp-content/uploads/2016/11/2014-Chronic-Pain-FULL.pdf

International Association for the Study of Pain (2017). IASP Terminology. Retrieved from https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698#Pain

Searle, A., Spink, M., Ho, A., & Chuter, V. (2015). Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomized. Clinical Rehabilitation, 29(12), 1155–1167.

Rainville, J., Hartigan, C., Martinez, E., Limke, J., Jouve, C., & Finno, M (2004). Exercise as a treatment for chronic low back pain. The Spine Journal 4(1), 106–115.

Megan May