Exercising without triggering pain and symptoms

2017, Responses from: Cate Grace and Leanne Wait

Can you exercise without provoking or triggering more pain and symptoms?

Cate Grace: Absolutely! The research tells us that exercise can often help reduce pain and improve your quality of life but often because we are in pain, there’s a temptation to skip exercising. Everyone can do something, we just have to be mindful that exercising with pain is a fine balance, between doing too much and not doing enough.

Set out to discover what exercise you can do by discovering movement and activities you enjoy and can do without increasing your pain by more than two points from your baseline. It may look different than you knew before, maybe its walking instead of running, swimming instead of cycling, aqua class instead of hip hop. The possibilities are endless.

Seeking advice from physiotherapist or a registered exercise professional who understands chronic pain can assist in working out varied solutions and specific plans that work with your pain, and current levels of functioning. All the best and remember to keep in the back of your mind the benefits of exercising and aim for activities you enjoy doing!

Leanne Wait: Exercise has a well-established part to play in a management plan for anyone with persistent pain however there is a right type of exercise and amount for each individual. Too often patients are told to go and exercise so do too much or the wrong type of exercise which increases their pain and or symptoms and continues the cycle.

Current pain science tells us that for anyone experiencing pain for 3 months or more no matter what the cause will develop changes in their nervous system as the body tries to adapt, cope and protect us. This phenomenon is called “Central Sensitisation” and contributes to the complexity of persistent pain of any cause.

If you have had pain for more than 3-6 months you should expect the increase in nerve signals to cause signs and symptoms to be worse with only minor triggers, last longer and things that would not normally cause pain will begin to trigger symptoms. If this is the case, then even simple small amounts of exercise can cause trigger pain and deterioration in symptoms. This in turn can lead to fear of movement as seemingly minimal exercise has previously triggered pain.

Exercise is an important part of any treatment plan as has many established benefits. Exercise can also help calm the nerves that are sensitised as long as the appropriate exercise, duration and intensity are chosen. Activity where there is a strong pelvic floor component like running, pilates, boot camp or core training in a gym are not usually helpful in anyone with pelvic pain due to in most cases overactivty in the pelvic floor. By working the pelvic floor more symptoms often increase – this could be noticed as bladder pain urgency or frequency, bowel pain, altered form of the bowel motion or bloating or increases in abdominal pain. Pain with intercourse or even pain with movement are also common when exercise has been overdone.

So the question is can you exercise without provoking or triggering more pain and symptoms?

The simple answer is yes! Where to start depends on how much you are currently able to move without provoking protective pain or symptom changes. Obviously, that means everyone is different. Sometimes we have to start with “graded motor imagery” where we imagine movement. Others can start with much more but either way the progression needs to be SLOW.

My experience is that any exercise needs to be individually tailored and graded which means a very slow gradual increase in activity with the focus on preventing flare ups and triggering an increase in symptoms. Sometimes my patients start with a 5-minute walk or 2 or 3 gentle yoga exercises prescribed to meet their individual needs. If they feel the benefits then after 3 trials we increase the intensity, load OR how long they exercise for. Understandably this can be very frustrating but is the way to your exercise or fitness long term goals. Fitness professionals not familiar with pelvic pain will be unaware of the potential to increase symptoms so inadvertently while trying to help often make the situation worse. It is therefore important to access pelvic health physios or fitness professionals familiar with this unique situation or even better work together to optimise individual client outcomes.

Visit Physiotherapy New Zealand Find a Qualified Physio in NZ now | Don’t Say OH! Say Physio to find an “Experienced Pelvic Health Physiotherapist” near you.

Nijs, J , Kosek, E, Van Oosterwijck, J, Meeus, M. (2012) Dysfunctional Endogenous Analgesia During Exercise in Patients With Chronic Pain: To Exercise or Not to Exercise? Pain Physician 15 (3 Suppl), ES205-ES213. 7 2012. http://www.painphysicianjournal.com/current/pdf?article=MTcxNw%3D%3D&journal=68

Nijs, J., Lluch Girbés, E., Lundberg, M., Malfliet, A. and Sterling, M. (2015). Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories. Manual Therapy, [online] 20(1), pp.216-220.

Evans S. (2013) Managing chronic pain in girls and women. Medicine Today 14 (5): pp54-58. http://www.drsusanevans.com.au/managing-chronic-pelvic-pain-in-girls-and-women/

Vandyken, C., MDT, C. and Hilton, S. (2012). The Puzzle of Pelvic Pain. Journal of Womenʼs Health Physical Therapy, 36(1), pp.44-54.

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