Managing Chronic Pain with Exercise

Chronic pain affects up to 28% of American adults each year and is one of the most common reasons adults seek medical care. Chronic pain develops when the nerves that communicate pain to the brain become hypersensitive, causing the brain to perceive that area of the body as a potential threat and therefore painful beyond the normal healing timeframe. Exercise is an effective way to manage chronic pain by building muscle strength, reducing pain sensitivity, and improving mobility through targeted strengthening, low-impact aerobic exercise, stretching, and aquatic therapy.

Understanding Chronic Pain

Chronic pain is one of the most common reasons that adults seek medical care in the United States. It is estimated that 20% of American adults experience chronic pain with an additional 8% who experience frequent and debilitating chronic pain. Chronic pain is defined as pain that persists beyond the normal healing process, extending beyond 3 months.

Chronic neck pain and low back pain are among the most common chronic pain cases treated by physical therapists. Chronic pain also includes headache, arthritis, fibromyalgia, limb amputation, chronic fatigue syndrome, and pelvic pain. Diabetic patients may also experience neuropathic chronic pain, which involves damage to nerves and an experience of tingling, burning, or numbness.  

Chronic pain can seriously affect an individual’s daily activities and quality of life. Chronic pain can lead to a self-limiting cycle in which the individual reduces activity due to the pain, which reduces muscle strength, leading to more pain, increased rest, and even less activity. Too much rest can be detrimental to the chronic pain patient’s overall fitness and can contribute to atrophy of the muscles, which can lead to further health problems, less joint stability, and poor posture, exacerbating their pain.

Many chronic pain patients are prescribed opioids for their pain, which not only merely mask the persistent pain but can also lead to addiction while only providing acute relief, not long-term pain management. A JAMA study assessed 240 patients with chronic back, hip, and knee pain, comparing the pain of those prescribed opioids vs. those who had non-opioid treatment. The study found that after one year, those in the non-opioid treatment group reported less intense pain.

Chronic pain develops when the nerves that communicate pain to the brain become hypersensitive, causing the brain to perceive that area of the body as a potential threat and therefore painful even if there is no longer any acute tissue damage to that area. Pain functions as the body’s alarm system and the nervous system acts as the alarm. Normally, pain decreases as the nerves reduce their sensitivity once the injury heals. However, with chronic pain, the sensitivity of the nerves is turned up too loud for too long, leaving the individual with an extra sensitive pain alarm system.

How Exercise Can Help Manage Chronic Pain

Exercise is an effective way to manage chronic pain by building muscle strength, reducing pain sensitivity, and improving mobility in the chronic pain patient. Experts recommend chronic pain patients start with stretching and flexibility exercises to gently improve their range of motion, increase circulation to the muscles, and activate the calming parasympathetic nervous system. A 2017 review of 264 studies with 19,642 patients examined the impact of exercise vs. no exercise in adults with chronic pain. The review found that physical function was significantly improved as a result of exercise interventions and that patients experienced a reduction in pain severity.

Low-impact aerobic exercise can then be introduced. Physical therapists guide patients through a low-impact aerobic exercise program initially to slowly increase their aerobic ability, improve movement and coordination, and reduce stress on the body. The therapist carefully introduces graded exercise, which allows the affected body part (that is the source of chronic pain) to move gently and safely. This trains the brain to sense the problem pain area without eliciting and increasing hyper-sensitive pain messaging. Chronic pain patients often start with walking or cycling, aerobic exercises that are easy on the joints while being safe and effective. Both these activities increase circulation and build endurance, gently decreasing pain and stiffness in affected joints.

Aquatic therapy and water aerobics are other great options for chronic pain patients as exercising in water reduces the impact of movement on joints and eases pain and stiffness. Water provides buoyancy which provides offloading of stress on the joints while simultaneously providing resistance. The hydrostatic pressure of water that is experienced when moving in water can help increase the load on the respiratory system as fluids are driven towards the trunk. The hydrostatic pressure also provides support allowing the patient to gain better postural control.

The hydrodynamic drag forces of water allow for resistance to increase as the patient increases their speed, but once movement stops, resistance stops too. This allows the patient to have complete control over how much resistance feels safe to them. Researchers conducted a randomized control trial to evaluate the effectiveness of a water aerobics program for low back pain in 49 sedentary adults. The results showed that those who engaged in water aerobics 5 times per week over the two-month study period experienced a significant reduction in low back pain compared to the control group who did not participate in water aerobics.

As the chronic pain patient improves in overall fitness and builds strength through aquatic therapy, they can progress to targeted strength training. Resistance training targets specific muscle groups around the affected area or joint to build muscle strength and relieve stress on the joint. Strong muscles support the body and bones better, helping to ease pain. Researchers worked with 30 patients with chronic low back pain who had been experiencing back pain for 3-12 months and even more than 12 months using an intervention of core and gluteal strengthening and a lumbar flexibility program. After 6 weeks of the program, the patients were assessed. Nearly all the participants showed significant improvement in low back pain regardless of how long the back pain had persisted prior to the intervention.

Are you experiencing chronic pain? Managing your chronic pain with exercise under the supervision of a physical therapist can help you regain function and mobility!