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Exercise and Persistent Pain

Author: Kyle Aitken, Registered Physiotherapist

Chronic pain is a challenging beast. It can rob you of the things you love to do, impact your relationships, and challenge your identity. Unfortunately, there’s also no “Thanos-eque” snap-of-the-finger-quick-fix, despite what you see on the late-night infomercials. BUT! That doesn’t mean things are hopeless. There are still many, many ways to improve, get out of pain, and get your life back. 

One of the most important things to understand about chronic pain is that it’s incredibly complex and unique to the individual. Learning how to manage your pain can take some time, self knowledge, effort, patience, and creativity. This is because there are many aspects of your individual situation and environment that can contribute to your pain, whether it’s your physical activities, your habits, your emotions and mindset, and your social support system. These all need to be taken into consideration when developing a plan of action.  

Exercise is a vital component of any chronic pain rehabilitation program as it helps manage so many contributors to chronic pain. To understand this further, let’s take a very simplified look at what exactly chronic pain is and how it develops. 

Chronic/persistent pain is characterised by a pain response that exceeds what our nervous system expects relative to the state of a person’s tissues (ie. and injury has healed, but the pain remains.) We know that as pain persists, it becomes less and less about the state of your tissues and more about the sensitivity of your nervous system. 

Imagine pain as a house alarm, but for your body, it’s an alarm indicating potential threat to your system. As pain persists, this alarm starts tripping in situations where it doesn’t need to. Instead of someone trying to break into your house, a bird landing on the windowsill is enough to set it off. While there is no danger, the alarm is sensitive to any disruption in the norm. Similarly, your injury may have healed on an X-Ray or MRI, but your alarm system can still continue to interpret a threat. 

The reason exercise is so beneficial is due to it’s ability to improve many of the things that contribute to nervous system sensitivity. It improves your tolerance to physical stressors/activities that your life requires; improves mood, stress levels, and sleep; gets you moving and participating in fun activities again; can help foster new relationships and connections, as well as many other aspects of your overall well-being that influence your pain sensitivity. 

The trick with chronic pain is often figuring out where to start. This is where seeing a physiotherapist is important. We can help you figure out what type of exercise may be most beneficial or meaningful to you and how much or how often you do it. 

Where people often go wrong is starting an exercise program that’s inappropriate for their current tolerances. They do too much, it flares up their pain, then they stop all activity to let it settle back down, leading to further frustration, helplessness, and the belief that that exercise won’t be helpful for them or is dangerous. The problem is likely not exercise itself, but rather the dosage. Any medicine requires the right dosage to be effective. Too much and you have side-effects. Too little and it has no-effect. Exercise is a stressor and that amount of that stressor needs to be carefully considered depending on a person’s pain levels and current/past activity levels. 

The human body and nervous system are adaptable. Just as your skin darkens in the summer to tolerate more sun, or how your body adjusts to the temperature of a hot tub. If we apply an appropriate level of stress (exercise), the body will adapt positively by getting more resilient to that stressor. From there, we gradually increase that stress over time as your body can tolerate more, until you’re back to doing the things you love to do. 

Below is a simple diagram to illustrate. Each of us have a “circle” of function that represents the activities our bodies are prepared for. After long periods of inactivity due to chronic pain, things that used to be within our circle may all of a sudden fall outside of it and trigger our pain. Physiotherapy helps improve your tolerance to these things through exercise and activity modifications, effectively growing the size of your circle. 

he Sp🎅🏻rts Physio on Twitter: "Yep seminal paper from 1995... but circles  are eas
he Sp🎅🏻rts Physio on Twitter: "Yep seminal paper from 1995... but circles  are eas
he Sp🎅🏻rts Physio on Twitter: "Yep seminal paper from 1995... but circles  are eas

When it comes to the type of activity, the good news is that it doesn’t have to be some boring form of exercise you’re not interested in or not likely to stick too. Anything can be used to help improve the size of this circle. The key is finding something you enjoy that gets you moving. This could be exploring local Hamilton trails, running, walking, biking, dancing, rock climbing, strength training, kayaking… You name it. Anything combined with the right dosage can be used to help you improve your body’s daily function, activity tolerance, and pain. 

If you’re struggling with chronic pain and having trouble getting started, give us a call, text, or email and we can chat about how physiotherapy can help get you back to doing the things you love again. 

Quarantine Tips for the Combat Athlete

It’s been a challenging few months for staying active. We saw the closures of our favourite Hamilton gyms, dojos, studios, trails, and outdoor workout spots. Many people are anticipating the imminent opening of gyms and workout spaces. However, for martial artists, especially in grappling and close combat sports the wait may be a bit longer. 

Having competed in martial arts for many years and being sidelined by injury, I know what it’s like to sit on the sidelines. Here are some tips I’ve gathered from personal experience as a fighter and physiotherapist as well as from the scientific evidence about staying in fighting shape and mitigating injury risk during downtime.

  1. Go back to the basics.
    We all remember our first day of training. For many people so used to the strict movement patterns of weightlifting, or other sports, being asked to contort into different positions seemed insurmountable. As we advance in our techniques and combat sport vocabulary we take the basics for granted. But even the strongest buildings need foundation work now and again. Now is the time to go back to those early movements: bridging, shrimping, rolling, bear crawls, crab walks, and any other weak links that need work. For striking sports it would be basic kicks, stances, and movement patterns.
  2. Train both strength and muscular endurance.
    These two systems are very important in a well rounded combat athlete. If you don’t have the strength to push your opponent off of you, or if you don’t have the muscular endurance to hold onto a submission it’s tough to make any headway. Strength is trained at lower reps, higher rest, and higher weight (think squats and deadlifts) while muscular endurance is trained with higher reps and lower rest between sets (think sprinting, jumping etc). Now is a great time to work on muscular endurance. Find a field, get to the stairs and put the work in.

    In addition to becoming a better fighter, training those two energy systems are important when preventing injury. Which brings us to our very important third point:
  1. Train at end range.
    Injuries are a part of combat sports. By its very nature a submission is designed to force your partner to ‘tap out’ in order to prevent themselves from sustaining injury. While no injury is 100% preventable, we can increase our resilience and ability to control vulnerable positions.

    Many grappling injuries happen when joints are taken to their end ranges. When you’re strength training, it’s important to make sure you are working a full range of motion, especially those extreme ranges where injuries can happen. When you’re strengthening, completely straighten out your knees at the top of a squat, Work your shoulder at its most vulnerable point (90 degrees of abduction and external rotation.) If you have strong dynamic structures (muscles) supporting the passive joint structure (ligaments), it will help mitigate the most common grappling injuries. Most of us are not strong in these positions so take it slow and build the strength over time.
  1. Focus on recovery.
    We all feel like we’ve been in a constant state of recovery over the past months. But resting on the couch with a bag of chips until 2 am while watching the latest episode of your favourite Netflix show isn’t true recovery.

    When we talk about injury rehabilitation at Revive, we spend a lot of time focusing on what happens outside of training sessions. Many injuries aren’t as much a result of training stress as they are poor recovery from training stress. Remember, exercise is (positive) stress we put on our bodies, how we adapt and grow depends on how we recover.

    Take this time to focus on creating a positive routine around the important elements of recovery. Good sleep hygiene, good nutrition, and good stress management. If you have these pieces in place you’ll be amazed at how well you perform when you return.
  1. Remember why you started.
    Burnout and low motivation don’t just happen when you’ve done too much of something. Not having the social aspect of training, not competing and training at home without direction can all lead to low motivation and burnout. Take some time to remember why you started training. Watch some videos online, read some books (A Fighter’s Heart by Sam Sheridan is my personal favourite).

If you have any questions, have an injury that needs attention, or want to learn more about injury prevention, motivation and recovery, drop us a line at 289-941-4878 (text works too!) or book online at www.hamontphysio.ca

COVID-19 Appointment Protocol

While Revive Physiotherapy is now authorized by Ontario Public Health and the Ontario Physiotherapy Association to provide in-person care, there are a number of adjustments made to our appointment protocol that must be followed to ensure client, staff, and community safety with each visit.

Please review the following steps to be taken before, during, and after each in-person appointment at Revive Physiotherapy. We appreciate your willingness to follow these standards and promote health and safety for all


On the day of your first appointment with Revive, or your first appointment back, we will require you to fill out an online ‘Client Screening Questionnaire’ no more than 2 hours before your appointment. This form ensures you are an appropriate candidate for in-person care, and are comfortable with the risks associated with an in-person appointment.


Your Physiotherapist will be wearing a mask and gloves for the duration of your appointment. Please bring a mask from home. If you don’t have a mask, or forgot yours, masks will be provided for your appointment. If you are unable to wear a mask please let your physiotherapist know prior to your appointment


Please leave as many personal items (Jacket, hat, umbrella, bag etc) as possible in your vehicle. We are a bike friendly facility and will still allow bike storage inside the clinic during your appointment. If you ride your bike, please leave all belongings in your helmet, backpack, or next to your bike.


We are proud of the fun and laid back culture we have created at Revive, and usually welcome your guests to hang out during appointments. At this time we are asking clients to refrain from bringing guests along.

Clients under the age of 16 should still be accompanied by a parent/guardian. 


Upon entering and leaving the clinic you are required to sanitise your hands using the hand sanitiser provided. 


After entering the clinic and sanitising your hands, please stand behind the blue line marked on the floor as you wait for your physiotherapist to come and get you.

Please avoid touching any surfaces while you are waiting for your therapist. When they are available, your therapist will bring you to the treatment space for your appointment.

We will be removing all reading material and reusable coffee cups from the waiting area until further notice.


The appointment itself will take place fully in the physiotherapy space – only under specific circumstances will clients be using the gym space.

This may mean that certain equipment will be brought into the office for your use during the appointment. All equipment is thoroughly sanitised after each client’s use


Since we direct bill most insurance companies, contact with the front desk will be kept to a minimum. If you must make a payment, we can do so by e-transfer, a credit card on file, or through a contactless transaction. The Point of Sale system will be kept at a distance from the front desk, and you will be informed when to tap when the time comes. We will not be taking cash at this time.


You will be asked to sanitise your hands again when exiting the clinic. Paper masks can be disposed of in the garbage by the door. If you do wear a mask, please sanitise your hands again after removing it.

After you exit the clinic all surfaces will be thoroughly cleaned and sanitised to be ready for the next patient.


Thanks so much for your cooperation. We can’t wait to see you all again while keeping it safe.


We’re Finally Back!

The re-opening of Revive Physiotherapy is very exciting news, particularly because it allows us to see all you wonderful people in the flesh once again. It’s definitely been a trying time for everyone; we’ve all drastically altered our lives to accommodate the situation before us. There is, yet, light at the end of the tunnel. 

We understand what a change of this magnitude can bring to our bodies; many of us have been completely displaced from our usual exercise routines and left to put together a rag-tag program. Pain, aches, and decreased levels of fitness are bound to arise, and often, we’re at a loss for how to attend to them. When you’re dealing with these worries, you just don’t feel quite at your best. We’re here to get you back on track; back to doing things that make you, you.

Just as your body can take a bit of a hit amidst months of general decreased activity, so too can you rebound, perhaps even better than before. The key is to do it intelligently, which is our expertise. Far too often, people begin to jump back into previous levels of activity without a plan, which can result in injury, pain, and set you back even further. 

No matter what ails you, we want to help you understand what’s going on, and craft a plan that best fits with your predicament. When you leave, we want you to feel confident in your ability to manage your problem. 

Starting from a comfortable baseline, we’ll guide you through a series of progressive sessions that lead to your ultimate goal – from rehabbing a particular injury to reaching new levels of fitness, and everything in between. The expectation is not to get you in for a predetermined number of visits for a predetermined amount of time; the goal is to work with you as a human being and adjust as your rehabilitation progresses.

When you see us, you’ll be getting 45 – 60 minutes of strict 1 on 1 time with your physiotherapist. There’ll be full gym access, and all necessary precautions will be in place (see above). We want your return to Revive to be a safe, impactful, and productive experience!

We can’t wait to see everyone again!

– The Revive Team

Exercise at Home During COVID-19 – A How To Webinar

Making the switch from daily life and routines to working out at home is tough. There are so many online classes/routines it’s overwhelming. How do you create a sustainable home workout program?

Join Julian Quaglia PT and Alan Richter PT of Revive Physiotherapy in Hamilton, Ontario as they walk you through the process of designing an intelliegent, custom, and targeted home workout program using equipment you may already have.

Wednesday May 13th. 5:30pm
Password: 3WsNx8

Click here to begin