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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.