For those with chronic pain, developing a fitness routine can be a frustrating process. Finding the right balance can be worth the challenge.
Starting at age 14, widespread body pain and bone-crushing fatigue gradually eroded my energy levels and mobility before setting up roadblocks and booby traps around my love of exercise.
From family hikes to embracing the burn while playing basketball or at the gym, much of my happiness growing up hinged on my body’s ability to flow freely.
Developing chronic pain forced a change I never saw coming: I was terrified to move in case it triggered a flare-up.
For the 51.6 million U.S. adults experiencing chronic pain and 17.1 million living with high impact chronic pain, movement can morph into a looming shadow resulting in a significant restriction on daily activities.
The causes of chronic pain are numerous, spanning everything from rheumatoid arthritis and TMJ disorder to chronic migraine and irritable bowel disease. Its definition, however, is simple: Chronic or persistent pain is any pain that lasts for longer than 12 weeks, despite medical intervention.
With 1.5 billion adults globally living with chronic pain, developing exercise routines and methodologies that apply universally is difficult. The manifestation of chronic pain is just too variable.
Nearly 15 years after the first invisible lance of pain speared my ribs, I believe I have a relatively complete understanding of my chronic illnesses. The headliners, which inflict the most prolific pain, are endometriosis and fibromyalgia.
My relationship with exercise died a slow death over the first decade. Fatigue obliterated my once boundless energy, and my tolerance for pain was tested like never before. Movement got increasingly difficult. At points, I needed a cane to ease the pain when climbing stairs or walking for long stretches.
Numerous doctors and physiotherapists prescribed exercise, but I often couldn’t tolerate the pain, and when I did, I pushed beyond my capabilities and triggered flare-ups that would force a week-long retreat to my bed.
Eventually, I developed mild kinesiophobia, a fear of movement, which one study estimated affects 51–72% of chronic pain patients. Ultimately, becoming stagnant made my pain significantly worse.
Chronic pain is often overwhelming, and it feels particularly intimidating early on, making a sedentary lifestyle or a temporary ceasefire on all exercise attractive options.
Josephina Worrall, a medical translator who developed chronic pelvic pain 2 years ago while in the late stages of pregnancy with her daughter, also felt the impact of the loss of her ability to exercise keenly.
“I used to run, swam a lot, was out on my road bike a lot, lifted weights a few times a week, and I did lots of hiking,” she says. “When the chronic pain started, I just had to stop absolutely everything. Alongside the physical pain itself, that loss of this huge part of my life, my identity and my social life, felt almost as big a loss as the pain.”
The studies into the relationship between chronic pain and exercise are varied, numerous, and often confusing for chronic pain patients to follow.
Overall, however, the research shows that increased movement is beneficial for chronic pain patients. One study concluded that consistent aerobic exercise increases pain tolerance.
Though just because something is likely to help us doesn’t make it easier to do.
Living with chronic pain is exhausting, demoralizing, and frankly, heartbreakingly unfair. Exercise teases us with the promise of increased mobility and reduced pain, yet threatens heightened pain or a fatigue wipeout if not carried out correctly.
“The hardest thing about chronic pain, whether it’s fibromyalgia, or any number of chronic pain that falls into chronic, persistent pain, is that the thresholds to trigger an alarm in the nervous system are much lower,” explains Dr. Erson Religioso III, a physical therapy doctor with 25 years experience.
As a result, flare-ups are likely during the trial and error stage, especially if you commit too hard to something you’ve been convinced is a magical cure. Personally, I made this mistake twice by pushing my joints too hard in yoga and overtraining cardio, neither of which were effective.
Recent studies indicate that exercise programs that include a range of activities, such as aerobic, resistance, and flexibility, can result in a marked reduction in pain. Religioso agrees, advising a combined approach for the best result.
“It can’t be one or the other. It can’t be no strength training or only strength training; it has to be somewhere in the middle — that’s the best of both worlds, where you get cardio to raise your heart rate, plus also getting some strength training in,” he says.
The best place to start is getting to know your body. Identify trigger points, measure your limits, and then mold a routine that works for you.
Zoe Haydn Jones, director of Jobs for Women and a yoga teacher, lives with chronic migraine and pelvic congestion syndrome. Jones initially stopped exercising altogether because her pain was debilitating, but now has a regular routine built on a keen understanding of her body.
“I have had to become so in tune with what my body needs, including what it can and can’t do,” she says. “High-impact exercises like running can exacerbate chronic migraine, and I can’t run on my period due to the pain. Instead, I focus on low impact activities like yoga and walking, which are less stressful on the joints and are a great way to stay active without aggravating the pain.”
“Being in tune with my menstruation cycle is my indicator,” she adds. “I also listen to my body, and if it’s midway through the cycle and I get a very bad migraine [episode], I take a rest and stop. Our bodies know best.”
Learning your body’s new needs will take time, and it’s far from a perfect system. With over 15 years of chronic pain experience under my belt, I know not to trust too much in what my body can currently do because it’s often subject to change.
“Listen to your body and adjust your exercise routine accordingly and rest when you need to,” advises Jones. “If you experience pain every day, keep a diary so you know when you feel strongest or to detect a pattern that you can work around. Living with chronic pain is about finding the best quality of life you can and staying true to you.”
I reintroduce myself to my body regularly by keeping track of my symptoms and adjusting my routine accordingly. Bizarrely, developing chronic pain also helped free me from chasing beauty standards. I no longer exercise to look slender — I do it to feel strong.
Worrall found a perspective shift helpful too.
“I’ve had to change the reason why I do exercise. I think a lot of it before was about trying to be as skinny and strong as possible, very appearance-based goals,” she says. “Whereas now, I set my goals as to keep my body moving in some way. That’s literally my goal: just keep my body moving.”
“One of the paradoxical things about chronic pain is that the best way to build up your threshold is just to essentially poke the bear,” says Religioso. “The bear might get angry, but even if you have a major flare-up, every flare-up ends and that’s one of my messages to patients.”
However, poking a wild beast should be done delicately. I jumped headfirst too quickly, and I was mauled on multiple occasions before I carved out a routine that respected all of my limitations.
At first, I took every “good pain day” as an opportunity to push myself to the limit, meaning 2–3 hours of gym time once or twice per week and then remaining sedentary or bed-bound the rest of the time. It failed to rejuvenate my energy levels or ease my pain, instead resulting in more time in bed and a reliance on pain medication to cope.
It took a lot of tinkering before I got the balance right.
Now I know a combination of hiking, dancing, daily mobile and static stretching, combined with physiotherapy and weightlifting, is the right recipe for my body. I got there by starting with basic physiotherapy exercises and building one block at a time. I test my limits carefully and incorporate adaptations where necessary.
When weightlifting, I use foam pads to ease the pressure on sensitive pressure points and reduce the weights when my fatigue or pain levels fluctuate. While hiking, I force myself to turn around at the first spike of pain, not the tenth, and I am carefully building supplementary routines that target the weaker points of my body, such as my lower back. Over time, I’ve gradually increased the regularity and intensity of my workouts in correspondence with health and pain tolerance improvements.
Even when poking the bear, however, it’s important to be mindful of our limitations.
“The easiest way to trigger that alarm is to go over your capacity, and the easiest way to go over the capacity is to do the same thing over and over and over again,” says Religioso. “It could be that you’re doing a lot of squats or deadlifts or something that could actually cause a flare-up because if you do too much again without a good enough rest or you just do too much too soon, then it’s easy to trigger the alarm.”
This is where pacing comes into play.
Pacing means adapting your life to meet the needs of your chronic pain by not pushing your body past its point of intolerance or into a flare-up. Basically, it means slowing down to a snail’s pace and then building a carefully paced routine that works for you.
“With cycling, I started very slowly and very, very gently for short periods of time,” says Worrall. “I have learned what my triggers are, I know that exercise is too strenuous if I can feel myself tightening and clenching my pelvic floor muscles.”
“It’s a huge mindset shift, mainly because pre-pain I was used to pushing my body to its absolute limit. That is so far from being the goal now. I think I just try and keep in mind: gentle, short, and enjoyable,” she adds.
“The easiest answer is: You have to be an advocate for yourself — no one can help you out of the hole, you have to climb out of the hole,” says Religioso.
I froze for a long time with chronic pain. Accepting that no miracle cure could or would return my old body to me was an excruciating lesson to learn, but it was worth it.
I failed a whole bunch, and I gave up numerous times. Tuning my relationship with exercise has stopped me from trying to reclaim my old body. I learned to refocus on embracing the new one I’m building.
A few years ago, there were days I could barely get up a flight of stairs. Now I’m squatting over 100 pounds, and my energy levels are the highest they’ve been since pre-illness.
Having good health is often luck, but prioritizing preventive health measures is not. Keeping your body fluid and moving is not a cure for chronic pain, but it is a coping mechanism worth investing in.
Medically reviewed on June 07, 2023
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