How to safely exercise for chronic pain (without suffering later)
Everyone with chronic pain has been here:
Today is the day you’re going to try to walk a mile in your neighborhood. After all, you used to log 4-5 miles in your daily walks easily. One mile shouldn’t be too hard.
So you lace up your sneakers that you haven’t worn in a few months, and you stroll down to the end of your block.
Okay, this is good. I’m doing good. It’s not so hard after all.
You cross over to the next block. Just a few more blocks, and you’ll hit your local coffee shop, which is exactly half a mile from your house.
You’re taking it slow, and yet, by the third block, you start to feel your lower back tensing, your breath shallow, and your legs fatigue.
It’s just two more blocks! You think to yourself. You can push through!
By the time you’re at the coffee house, you are dragging your feet, your back is now giving you sharp pains, and you can barely catch your breath.
Now there is the daunting task of returning home.
You don’t know how, but somehow, you made it back home and onto your bed. You’re so exhausted by the exertion that you don’t bother changing out of your sweaty clothes.
For the next few hours, you try to nurse your crying lower back. You haul yourself into the kitchen to grab yourself a piece of toast, and haul yourself back onto bed.
For the next few days, you are mostly bed-ridden. You try ice, then heat, then ice again, on your lower back. Your whole body feels like lead, and it is not responding to you. Staying hydrated helps, but then the task of just walking to the bathroom is too strenuous.
For a week you stay in bed, depleted by that 1-mile walk. By the time you feel better, you are too afraid to go out again. You don’t want to repeat that same experience.
Avoidance does not help
The classic aftermath of that experience is to avoid repeating that same experience again, which is absolutely a smart thing.
However, the mistake here is that now we associate walking with pain, and so we decide we should never take walks again.
That is simply not true.
We cannot let the anticipation of pain trap us in this cycle. Instead, we look at how we can take walks without straining our bodies, without depleting us, and make it more enjoyable.
In other words, how can we approach a movement or activity from a different angle, strategy, mindset, and intensity?
Key questions to ask yourself when participating in a movement/exercise
There are 4 key questions to inquire and be curious about when participating in a movement and/or exercise.
Am I/ Is this safe?
Will I be okay later?
Can I calm my breath?
Can I reduce my body tension?
AM I / IS THIS SAFE?
Pain helps protect us, but sometimes it can overprotect. It can give us confused signaling even in an environment that is safe, because pain is a feedback cycle that causes the brain to learn how to feel more pain.
The first step in breaking out of this cycle is to honestly ask yourself: Is this safe?
While you may perfectly well know that there is little danger walking down a few blocks from your house, your body may not know that. Instead of asking yourself intellectually if something is safe, ask your body if it feels safe doing this specific activity. The answers may not always line up between what you know intellectually and what your body feels.
When there is evidence of safety, the brain and body relaxes. As they do so, overtime, they release less pain signals.
Trust what your body feels, and if you are still unsure, use the following questions to guide you in making a decision whether this movement/exercise is the right one for you or not.
WILL I BE OKAY LATER?
Though this may take some trial and error, most of us will eventually know where our boundaries and edges are when it comes to movement and activities.
The trickier bit is to know when to stop especially when we are feeling good in the moment or having a good day from chronic pain. After all, don’t we want to take advantage of this good day to knock down some more errands, tasks, and exercising?
But that is when the crash may happen. Knowing very clearly where our boundaries are and learning to pace ourselves are key.
Ask yourself honestly: Will I be okay later?
Will you crash? Will you have to “pay for the consequences” later if you push through now? What is the smartest thing to do now?
We want our body to trust our decisions. If our body does not trust what we do, it won’t feel safe. As a result, it will keep sending pain signals to us to prevent us from doing anything. By knowing when to stop, our body will slowly start to feel safer in our decisions, and dial down pain alerts, knowing that it will be taken care of.
CALM I CALM MY BREATH?
Breath is a very good indicator of the level of stress in our body.
Our breaths reflect our physiological, mental, and emotional states (short, shallow breaths when we feel unsafe, stressed, angry, upset, etc, and long, smooth breaths when we feel safe, supported, and calm). Being in tune with our breaths ultimately can let us know whether we have gone too far in pushing our boundaries.
Sometimes, when engaging in activities that require some effort, our breaths naturally become quicker as our body requires more oxygen to generate energy. A good indication on whether we are working within our boundaries is to see whether we can calm our breaths while engaged in this activity. If yes, then we can assume this movement at this intensity is safe and okay. If not, then we most likely need to dial down the intensity until we can calm our breaths, or let ourselves rest.
Regulating our breath helps regulate our nervous system. Breath can be a natural analgesic. Breath helps with relaxation. During relaxation, the body naturally produces hormones that are endogenous (naturally produced in your body) pain killers.
When the breath is calm, the nervous system is calm. When the nervous system is calm, the body feels safe. When the body feels safe, there is less need for it to generate pain signals.
CAN I REDUCE BODY TENSION?
When the body tenses up, it usually means your nervous system is already agitated and in a fight-or-flight mode. Body tension creates more body tension, and more body tension and an agitated nervous system create more pain sensations.
Along with calming our breath, if we can reduce our body tension while doing a certain movement or exercise, it will ultimately help us more with more ease and less strain.
Monitoring your body tension is also a good way to tune in to how much your body can be challenged without being overly strained. You DO want to challenge your body, but within the boundaries where you feel safe, where you know you will feel okay later, where you can calm your breath, and where you can keep your body tension low.
Applying the 4 inquiries
Let’s use the walking example here again. Take number two.
You step out of your front door and down your driveway. You look around at the evenly paved roads in your neighborhood, and clear STOP signs. You think to yourself: Okay, I am in a safe place. There is little chance of me tripping over an unevenly paved street.
You manage to stroll down to the end of your block, and you check in with your body: Do I still feel safe? If I keep going, will I be okay later?
With nothing much planned for the rest of the day or tomorrow, and sensing that you still have a little bit of energy and nothing is flaring up, you decide to go for another block.
By the middle of the second block, you start to notice some tension in your lower back and your breath starts to become shallow. You slow down your pace just a little and try to regulate your breathing. Inhale, exhale. You feel a little better now, and you focus on reducing some body tension.
By the end of the second block, your lower back tension isn’t going away, so you rest there for a few minutes, keeping your breaths calm and practicing some stretches to see if the tension will resolve.
The tension continues, though not badly, but you know what if you keep pushing, you might not be okay later. You decide that the wise thing to do is to head back to the house and pat yourself on the back for accomplishing a walk today.
You return home and pour yourself a glass of water to rehydrate. There is some fatigue in your body, but over the next few hours, as you rest, that weariness is manageable.
By the next morning, you don’t notice a flare in your lower back, and your energy levels are pretty stable. You know that you have been very in tune with your body the previous day, and challenged it to just the right level while honoring its boundaries. You feel good, and tomorrow, you will try the walk again, paying just as much attention to these 4 key areas as you had yesterday.
Maybe you are able to cover more than two blocks the next day. Maybe you don’t. But the objective is that you learn how to better read your body, manage energy levels, and challenge your body within its edges so that you need not be afraid of doing certain activities.
You just need to approach them from different angles, strategies, mindset, and intensity.
Take your pain care journey one step further
If you are ready to not let your chronic pain run your life anymore, to become more independent in your own pain management, and create yourself a life of resilience, then you, my friend, are ready for the Becoming Resilient program. In this program, you will be with a community of chronic pain warriors just like you, learn practical and evidence-based pain management strategies that doctors don’t tell you about, and experience gentle yoga therapy to help you move with more ease.
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