Although exercising may seem counterintuitive for those living with chronic pain, experts say it can help improve function, mobility, and quality of life in the long run if done correctly.

About one in 5 adults or 1.5 billion people globally are said to suffer from chronic pain with prevalence increasing with age.

Chronic pain is typically described as pain in one or more anatomic regions that persists or recurs for longer than three months. Chronic pain can come in many different forms: musculoskeletal such as chronic lower back pain and osteoarthritis; chronic neuropathic pain caused by a nervous system dysfunction or disease; and chronic widespread pain or fibromyalgia.

Benefits of exercise

While patients who suffer from chronic pain may find it counterintuitive to exercise, there is a growing body of evidence that exercise is essential in reducing the severity of pain and improving the function as well as quality of life of patients.

Dr Darren Leong Kok Cheong, Senior Staff Registrar, Singapore Sport and Exercise Medicine Centre at Changi General Hospital  says patients can expect to glean physical benefits as well as a sense of well-being from an exercise plan that is correctly prescribed for and undertaken by patients with chronic pain.

“Aside from the benefits to cardiovascular and bone health, exercise can improve the gliding and lubrication of joints, making for increased joint mobility; increase muscle strength, balance and endurance as well as reduce flare-ups of certain conditions. Exercise also improves the function of nerves and intervertebral discs as movement facilitates bodily structures in their acquiring of nutrients,” explains Dr Leong.

“Endorphins, the body’s natural painkillers, are released during and after exercise, which increases pain tolerance, and brings about an improvement in mood that can help modulate or reduce anxiety and depression,” he adds.

Trust the process

According to Dr Mark Reyneker, Clinical Director and Founder of Family Podiatry Centre in Malaysia and Singapore  some patients with chronic pain can and do experience pain when exercising, even when done correctly. However, this should not deter them from exercising as the benefits in the long run are far greater.

“A study comparing a group of patients with knee osteoarthritis that persisted with the prescribed knee exercises, to that of a group that stopped when they experienced pain, found that the former group experienced improvements in their overall condition,” says Dr Reyneker.

“Some conditions that require stretching, not strengthening, involve undoing muscle stiffness or tightness that has been there for years. Undoing stiffness can be very uncomfortable but the discomfort is part of the process, and the exercise encourages increased blood flow to the joint which then helps the patient’s condition.”

Left: Dr Mark Reyneker. Right: Dr Darren Leong

Know your pain

In order for the patient to know that they are exercising correctly, Dr Reyneker recommends that the prescribed exercises are accompanied by very clear instructions and references, as well as explanations of whether pain during exercise is to be expected.

“For general non-prescribed exercises like gym work or outdoor running, you should not be experiencing any pain. If an activity makes the condition hurt, then you should not continue with it, and if it persists when you resume the activity, then seek help,” says Dr Reyneker.

Dr Leong recommends that the exercise session be fun and enjoyable in order to encourage patients to keep at it, and gradually scaled up in volume first before intensity. Patients should be closely supervised initially, with regular reviews on their progress conducted by the therapist or healthcare professional. As they become more active, it is normal for patients to experience increased symptoms or slight discomfort.

“From the onset patients should be educated and reassured that pain does not necessarily equal further injury. Patients should not overdo the exercise on good days when pain is better, and not cut back on bad days. In relation to exercise for chronic pain, the motto is ‘know pain or no gain’, as opposed to ‘no pain, no gain’,” says Dr Leong.


Featured photo by Dreamstime.

Doctors’ photos are their own.

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