EXERCISING WITH CHRONIC PAIN: HOW TO ALLEVIATE STRESS ON THE BODY

WHAT ARE THE DIFFERENT TYPES OF CHRONIC PAIN?

There are several types of chronic pain though the most common types of pain seen in a personal training practice are neuropathic, musculoskeletal, and inflammatory in nature. Here are a few examples:

NEUROPATHIC PAIN

This type of pain is caused by damage to the nerves and is often described as burning, tingling or numbness. This type of pain can be seen in diabetics (diabetic neuropathy), in individuals with a history of Alcohol Use Disorder, and in some cases, the result of chemotherapy.

MUSCULOSKELETAL PAIN

This classification refers to pain stemming from either the muscles, connective tissue (tendons, ligaments), joints, or fascia. Some examples of musculoskeletal pain could be low back pain, plantar fasciitis, and osteoarthritis.

INFLAMMATORY PAIN

This type of pain arises from chemicals released from immunocytes invading bodily tissues. It can affect the entire body or certain parts. Inflammatory pain can result from chronic conditions such as autoimmune disease, chronic oxidative stress, and low levels of chronic inflammation (Pahwa & Jialal, 2019).

WHAT IS THE LINK BETWEEN OBESITY AND CHRONIC PAIN?

Obesity can directly or indirectly cause all three of these types of pain. First, obesity is a significant risk factor for the development of diabetes and subsequently diabetic neuropathy. Comparably, increased loading on the spine and other joints (i.e., knees and hips) can lead to increased compression forces, degeneration of connective tissue, and closing of joint space leading to conditions such as osteoarthritis and degenerative disc disorder. Singh et al. (2015) conducted a study measuring the compressive forces on laborers with a BMI over 35 kg/m2. The compressive forces on the spine from lifting moderate loads in these individuals exceeded the Occupational Safety and Health Administration (OSHA) safe limit. The researchers concluded that excess body weight can in fact lead to chronic pain from musculoskeletal dysfunction. Similarly, obesity can lead to endocrine changes which creates a chronic low level of inflammation in the body such as macrophage accumulation in fat tissue in addition to increased levels of C-reactive protein (CRP) and interleuekin-6 which are both markers of chronic inflammation. Likewise, it is common for individuals affected by obesity to also suffer from sleep apnea reducing the likelihood of achieving restorative sleep. This can further predispose someone to chronic pain (Okifuji & Hare, 2015).

WHAT TYPES OF EXERCISE CAN HELP WITH CHRONIC PAIN?

Exercise has been frequently studied as an alternative to pharmacologic therapy in treating chronic pain. First, exercise is often part of a weight management program to treat obesity. The achievement of a healthy body weight may reverse a chronic inflammatory state, increased mechanical loading on the joints, and sleep disturbances associated with chronic pain disorders. Similarly, physical activity alone (without weight loss) can improve sleep and reduce chronic inflammation in the. In fact, avoiding movement, even in those dealing with chronic pain, may lead to loss of strength, range of motion, and independence body (Ambrose & Golightly, 2015).

STRETCHING/SELF-MYOFASCIAL RELEASE (SMR)

Stretching is often looked at as the first line of defense so-to-speak when using exercise to treat chronic pain. In general, regular flexibility training can improve range of motion, increase circulation to the muscles, and activate the parasympathetic nervous system. All these factors will allow for greater movement. Additionally, many chronic pain syndromes can be the result of improper length-tension relationships of various muscle groups. For instance, shortening of the back extensor and hip flexor muscles can lead to lordosis (abnormal spinal curvature) due to increased mechanical stress on the spine. Likewise, shortening of the hamstrings can alter the range of motion in the hips, possibly leading to back pain (Gordon & Bloxham, 2016). Regular stretching combined with SMR or “foam rolling” can help to restore appropriate length tension relationships thereby decreasing the potential for pain.

Read also: Foam Rolling - Applying the Technique of Myofascial Release

YOGA

Yoga is a practice that began in India more than 4,000 years ago. The practice includes components of balance/flexibility through various postures, control over breathing, and meditation. The breathing and relaxation techniques taught through yoga have been demonstrated to increase relaxation and help individuals with chronic pain syndromes deal with the emotional aspects of these conditions. The balance/flexibility portion of yoga can help an individual with chronic pain improve range of motion and circulation to the muscles and reduce the potential for disability associated with chronic pain (Vallath, 2010). Holtzman & Beggs (2013) conducted a meta-analysis of randomized controlled trials examining the affect of a regular yoga practice on chronic low back pain. The researchers determined that regular yoga practice can significantly improve low back pain, especially in the short-term and reduce markers of functional disability in these patients. Based on these findings regular yoga practice may be a great first step in exercising to reduce chronic pain.

Read also: Heart-Opening Yoga Poses

RESISTANCE TRAINING

Resistance training can help to reduce chronic pain in a few ways. First, strength training can be used as a tool for strengthening muscles that are relatively weak which could be a potential source of pain or as part of a constellation of muscle imbalances leading to painful movement. For example, clients with chronic low back pain may have a history of sitting for long periods of time. This position shortens the hip flexors, lengthens the gluteals and causes a persistent anterior pelvic tilt altering the position of the spine (Clark et al., 2014). A corrective exercise program that helps to inhib