UNDERSTANDING YOUR PAIN
PHYSIO FOOTNOTES 6
Liz MacLeod is a physiotherapist with a pain management programme. She explains why pacing your daily activities can prevent those bad pain days

I imagine all or most of you reading this will have been advised that exercise has an important part to play in the management of your chronic pain. You may already have a regular programme, which you can rely on to keep you fit without flaring up your pain. Others of you will have had difficulty finding a level that is manageable and may have stopped attending your physiotherapy department or local gym altogether. I certainly meet patients on the pain management programme who have been disappointed that their exercise experience has been so unhelpful and even miserable.
Pain has different ways of behaving. Let’s look at this a bit more and see if by recognising your pain you could find a way of exercising that would be helpful for you.

PAIN FROM TISSUES
We can experience pain from our muscles, tendons, joints, etc., if we overdo activities or are not quite fit enough for that activity. If you are gardening, especially at the start of the summer, you may feel pain from the joints and soft tissues letting you know when they need a rest. You may stop from time to time for a stretch or a break, which helps, but if you carry on too long you find yourself creaking into the standing position! Usually a soak in a warm bath and a couple of paracetamol do the trick, and next day you’re ready for the garden again.

This kind of pain is less of a problem if the joints and soft tissues are strong, healthy and well conditioned. By the end of the summer, this pain becomes less noticeable as the muscles and joints become stronger, fitter and more tolerant to the activity.

When pain behaves in this way, i.e. coming at the time of activity and settling down with soothers, an exercise programme can be planned and built up. The messages from the tissues at the time help you decide a sensible level and should you overdo it, the pain will settle quickly when you stop.

PAIN FROM A ‘SENSITISED’ PAIN SYSTEM
Some folk have a different pain experience. Working in the garden may produce very little discomfort from the tissues at the time but later, often the next day, the pain flares up. This increased pain can often last for days and a rest, warm bath or tablets may make things more bearable, but the pain takes its own time to settle down.
The same thing can happen after exercises given as part of a physiotherapy programme or from the fitness instructor at the gym. Getting no pain signals from the body at the time of exercising means it is difficult to set a level which can be kept going and increased over time.

WHY DOES THE SYSTEM BECOME SENSITISED?
We know from the pain scientist that this kind of pain is happening because of changes to the pathways carrying signals to the brain. These changes result in the pain messages remaining switched on even though nothing is happening to the tissues at the time. The trigger was the bending and kneeling in our gardening example, but because the sensitised pain system stays switched on, messages are still being sent to the brain hours or days after the activity has stopped. This system dysfunction, although recognised, is not yet well understood even by pain specialists.

I SEEM TO HAVE BOTH KINDS OF PAIN
Some people have pain at the time as well as flare-up pain later. Although this is hard to cope with, it is sometimes easier to find a start point for exercise. Setting limits within a comfortable range at the time is usually a good guide to reducing the chance of flare up later.

SO HOW DO I MANAGE TO EXERCISE WITHOUT PRODUCING A FLARE UP?
If you have a sensitised pain system you will have good days and bad days as well as flare up. Set a level of exercise that would be comfortable on a bad day and stick with that amount on a good day. You will be able to gradually build up the amount over time if you are patient and are prepared to go slowly. If you are not patient you will be tempted to do more on your good days and this will lead to flare up and disappointment. Worse still, you might give up altogether believing that exercise is unhelpful. The exercise is not the problem; the amount set is too high.

Physio Footnotes © Liz MacLeod. All Rights Reserved.