Pain in Motion

Exercise is often a “dirty word” for someone in pain, but it is absolutely essential. If the concept of exercise is something you struggle with, the first step is to discard all your previous ideas of what exercise means. Exercise does need to be routine and frequent, but it does not need to be intensive or prolonged. Some of my patients have really taken this advice to heart and even when they are having horrible pain days they still drive to the gym, walk indoors and at least sit in the hot-tub. That may be all they do, and it may not seem like much, but it keeps them in the habit and in the right frame of mind – these are people who have taken charge of their pain. When the routine of going to the gym is established, then and possibly only then, is the person ready to begin a two minute walk on the treadmill. Which then becomes a five minute walk, and then so on.

Most gyms have staff that can suggest exercises and routines that are gentle on damaged joints. Use this resource to design a program that works for you. Estimate how much you can tolerate, then cut this in half. If you think you can do ten reps on the biceps machine, do only five. If you think you could walk slowly for fifteen minutes, walk for only eight minutes instead. Then make an assessment of your body the next day and decide whether that was too much, too little, or just right. A little soreness the day after exercising is normal and desirable. It shows that your muscles are changing – they are going to get stronger.

A very helpful concept is to view each major body region as either stable or flexible. The goal is to strengthen the stable parts, and stretch the flexible parts. For example, the foot is considered stable – it is not meant to do much more than flex moderately with each step. The ankle, on the other hand, is flexible – it moves all around in an arc. The knee is stable – only meant to move back and forth, but the hips are flexible and meant to move widely. The lower back is again stable, meant to support the upper body, but the mid back is flexible, meant to allow twisting and bending. The upper back is again stable, the neck flexible.

If the hips are limited by pain, then there is more strain placed on the adjacent lower back. That which is meant to be stable is being asked to make up for some of the lost flexibility in the adjacent areas. If you have lower back pain, i.e. pain in a region meant to be stable, then your exercises should be about strengthening the muscles of the back (without exceeding the back’s comfortable range of motion) and additionally about increasing the flexibility of the hips and mid back.

People who sit a lot tend to cause their hips and mid-back to stiffen while at the same time causing their lower back to flex or extend excessively due to poor posture. Increasing the mobility of the flexible areas while strengthening the back will help to reduce pain. Proper posture and proper gait will make a significant difference, and proper posture and gait require adequate strength in the back and knee and sufficient range of motion at the hip.

Spend time in the gym not just on the area with the most pain, but also on the adjacent areas. If the painful area is one that is meant to be flexible, such as the hip, then strengthening the adjacent lower back and knee will help reduce the stain on the hip joint. If the painful area is meant to be stable, such as the lower back, then increasing the flexibility of the adjacent mid-spine and hip will help to reduce the low back pain.

You should have a daily plan and an emergency plan. A daily plan is what you do day by day – your exercise and stretching program, your oral and topical medications, your sleep hygiene, etc. Your emergency plan is what you do when the pain flares significantly, something you know will happen from time to time. Emergency measures may include rest, but they never include doing nothing. Apply heat or cold or both by alternating them. Use additional topical medication. Sit in the hot tub longer. Get an extra massage.

Having a plan is not something that just falls into place. You have to make it happen. It takes thought, and the desire to have that thought. Write it down and commit to following it. If all you do is take medication, then your medication will begin to seem insufficient. And then you will struggle with thoughts of wanting even more medication, and your belief in the failure of your current dose will further limit its ability to help you.

Many of my patients have taken this advice to heart. They are losing weight, improving their health and reducing their pain. Give it a try. We know it works. 

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