Physical

What does being physically active have to do with chronic pain?

Everything.

Being physically active while battling constant pain is as important as improving diet / nutrition while battling constant pain.  Unless your doctor has placed specific physical restrictions you must remain physically active.  If you are unsure, ask your doctor for a “green light” authorization to get active.

Chronic pain will not go away on its own.  Over time, your chronic pain may worsen and become complicated due to inactivity and living a sedentary lifestyle.  Chronic pain does not mean an “excuse” from being physically active.  On the contrary, chronic pain requires you to be physically active.

mypainweb was in complete control of my life during the times I remained inactive.  Being sedentary was yet another powerful strand within mypainweb.  When I made the effort to be physical I was in a sense starting to control mypainweb.

Being physical may feel unpleasant at times; however, severe chronic pain hurts much worse.  Physical activity will not cure something like a spinal defect, but being physical will:

  • help you cope with degenerative changes and pain
  • stabilize the spine
  • strengthen back, trunk, and abdomen
  • improve your overall level of health and fitness
  • help to avoid the tendency to avoid movement for fear it will cause more pain
  • reduce the need for pain medication
  • improve outlook and help quell depression while improving confidence giving one a sense of control
  • help maintain ideal body weight

How should I be physically active with Chronic Pain?

Ask your doctor.  Daily walking is the best overall physical activity I do to help manage mypainweb.  According to the Mayo Clinic, the benefits of walking include:

  1. Lower low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol)
  2. Raise high-density lipoprotein (HDL) cholesterol (the “good” cholesterol)
  3. Lower your blood pressure
  4. Reduce your risk of or manage type 2 diabetes
  5. Manage your weight
  6. Improve your mood
  7. Stay strong and fit

 

All it takes to reap these benefits is a routine of brisk walking. It doesn’t get much simpler than that. And you can forget the “no pain, no gain” talk. Research shows that regular, brisk walking can reduce the risk of heart attack by the same amount as more vigorous exercise, such as jogging.

The following is a list of a few “moderate” activities:

  • Walking up stairs instead of taking an elevator
  • Walking, wheeling, or bike riding instead of driving
  • Getting off the bus a few stops early and walking the remaining distance
  • Mowing the lawn with a push mower
  • Raking leaves
  • Gardening
  • Pushing a stroller
  • Cleaning the house
  • Doing exercises while watching television (stationary bike; arm, shoulder, or other exercises with weights)
  • Brisk walking or wheeling (around neighborhood, park, etc)
  • Taking a brisk 10+ minute walk in the morning, at lunch, and after dinner
  • Jogging
  • Bicycling
  • Swimming or water aerobics
  • Racket sports
  • Golf (carry clubs)
  • Traditional sports
  • Dancing
  • Participating in an exercise program at work, home, school, or the gym

The Center for Disease control has published a chart listing activities by level of intensity.  If you’re looking for more ideas, the following website will get you started: Activities Intensity Levels

Read this interesting report about chronic pain relief and exercise: Relieving pain through exercise, not medication.

Before you embark on any physical activity effort be sure to get a “high five” (authorization) from your doctor.

If you’re unsure on how to get started, then check with your health insurance carrier.  Most will pay for a certain number of physical therapy and / or personal training sessions with a certified personal trainer.  Your doctor and health insurance carrier can provide you with referrals.

Another effective way is to simply use a “buddy” system.  Walking the neighborhood and / or mall with a “buddy” is a great way to start and keep motivated.

On a side note, if you smoke…..stop.  Smoking will further complicate your pain web.  Check out the following informative websites to learn about how to quit smoking:

Quit Smoking in 30 Days

Quit Smoking Community

 

Here’s another look at the importance of being physically active compliments PMIR:

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Click on the following link to learn more:

Bring An End to Joint Pain

 

Specific to Back Pain

 

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For those suffering with Chronic Back Pain that may be looking for a specific exercise program, take a few minutes to familiarize yourself with the Low Spine Compression Training program.

 

Below you will find details of the Low Spine Compression Training program that you should discuss with your doctor prior to starting:

 

Low Spine Compression Training:

 

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Cautions / Considerations:

•Avoid standing extension and flexion exercises. These increase vertical spinal compression.

•If Low Back or numbness is present, avoid hamstring stretching.

•Avoid sitting or standing exercises whereby the head is put into extension, i.e., bending backward.

•Avoid exercises that require sitting / standing and raising the arms higher than shoulder level (exceptions include cable bar pulldowns for the back). You don’t want to do presses above the head or shoulders.

•Avoid picking up free weights when standing or sitting.

•Avoid hard-floor-impact exercises, jumping or twisting.

•When lying on your back, keep the knees up and feet flat. This reduces the lumbar curve and spinal pressure.

•Avoid ball exercises. Trying to keep oneself balanced causes stressful positioning and tensing of muscles. Tensed muscles contract, shorten and compress the spine.

•Avoid lunges if back arching is painful. Do not hold weights while lunging.

 

Low Spine Compression Exercise Routine:

 

1. Seated or supine chest presses. If on your back, historically called bench presses. Seated, your back is against a seat-cushion back support.

This exercise works the pectoral muscles, triceps and deltoids (anterior and some lateral elements).

2. Supine bench presses. Lie on your back, knees up, feet flat. This is important; having your knees up flattens and decompresses the lumbar spine.

(Choose Exercise variation 1 or 2)

3. Upper back rows. This is a pulling exercise. There are two ways to do this most safely (perform one or both during a workout):

a) Seated rows. For this exercise, you use a rowing machine so you can place your chest against a support.

The following muscles are used: deltoids, latissimus dorsi, rhomboids, infraspinatus, teres minor and biceps.

b) Seated pulldowns. In this exercise, you are sitting under a bar with a cable attached to it, and the cable is attached to weights, which you can adjust.

This is a pulling exercise and it exercises the same muscles as seated rows, but at a different angle.

4. Lateral raises – shoulders. This exercise is for the outer (lateral deltoid) muscle. The deltoid has three divisions: front (anterior), side (lateral) and back (posterior). This muscle’s purpose is to raise your arm (abduct) laterally away from the body. Traditionally, exercising it is done sitting or standing. Since we are trying to reduce positions involving maximum lumbar or thoracic compression, do the following instead:

Lie on your side. Support your head with your downside arm or use a pillow. The upper arm is at your side. While on your side, head supported, light dumbbell in your hand, palm down, laterally raise (abduct) your right arm toward the ceiling as far as you can comfortably go. Stop, then lower the dumbbell back to the hip region. Perform 10-12 repetitions for three sets on each shoulder.

5. Biceps curls. Again, traditionally biceps are exercised in the seated or standing position. But as mentioned, holding weights seated or standing will cause considerable lumbar and thoracic compression. So, biceps curls can be easily done in a non-compressive mode while lying on your back.

While on your back, knees up and feet flat, arms at your sides, palms up, head supported by a pillow, curl dumbbells to 90 degrees at the elbows, then bring the dumbbells back to floor position.

6. Low back exercise: There are machines that allow you to do back extension motions (e.g., sitting and extending backward against a resistance backrest or pad). This may work effectively for some back problems, but it may aggravate others. It is a trial-and-error situation.

7. Supine lumbar / pelvic raises. Lie on your back, head supported by a pillow, knees up, feet flat. Raise your pelvis upward toward the ceiling to the point of comfort. Come back to the original position.

8. Abdominal exercises. These are crucial “core muscle” exercises. If you have low back problems, you have to differentiate them under the following circumstances:

a) If bending backward is painful, but bending forward is not painful, then avoid back-bending exercises, but do cautious partial sit-ups with knees bent upward. Crunches are also alright. Proceed with caution.

b) If bending forward is painful, but bending backward is alright, then sit-ups and crunches may and probably will be irritating. Crunches on the gym machines, especially in the seated position, increase injury risk in this situation.

c) If bending forward and backward is painful, sit-ups and crunches should be avoided.

A safe solution to any of the foregoing conditions: pelvic tilts. The pelvic tilt is an exercise that tractions the lumbar spine (creating more room for nerves) and decreases disc pressure. Additionally, it contracts the abdominal muscles and tones them with decreased disc pressure.

A variation of this exercise is abdominal crunches. If forward bending is not painful or if there is no painful disc problem, you may cautiously try crunches. Just raise your shoulder blade region 1-2 inches off the floor as you flatten your low back. You can support your head with your hands.

9. Seated Leg presses. Instead of doing squats with a weight across your shoulders, which creates vertical compression of your spinal joints, you get to sit and push a weight horizontally away from you.

 

 

Swimming:

 

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After experiencing significant pain & disappointment due to my inability to follow the Low Spine Compression program, I continued to search for another option to get off the “sedentary bench”.

 

Swimming appeared to be a viable option to try.  Included below is some of the convincing research & information that I read that explains why swimming can be effective in establishing and maintaining some physical activity:

 

There are a few main reasons why swimming is a good rehabilitation tool:

 

1. It is low impact. (Unless you are training to be an elite swimmer at which point you will be putting your body through a more intense, higher impact workout.)

2. It is a form of active stretching – swimming technically will ensure full range of motion movements for many different body parts.

3. It provides just enough resistance from water to provide, over time, sustained aerobic conditioning to the rehabilitating subject, allowing them to continue to workout while rehabbing at the same time.

 

Click on the following link to read more:

 

Rehab Your Back Injury with Swimming

 

Preventing Back Pain from Swimming:

 

• Use proper form for front strokes, such as the crawl or breaststroke, while swimming; keep body level in the water (hold lower abdominal muscles up and in) and keep the head straight rather than lifted

 

• If preferable, swim with side or back strokes instead of front strokes

 

• Roll the body to the side and keep the chin in when taking breaths during the crawl, rather than jerking the head backward, to reduce the amount of movement in the neck while swimming

 

• Use a snorkel to eliminate the need to move the head for breaths

 

• Wear goggles to reduce improper head movements when trying to keep water out of the eyes

 

• Use flotation devices (noodles, boards, life preservers, wet vest) to maintain proper form when swimming

 

Read more at the following link:

 

Swimming and Back Pain

 

Pool Therapy Exercise Techniques:

Some of the basic techniques for pool therapy exercises are as follows (they can be modified for varying degrees of difficulty):

• Knee-to-chest exercise. This movement is performed while standing on one leg, which is slightly bent, and one leg outstretched in front while one hand holds onto the side of the pool. It strengthens and stretches the muscles in the leg, hip, and lower back.

• Leg raise exercise. This movement is performed with one leg outstretched and the supporting leg slightly bent while one hand holds onto the side of the pool. It strengthens and stretches the muscles in the leg, hip, and lower back.

• Wall-facing leg stretch exercise. In this stretching exercise individuals assume a “Superman” position with hands resting on side of pool and the body and legs outstretched into and supported by water. This extends all regions of the back and the joints in the back, as well as stretching shoulder muscles.

• Pool walking exercise. Walking both forward and backward in chest-high water works the leg muscles while exerting no impact of the knees or hips, which is particularly important for people who have arthritis in those joints. The walking exercise can be made more demanding with the addition of hand floats or light weights, so a stroll in the pool becomes an aquatic version of power walking.

◦Also see Exercise Walking for Better Back Health

• Quadruped activity and exercise. This exercise works legs and arms and is performed while floating on one’s back (sometimes achieved with a therapist supporting the trunk or using a flotation jacket). The individual makes paddling motions with his or her arms and legs.

 

Click on the following link to learn more:

 

Water Therapy Exercises

 

The paragraph below is an excellent study published by Kurume Medical Journal:

 

It has been well recognized that exercising in water can be an effective and useful mode of therapeutic exercise, especially for the individuals with arthritis or various orthopedic dysfunctions who have difficulties with the weight-bearing components of land exercise. When exercising in water, buoyancy and the frictional resistance of water have particular mechanical effects on the body. Furthermore, fluid pressure is exerted equally on all surface areas of a stationary immersed body at a given depth. Since the impact load acting on the spine during exercises can be easily controlled by changing the extent of submersion in water, exercising in water may be the most advantageous mode of exercise for individuals with low-back pain. The main part of the exercises in water are walking; forwards, backwards, and sideways. Other exercises except swimming are also performed in the standing position.

 

You can access the entire study at the following link:

 

Efficacy of Aquatic Exercises for Patients with Low Back Pain

 

What are the best swimming strokes to alleviate lower back pain?

 

The following 2 links are informative resources to understand the best swimming strokes to prevent / alleviate low back pain:

 

Swimming to Ease Back Pain

 

Splash Away Back Pain

 

 

Click on mypainweb Journal below to see how my personal swimming progress is going:

 

mypainweb Journal

 

 

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GET STARTED!

With your doctor’s consent get started.

Some of the most gratifying moments I’ve had in battling my chronic pain is proving to myself I can do it.  The 5 minute walk, stretching in front of the TV, and physical therapy in the pool were some of my personal accomplishments in starting to manage my chronic pain.  It was my start.  It was my daily goal to do something physical.

I stopped comparing myself to friends around me who were unconstrained by chronic pain.  Competitive running, cycling, aerobics, and strength training were done at will with ease by those around me, things I could no longer do.  Those of us with chronic pain must realize we are different.  I realized the “no pain no gain” rhetoric no longer applied to me.  Sure I miss it.  You will miss it too.

However, mypainweb has allowed me to see life in a new perspective.  Comparing myself to others has been replaced with accepting and understanding chronic pain.  It’s no longer about beating my time, or getting stronger, or being in first place.  It’s about the silent, personal confidence in knowing that the little physical activity I do each day gives me the strength I need to control mypainweb and improve my quality of life.  Get help..internet, friend, personal trainer, back school, physical therapist, books, magazines.  Experiment; try swimming, walking, biking, yoga, tai chi, or pilates.

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