Written by Alexis Ordelheide PT, DPT, CMTPT
A common thought among individuals who suffer from chronic pain, is “If I move, I will hurt. If I don’t move, I won’t hurt.” As a movement specialist, also known as a physical therapist, I would like to attempt to alter your thoughts that movement equals pain.
Research shows that if a large group of individuals had an MRI of the lumbar spine, 40% of those individuals would have a bulging disc without experiencing any back pain. ⅓ of people over the age of 30 and ⅔ of people over the age of 70 have rotator cuff issues on an MRI with no pain and no loss of movement. 25% to 50% of people with no knee pain have “arthritis” on their MRI scan. ⅓ of basketball players with no knee pain show significant “arthritis” on their scan.
What do all of these statistics tell us? Even though our body's musculoskeletal system changes over time, it does not mean we develop pain. Most individuals develop pain because they stop moving.
Have you ever wondered how someone can become a marathon runner? Why would anyone want to run 26.2 miles for fun? The answer is that "movement is the biggest pain killer on the planet." Research shows that a six-mile run stimulates an endorphin release that is equivalent to 10 mg of morphine. Long distance runners experience a runner’s high; a feeling of pure euphoria, reduced stress, and a decreased ability to feel pain due to a flood of endorphins released by exercises. So why do people run marathons? They crave the happy chemicals that our brain produces with exercise.
The good news is, you do not have to become a marathon runner to produce happy chemicals. Research shows that a heart rate of 120 beats per min or more and a duration of 10 minutes or more produces an analgesic effect, the inability to feel pain. Simply put, work hard enough to produce a sweat.
For people with chronic pain, accessing the benefits of exercise can take time. Developing an exercise program that is consistent with pacing and graded exposure sets up the person for success. We need to throw out the idea, “no pain, no gain.” To better understand this, let’s look at a metaphor that pain expert Adriann Louw describes. It is recommended that we brush our teeth 2 times a day which would equal 14 times a week. You decide to save time during the week and instead will only brush your teeth 14 times Sunday night. How do you think your mouth will feel? Not only will you have bad breath all week, your gums will bleed and be more likely to develop decay and cavities. It's the same idea with exercise; it can't be all or nothing. We have to develop a program that consists of pacing and graded exposure to movement.
Discovering the fine line where you can participate in exercise without skyrocketing your pain can be difficult. So how do we introduce movement safely? Louw describes it as “Tease it, touch it, nudge it.” Start with a simple exercise like walking for 2-3 minutes. Begin walking to the point of discomfort and back off. Repeat. What happens? Our brain begins to learn that safe movement is no longer a threat to our body allowing our central nervous system to calm down and become less sensitized. Before you know it, you will be walking for a longer duration of time without an increase in symptoms.
Our symptoms worsen because we stop moving. If you are suffering from chronic pain, the best thing you can do is make an appointment with your physical therapist to develop an individualized safe exercise program. Always remember motion is lotion.
The How-to of Teaching Patients about Pain-Adriaan Louw; Medbridge Webinar