Dealing with pain is never easy.
It's complex, individualized, and often times constricting.
It can sometimes make us feel like we have no control.
There are many ways to deal with pain.
Some unhealthy ways: self-medicating, over-numbing, avoidance, catastrophizing, etc.
And some healthy ways: improving sleep, exercise, diet, meditation/mindfulness, socializing, optimism, etc.
Then there's the common way most Americans deal with pain...drugs.
While drugs such as NSAIDs or prescription pain pills can help in the short term, they often lead to an increase in pain in the long run.
A better option might be aerobic exercise.
Aerobic Exercise
Aerobic exercise has a ton of benefits. Here's a list of just some of the rewards:
decreased pain, improved oxygenation of the brain, improved cognitions, improved memory, improved mood, decreased upregulation of the central nervous system, oxygenation and energizing of tissues, decreased sensitivity of the tissues, improved blood flow throughout the body, improved cortisol changes, aids the immune system, decreases chronic inflammation, decreases anxiety, decreases nerve sensitivity, improves motor function, improves quality of life, etc.
But most importantly for those in pain, we should acknowledge the power of aerobic exercise to reduce pain. Not only is there plenty of scientific studies demonstrating this effect, but there is a ton of empirical support as well.
Plus, aerobic exercise is an active intervention that gives us back control of our bodies. This is much more useful over time, since passive interventions only lead to short term solutions.
But I'm in Pain...
Sometimes when I discuss aerobic exercise with my patients they get anxious.
"I can't run for 30 minutes because my knees hurt.."
"I can't go to a spin class because it'll hurt my back..."
"Swimming 50 laps will hurt my shoulder..."
After education on pain, resiliency of the body, tissue damage vs. thought damage, and graded exposure, I educate them on aerobic exercise.
Exercise doesn't have to be painful. You don't have to lose your shoes. (image source)
Aerobic Exercise For Pain
Research shows that to attain the analgesic effects from exercise we only need to exercise for >10 minutes at an intensity >50% of our max heart rate (220-age).
It's that simple. To get pain relief from aerobic exercise we don't have to run a half marathon or go on an excruciating bike ride. It just needs to be a 10 minute brisk walk or bike ride.
Once we find the right type of exercise (walking, running, biking, elliptical, etc.) and establish a baseline we can progress either the intensity, duration, or load using the 10% rule.
2 Common Mindset Errors
A common problem I see in the clinic is in the psychological approach to exercise.
For acute injuries or people not in pain, these approaches are usually not an issue. But for people in chronic pain it can make the situation worse.
The two common mindset errors:
- No Pain, No Gain - pushing through pain and exacerbating the injury, reinforcing the pattern, and further increasing the sensitivity of the nervous system
- If it Hurts, Don't Do It - avoiding pain and creating fear, anxiety, uncertainty, atrophy, and increased sensitivity of the nervous system
Instead the approach should be to just "touch" the pain. To just go into slight discomfort. To explore the pain just a little bit. Often times, with the right mindset, we find that the pain isn't as bad as we expected it to be. We find that we can not only handle this nudge into the pain, but overcome it as well.
It's like putting our foot in the water before we jump in. It's not staying out and being scared of getting wet, it's not a cannonball in to make a splash. It's a controlled way into the water.
Not the best way to approach pain... (image source)
Strategies
Some strategies to help aerobic exercise reduce pain:
- Start with a small achievable goal
- Keep an exercise log
- Specifically schedule the exercise (day, time, activity)
- Stay consistent
- Try to make it a habit
- Be patient and see the forest for the trees (long term benefits)
- Try different types of exercise to find the right one
- Understand pain does not equal tissue damage (no one has increased their physical tissue injury after 10 minutes of exercise at 50% max HR)
- Move with your animal (The Lassie Effect)
- Exercise outside if possible
- Maintain a positive outlook
- Join a group or exercise with friends
- Track the progress
Summary
Aerobic exercise is a proven analgesic for pain.
Not only can it decrease pain, but it can lead to many other improvements in our lives.
So instead of reaching for the Advil, maybe we should go outside for a brisk 10 minute walk.