Exercise for chronic pain: How physical activity can help you feel better

Adapted from Pain Relief Without Drugs or Surgery , Medical Editor: Melissa L. Colbert, MD, Instructor in Physical Medicine and Rehabilitation, Harvard Medical School; Interim Medical Director, Spaulding Rehabilitation Outpatient Center.

It’s true: physical activity can play a helpful role for people with some of the more common pain conditions, including low back pain, arthritis, and fibromyalgia. These chronic conditions often create a vicious cycle in which pain stops people from exercising, but lack of exercise causes muscles to lose strength and flexibility, making it even more difficult and painful to exercise.

Staying physically active, despite some pain, can prevent that vicious cycle from starting — or at least keep it from accelerating. Physical activity can also combat obesity, which is a risk factor for a variety of painful conditions such as osteoarthritis of the knee and hip. And physical activity releases endorphins, which can improve your mood.

Exercise is generally safe, provided you don’t push too hard, and it may decrease the severity of pain while improving functioning in people with various chronic pain conditions. The challenge is to get started and work through the fear that pain may occur or worsen with activity.

Types of exercise for chronic pain

Try regular gentle aerobic activity such as brisk walking, swimming, or bicycling to improve cardiovascular health and stay limber. Such exercise may also ease dull, cramping pain in the limbs caused by poor circulation.

Another option is Pilates, a form of exercise that focuses on building core strength in the abdominal and back muscles. Though few studies have reviewed Pilates as a method of pain relief, there is good clinical evidence that it may be particularly useful for neck pain. It can be modified or used with special equipment if you have specific physical ailments. It also can be done without special equipment to improve awareness and control of movements, posture, and strength.

Or you can try exercise that includes a meditative component, such as yoga or tai chi — both of which can calm the mind while invigorating the body.

For some pain conditions, physical activity is part of a therapeutic program. For instance, prescribed exercises are a key component of treatment programs for most people with back pain. Similarly, people with arthritis often benefit from range-of-motion exercises to increase their joint mobility. Although exercising won’t specifically relieve pain in arthritic joints, it helps the joint move through its range of motion more easily, an important improvement for people with arthritis pain. It also helps prevent loss of range of motion, which can lead to other problems and limitations.

Check with your doctor before you begin. Although any exercise routine should be customized to you and your specific pain problems, all successful exercise programs share a few essential elements:

• They are gradual.
• They set reasonable, step-by-step goals so you don’t get discouraged or injure yourself.
• They emphasize stretching muscles and loosening joints through range-of-motion exercises.
• Finally, they focus on strengthening muscles, conditioning your core to help you maintain proper alignment, and building endurance.