Turning Physical Pain Around with Exercise
The presence of persistent pain is significant in Australia, with the ripple effect of its impact reaching far and wide.
Currently, pain is the most common reason for people seeking medical help in this country.1 Yet, pain is a misunderstood facet of healthcare, and has detrimental economic and social costs associated with it.1
In this article I want to expand upon your current understanding of pain management from a movement perspective, whilst empowering you with ideas for where you could encourage pain customers towards a more physically active and whole-person approach to reducing pain and regaining confidence.
A Vicious Circle
A significant part of a pain client’s reality is the decreased ability to physically function in their daily life. And when physical activity decreases, in just five weeks of inactivity, muscle strength will decrease by 50%.
This staggering outcome means that completing grocery shopping, vacuuming or walking takes twice as much perceived effort as before! And here begins the vicious cycle: decreased strength means increased effort of tasks and a ‘no go’ list of things they cannot do, steadily increasing over time.
This can lead to anxiety, fear, frustration and reliance on medication to make the pain cease or at least manageable.
Negative thinking and increased presence of depressing thoughts then persist, which is likely to result in more pain, which leads to less physical activity, and so on.
Benefits of Exercise
If the client can be gently encouraged to move and exercise their body and mind in a safe, effective and, importantly, enjoyable way, there is less risk of the negative cycle either starting or continuing.
In as little as five weeks, a muscle can be strengthened.5
When resistance exercises are completed regularly (2–3 times per week) and consistently (4 weeks plus), there are both neural and muscular adaptations, including increased protein synthesis and increase in muscle fibre cross-sectional area.
This physical strength translates to feelings of accomplishment, self-confidence boosting, and the satisfaction of being able to complete daily tasks again — like picking up grocery bags or washing, or driving a car. Socialising more with family, friends, community, and even going back to work become a possibility.
Overcoming the Barriers
‘But exercise is hard work and it always hurts me,’ exclaimed the pain client.
These are common excuses I have heard in my decade plus working with clients and patients. I’m sure you hear it too!
This doesn’t have to be their experience, with positive effects on mental health being felt in as little as ten minutes of walking per week!6
Also, there is mounting evidence that mental imagery has the ability to increase the excitability of the cortical areas involved in movement and motion planning.7
Time spent imagining performing movements and/or exercise is time effectively spent, especially during initial phases of rehabilitation.
Other evidence-based methods of movement that can result in positive outcomes for strength, mobility and balance, with little to no negative impact on pain levels include tai chi, hydrotherapy and pilates.
A ‘Whole Person’ Approach
By applying the ‘patient-centred’ process to medicine,3 combined with the bio-psycho-social approach2 to recovery, each health care professional can assist the patient with overcoming barriers that are hindering recovery, and empower them to return to optimal function.
As pharmacists, keeping the ‘whole person’ approach to recovery in your mind during interactions means you can remind your clients there are other avenues to rehabilitation and pain reduction they may not have realised were possible.
This could be as simple as asking your clients about the impact of their pain on social life, or if their physical activity has been negatively impacted by their pain, or what they miss doing physically and whether they need guidance in getting back to doing it.
It opens up the dialogue for not only recognition of barriers to recovery, but also what’s important to them — finding their intrinsic motivation.
The bio-psycho-social approach is what Accredited Exercise Physiologists work within, resulting in the physical tissue being treated, recognising unhealthy beliefs hindering recovery, and work or living situations that are exacerbating pain or adding to their imbalance, and it leads to effective prevention or management of persistent pain, activity limitation and participation restriction.2
What is an Accredited Exercise Physiologist?
An AEP is a tertiary-trained health professional with extensive knowledge in the clinical application of exercise as a form of medicine.
Trained in understanding exercise as a positive catalyst in both healthy and diseased persons, movement can be prescribed in specific doses and quantities to result in various outcomes.
There is no hands-on therapy involved, and the pace of the exercise is tailored to the individual.
Some AEPs have gone on to specialise in persistent pain and the application of exercise in the management or improvement of pain.
They are trained in lifestyle and behaviour modification, which means there is a strong element of coaching, health consulting and counselling within consultations.
This translates into less dictation and a more client-centred approach, which leads to the individual being better self-managed in their long-term health.
Fiona Bond, Accredited Exercise Physiologist
References available on request.