Most patients suffering from chronic musculoskeletal problems are told, “listen to your body”. They are led to believe that this will make them feel better. However, when following this recommendation, the pain does not usually decrease and the patients do not get better.
Initially, the patient tries “rest” to recover from injury or the sensations of pain and fatigue. This is an appropriate response, but only for a few days, according to research. What the research does not explain is why, in some cases, the pain or fatigue persists at such an intense level and when does one know that it is safe to get moving again?
Furthermore, a “no pain, no gain” adage is promoted in sports. However, when applied by patients, it is usually accompanied by increased pain and decreased function.
If rest is not recommended and intensive exercising does not help, what can the patient do?
The first step is to understand that after three months, healing has occurred in muscles, bones, ligaments and tendons. There is no danger to the healing process when one starts to move.
Once this is acknowledged, basic physiological principles of fitness training must be applied. This encourages faster improvements than the “listen to your body” recommendation.
No increased pain is to be tolerated during physical training. Pain increases mean that you are doing something wrong. There is a difference between discomfort and pain. Muscles cannot get stronger when there is increased pain, because they are busy protecting from perceived injury. If exercise prescription is adequate, the pain levels remain the same or decrease by the end of the activity.
Pain can increase later in the day, but it will decrease again if you do the same movements the next day.
In order to become fitter, one has to train at a certain intensity or achieve a certain level of activity. Most athletes gauge the intensity of their workout by checking their heart rate. Usually, if the heart rate is between 110 and 140 beats per minute, the body is working hard, without going into overtraining. This can be done safely for periods of 30 to 60 minutes at a time, even for unfit individuals.
In England, research has shown that individuals suffering from chronic pain were able to decrease their symptoms by logging more than 7,000 steps/day on their pedometer. At the start of the research project, the subjects were only walking about 3,000 steps/day.
Therefore, to attain measurable improvements, one usually has to rely on objective tools (heart rate or steps/day, for example), rather than their perceptions.
If you are doing the right thing, you should see immediate, if temporary, results. Either the pain decreases immediately after the exercise, even for a short period, or you can see changes in mobility or strength.
Your physiotherapist can help you select the best exercise and measure the results.
Dominique Gilbert is a Clinical Specialist in Physiotherapy, Pain Sciences. She works with clients suffering from chronic musculoskeletal pain and provides expert witness services at different administrative and legal levels.
The Canadian Physiotherapy Association (CPA) represents physiotherapists, physiotherapist assistants and physiotherapist students across Canada. CPA members are rehabilitation professionals dedicated to the health, mobility and fitness of Canadians.
Physiotherapists are primary health care professionals who combine their in-depth knowledge of the body and how it works with specialized hands-on clinical skills to assess, diagnose and treat symptoms of illness, injury or disability.
More than 20,000 registered physiotherapists work in Canada, in private clinics, general and rehabilitation hospitals, community health centres, residential care and assisted-living facilities, home visit agencies, workplaces, and schools.
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