Physio Footnotes: Exercise

Liz MacLeod is a physiotherapist with a pain management programme. She explains why exercise is important and how it can help your pain.

I have chosen to write about exercise, partly because as a physio that’s my business and so may be expected from readers, and partly and in fact mostly, because I believe so much in its value for all of us, pain or no pain!

FLARE-UPS

How many of you have pain that you manage quite well until a bad episode comes along? The flare-up may have started for no reason that you can think of, or may have been the result of a movement such as twisting or reaching. What do you do to help you get through the bad patch? Many of you will consult your GP who may send you to the physiotherapist. You may indeed have seen the physio last time you had a bad patch. The chances are that as part of the treatment plan, you were taught a range of exercises and asked to practise these every day. You would have carried on until the acute pain settled and you were left with your old manageable pain. Exercise practice seemed less important then and maybe stopped being regular or stopped altogether. The crisis over! Does this sound familiar?

This is not unusual – it’s human nature! We can all think of other instances where we promise if only we could be relieved of a self-inflicted misery we would never let it happen again! What about the misery of a hangover, or lying in the sun too long without enough protection! These events can lead to major misery and absolute promises never to let it happen again! So it is, in the agony of acute back pain. We promise we will continue with the exercises forever if only the pain would settle down!

FEAR OF MOVING

Some of the patients on the pain management programme tell me they recognise the trap of “crisis” management. Others have tried to keep going with exercises the physio taught them but have found this difficult. Some have managed to practise one or two exercises regularly and are pleased to be able to move more freely as a result.

You wouldn’t think about starting your day without some teeth maintenance,

so why not some body maintenance!

If regular practice has not been a habit, stiff and tight tissues will have led to poor posture and lack of confidence and fear of moving. The combination of these outcomes means the patient has much more difficulty with ordinary activities such as climbing stairs, getting on and off the bus and pushing the shopping trolley. They often say if there’s anything around to trip over, they’re the one to find it!

I believe the likelihood of pain flare-up can be reduced if body tissues are kept in good condition. That means a regular commitment to exercise – maybe even a daily commitment to exercise. After all you wouldn’t think about starting your day without some teeth maintenance, so why not some body maintenance!

FEELING FITTER

All patients on the pain management programme make an agreement to exercise while attending the twelve-week course. A programme is established at the start of the course and daily practice recorded. Patients decide the numbers of exercises they do and how quickly they progress. Most important too is that they learn how far to move with each exercise to get success. If they push through the pain, flare-up is a likely consequence and they will then be unable to build up repetitions and benefit from improved exercise tolerance and fitness. This has been the main reason in the past for giving up.

By the end of the course it is very unusual to have a patient report no benefit. Some patients are surprised at how much better they feel and others amazed that they have been able to continue with regular practice even in pain flare-ups. Reports of suppleness and flexibility are regularly recorded and patients are pleased to be feeling fitter.

‘FEEL GOOD’ HORMONES

Exercise we know also improves mood, sleep and general well being by releasing the body’s own “feel good” hormones – endorphines. It also helps to condition soft tissue and bone, which results in a strong body structure. It has a part to play in weight control too, so it really does have a lot to offer us!

Why not make time in your day for some exercise practice and see if you can improve your feel-good factor!

• Pick a “best” time for yourself during the day. Some people will prefer mornings, others will find later in the day suits better.

• Take your time and don’t push through the pain: that’s not helpful and can lead to flare-ups.

• Start with a few repetitions and gradually build up. You shouldn’t need to spend any more than 10 – 15 minutes each day to get results.

• Give commitment to daily practice for three months before judging whether or not this is worthwhile! If you’re very unfit, it may take this time to feel an improvement, so don’t give up!

The best exercise programme for you to start work on will be one which you have been taught by your physiotherapist. If you haven’t attended your physio for some time, why not pick up Margaret Graham’s book Keep Moving, Keep Young* or failing that, drop in and see the fitness instructor at your local sports centre. You would be able to discuss your difficulty with him/her and have a suitable programme designed for you.

Remember though, this is YOUR exercise programme so YOU decide after discussion what you feel able to manage. There is no benefit in rushing practice. Remember the story of the tortoise and the hare! Don’t be a hare!

Enjoy exercising and feel the difference! Oh yes, you might be surprised to find a lot of your old manageable pain is less too or has gone altogether!

1. * Further reading: Keep Moving, Keep Young – Gentle Yoga Exercises by Margaret Graham, published by Conker Productions. Gentle exercises and

relaxation techniques to help you manage your condition whatever your age or limitations. Originally written for older adults, this book is invaluable to people living with persistent pain and to anyone who wants to help themselves stay well and active throughout their lives. Recommended by chronic pain specialist Liz MacLeod. Costs £9.50.

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I manage OK with housework based workouts, wall pushups, a selection of body stretches before I even get out of bed, I do these again before I go to sleep and walking. Walking is the safest form of all round exercise I can do, I really miss cycling and cannot see the point of walking for walkings sake. I do try to make this functional as well so that it has a purpose.

During flare ups I carry on with the routine even if I have to do less at a time but more frequently. Its all balance and I have to check myself not to over-exert myself on the good days, otherwise I end up with a couple of horrendous days.

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Thanks for the reminder but it's really difficult to get physios' to listen to you when you try to tell them that your being pushed through pain, often you just can't manage to keep going at home due to flare ups. My experience of physios' has been very mixed. I do only a few of the exercises taught, almost daily and always when I get a new twinge(reminder) but have to be honest and don't do extra until after the flare up which reminds me settles down. As you say human nature. I wish all physios' would adopt your realistic attitude to pain. I am now going to do my short exercises as that's all I can manage at present but at least it's something.

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I've just been given an appointment and I am a great believer in movement to help the pain, but My problem of late is the more movement I make the worse I become mainly from my neck now, because I always was able to manage my moving and slowly build up to a point where It get's easier, but I forgot about just what used to happen before if I pushed too much, and that was people would try to catch me as if I was going to fall , but that has changed drastically and my neck makes it almost impossible to get anywhere near what I was able to before, even at home now the reaction from my neck is so bad that only lying down eases it, but then my back more often than not starts when I'm lying down, that said I'm hoping the physio can advise me on swimming, but I will say Im avoiding taking pills unless I have something I need to do then I will take Gabapentin and tramadol or ibuprofen cream, my experiences with physio's is at best 3 out of 10, but with pain I understand the belief factor plays it's part in how one is perceived, which for someone like me grinds me down further which then makes me shun anyone least of all my last physio who made no bones about what she thought , but as long as I'm believed I will go and get the help on offer.

[Hermes123]

Number one thing physiotherapist never ask, which is key to starting exercise, is do you suffer from exhaustion? Why is this so important is the will to do exercise in the first place, so many people go through physio, knowing exercise is good for them, I was a long distant cross country runner, a boxer a road race cyclist football player, all many years ago but one dose forget exercise is good for the body, but when a collection of pain sauces stress, the last thing on ones mind is exercise, what is the old saying pure in mined pure in body. I really think a lot of physiotherapist need to go back to the drawing board and find out not what is not just the injury they are treating, but what is going on in the patients head with there re-scepticals.