As someone living with chronic pain I’m sure you have had many people tell you how exercise will solve all of your problems. While good intentioned, those who do not live with chronic pain often don’t realize how difficult it can be to regularly work out while living with a chronic health condition. How can you effectively exercise when you are in too much pain to actually do the exercise? How do you build strength with muscles that are already tired and sore?
As a physical therapist it is my job to teach those living with pain—whether it be acute or chronic—how to complete strengthening exercises to help reduce that pain. Here are my top tips for reducing pain while completing your strengthening exercises of choice, whether it is weight lifting, resistance band training or body weight exercises.
Breathe—the right way
Have you ever noticed that when you are concentrating really hard or doing something difficult you hold your breath? Of course you have! We all do it. We brace for pain, we bear down for strength, or we simply get distracted and forget to do it altogether. Improper breathing during exercise has many negative side effects including increased stress on the abdomen, elevated blood pressure, and decreased oxygenation to the muscles. What we assume to be a second-nature task often takes constant effort when exercising—at least at first.
So what exactly is the right way to breathe when you work out? Here are a few quick tips:
- Keep breaths as slow and even as you can- take deep breaths and let it them out gradually. Your exhale should last longer than your inhale. Exhale until you feel you’ve emptied your lungs.
- Breathe from your diaphragm. Your diaphragm is a dome-shaped muscle that sits below your lungs and is designed to do the majority of the work of breathing. Many of us get in the habit of breathing only from our chest resulting in shallow, inefficient breaths. To find your diaphragm, place two fingers at the base of your sternum (also commonly known as the breastbone) and sniff quickly through your nose. The muscle you feel contracting is your diaphragm. The key to engaging your diaphragm is to breathe into your belly and not just your chest. This can be a bit tricky to get the hang of and I plan to devote an entire post on diaphragmatic breathing in the future.
- Pair your breathing with your movements. For example, when performing a bicep curl inhale as you lift the weight toward your shoulder; exhale as you lower the weight down. This technique will also help you to ensure that you are not moving too quickly through your exercises—hint: if you feel like you are hyperventilating you are moving too fast! Which brings me to my next tip:
This has got to be the #1 nag I give my clients. Slow down! Let’s go back to the biceps curl example. It is best to lift and lower the weight in a slow and controlled manner, both on the way up and as you lower it back down. Here’s why:
- Going slow makes your muscles work harder. Fast movements result in assistance from both momentum and gravity.
- Moving slowly can prevent excess strain on the muscles.
- When you move slow you can identify the portions of the movement that increase your pain. Which brings me to…
Move within a range that does not increase your pain
Typically the end ranges of movements, where your joints are fully extended (or straight) are the most painful. This is due to increased stress on your joints as the weight is the heaviest the further it moves from your center. This is also the point of the strongest pull on your muscles as they are now on full stretch.
Back to the biceps curl: imagine that you can lift the weight all the way up to your shoulder without pain. As you lower the weight your elbow begins to ache about half way down. At this point immediately bring the weight back up to the shoulder instead of continuing to lower the weight further. On the next repetition only move as far as just before the point that the pain started. As you continue the exercise you may notice that the range you can move through without pain increases. Be patient.
Decrease resistance, increase repetitions
The best exercise prescription for chronic pain sufferers is the following: low weights, high reps. In order to complete any exercise without pain you may need very light to no added resistance. In order to still adequately exercise the muscle enough to build strength you then will have to increase the total number of repetitions you perform. Try this: instead of performing the traditional three sets of 10, perform two sets of 20-30 reps.
Modify, modify, modify
Did I say modify? My role as a physical therapist is not only to prescribe exercise but also to modify any exercise that is not working for my client. If an exercise doesn’t work for you, change it! If applying the above stated tips does not work, try a different exercise. There are many ways to strengthen every body part—don’t give up!
As always: keep moving and stay positive
Remember that even if you are using light weights, moving in a limited range and moving super slow, you are still exercising! Keep consistent and you will get stronger!