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Exercise is not evil: it is part of a treatment plan

There is said it. Exercise is not evil. Although you might give me this face…
And in general it may feel like…
It is likely the most common form of advice we get from doctors. I hear it from every neurologist I see. You see there was this study, and there always is a study, that states aerobic exercise of an hour three times a week is equivalent to the migraine preventative medication Topamax on migraines. I received the same advice from the pain clinic. You see, they had read that same study. The difference being they understood I had comorbid fibromyalgia and could not just jump on in and go at it without significant problems. For example, feeling like I was smashed by the Hulk repeatedly. 

So first I will say there are things not to do when exercising. We should never exceed our limits. Ever. Not even if some douchebag neurologist says to you, and I quote, ‘That is not sufficient to do anything. You will have to do more than that to get any effect.’ So you double what you are doing and cause a back injury. So don’t do that. Yes, I did that. I had worked my way up to, slowly, twenty minutes of yoga a day and twenty minutes of walking a day, on alternating days. So I doubled it up. I walked 20 min and did 20 min of yoga every day. How I injured my back I am still not certain although I suspect it has to do with being double jointed since the injury was not a constant persistent pain. No it was some sort of nerve tingling issue and pain after walking for ten minutes but then fine after sitting. I had to not do a thing for six months as a result. So that was hardly productive. The point here is that I did not listen to my body, I listened to someone who knew nothing about fibromyalgia. That is a mistake. They do not know us like we do. We are the ones doing it so we are the ones that know the pain, the limits and the pace.
What should we do?
  • Start infinitely slowly- Test yourself out. Start with going for walks. See how far you can walk before you get tired. Use that as your guideline and continue to do that. 
  • This is not a race- Increase by minutes if you need to. If you can do ten minutes comfortably then go up to 11. If that works, then 12 the next day. If that was pushing it stay there for a bit.
  • Once you have gotten used to walking for a bit choose activities that work for you. For me it is a stationary bike. Although I may try water aerobics soon. Again pace yourself, find where you are at on that exercise and go through the same steps. On my stationary bike I also started at the lowest resistance and slowly got myself able to do 20 minutes, then increased the resistance and again slowly got back up to 20 minutes and then again.
  • You can break exercise up through the day as well. I used to do gentle stretches during certain parts of the day, then later do yoga. 
  • You never want to exceed your pain limit when exercising. You want to get to just the point of pain and back off. The point is to teach your brain you can do these things without feeling pain. So to go to past that pain point would cause a flare up and be counterproductive and likely losing more than a few days of exercise as well. So keep it easy, slow, and consistent just meeting to that point.
  • Be patient- it took me a month of riding a stationary bike at 10 minutes to get past that point from a pure muscle fatigue point. Not even to the pain issue. My timeline I was given to get to an hour of exercise was more than six months of consistent exercise by the pain clinic.
  • Allow yourself pain days- there is no point in exercising on high pain days. And no reason to feel bad about ‘ruining’ the routine. As far as I can tell I have no routine but I still manage three to four times a week. Just so happens it changes a lot to what time of day and which day of the week it is. Nothing wrong with that.
  • Don’t let anyone say you are going to slow, not doing enough, not doing the right sort. Any activity is actually good activity when it comes to chronic pain. It is all beneficial to us. Maybe not what some doctor read in his study, but you know I read a study that said 20 minutes of walking had a great deal of health benefits.
  • Never compare your progress to others- other people have different bodies, different levels of different conditions, different timelines. I know of some people with fibromyalgia that can exercise a lot and I am vastly impressed given my awesome start time of 10 minutes on the stationary bike but it is what it is. I have more than one pain condition and my pain is just at that point. I have to look at my progress day by day and not anyone else. Then when I got to 20 minutes I did a happy dance because it seemed like an insane improvement to me, relatively speaking.
Best choices for chronic pain generally are walking, yoga, stationary bike, water aerobics and Tai Chi. However, depending on health conditions and other factors it is best to ask your doctors what sort of exercise they think you should look at.
Regular exercise can boost the production of those feel-good endorphins and dopamine and reduce chronic pain. They also overall prevent our muscles from weakening and joints from stiffening that can also worsen chronic pain.
So the benefits of exercise according to WRIISC are:
  • decrease pain
  • decrease fatigue
  • decrease joint and muscle pain
  • decrease blood pressure
  • decrease resting heart rate
  • decreased risk of heart disease or stroke
  • improve sleep
  • decrease anxiety and depression
  • increase efficiency of the heart
  • increased control over blood sugar levels
  • increased ability to burn fat
  • decreased loss of muscle fitness
  • increased energy
  • improved cholesterol profile
  • improved feeling of wellbeing
  • improved work and recreational activities.
The first couple ideas here of importance are mood and fatigue. Exercise has been known to help with both these issues even when it is mild to moderate. We need as much mood maintenance as we can get and I’ll get it where I can to be honest. I do find a little exercise gives me some mental clarity as well, so helps with mental fatigue. The next point is that it is helping with overall muscle health and endurance that contribute to our existing pain levels. Improving that causes no harm. Lastly, is the most important of course, the hope that the end goal it could improve our chronic pain itself. That I believe is a longer term goal that I have not seen yet but I have seen my muscle strength and endurance improve, my mental fatigue and mood.
It is a difficult challenge. It is a slow process. It does seem odd we are doing something that causes pain to help with pain, but that is why we have to really pace ourselves. We are trying to retrain the brain by getting to do movement in a non-painful fashion regularly as to lower our pain sensitivity over time. In the beginning though it is very difficult because I had weak muscles and weak endurance and still do, so we must get past that point first. I also believe it is very beneficial to do this with the aid of your doctor to have some sort of plan. I am currently at a pain clinic and they put me on a slow release pain killer to help me exercise. What I have been able to do, which has been infinitely slow progress, has been with that. Without I was at half that. So pain management while doing an exercise program in the beginning is something to consider.
- Originally a guest post of mine on Positivity in Pain
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