Chronic pain is a condition in which the brain decides a threat to the body exists based on bodily signals, even if there is no existing threat anymore (6). It is often described as pain that “has a mind of its own.” Chronic pain is an extremely difficult, challenging, and exhausting condition to experience. Individuals often depict chronic pain as a constant bother, with painful but consistent flare-ups. These individuals may have pain that is rooted in previous injury or illness, but even after being treated for their condition, the pain did not stop. Pain is considered “chronic” when it lasts longer than 6 months straight. With medical consultation and continued treatment, most individuals make a full recovery and do not exhibit painful symptoms following injury or illness. Yet, for some, the pain never leaves and continues to plague the client for months or even years to come. However, a previous injury or illness does not have to be the root cause for continued chronic pain. Many individuals without a history of ailments have developed and continue to struggle with chronic pain. As difficult as it may be to deal with, there are many options for individuals with chronic pain to help ease their discomfort, help them live comfortable and stronger lives, and reduce the pain of flare-ups over time. In particular, maintaining regular physical activity, developing a relationship with a physical therapist, and consistently seeking physical therapy services has been shown to alleviate chronic pain symptoms.

Benefits of Physical Activity

Exercise has shown in many studies to significantly reduce pain and illness overtime in individuals. For those who suffer from chronic pain, the main benefit of exercise is the release of natural endorphins (1). Endorphins are brain chemicals that work to not only improve your mood and well-being, but also block pain receptors and signals (1). Endorphins are known as the body’s “natural painkillers” (3).

Consistent exercise has been shown to reduce pain, since it prevents injuries and strengthens our muscles. Exercise helps reduce heart risk disease and weight gain, both of which can cause further and unnecessary pain down the road (1).

Even if there is some pain experienced with physical activity, the benefits far outweigh the small spouts of pain that may occur. Staying active has been shown to immensely benefit individuals with pain related to the lower back, fibromyalgia, and arthritis (2). Maintaining consistent physical activity is important as too much rest can put you at risk of further injury and even more chronic pain in the future. Many studies show that consistent exercise on a weekly basis goes a long way to reducing pain overtime, while also increasing the individual’s flexibility, muscle definition, and strength (3).

Staying physically active for healthy weight is extremely important, as many chronic pain ailments begin and significantly get worse when an individual is additionally suffering from obesity. Losing weight can relieve pain associated with weight gain (2).

How Physical Therapy Helps

Physical therapy goes a long way in relieving pain and discomfort all over the body, but specific methods can change or vary depending on the specific body part that has weakness or injury. Those with chronic pain benefit from physical therapy as it helps individuals cope with the condition and manage it long-term on both an active and passive level. A physical therapist can work with each person in order to provide education on chronic pain treatments and solutions for improving your quality of life. The education and guidance can include pain management, movement improvements, and more. Due to the fact that chronic pain varies between clients, physical therapists will perform an examination in order to discover the best individualized treatment for you (6).

Physical therapists will provide the education needed to understand the chronic pain you are living with, giving you the knowledge to process what occurs in the body with chronic pain and what can be done about that pain. You will learn techniques necessary to manage pain flare-ups while also receiving guidance on how to engage in activities daily without difficulty (6). This education may also encompass posture and body positioning training to understand the best ways to maintain bodily form to avoid pain or add to injury. The physical therapist may actively adjust your movements during sessions to improve your functional ability (6).

At physical therapy sessions, the PT will often perform manual hands-on physical therapy such as a joint manipulation, therapeutic massage, therapeutic stretching, electrical stimulation, therapeutic ultrasound, acupressure, dry needling, and more in order to reduce pain and tension in problem areas, increase range of motion, improve tissue quality, and more (1,6). Therapeutic massages that work on soft-tissue manipulations can work to relax inflamed or painful joints, tendons, and muscles (2). Additionally, massage has secondary effects in reducing anxiety and stress, which helps reduce tension in the body and potentially slow/stop pain signals to and from the brain (2). Therapeutic massage techniques can also increase your flexibility, improve blood circulation, improve posture and form, reduce overall stiffness, and reduce inflammation (5). A lot of individuals with chronic pain experience muscle spasms due to continuous injury to the body from chronic pain flare-ups, so deep tissue massages will work to relieve that tension and pressure (8).

A physical therapist may also add modalities to the weekly treatments, such as cold and heat. The use of cold, often called Cryotherapy, will help reduce inflammation, pain, and muscle spasms, and encourage recovery. The cold slows blood flow in order to assist in these processes (5). Heat will increase your pain threshold and relax tense muscle systems (2). Heat can also dilate the blood vessels and encourage proper healing after an injury (5). As blood flows properly, the body can remove waste byproducts that are sometimes created due to consistent muscle spasms, muscle guarding and unnatural tension (8).

The physical therapist may also use devices and technology such as ultrasound, which involves direct sound waves that penetrate muscle tissues, that can improve the body’s blood circulation, decrease overall inflammation, and promote recovery and healing (2). Other technology devices can consist of equipment like red light therapy, TENS, and electrical stimulation as well (5,7). TENS therapy can reduce muscle spasms and also improve endorphin production, reducing overall pain levels (8). Devices that further reduce pain, such as braces, canes, crutches, walkers, shoe orthotics, and more may be utilized in order to support any aching joints, relieve overall pressure on the painful joints and nerves, and soothe the pains as they arise (2).

Physical therapy can help those who have lost their mobility and ability to walk easily due to their chronic pain (2). Through physical therapy, you will be able to develop the ability to perform common daily living activities necessary for a more comfortable lifestyle – such as, bathing, eating, dressing, and more (2). Physical therapy may consist of weekly therapeutic exercise regimens, scientifically based movement techniques, and devices necessary to aid in not only a comfortable daily living, but also in strengthening the body and increasing flexibility to improve livelihood overtime.

During your session, the physical therapist will focus on therapeutic exercises surrounding strength and flexibility improvement (6). These two combined will help an individual with chronic pain live a life that has far less discomfort and difficulty. The exercises provided are usually tiered, with prescribed routines including movements that continue to increase in challenge as you strengthen in your abilities (6). This is the main benefit of physical therapy – it progresses as you do. The level of challenge in your exercises matches your current health and mobility limits. As you gain strength and flexibility, the routines advance to make sure your unique needs are met and improved upon over time. Overtime, the stress and pain on your body decreases (6). Additionally, chronic pain often has a mind of its own. Introducing a plan of care promotes exercise routines that improve as you do and helps you retrain your brain to connect with your true body cues of progress. As you learn to move without pain or difficulty, you are teaching your brain that the movement does not and will not hurt – helping those with chronic pain train the brain to avoid sending unnecessary pain signals (7).

A good rule of thumb for physical therapy is to let your Physical Therapist (PT) know in between sessions how you have been feeling with your prescribed exercise routine. How you do this is entirely up to you. Some patients keep a pain journal where they log difficulty or pain experienced during different exercise sessions(1). Simply bring this information back to your PT so they can change the weekly regime to include exercises that are more comfortable.

Activities/Exercises

Your physical therapist may recommend a number of activities and exercises to help reduce pain. Yoga and Tai Chi are two forms of exercises that help focus on breathing control, meditation, and movements to encourage flexibility and the development of strength (2). Yoga and Tai Chi in particular have been shown to help individuals with chronic pain ailments such as lower back pain, headaches/migraines, arthritis, and fibromyalgia (2).

Even if these activities do not alleviate every ounce of your pain, studies have shown consistent yoga helped individuals cope with chronic pain, and those individuals were more in control of how their pain affected their everyday life” (5). The benefits of Yoga and Tai chi are that these exercises can be done from anywhere, such as at home through online videos or virtual instruction, due to the ease of performing it without equipment.

Tai chi is a type of exercise that involves slow movements that are fluid in nature, with an emphasis on the breathing techniques during the motions. The slower speeds make it much gentler on our muscles and joints. Tai chi, similar to yoga, can improve an individual’s overall strength, flexibility and stability. It has an added benefit of improving mood, as the exercise requires a level of concentration on bodily factors. A 2016 study showed that individuals with rheumatoid arthritis, osteoporosis, and back pain experienced an improvement in their chronic pain when performing tai chi over a long period of time (5).

For aerobic exercises, individuals with chronic pain have seen improvement through activities like swimming, rowing, biking, and walking (3).

Stretching can improve flexibility and release tension in the muscles from chronic pain flare-ups. Perform full body stretches regularly for about 10-15 minutes at a time, at least once a day. You can also stretch while engaging in activities like yoga and tai chi.

Strength training is key to increasing muscle development, which will improve stability and reduce the overall pain of everyday activities. There are exercises you can do only with your bodyweight at first, so you don’t strain your muscles by adding weights too early.

Make sure with any activity you partake in, you take it easy and pace yourself. This is why a physical therapist is beneficial, as they can guide the proper reps, sets, and time you need to do the workouts for so that they are challenging, but not impossibly difficult. Take it a day at a time, and if you begin feeling extreme pain or discomfort, stop. Take frequent breaks as well, and even decrease the time or repetitions if it becomes too difficult at first.

By Ashley Gresko

Blog Editing Consultant for Health Industry Designs

References

1) https://www.webmd.com/pain-management/guide/11-tips-for-living-with-chronic-pain

2) https://www.health.harvard.edu/staying-healthy/non-opioid-options-for-managing-chronic-pain

3) https://www.webmd.com/pain-management/guide/pain-management-treatment-overview

4) https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/8-tips-for-managing-chronic-pain

5) https://www.medicalnewstoday.com/articles/pain-management-techniques#physical-methods

6) https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-chronic-pain-syndromes

7) https://www.verywellhealth.com/pt-for-chronic-pain-4179087

8) https://www.spineuniverse.com/conditions/chronic-pain/physical-therapy-chronic-pain