One of my colleagues at Duke Integrative Medicine, Sam Moon, M.D., M.P.H., in the Department of Community and Family Medicine, Division of Occupational and Environmental Medicine, is an expert in integrative approaches to pain and healthful lifestyles. Here is what he has to say:
Chronic pain frequently produces 'collateral' harm, including the many adverse effects of physical inactivity, such as decreased vigor, muscle weakness, worsening obesity, low mood, and so on. It is human and natural to withdraw a bit and 'nurse' one's pain with rest. This is good early on. Chronically, this natural instinct becomes part of the problem. Exercise (physical activity) is but one small slice of a full, long-term pain management plan, and that 'slice' is as crucial as it is highly individual, complex, and tricky. Success is finding combinations of activity that are safe, beneficial, fun, sustainable over seasons, and 'elastic' (i.e., their intensity and duration can be scaled up and down easily). If this goal becomes a struggle, you should seek a professional 'integrative exercise prescription.'
This process considers such obvious medical details as heart and lung status, injury risks, baseline fitness status, undiscovered medical problems, and specific biomechanical issues. And it ideally includes support through nutrition, pain/inflammation reducers, appropriate physical supports, movement awareness training, and numerous other treatments. Potential barriers that can arise from your mind, body, or circumstance should be explored, and a plan to support you in overcoming them can be created. Reassessing and modifying this over time is an important part of the process. Your life isn't stagnant, so your plan can't be, either!
While one size never fits all, here are some tips you should consider: Be practical and careful. Don't fall and break bones. Have your balance assessed, and get direction on improving it. You may want to consider practices that help bring attention to balance, such as tai chi or qigong.
Ask specifically for professional guidance on your boundaries for avoiding actual physical harm versus experiencing temporary 'hurt.' These distinctions may vary from one body area to another. Start by using all your pain-free, healthy body parts within your boundaries, then move very patiently into touchy areas. Start conservatively. Be steady, and make tiny increases slowly. Water is your friend. Injuring yourself during water exercise is not impossible, but it is harder than on dry land.
Always warm up initially and thoroughly, which takes probably longer than you think. Gentle stretching after exercise may help. Use layers of 'wicking' clothing (i.e., polypropylene, etc.) to keep body parts warm enough but comfortable during all stages. Don't give up. Don't be discouraged that your inner struggles with this delicate balance are invisible from the outside. Learn to mix deep relaxation skills, acceptance of realistic limits, and persistent exercise—all in one complex package. And whenever possible, choose activities that you enjoy! This makes it more fun and more sustainable.
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