My chronic pain doctor suggested I exercise more
I asked him “how?”
He looked confused. Said I should try a bit every day
I said “not when, how?” I asked what exercises I should do
He suggested half a dozen options that had all been explicitly banned by other doctors. I’m not allowed to run. I’m not allowed to bike. I’m not allowed to use my rowing machine or my punching bag.
I walk my dog whenever I have the energy and when it doesn’t hurt too much
What else can I do?
He told me I should exercise more
And then he changed the subject.
Next time a doctor tells me that, I'm asking "how?"
the first thing I did in my journey out of bed was kind of an accidental win. I bought a weighted blanket when I didn’t even have a gp because my other one left the area just before the pandemic hit, and didn’t give me any suggestions where to go when I was struggling a lot with brain fog; so I was without support or painkillers for a year.
it’s pale pink and fluffy. lighter than the one the company recommended for my age and size, and it’s still very heavy for me. the way all of the beads pull in such an unwieldy fashion can make it difficult to pull onto the bed. I could only handle half an hour at a time at the beginning.
but slowly, completely by accident, it actually helped. especially my core muscles and thighs from turning over in bed. I was just feeling anxious. I had no room in my head for thoughts of exercise. but I actually put on a scant bit of muscle. it was crazy
the second bit of exercise I started doing was to get out of bed and sit in a chair by the window instead of laying in bed.
the third, wearing clothes. showering a little more often. putting two braids in my hair instead of one.
then doing laundry
then learning to cook again, because brain fog had robbed me of most of what I knew.
and of course cooking meant more and better food, which gave me more energy and helped my body get a bit stronger
in there were stretches. I had no room in my head for videos or books so I did the three I could still remember from back when I saw a good physio years ago. I could only do three repeats at first, not even the five that was a recommended set.
all of that helped me get strong enough to make it to sit through a two day course at the pain clinic, and thankfully they weren’t like OP’s doctor, they were adamant that pacing is vital to any improvement if you have chronic pain. pushing too far too fast is the enemy. low and slow. persistence. is key
it was crazy to sit in that chair with my blanket and a pillow to hold onto so I could lean on it, and prop myself up, because a lot of what they said I’d kind of worked out. but they were scientists and doctors who had all experienced chronic pain and so they had the terminology and were able to piece it together
and most of all they vindicated my own course that I’d stepped on by accident.
and finally when my new gp asked me every month whether I’d thought about taking some walks I was able to say ‘I believe I’ll get there, but not yet. and the pain climic agree with me.’
and I did get there. I don’t walk as much as she would like but honestly I don’t think she’ll ever be happy lmao
the thing most doctors, even many chronic illness specialists and chronic pain specialists fail to account for is that the activity you’re already doing is important (vital, even, because personal maintenance and living life is very important!) and it’s already exercise and strain and very energy consumptive. it counts! and also they greatly underestimate the incredible value of seriously seriously small, tiny, incremental steps that can actually account for massive improvement over time for the chronically ill—if we’re allowed to pace ourselves properly, for, like…ever and not just a certain period of time
I don’t know your pain, I don’t know your body. but I recommend that you sit down and think about—or perhaps actually just take note over the course of your days and weeks, what activity you’re already doing. maybe at first you’ll only notice when something makes you hurt, but take note of it. because that matters*. and you can build off of that. slowly slowly slowly.
you’re a persistence predator. we walk slower, we do everything slower; and many of us will never get to a place where the average physio will approve of our condition.
but fuck them. we can build muscle; I’ve seen it. we can gain small amounts of improvement without undoing all of the good work we put in. but we have to be patient, and persistent, and we have to be cautious and we have to be brave
*I do feel the need to add that I also learned how to arrange my day so that some activities hurt less. and I learned over the course of a year —and really i’m still learning—to see my days in fifteen minute to half hour increments because I have to consider PEM as well. stretches have to happen if I sit in the chair too long. especially if I’m on my computer. a very short walk is best if I’ve been out and sitting at tables because that puts so much strain on my back. it takes spoons and it’s really tempting to think it’s too much but I generally find the pain the next day if I don’t takes more spoons than if I do. most activities at home are done in fifteen minute on thirty minute off shifts. when I say slow I mean slow
that’s not always possible. I don’t have kids, and just sent the cat I was living with to another home with someone who could bend without crying all the time. I have time and space to set that pace and not everyone can. life can be complicated.
but
you can exercise. you just need to vastly vastly change what the word exercise movement activity mean for you.
anyway I hope that helps
big pain day today so I’m feeling very bitey esp about doctors
I suffer from chronic pain and hypermobility which means I have some permanent soft tissue damage from doing sports like karate and gymnastics while hypermobile, which makes exercise difficult. As a result, and because I'm working full time which takes up all my spoons and have literally no movement the entire day except for going to the kitchen for a coffee or to the bathroom, I've been experiencing some nasty muscle atrophy.
I can physically feel myself lose all my muscle tone, and I've taken to doing full range squats every time I take milk out of the fridge or put it back, and carrying water buckets to water the animals that are just barely a bit uncomfortable to carry and eating as much protein as I can, just so I don't end up completely immobile. It didn't feel like enough, so I looked up exercises to prevent muscle atrophy, and it took reading through 14 listings to find good, sound, evidence based advice for people actually dealing with degenerative conditions and chronic pain.
The advice? Aerobics. Seriously mild aerobic exercise is what's recommended to maintain muscle tone and manage pain. Stretching too if your body allows it but mostly just basic aerobics. Like grab a beginner zumba video, follow along within your limits, and do that until you have some sweat and are out of breath. If you feel dizzy you should breathe deeper, and if you're unable to speak a full sentence you've overdone it.
Seriously I'm not even kidding the advice is "do light aerobic exercise until you have some perspiration and are comfortably out of breath" and you do that every other day, less at first if you're very sore after a session, until you can build up to 30 minutes of light to medium intensity aerobic exercise every other day.
The reason aerobics is suggested is because it improves cardiovascular fitness, but it also improves mobility and muscle strength. Every other article I read through suggested hiit or weight training, and I knew that wasn't possible for me because of my hypermobility and accumulated injuries. Aerobics? I can do that! That's easy and fun! And it prevents muscle loss, helps stabalize your posture by training deeper muscles and your core muscles, and also improves cardiovascular fitness which can have a positive influence on chronic pain and even mental illness.
And because the article gave a hard and clear limit, light perspiration and comfortably out of breath but still able to speak a full sentence, it's easy to monitor whether I've over or underdone it. They also say that if your muscles are sore for more than a day that you overdid it, and if the poke test hurts too. Literally if you poke your thigh and it hurts like a bitch you did too much too fast. Like it can be sore but you should still be able to move around comfortably and if you walk into something not want to collapse in pain.
This is completely different from everything I've ever been taught about exercise and it took me very much by surprise. They also suggest yoga for those capable for more core stability, but it's something you have to work up to. Light weight training is an option, but it has to be at that sweet spot where you can do 10 to 15 repetitions without shaking or jerking. If you're doing that your weight is too heavy. If you can comfortably do 20 reps or more your weight is too light. Remember we're not only not in the type of peak physical condition that weight lifters are in, we're also not trying to build a huge bulk of muscle in a short amount of time. We're just trying to gain and maintain enough muscle mass to be more physically supported and less prone to injury to decrease our pain.
And some additional info I learned years ago is your heart rate can increase however much it does, but if you're dizzy, experiencing chest pains, or getting a bounding pulse (which is where you feel your pulse throughout your entire body) then stop immediately. It also won't at first but ideally you should be able to get back to a resting heart rate after exercise in 5 to 15 minutes. If it takes longer you overdid it. The shorter the recovery time the fitter your heart is.
In the paraphrased words of Alexis Nicole, Happy exercising, don't die!