Managing activity
With Professor Paul Cameron
Paul is Director of Allied Health at NHS Forth Valley and Honorary Clinical Professor at the University of Stirling. He is an advisor to Pain Concern.
This information was last updated in June 2025. It is due for a review in June 2028.
Physical activity is vitally important in all types of chronic pain. It improves mood, sleep and general wellbeing by releasing the body’s own ‘feel-good’ hormones: endorphins. It helps condition soft tissue and bone, which results in a strong body structure, and has a part to play in weight control. It really does have a lot to offer us. While some of you may have a regular programme that keeps you fit without flaring up your pain, others may have had difficulty and become largely inactive.
Flare-ups
Do you have pain that you manage quite well until a bad episode comes along? The flare-up may have started for no reason that you can think of, or resulted from a movement such as twisting or reaching. In some people with neuropathic pain even a slight breeze can be enough.
What do you do to get through the bad patch? Many of you will consult your GP, who may send you to the physiotherapist. Indeed, you may have already seen the physiotherapist. You were very probably taught a range of exercises as part of the treatment plan and asked to practise these every day. You perhaps carried on until the flare-up settled and you were left with your old manageable pain. Exercise practice seemed less important then, and maybe you stopped doing it regularly or stopped altogether. Crisis over! Does this sound familiar?
This is not unusual: it’s human nature. Whether it’s indigestion after overeating or sunburn after not putting on cream, we all make promises that if only we could be relieved of a self-inflicted misery we would never let it happen again. So it is in the agony of a flare-up. We promise to continue with the exercises forever if only the pain would settle down.
Body maintenance
Some of you may recognise the trap of ‘crisis’ management. Others may have tried to keep going with exercises taught by the physiotherapist but found it difficult.
If regular practice has not been a habit, stiff and tight tissues might have led to poor posture, lack of confidence and fear of moving. You might have much more difficulty with ordinary activities such as climbing stairs, getting on and off the bus and pushing the shopping trolley. If there’s anything around to trip over, you’re the one to find it!
The likelihood of pain flare-up can be reduced if body tissues are kept in good condition. That means a regular, maybe even daily, commitment to exercise. After all, you wouldn’t think about starting your day without some teeth maintenance, so why not some body maintenance!
Build up gradually
It’s really important to learn how far to take each exercise to get success. If you push through the pain, flare-ups are a likely consequence and then you’ll be unable to build up repetitions and benefit from improved exercise tolerance. This is the main reason for people giving up.
Find the level of activity or exercise you can tolerate. This may be just one repetition. Many people think they should be able to do more than that, but when they try to increase it they flare up and get set back. So start at one repetition and increase it to two and then three and so on. The increasing tolerance phase between increased repetitions allows the body to build up the muscles, tendons and ligaments. This doesn’t happen overnight, it can take two to four weeks.
The golden rule of exercise and chronic pain is that you should not feel significantly worse afterwards. If you do, it is not that you have caused yourself more harm or damage, but that you have flared up a sensitive nervous system. It might be useful to think ‘would I be able to do the same thing again tomorrow?’ If the answer is ‘no’ then you are probably overdoing it!
Feeling fitter
Why not make time in your day for some exercise practice and see if you can improve your feel-good factor.
- Pick a ‘best’ time for yourself. Some people prefer mornings, others find later in the day suits better.
- Take your time and don’t push through the pain. That’s not helpful and can lead to flare-ups.
- Start with a few repetitions and gradually build up. You shouldn’t need to spend any more than 15 minutes each day to get results.
- Commit to daily practice for three months before judging whether or not this is worthwhile. If you’re very unfit, it may take some time to feel an improvement, so don’t give up!
The best exercise programme for you to start work on will be one you have been taught by your physiotherapist. If you haven’t attended physiotherapy for some time, you may want to try gentle, low-impact exercise such as swimming, walking, yoga or tai chi, being sure to build up gradually.
Over time you will notice that you feel stronger and more confident. You’ll have improved self-esteem as your body adapts and you start being able to do things that you thought were written off.
