Top 10 Activities for Chronic Pain

If you're hurting, these activities will help.

Posted Jul 25, 2020

 Henri Snijders / freeimages
Pacing changes brain & body.
Source: Henri Snijders / freeimages

Pain takes away power. That’s just what it does. It makes you feel like your body and life are no longer under your control. It steals your health, mobility, relationships, sex life, hobbies, job, and dreams. But there are ways to take that power back.

It can be hard to move when you hurt. This often leads to resting for weeks and months on end. While stopping all activities understandably seems like the right thing to do, lack of movement actually makes muscles stiffer, “sensitizes” the brain to pain, and makes it harder to recover. Treatments like Cognitive Behavioral Therapy (CBT) and other evidence-based interventions therefore incorporate a technique called pacing: a gradual return to functioning, one small step at a time. Just as you’d gradually work your way up to running a marathon, pacing for pain similarly involves a gentle, slow increase in activity. You can pace for any activity: from activities of daily living, like grocery shopping, to favorite hobbies, like dancing or soccer. Research shows this technique can lead to improved functioning, less fatigue, and less pain over time.

Pacing not only strengthens your body, it also changes your brain! This occurs via a phenomenon called neuroplasticity: the ability of the brain to adapt to new inputs and changes in the environment by forming new neural connections over time. Anytime we talk about effectively treating chronic pain, we always want to talk about this "brain rewiring." Neuroplasticity is the reason humans are able to learn; improve at skills we practice; change thought patterns and behaviors; adjust to new environments; and recover from accidents, trauma, and pain.

Note that pacing is not the same as “pushing through the pain” or the concept of “no pain, no gain.” Instead, pacing is a method of graded exposure to activity that requires finding a safe, comfortable starting point – even if it’s 60 seconds of activity – then stopping at the designated stopping point. It also incorporates taking breaks to stretch and rest.

Here’s a list of ten physical activities that can help you take charge of pain. For additional support, use physical therapy, books, and other resources to develop an individualized pacing plan that's right for you. Changing your behavior can change your body, your brain – and your pain.

Top 10 Physical Activities for Chronic Pain

  1. Walk outdoors: Walking is a good starting point for any pacing plan, and you don’t need to belong to a gym to do it. Just throw on some pants and step outside! Walking outside strengthens the body, lubricates joints, and exposes you to sunlight and nature – which facilitate health and pain reduction. One reason for this is that sunlight stimulates the production of a neurotransmitter (or brain chemical) called serotonin – which regulates mood to help you feel happier. Positive emotions then change the pain you feel. Being in nature similarly stimulates production of brain chemicals that facilitate improved mood, less stress, feelings of reward and pleasure, and less pain.
  2. Stretch: Stretching improves range of motion and flexibility, which can help reduce pain related to muscle tension. Stretching also stimulates blood flow, bringing nutrients and immune support to injured body parts, and facilitates full-body relaxation – which eases pain.
  3. Swim: Swimming is one of the lowest-impact, most joint-friendly activities out there. Engaging your limbs and core, it offers opportunities for whole-body fitness and strengthens muscles while increasing endurance and lung capacity. Immersion in water, particularly warm water, is also a form of self-soothing that can ease pain and stress.
  4. Yoga: Yoga has taken on a life of its own in trendy fitness circles, from absurdly expensive pants to fancy yoga studios. However, yoga was originally developed in Eastern meditative practices as a form of mindful movement integrating stretching, breathing, meditation, and body awareness – and has nothing to do with the brand name of your yoga mat. There are plenty of free, virtual yoga classes out there for folks stuck at home, including YouTube options.
  5. Tai Chi: The Mayo Clinic calls Tai Chi “a gentle way to fight stress.” Harvard suggests it may be “the perfect activity for the rest of your life.” Tai Chi, an ancient form of Chinese martial artistry, integrates mind and body. Movements are gentle and mindful; muscles and connective tissues remain relaxed. It’s low-impact, soothing, stimulates blood flow, and reduces stress and worry – particularly important when living with pain.
  6. Strength training: Strength training for pain incorporates light weights and isometrics to target specific muscle groups. This can increase strength and fitness while improving circulation and cardio health. Endorphins released during muscle-building serve as natural painkillers.
  7. Dance: Dancing is an under-appreciated form of exercise. It strengthens core, legs, and arms, stimulates circulation, and facilitates self-expression – which is a helpful way of releasing negative emotions that amplify pain. Dancing can also decrease fear of movement, generate pleasure and enjoyment, and increase motivation to move – leading to behavior changes that can break the pain cycle.
  8. Stationary bike: Riding a stationary or recumbent bike is low-impact and a great way to reintroduce more strenuous movements. Biking strengthens leg and heart muscles and increases endurance.
  9. Walk on a treadmill or in a pool: Walking on a treadmill or in a pool is often the first activity introduced in pacing-for-pain programs. It improves blood flow, strengthens muscles and your cardiovascular system, and offers control of pace, resistance and incline.
  10. Sex: Yes, really. Sex not only requires cardio work and endurance, it also triggers the release of endorphins—your brain’s natural pain killers – along with dopamine and serotonin, brain chemicals that confer feelings of pleasure, reward and happiness. Together, these chemicals can turn down pain volume. Get out of breath, retrain your sensitive brain, and use your body!

References

Zoffness, R. (2020). The Pain Management Workbook: Powerful CBT and Mindfulness Skills to Take Control of Pain and Reclaim Your Life. New Harbinger Press.

Zoffness, R. (2019). The Chronic Pain & Illness Workbook for Teens: CBT & Mindfulness-Based Practices to Turn the Volume Down on Pain. New Harbinger Press.

Antcliff, D., Keeley, P., Campbell, M., Woby, S., Keenan, A. M., & McGowan, L. (2018). Activity pacing: moving beyond taking breaks and slowing down. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 27(7), 1933–1935. 

Doidge N. (2016). The brain's way of healing: Remarkable discoveries and recoveries from the frontiers of neuroplasticity. Penguin Books.

Harvard Medical School, Harvard Health Publishing. The Health Benefits of Tai Chi. https://www.health.harvard.edu/staying-healthy/the-health-benefits-of-tai-chi. August 20, 2019. 

Mayo Clinic. Tai Chi: A Gentle Way to Fight Stress. https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/tai-chi/art-20045184. Sept. 26, 2018.

U.S. Department of Veteran's Affairs. VHA Pain Management. Pacing for Pain. https://www.va.gov/PAINMANAGEMENT/Veteran_Public/Veteran_docs/Pacing-formula.pdf

Yoshino A, Okamoto Y, Okada G, et al. (2018). Changes in resting-state brain networks after cognitive–behavioral therapy for chronic pain. Psychological medicine. 48(7): 1148-56.