Chronic Pain and Exercise: When the Answer Hurts

I was a recent guest on Dr Joe Tatta’s Healing Pain podcast (give it a listen). During our recording last week it really woke up some thoughts and reminded me of my secondary mission: to elevate the standard of fitness options and the industry overall to give you better choices. During my conversation with Joe we spoke about the value of exercise for chronic pain patients in his case, clients in mine.

I think we’d both love it if at some point in the future he had to rename his podcast because there weren’t enough people in pain who cared about the topic. Unfortunately, today there are.

I want to share a few thoughts from our conversation and add some things in print for you to use or share with someone you know in pain.

There are all kinds of chronic pain. From emotional pain that includes depression and or anxiety, that might lead to or have been caused by insomnia whether it’s situational or more sustained to physical types of chronic pain in the form of back pain, headaches/migraines, joint pain, and pain compounded by issues like osteoporosis, diabetes, and high blood pressure. This list is by no means all inclusive. In reading, you may have thought of something I haven’t listed. There is pain from cancer and dozens of other conditions both by themselves and in combination with others. Joe and I mention more on the podcast.


When Exercise is Both the Answer and It Hurts

The first step is not an exercise prescription from a text book. It’s not about looking at cardio, strength, endurance, and flexibility. It’s about stopping pain or often reducing the intensity, frequency, or duration of pain when it does occur.

There’s no measure of how many sit ups, how many push ups, how long can you hold a plank or how fast can you do a mile. We benchmark first the very most important things and that is getting out of the “red.”

The focus first then is often to restore mobility. Not full range of motion based on some arbitrary scale of “this is where it should be,” but based on your right to left sides and your ability to move (and sometimes rest) well in daily activities of your life. Can you do activities that are important to you and bring you joy? That’s worth talking about far more than whether you can touch your toes.

How Do You Choose a Fitness Professional?

If you’re in pain this is a scary thought. I tell fitness trainers frequently that the three little words they’re going to hear most often when working with adults in mid-life and beyond are not “I love you!” they are “Don’t hurt me!”

We know that being injured sets us back further from getting results we want. The less we can move and the more pain we’re in, the more depressed, the more we tend to make poor eating choices and it spirals downward.

In fact, many of us collectively, might choose not to seek support for fear of worse pain, in favor of tolerating where we are – either hoping it will go away, or using meds or other passive ways to try to solve our pain problems.


When you do reach for help a few tips:

  • Don’t judge a book by it’s cover. A young trainer with little experience might actually have the empathy and resources to be a good fit for you. An older trainer who “gets you” may be as brand new and unexperienced as the 23 year old fresh out of college. I do prefer a four  year degree, a basic certification, and then more advanced and specific qualifications or experience – Medical Exercise Specialist (ACE), Clinical Exercise Specialist (ACSM), Breast Cancer Specialist (Stott), etc. as appropriate for your condition. Sometimes an internship or mentor relationship with a Physical Therapist or physician is the route a trainer has taken.
  • Interview. You’re hiring them. Be in your street clothes. A screening tool I would use would be – anyone who won’t do a consultation or who asks you to come in exercise clothes to do a workout – is probably not your match. A chronic pain situation warrants a trainer who would first want to be sure they can help, and who first wants to communicate with your allied health care provider before doing any movement with you.
  • Ask your physician. Your health care provider may have a relationship with a trainer already who they feel good recommending. Ask your physician if exercise is appropriate and if they will provide guidelines and recommendations for a trainer. You ultimately will be the liaison between your trainer and physician and you must sign a waiver to allow communication to happen. Bringing forms with you from the trainer to your doc to sign agreeing you want them to release certain pieces of information is a big part of your success. You want a congruent and open relationship about your treatment, exercise, and progress.
  • Ask for testimonials from clients like you. Has the trainer worked with someone with your condition before? What were the results? Can you speak to those individuals? Now, even as a 30 year veteran in the fitness industry I can work with a client with a new set of conditions at any time. So there is always a first. What you want to know is whether or not the trainer has a network, has worked with one or two of the conditions you might have, and you should feel good about the responses you get.
  • Ask for the trainer’s plan. Based on information you give her, does the trainer have a first and second step that she can reveal to you so you do feel there is a GPS in place? Do you feel comfortable with the recommendations? Trust your gut.
  • Can you stop training, get a refund? What if it begins to go backward? Can you stop training and get a refund? What if you have a flare and have to cancel without notice? Identify any road blocks that might be true for you along the way.

These are just a few tips that you want to put to use no matter what your condition. The fact is, the older we are the more likely we’ll have something to deal with. It doesn’t make exercise something we can’t do: its more likely reason it becomes more important for us to do.

If you’ve had a challenge finding exercise support for specific conditions, I’d like to hear from you.

Add a comment and share your experience with me. Have you found a referral network through your physician? Is there a medical fitness facility tied to your hospital or clinic?


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