Long term conditions
Persisting pain can be defined as pain that has been present for more than 3 months. When pain has been present for this long it is often associated with a reduction in activity levels, which in turn can lead to decreased fitness and muscle weakness. This in turn can lead to symptoms such as fatigue, tender joints and muscles away from the original site of pain. People with persisting pain often experience mental health symptoms, if this is the case you should read our useful guide here.
Because of the negative cycle described above persisting pain tends to make normal day to day activities harder to perform and you may experience more pain with even simple day to day tasks.
The most important thing to realise before getting going is that regardless of having persisting pain or not it is normal to get some low grade stiffness and muscle aches after exercise. This phenomenon is known as delayed onset muscle soreness (DOMS) and usually occurs 24-48 hours after exercising. The fitter you get the less noticeable this will become.
It is important to note that exercise does have the potential to flair up persisting pain symptoms which if not managed properly can hinder progress and make it less likely that you will want to continue exercising. The good news is flair ups can usually be kept to a minimum by understanding and managing your symptoms irritability.
Irritability is a term that is used to describe how easy it is to provoke pain and then how quickly symptoms settle again. Irritability is different for everyone . Symptoms with low irritability usually take quite a while to increase and then settle reasonably quickly. Highly irritable symptoms stir up quickly and then take a long time to settle.
When starting to exercise with persisting pain being aware of how your symptoms behave and whether they have a low or high irritability is important as this knowledge will allow you to plan how much exercise you want to do and how quickly you will want to increase things.
The diagram above shows the difference between starting exercise with and without an appreciation of irritability. The vertical scale represents pain and the horizontal scale represents time.
The blue line represents a patient who has set themselves a time goal without considering irritability. They complete a planned work out of 40 minutes, their pain becoming more intense over time. As you can see as a result of pushing through pain to reach the time goal the pain symptoms are exacerbated and take a number of days to settle. The green line represents a patient who has set themselves an exercise goal based on irritability. They have decided that they will only allow their pain to increase by two points on the 0-10 during exercise before they stop. As you can see they reach this goal within 20 minutes, they then stop and their symptoms quickly return to normal.
We would normally recommend setting your exercise goals around irritability and not allowing your pain to move more than 2 points on a 0-10 scale above your pain at the start of activity. Depending on how irritable things are this may mean your initial exercise sessions are quite short.
You should be aiming to exercise initially for between 5 and 15 minutes per session 3 times per week, based upon your symptom irritability. As your tolerence improves you should be able to increase the time and the intensity of training. We would expect you to see benefits within 3 months.
The most common issue encountered is flair of pain following an increase in exercise volume or intensity. In this situation it is best to reduce your exercise back down to the pre incremental level and try again once flair has settled. It is a good idea to then increase your activity by half the amount of the increment that caused the flair.
You can arrange a consultation with us by clicking here. (link to self ref page
Alternatively City of York Council run a program designed to support participation in exercise. The scheme can be accessed by GP referral. To find out more click here.