Aerobic exercise-chronic pain

Article by Jennifer Chu, M.D.

Aerobic exercise-chronic pain – Health

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Aerobic exercise is commonly performed through pain since commonly people subscribe to the notion that “no pain is no gain. In nerve related muscle pain, however, the major component of pain is secondary to lack of blood supply to the muscles and nerves. This arises because the muscles have become very tight and shortened secondary to spinal nerve root irritation from sudden onset or slow insidious trauma. The tight muscles press upon the intramuscular nerves and blood vessels. These tissues are very pain sensitive and in the presence of poor blood supply to these tissues as well as muscle, pain results. Additionally, the tight and shortened muscles can have a traction effect on the bones and joints creating more pain. When one performs aerobic exercises in the presence of chronic pain due to tight muscles, the muscles shorten even more causing further compression on the intramuscular nerves and blood vessels. This leads to more pain since the contraction of muscle utilizes energy which in normal situations is supported by an increase in blood flow to the muscle but this mechanism is unsupported in patients with chronic pain. The supply of blood continues to be poor while the demand for more blood is increased. The exercise also produces pain provoking waste products that need to be washed out but their stagnation causes congestion leading to more pain. Additionally, the increase in tightness of the muscles will have a further traction effect on the pain sensitive bones and joints and the pain becomes magnified. Further nerve damage will also add on to the pain.Many patients state feeling better during the aerobic exercise or stretch exercise. This may be due to the release of morphine like neurochemicals called endorphins from the brain and spinal cord which have pain relieving effects. However, the pain increases over the next day or two. Although they feel worse after the exercise, patients feel compelled to continue with daily exercise even though they have more pain. They do not see the direct connection between exercise and the increase in pain since during exercise they may feel better. Often, chronic pain patients also perform aerobic exercise in pain believing the “no pain no gain” model. This is an inappropriate model for patients to follow. Patients who have pain must stop immediately when they feel their muscles tighten, allowing the muscles to rest. Patients should exercise and rest for an equal amount of time that they exercised, for example, if they exercised for five minutes, they must rest for five minutes. They can do this type of of exercise multiple times during the day rather than one long period of exercise for 30 minutes. The duration of exercise is best determined by the time of onset of the exercise to onset of discomfort rather than to increase in pain. The duration of rest is determined by the time taken for the pain to dissipate. This pattern of exercise will help prevent the underlying pain from getting worse.http://technorati.com/tag/aerobic+exercise