Living a Healthy Life with Chronic Pain (20 page)

To learn more about the topics discussed in this chapter, we suggest that you explore the following resources:

Dahm, Diane, and Jay Smith, eds.
Mayo Clinic Fitness for Everybody
. Rochester, Minn.: Mayo Clinic Health Information, 2005.

Foreman, Judy.
A Nation in Pain: Healing Our Biggest Health Problem
. New York: Oxford University Press, 2014 (see
Chapter 13
, Exercise: The Real Magic Bullet).

Moffat, Marilyn, and Steve Vickery.
The American Physical Therapy Association Book of Body Maintenance and Repair
. New York: Henry Holt, 1999.

Nelson, Miriam E., and Sarah Wernick.
Strong Women Stay Young
, rev. ed. New York: Bantam Books, 2005.

Vernikos, Joan.
Sitting Kills, Moving Heals: How Everyday Movement will Prevent Pain, Illness and Early Death
. Fresno, CA: Linden Publishing, 2011.

White, Martha.
Water Exercise: 78 Safe and Effective Exercises for Fitness and Therapy
. Champaign, Ill.: Human Kinetics, 1995.

I
N
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HAPTERS
6
AND
7
WE TALKED ABOUT
the importance of keeping physically active when you have chronic pain. This chapter is your guide to a gentle set of 26 range of motion and flexibility movements called the Moving Easy Program (MEP). Once you have learned the sequence of moves, you can include the MEP in your exercise routine as a warm-up or cool-down to aerobic exercise, or you can do the MEP by itself to promote relaxation and relieve stress and tension. This chapter also includes six exercises that improve your balance and a short introduction to water fitness, tai chi, and yoga exercises.

There is an old adage: use it or lose it. If you don’t use your body—by moving your muscles and joints and being active—you will start to lose strength and flexibility. A common problem with chronic pain is that you often stop using your body the way you used to. You aren’t as active and you don’t exercise as much. You tend to hold your muscles in tension, which leads to restricted movement, and your joints become stiff.
As a consequence, you become less flexible and have limited range of motion of your joints. This becomes a vicious cycle because the less flexible you are, the less you do and the more your muscles shorten and weaken, which leads to even less flexibility and so on.

Flexibility refers to the ability of muscles and joints to move comfortably through a full range of motion. As an example, think of your wrist. You can make a circle with your wrist going clockwise and counterclockwise. You can extend your wrist back and flex it forward. Holding your forearm straight in front of you, you can move your hand to the right and to the left by using your wrist. These moves put your wrist through its range of motion, which involves gently stretching the muscles that act on the joint. Doing these kinds of range of motion and gentle stretching exercises for all your joints helps keep you flexible.

Flexibility exercises, like the ones in the MEP, help loosen tight muscles and joints and reduce stiffness so it’s easier to get going in the mornings. They are gentle so they can be done every day, even on days when you are not feeling your best. They can help with relaxation by promoting body awareness, which leads to improved posture and better breathing. And because they increase circulation to muscles and joints, flexibility exercises are a great way to warm up or cool down before and after aerobic exercise.

The Moving Easy Program is an enjoyable way to safely improve your flexibility. It gently loosens muscles and joints and increases circulation. It incorporates the whole body and is not meant to be strenuous. The MEP consists of 26 movements that take less than 15 minutes to do. Flexibility exercises and gentle strength training combine with better breathing to reduce stress and tension. The program is safe for almost all people with chronic pain. To help you get started, an audio CD of the 26 moves is included in this book. Use the CD and the photographs on
pages 128
–
142
as your guide when doing the MEP at home. The box on the next page lists important tips to keep in mind as you get started with the MEP.

1. The MEP program contains gentle neck and back exercises. If you have neck or back pain or are not sure if these exercises are right for you, check with your doctor, physical therapist, or other health care provider before doing these exercises.
   
2. If there are some moves in the MEP you know are not right for you, don’t do them. Instead, modify the moves (see suggestion 7 below) or just imagine you are doing them. Scientific evidence suggests that imagining moving an area of the body actually activates areas of the brain and stimulates nerves that connect to that part of the body.
   

3.   Loosen your joints and relax your muscles with the MEP before proceeding to aerobic exercise.

4.   You can do the MEP even on days when you don’t feel up to par because it is not a strenuous program. However, modify the movements to avoid any increased pain or stress on days when you are not at your best.

5.   Although your long-term goal is to be able to do the MEP routine to the full range of motion, always avoid straining or forcing beyond your current comfort level. Your goal is not to achieve perfection but to reach a level of flexibility and fitness where moving feels good!

6.   When moving from sitting to standing positions, avoid tipping your trunk backwards, which may strain your lower back.

7.   You may modify any of the MEP movements if you are not able to perform specific moves. If you are unable to stand, you can modify most of the moves so you can do them while sitting.

8.   To gently increase the active range of motion of a specific joint, move the joint to the point of comfort, pause and relax, and then move it again without straining.

Begin by placing a stable chair in an area where breathing … take a few deep, relaxing breaths you have enough space to move freely. Sit down before beginning. Remember to breathe natuand get comfortable. Take a few moments to rally throughout the program and not to hold clear your mind. Now, start by focusing on your your breath.

Inhale, lift your arms, raising them as high as you can, very gently and slowly, and if you can past your shoulders. Bring your hands together and guide them down toward the center of your body. Let’s repeat this … lifting up … hands together … and guiding them down. Let’s finish by guiding your arms back down to the side of your body.

Focusing on your head, bring your ear a little closer to your shoulder … Hold this stretch … and return to center. Let’s repeat to the other side, gently dropping your ear to your shoulder. Hold this stretch … and return to center.

(
Note:
For every move in the MEP, “return to center” means “go back to the starting position.”)

Special thanks to Ned Pratt for the photographs in this section
.

Gently turn your head and look to the side. You may feel a stretch or tension release … Return to center. Repeat, gently looking to the other side, holding your stretch … and return to center.

Drop your head gently to your chest and hold … feeling more tension leave that area … Return to center. Repeat … gently dropping your head forward … and return to center.

Bring your attention to your shoulders and think about making small gentle circles forward, starting with small circles and increasing them, remembering that even the smallest of movements can be beneficial … Now reverse this circular movement back … making small, gentle circles and increasing them and feel the tension start to ease … Repeat this a few times.

Placing both hands on one thigh and using your body’s mid-section, gently look to the side turning your head, shoulders and chest … feeling a lengthening of your spine, and hold … Come back to center. Now place your hands on the other thigh, and gently turn your head, shoulders, and chest to the other side … feeling your body lengthen. Come back to center … Now repeat these moves two more times. First to one side … and now the other.

With larger movements, reach your arms behind you, while you bend forward from the hips—keeping your back straight—reach down to the best of your ability, with comfort and no pain, and picture scooping water from beneath you … and slowly sit back up, splashing the water over your shoulders. Good … Let’s do that two more times.

If you are able to stand, using your hands, lean forward and lift yourself out of the chair, focusing on the large muscle groups in the tops of your legs and stand up.

(
Note
: Avoid tipping your body backwards since this may strain your lower back.)

Now move to one side of the chair. Holding gently onto the chair for balance (or sitting in your chair), extend one leg forward as if moving your foot through a shallow pool of water … back and forth … back and forth … Repeat this a few more times.

Using the same leg, gently glide your leg through this shallow pool of water from side to side in front of you … Repeat with gentle, slow, easy movements a few more times.

Now, keeping this leg extended in front of you, flex your toes up … and point your toes down. Feeling the tension in your calf flexing up, and releasing by pointing down. Repeat this again … up … and down … up … and down.