Resting for persistent pain - a false sense of security

For a lot of people living with persistent pain, resting can temporarily make their pain feel better. 

However, you’ve probably also heard that you should keep moving, that movement is key to recovery, movement prevents losing mobility, strength and it is crucial for our general health and well-being. 

And if you’ve been using rest to manage your pain, you might have experienced some of this already. You may have noticed a decrease in strength, less mobility, reduced fitness and the inability to do certain physical things that were previously not a problem (e.g., carrying a washing basket, playing with kids). 

And you may have also noticed that when you try to move more and be more physically active, the pain is even worse! 

This can make people feel stuck - ‘I know I need to move more… but it just makes my pain worse.’ 

People can start avoiding certain movement that have been painful in the past. Or they avoid movement in general. After a while, this can become more about the expectation that it will hurt. In research this is also referred to as ‘fear avoidance’.

First of all, it makes complete sense that we might want to avoid things that make our pain worse. 

You might be thinking, ‘I get this… but what do I actually do about it? I would love to be active, I would love to be gardening again, playing sports again, etc.’ 

This is where gradual progressive physical activity and/or graded exposure can come in. 

Gradual progressive physical activity 

This is an intervention we use if we have avoided movement in general. In simple terms, this approach is about slowly reintroducing movement and physical activity. 

We will often explore appropriate and gentle movement options for the person and this can look very different for each person. To make this easier to picture, let’s use walking. We may want to be able to take our dog for a walk again. We would start with some shorter, slower walks with/without breaks. We would then slowly increase the duration and distance as tolerated. Keeping flexibility for when symptoms fluctuate. There are several strategies we could implement to make it even more manageable, like adding mindfulness, interoceptive or breathing strategies. 

In most cases, we can usually find some form of movement that feels manageable, even when pain is significant. 

Graded exposure 

This is a strategy used when pain or fear shows up with specific movements. And when those movements are important for us. 

An example we often see is bending for lower back pain. For many people with persistent lower back pain, bending is generally safe and not associated with ongoing damage. However, it is a common movement that seems to aggravate pain. It is often helpful to completely break this movement down into smaller and modified movement patterns. When we break it down, bending often becomes more manageable.

Written by

Samuel Bulten

Exercise Physiologist | Masters in Medicine (Pain Management)

Director, Adapt Movement

Disclaimer

This information is for educational purposes only and is not a substitute for personal medical advice. These blogs are written by Sam Bulten and represent his opinions and insights and are based on his experience and interpretation of the research. As Sam is a human, these opinions and insights are not absolute truths.