For 25 years, Wei Liu had practiced and taught tai chi, even people suffering from chronic knee pain, believing that the exercises strengthened the legs and instilled calm.
Then he started experimenting with tai chi and surprised himself. A professor of physical therapy at the University of Texas Health Sciences Center at San Antonio, he used motion capture sensors to analyze people’s movements during a typical tai chi session. He noticed that people shifted their weight and squatted, movements that can actually stress the knees and exacerbate pain in some people, rather than relieve it.
Now, Liu continues to tell his students that tai chi is good for chronic knee pain, just not all the movements or forms that make up a typical session. People with creaking knees should probably skip the Lute Laying (form 5) and Snake-Low Snatch (form 16), which caused the most stress on the knees in their study. They could continue with Part of the horse’s mane on both sides (form 2) and any other form that does not amplify the pain.
Read also: Six mistakes to avoid if you want to be a runner for a long time
Liu’s study, and a host of additional science and experience, demonstrate that movement is desirable and therapeutic for almost anyone experiencing chronic pain. But finding the best activities to help you deal with a particular pain may require mixing and matching exercise options, asking the right questions about why it hurts afterward, and finding the right trainer or physical therapist.
If it hurts, exercise helps
Not long ago, most doctors and therapists advised people with chronic pain to rest and avoid activity, according to a 2017 review of studies related to exercise and chronic pain.
But the accumulation of evidence in recent decades showed that “Being inactive will tend to reinforce pain sensitivity pathways“Said Daniel Belavy, a professor of physical therapy at the University of Applied Sciences in Bochum, Germany, who studies how movement influences chronic pain, especially back pain.
By contrast, exercise tends to reduce pain sensation immediately afterward and raises people’s pain thresholds, studies show. Its benefits, in fact, often overshadow those of other common treatment options, such as massage and stress management.
Currently, “International clinical guidelines for most chronic musculoskeletal pain conditions recommend exercise therapy and physical activity as basic treatments”says Jonas Bloch Thorlund, a professor of musculoskeletal health at the University of Southern Denmark who studies exercise and pain.
The problem is that while some types of exercise tend to help almost everyone cope with chronic pain, finding the right training to relieve your particular pain often takes trial and error and persistence. Even famous pain relief activities don’t work for everyone.
Find the right routine
For example, yoga. In a 2020 review of research on this practice and others like it, the authors conclude that yoga tends to improve physical function, quality of life, and pain for many people with “Knee osteoarthritis, rheumatoid arthritis, neck pain, headaches and low back pain”. However, according to the review, the relief is usually mild and some participants end up reporting more pain after practicing yoga.
The same dynamic holds true in other studies on exercise therapy for chronic pain. “Some people respond well” to yoga, tai chi, swimming, strength training, or walking, and others don’t, said Melissa Phuphanich, a physical medicine resident at the University of California, Los Angeles, who authored the 2020 analysis.
The good news is that this very inconsistency opens up options. “In knee osteoarthritis, which is one of my areas of research”said Thorlund, “researchers can’t find a big difference between different types of exercise” for pain management. So you can start with a short walk through a picturesque place, like a park, and see how your body reacts (after consulting with your doctor, of course).
In the gym? In water? In the garden? Yes
Once a health professional authorizes you to exercise, evaluate your pain, your life, your schedules, your troubles and your finances in the most objective way possible, since each of them influences your ideal exercise routine.
“Certain activities may be friendlier for people with certain limitations”said Kirsten Ambrose, associate director of the Osteoarthritis Action Alliance at the University of North Carolina Thurston Arthritis Research Center. “Non-weight bearing activities, such as activities in the water or pool or cycling, may be more tolerable for some people with joint pain.” But signing up and arriving at a resort with a pool or buying a bicycle and riding the roads and paths can be intimidating or prohibitive.
In that case, you have to start small. “You don’t have to limit yourself to traditional exercise, like walking on a treadmill for a certain number of minutes or miles,” says Ambrose. “You can count gardening or walking the dog. The goal is to increase the amount of time you spend moving versus sitting ”.
Follow the two hour rule
However, anyone starting a new exercise program should be aware that exertion often hurts at first. According to Belavy, it is normal and even desirable that there is some pain one day after an unfamiliar workout, as it indicates that the muscles are reacting as they should to the exercise.
But it can be difficult to distinguish it from pain that indicates new damage. So follow the two-hour rule, Ambrose said. “If the pain is worse two hours after finishing the exercise than it was before you started, this is an indication that you have overindulged and should make it easier the next time.”
Also consult a physical therapist or exercise physiologist if you are concerned that your exercise routine may exacerbate your pain. “Sometimes, there will be things that you can’t see for yourself, like maybe you’re nervous about a particular movement.”Belavy said, and you end up doing it in such a tentative or truncated way that it becomes ineffective or even harmful to your joints or body.
Consequently, “It may be necessary to gradually expose yourself to certain types of movements, even if they seem scary”, said. People with knee pain who are concerned about going up and down stairs, for example, might start by walking in place, raising their knees as if climbing stairs, until they feel safe with that movement. “Career guidance can help.”
Exercise is a placebo. And that’s ok
Lastly, you need to know that some of the pain relief from exercise probably comes from your mind. “For many chronic pain patients, no matter the treatment, a large part of the effect is contextual”said Thorlund, who last year studied the impact of telling people that exercise would decrease or increase their pain sensations later, which he then did.
Context factors, he continued, are aspects of exercise that can be psychological or emotional, such as if you like your physical therapist, if you like the color and fit of your workout clothes, if you remember physical education classes at the gym. elementary school with nostalgia or fear and, yes, the unbearable enthusiasm of your teacher in spin class.
According to an extensive review Belavy wrote with colleagues this year, exercise is only slightly better at treating chronic pain than placebos, such as pills or false electrical impulses that subjects thought were pain relievers. But people experienced some relief in all cases, suggesting that placebos do help relieve pain.
“Exercise has undoubtedly beneficial effects on chronic pain”says Belavy. Only some of those effects depend on how well the exercise is expected to work.
So if you’re exercising and your pain is barely subsiding, try changing some – or all – of your workouts until you feel confident in its benefits. Approach the instructors of the spinning classes to find the one who best synchronizes their energy with yours, buy yourself some new and comfortable sneakers, ask your physical therapist to update the soundtrack of their gloomy waiting room or practice tai chi for the first time. time.
“Find the exercise that works for you and stick with it”Belavy concludes.
The images by photographer Justin J Wee are visual representations of pain, relief, obstacles, science, and advice featured in this special. Wee has carried out several projects on pain, partly inspired by his own battles with chronic back pain.