-Cheers.-Cheers. Can exercise relieve chronic pain?

NUEVA YORK.- Durante 25 años, Wei Liu había practicado y enseñado tai chi, incluso a personas que sufrían dolor crónico de rodilla, creyendo que los ejercicios fortalecían las piernas e infundían calma. Entonces empezó a hacer experimentos con el tai chi y se sorprendió a sí mismo. Profesor de fisioterapia en el Centro de Ciencias de la Salud de la Universidad de Texas en San Antonio, utilizó sensores de captura de movimiento para analizar los movimientos de las personas durante una sesión típica de tai chi. Se dio cuenta de que la gente cambiaba su peso y se ponía en cuclillas, movimientos que en realidad pueden estresar las rodillas y exacerbar el dolor en algunas personas, en lugar de aliviarlo.

Now, Liu continues to tell its students that Tai Chi is good for chronic knee pain, only not all movements or shapes that make up a typical session.People with knees that creak should probably omit the lying of the lute (form 5) and the outburst as a snake (form 16), which caused the greatest tension in 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.

Liu's study, and a lot of additional science and experience, show that the movement is desirable and therapeutic for almost any person who experiences chronic pain.But to find the best activities that help you deal with a particular pain, it may be necessary to mix and combine the exercise options, ask the right questions about why it hurts later and find the appropriate coach or physiotherapist.

If it hurts, exercise helps you

Not long ago, most doctors and therapists advised people with chronic pain to rest and avoid the 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 the paths of pain sensitivity," said Daniel Belash, a professor of physiotherapy at the University of Applied Sciences of Bochum, Germany, who studies how the movement influencesChronic pain, especially in back pain.

Exercise, on the other hand, usually reduces the feeling of pain immediately after and raises people's pain thresholds, according to studies.Its benefits, in fact, usually eclipse those of other usual treatment options, such as massages and stress control.

At present, "the international clinical guidelines for most chronic musculoskeletal pain conditions recommend exercise therapy and physical activity as basic treatments," says Jonas Bloch Thorlund, professor of musculoskeletal health at the University of Southern Denmark thatStudy exercise and pain.

The problem is that, although some types of exercise usually help almost everyone deal with chronic pain, finding precise training to relieve your particular pain usually requires trial and error and persistence.Even famous activities for relieving pain do not work for everyone.

Find the right routine

For example, yoga.In a 2020 analysis of research on this practice and other similar ones, the authors conclude that yoga usually improves the physical function, quality of life and pain of many people with “knee osteoarthritis, rheumatoid arthritis, neck pain, neck pain,Head and low back pain. ”However, according to the review, relief is usually mild and some participants end up reporting more pain after practicing yoga.

The same dynamic occurs in other studies on chronic pain therapy."Some people respond well" to Yoga, Tai Chi, swimming, strength training or walks, and others, said Melissa Phuphanich, resident of Physical Medicine of the University of California in Los Angeles, who was the author of theAnalysis of 2020.

The good news is that this same inconsistency opens options."In knee osteoarthritis, which is one of my research areas," said Thorlund, "researchers cannot 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 it 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 dislikes and your finances in the most objective way possible, since each of them influences your ideal exercise routine.

"Certain activities can be more friendly for people with certain limitations," said Kirsten Ambrose, associate director of the Osteoarthritis Action Alliance at the Thurston Arthritis Research Center of the University of North Carolina."The activities in which the weight is not supported, such as water or pool or cycling activities, can be more tolerable for some people with joint pain."But register and reach a center with a pool or buy a bicycle and travel roads and roads can be intimidating or prohibitive.

In that case, you have to start little by little."You don't have to limit yourself to traditional exercise, such as walking on a tape during a certain number of minutes or kilometers," says Ambrose.“You can count the gardening or walk the dog.The objective is to increase the amount of time you spend moving compared to the one sitting. ”

Follow the two -hour rule

However, anyone who begins a new exercise program must be aware that the effort usually hurts at the beginning.According to Belash, it is normal and even desirable that there is a little pain one day after an unknown training, since it indicates that the muscles are reacting as they should exercise.

But it can be difficult to distinguish it from pain that indicates new damage.Therefore, the two -hour rule follows, Ambrose said."If the pain is worse two hours after finishing the exercise of what it was before starting, this is indicative that you have exceeded and you must make it softer next time."

Also consult a physiotherapist or an exercise physiologist if you are worried that your exercise routine can exacerbate your pain."Sometimes there will be things that you cannot see for yourself, as perhaps you are nervous about a particular movement," said Belash, and you end up doing it in such a tentative or truncated way that it becomes ineffective or even harmful to your jointsor body.

Consequently, "it may be necessary to gradually expose certain types of movements, even if they seem terrifying," he said.People with knee who worry about climbing and lower stairs, for example, could start walking in their place, raising their knees as if they climbed the stairs, until they feel safe with that movement."Professional orientation can help."

Exercise is a placebo.And that's fine

Finally, you have to know that part of the relief of the pain that the exercise produces probably originates in your mind."For many patients with chronic pain, 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 sensations of pain later, whatthat then did.

The context factors, continued, are aspects of the exercise that can be psychological or emotional, such as if you like your physiotherapist, if you like the color and adjustment of your training clothes, if you remember the physical education classes of thePrimary school with nostalgia or fear and, yes, the unbearable enthusiasm of your teacher in the Spinning class.

According to a wide review that Belash wrote with his colleagues this year, exercise is just a little better to treat chronic pain than placebos, such as pills or false electrical impulses that the subjects thought they were analgesics.But people experienced some relief in all cases, suggesting that placebos do help relieve pain.

"The exercise undoubtedly has beneficial effects on chronic pain," says Belash.Only some of these effects depend on how well the exercise is expected to work.

So, if you are exercising and your pain barely yields, try to change something - or everything - of your workouts, until you feel sure of its benefits.Cover the instructors of Spinning classes to find the best synchronization with yours, buy new and comfortable sports shoes, ask your physiotherapist to update the soundtrack of its darger waiting room or practice Tai Chi for the firsttime."Find the exercise that works and continues with him," concludes Belash.

Six tips to treat chronic pain

1.- Understand it.For those who experience it chronic, pain is their own disease, not just a symptom.Scientists now say that it could be caused by specialized nerve cells that are unbalanced.

2.- The exercise helps.If you have chronic pain, you can continue to exercise.And, in many cases, it could help you reduce the feeling of discomfort and increase your pain threshold.

3.- Control pain from the origin.Although chronic pain is a disease, you have a lot of power over it and you can turn to your mind to start finding relief.What can help?Take a diary to vent your feelings.

4.- Reformulate your thoughts.Experts are discovering that pain specialized psychologists can help you change the way your brain processes pain.

5.- Use a useful descriptive language.Using metaphors or other languages to talk about your pain can really change how much you feel.For example, saying worseks without capujos may be more beneficial than using substitute words talking about your pain can really change how much you feel.

6.- Find your team.In an ideal world, doctors would know how to treat chronic conditions such as pain.In this world, you may have to actively search for the attention team for you.