Chronic pain, the type of pain that generally lasts more than 12 weeks, can often throw you into a vicious cycle. The initial pain causes you to move as little as possible and before you know it moving hurts more than ever and you cringe at the idea of doing nearly anything! Breaking that cycle requires you to move. That’s because you have to move to keep your muscles strong and your joints flexible. I know because I’ve been there. I have rheumatoid arthritis and fibromyalgia. I am also a Pilates instructor and group fitness trainer. I know from personal experience that when just completing your daily activities hurts, exercising can become unthinkable. Who wants to work out when it hurts to walk from your car to the door of the gym? Ironically, exercise is one of our best tools in defeating our chronic pain. It’s the way we keep our muscles strong and our joints moving freely. It’s the way we interrupt that vicious cycle. So how do you exercise in spite of your chronic pain? Read on for tips to maximize your success.

Note: The following tips are not intended to take the place of your doctor’s medical advice. If you aren’t sure what kind of exercise is safe for you, talk to your doctor.

1. Move gently.

Find a type of exercise program that is low-impact. Low-impact doesn’t mean low results. It means there isn’t a lot of bouncing around to add stress to your joints. Chances are, if you have chronic pain, someone has suggested you take up yoga or swimming. These are both excellent, low-impact forms of exercise. They certainly aren’t the only ones though. You might also like Pilates, Tai Chi, water aerobics, Silver Sneakers classes, strength training, or Arthritis Foundation fitness classes. It’s important to find something that you enjoy doing. You are much more motivated to exercise when it’s fun because it keeps your mind off your pain. Don’t have access to a gym or just prefer exercising by yourself? Walking is great exercise too.

2. Move often.

Because of our modern work schedules and sedentary lifestyles, most of us have come to think of exercise as a distinct one hour period of time that we set aside a few times a week to “work out”. There are two reasons why this model might not work for people with chronic pain. First, you may not be physically capable of exercising for an hour because it is too painful. Any movement, no matter how safe, can start to hurt if you keep doing it past the point of muscle fatigue. Second, that model of exercise means that entire days are going by when you aren’t putting your joints through their full range of motion. Remember that vicious cycle of pain I mentioned at the beginning? Moving often is the way to short circuit it. You may be better served by incorporating shorter, more frequent periods of exercise throughout your day.

3. Late morning to early afternoon is your target time to exercise.

Notice in the day I described above, that I don’t do any strenuous exercise first thing in the morning or late in the evening. If your chronic pain is caused by arthritis or inflammation, you probably wake up with stiff and achy joints. It can take an hour or two to loosen up (although the morning warm-up mentioned below can help speed up that process). Trying to exercise before that happens is a recipe for a painful workout. Similarly, if you wait until late in the day, after work and dinner, you may be too tired and sore from your daily activities to exercise. Late morning to early afternoon is the window where you are warmed up but not tired out. That being said, if you don’t have the option to exercise in that time frame, don’t despair. Just be sure to include an adequate warm-up and cool-down. Which brings me to my next tip.

4. Warm-up, warm-up, warm-up!

Your elementary school gym teacher taught you that warming up reduces your chance of injury. You may have ignored that advice for most of your life, but you need to heed it now that you have chronic pain. Think about your body position when you are in pain: You may scrunch your shoulders up by your ears, clench your jaw, hold your breath or even curl up in the fetal position. Muscles that stay in tense, shortened states all the time are more prone to strains and sprains, plus it just feels bad to live like that. You need to release that tension and uncurl yourself before you ask your body to do any big movements. Effective warm-ups start with small, low intensity movements and gradually increase in range of motion and intensity. Effective warm-ups do not include static stretches. Those may be appropriate during your cool-down if you choose.

5. Keep it warm.

The room temperature that is. Heat soothes aching muscles and joints, so you may prefer a warm environment. It doesn’t have to be hot-yoga hot, but you should be comfortable in your shirt sleeves before you start moving. If you are exercising at home that is easy enough, but many gyms are kept cold because of all the bodies working up a sweat. No one wants to run on a treadmill in 75 degree heat. You’ll just have to dress warmer. Try wearing layers that you can shed as you get warmer. Weightlifting gloves make you look tough and they keep your hands warm! Obviously, dressing warmer works for exercising outside as well. When I am really hurting, I can be seen walking my dog around the neighborhood wearing my winter coat, hat and gloves even if it’s 60 degrees outside. It just feels better to be warm.

6. Don’t forget to cool down.

It’s worth it to spend five to ten minutes cooling down at the end of your workout, especially if that workout is being done later in the day. Gentle stretching, deep breathing and guided relaxation exercises are great ways to cool down. Emphasis is on the gentle in gentle stretching (dynamic is better than static) – Your goal is to preserve normal range of motion, not to become a contortionist!

7. Have more than one tool on your tool belt.

Your chronic pain may be isolated to a problem part (or parts) of your body. You are your whole body, not just your problem parts! Don’t let pain in one part keep you from exercising the rest. In my case, rheumatoid arthritis causes my pain to move around. There is no single type of exercise that covers everything, so I modify my exercise based on where I am hurting at the time. On days when my knees hurt, I can skip the walk. Instead, I lift arm weights while seated on a chair and do core strengthening exercises while lying on my back. When my wrists hurt and I can’t hold the straps on my Pilates equipment, I can take a walk or go swimming. When shoulder pain keeps me from being able to swim with my arms, I swim laps holding a kick board instead. Are you getting the idea? Get creative!

8. Get trained.

I am a fitness instructor so I am clearly biased on this point, but good training makes all the difference in your ability to stick with an exercise program regardless of what exercise you choose. A good instructor will start you at a skill level appropriate for you and keep you progressing slowly enough that you aren’t overwhelmed yet quickly enough that you don’t get bored. Good training also minimizes the chances that you end up getting hurt. Even if you just do a few sessions with a trainer to learn proper technique before you head off on your own, it’s definitely worth the investment. When I started swimming again after a twenty-year hiatus, I didn’t bother to go back to swim lessons because I wasn’t trying to get faster. Then I learned that my sloppy strokes, with my arms smacking the water, put unnecessary stress on my shoulder joints. Two 30-minute sessions with a swim instructor made an immediate difference. And, I can go back anytime I need a refresher.

9. Get support.

Living with chronic pain is hard work. Committing to an exercise program when you have chronic pain is even harder. Don’t be embarrassed to ask for help. That could be exercising with a friend who will hold you accountable when you lack motivation. It could be having someone drop you off at the pool because, if you drive yourself there, you may have to walk a long way through the parking lot. It could be finding a trainer who encourages you by reminding you how much progress you’ve made or by finding the tough love kind who tells you to “suck it up and stop complaining”. It could be connecting with the other people in your fitness class who struggle with chronic pain. It could be asking your neighbor to watch your children for 30 minutes while you work out at home. We may need different kinds of support, but we can all use some type.

10. Rest is part of your exercise program.

People with chronic pain often need more rest than the average person. I said it before, but it bears repeating, “Living with chronic pain is hard work.” I combat the exhaustion with the occasional afternoon power nap, though you don’t have to actually sleep to rest. Sitting down and closing your eyes while you listen to relaxing music or focusing on your breath counts too. As little as ten minutes works wonders. Taking time out of your day to rest requires discipline just like exercising. In fact, you can think of it as part of your workout if that helps you get in the habit. When I first added rest periods to my day, I actually scheduled them in my calendar and set reminders for myself so I didn’t forget. Resting is that important.

These are the tools that I use in my own struggle with chronic pain. I hope that you, dear reader, find them useful in yours.