Chronic Pain Solutions for Complete Recovery Pt. 2: Movement

In Chronic Pain Solutions for Complete Recovery Part 1, we discussed “neuroplasticity”, the ability for the amazing brain to change and grow for the better.  For a quick review, check out this cool, short YouTube video  on neuroplasticity. Part 2 Movement will focus on how and why movement is crucial to help decrease chronic pain.

Motion is lotion.

The body and brain loves movement.  A sedentary lifestyle associated with fear of movement or lack of motivation to move leads to weakened muscles, stiff joints, weight gain, increased inflammatory cells, brain atrophy and… more pain. Movement grows new neuronal connections within the brain, basically rewiring the faulty circuitry associated with our internal pain alarm. Remember the burglar and alarm analogy from Part 1?

Use it or lose it

Above is an illustration of our brain. The region highlighted in rose color is the called the motor cortex, which basically  is a map of our body located on the brain, our virtual body. Each body part is represented on a specific region of our motor cortex. The tongue and hands have a lot of real estate on the brain compared to the knee because the tongue & hands are critical for survival.

For example, when you speak, the tongue section of the motor cortex is activated.  When you turn your head to look at an attractive person passing by, the neck and upper back  on your brain’s map light up like a Christmas tree.   However, if  you have chronic neck pain and can’t rotate your neck fully, your “virtual neck” doesn’t fire as quickly or intensely and can even atrophy.  The good news is that we can retrain our brain, restoring these lost connections which reduces pain because of the brain’s neuroplasticity.

No Brain, No Pain

OK, so we know that without a functioning brain, we cannot feel pain. With chronic lower back pain, patients have a smaller “virtual lower back” on their motor cortex as compared to healthy subjects.1, 2, 3. The good news is that no matter how long you have experienced chronic pain, with consistent practice of various techniques including daily movements we’ll discuss here, the brain can learn healthier patterns which results in 1) reactivation of the motor cortex and 2) less pain.

A study in 2010 looked at motor cortex activation of patients who had 4+ years of low back pain who either participated in a  walking program or a core exercise program4.  The group who participated in the deep core exercise program gained more lower back “real estate” on their motor cortex (ie showing more brain activation) and they reported a significant decrease in lower back pain.

The group who did the walking program showed no changes in pain nor brain activation. Walking can be very helpful for the joints, muscles and heart, but specific exercises targeting the area in pain can improve brain activation and lower pain.

Core Training

Below are three videos on training the deep core muscles (Transverse Abs, deep lower back). These videos are not to be used in lieu of seeing your medical doctor or physical therapist.

Level 1 Core Video

Level 2 Core Video

Level 3 Core Video

What about other areas of the body in pain? Generally speaking, there are actually core muscles for your neck which are the deep cervical flexors; the core muscles for your arms are the scapular muscles and the core stabilizers of your legs are glutes and pelvic floor.  Exercising these muscles can help change the brain to look and act similarly to those without pain.

Strength Training

When you think of strength training what do you visualize?

 

 

 

 

 

 

 

 

 

 

 

Do you picture the bulky weightlifter power-cleaning hundreds of pounds? While this is technically strength training, so is lifting 1 lb. dumbbells for 3 sets of 5 reps.  Your “heavy” is not your boyfriends “heavy”, is not your mom’s “heavy” and may not be your ‘heavy” 2 months from today.

Strength training streamlines the body and can create a more toned, slim appearance. It helps breakdown fat up to 72 hours after a workout, stabilizes your spine so your posture keeps in good alignment and nerves can function more easily. Strength training also prevents osteoporosis by building bone density, decreases visceral (abdominal) fat linked to heart disease, helps control appetite and decreases inflammation throughout the body5. Most importantly, it can help rewire the brain and eliminate pain just like core training does.

Here are three strengthening level 1 basics for anyone. Remember these are suggestions and if you are having pain, best to first consult with your physical therapist to get tailored advice.

Squats

Region targeted: thighs and glutes Frequency: 2-3x/week
Joints stabilized: hips and knees Intensity: heavy with minimal discomfort
Helps with: bending, lifting, sit to stand 2-3 sets 8-12 reps, 30s rest -> 3-4 sets 6-8 reps, 1-2’ rest

Bent Over Rows

 

 

 

 

 

 

Region targeted: back, shoulders, trunk, arms Frequency: 2-3x/week
Joints stabilized: shoulder, elbow, spine Intensity: heavy with minimal discomfort
Helps with: pulling, lifting, carrying 2-3 sets 8-12 reps, 30s rest -> 3-4 sets 6-8 reps, 1-2’ rest

Push Ups

 

 

 

 

 

 

 

Region targeted: shoulder, chest, upper back Frequency: 2-3x/week
Joints stabilized: shoulder, elbow, spine Intensity: heavy with minimal discomfort
Helps with: pushing, carrying, lifting 2-3 sets 8-12 reps, 30s rest -> 3-4 sets 6-8 reps, 1-2’ rest

Daily Movement

Another great way to begin to counteract sedentary lifestyle, especially if you sit for work or school, is to track your steps via a pedometer or on your phone. Depending on your fitness level and pain levels, aim for 5000 steps every day and gradually increase to 8000 then 10,000 steps (over time). Research shows that doing high impact cardio workouts is too stressful for many people with chronic pain so walking can promote similar benefits6.

Even if you are house bound, taking a stroll around the house/apartment once an hour can start to add up your steps. Instead of going to the mall to shop, let it be a destination for a comfortable walk with plenty areas to rest anytime you need.  If you work, walk an extra few blocks to the subway/bus stop, or park your car farther away from your home.  Instead of taking an elevator to your exact floor, take it to the floor below.

Once walking becomes easier, begin a targeted core and strengthening program for all of the benefits listed above. There are so many! Move every day, avoid being too sedentary, get guidance to help you find your best exercise plan and most importantly keep practicing this for at least 3 months. You’ll be amazed to feel less pain by that time.

References

  1. Strutton PH, Theodorou S, Catley M, McGregor AH, Davey NJ. Corticospinal excitability in patients with chronic low back pain. Journal of Spinal Disorders & Techniques 2005;18(5):420e4.
  2. Tsao H, Galea MP, Hodges PW. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain 2008;131(Pt 8):2161e71.
  3. Flor H, Braun C, Elbert T, Birbaumer N. Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neuroscience Letters 1997;224(1):5e8
  4. Tsao H, Galea MP, Hodges PW. Driving plasticity in the motor cortex in recurrent low back pain. European Journal of Pain, 2010; Feb 22
  5. Tatta J. Heal your pain now. Boston, MA: Da Capo Press; 2017.
  6. Kristen M. Beavers, Daniel P. Beavers, Sarah B. Martin, Anthony P. Marsh, Mary F. Lyles, Leon Lenchik, Sue A. Shapses, Barbara J. Nicklas; Change in Bone Mineral Density During Weight Loss with Resistance Versus Aerobic Exercise Training in Older Adults, The Journals of Gerontology: Series A, , glx048