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Exercise for Pain, Rehabilitation and Fitness

There is an old proverb that says, “Those who do not find time for exercise will have to find time for illness.”

It is my strong belief that it is virtually impossible to recover from injury and pain or achieve optimal health without exercise. The type, timing, intensity and duration of exercises will be different depending on whether you are currently in pain, gradually working your way out of pain or want to become as fit as possible. For each situation, I customize an Exercise Prescription. The following is a general outline of three important stages of exercises that I have my patients follow.

Exercise for Pain
My patients who are in chronic pain, those who are out of shape and those who are obese usually have the perception that movement will cause pain. When I introduce exercise, I start with movements that are painless. Experiencing exercises without pain helps my patients become confident and less hesitant, which enhance their response to other treatments. One of the
beginning approaches I rely on are known as Developmental Stretches which are done without pain. Our physical therapy department has a warm water pool for AquaTherapy which is often a good beginning place for gently encouraging movement without pain. The human body is designed to walk however many patients walk in a manner that worsens their pain. For these patients I do a gait analysis and spend time teaching them how to walk efficiently. A functionally efficient gait and regular walking are critical to recovery from pain. Another excellent option to encourage movement to reduce pain is the exercise system developed by Joseph Pilates. Although standard Pilates exercises may not be appropriate, Viva Pilates Studio has developed very successful modified programs for those in chronic pain.

Exercise for Rehabilitation
When my patients reach goals for pain reduction and improved daily function, I like to introduce strength and stability exercises. These will vary depending on each patient’s problem and progress. Again, Pilates is a great option for comprehensive core stability and strengthening. The body naturally moves as a harmonious unit. Instead of doing isolated exercises, like biceps curls or sit-ups, Pilates engages the full body in an integrated manner that has remarkable benefits. For exercises at home, I like the Dynamic Stability approach used by Stuart McGill, Ph.D., such as those in this article and short video. This is also a good time to increase the duration and intensity of exercises like walking or to gradually resume recreational
pursuits that pain may have made impossible such as golfing, running, soccer or other sports.

Exercise for Fitness
This graph is all in jest but it makes the point that many people don’t stick with exercise plans. But exercise doesn’t have to be done in a gym or with gym equipment. It can be done outside, in the garden, at the beach, alone or with friends. In fact, it doesn’t always have to be exercise. It can be activity. For a scholarly discussion of how daily activities can help achieve fitness, see Achieving Hunter-gatherer Fitness in the 21st Century: Back to the Future.

For patients who have recovered from pain, continuing Exercises for Pain and Exercise for Rehabilitation are often enough. Other patients want to maximize fitness or compete in sports. For patients who want to exercise for fitness and optimal health, components of strength training, flexibility, balance and cardiovascular training are all important. There are optimal approaches and depending on whether you intend to compete in a specific sport or event or just want to be as healthy as possible, my role is to give advice and provide resources so you can choose the best training and exercise methods that fit personal interests and goals. Based on the latest research and field experience, I prefer replacing aerobic exercise with what is called High Intensity Interval Training, (HIIT). Don’t let the term High Intensity frighten you. HIIT is scalable to each person’s fitness level. It could be simply walking for 20 minutes, with several 30-second intervals of faster walking.

See these three videos
VIDEO 1, VIDEO 2, VIDEO 3 for an explanation on one particular approach to HIIT, called Peak 8.

As for strength training, I will give you information regarding the best approaches to achieve your desired results and tell you a few secrets most trainers don’t know (like how to train phasic versus tonic muscles, what dietary choices interfere with building muscle and what other exercises break down muscles). For balance, strength and flexibility, again I recommend Viva Pilates Studio as a great resource. My patients who practice Pilates one to two days per week report sustained pain control, improved strength and coordination plus increased athletic performance, particularly in sports that rely on core strength such as golf, tennis and surfing.

Whatever a patient’s goal may be, whether to get out of or reduce pain, stay out of pain or improve athletic performance, there is an Exercise Prescription I can create to reach that goal.