How to Start Exercising when Everything Hurts

Hello and welcome back to my series on reframing movement and exercise when you live with chronic pain.

This a companion blog post to Episode 3 of the Rest Room podcast. If you you’d prefer to the audio version of this post, you can find The Rest Room on Apple Podcasts, Google Podcasts, Soundcloud and Spotify – and I’d love if you would consider subscribing there!

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In the last episode/blog post, we looked at ways to address barriers that come up when figuring out how to start incorporating movement and exercise into our lives.

We learned that we need to throw the whole ‘workout’ mentality in the bin, especially if movement is new to you, but we didn’t cover how to get started in really practical, tangible ways.

And that’s exactly what we’re going to do today!

This episode was written in collaboration with specialist physiotherapist Claire Campbell, who works with the Physiotherapy Pain Association. 

I’m going to say this every time, but I want to make it very clear that the aim of this series is absolutely not to push you into something that you’re not ready or able to do. All of this is here to provide information to people who could potentially make use of it.

Ok?

Good. Let’s get started.

Sustainable movement

Whether you have little confidence in your body’s ability to do the things that you need (and want!) to do day-to-day, or you struggle to find a way to make movement a sustainable part of your life, this post is for you.

You may remember that we spoke about the importance of understanding our barriers to movement, and how we often develop habits or fears for very legitimate reasons that may be holding us back now. 

Our aim is to help you find a way to move that feels safe, and that you’re confident you can stick with, even if it needs to be adapted on more challenging days. 

There are lots of approaches to exercise…

…and they all have their own advantages. 

I actually had an interesting conversation with Claire when we were working on the content for this episode.

She told me that until she started working with patients who live with long-term pain, she had never heard somebody say “physiotherapy doesn’t work for me.” 

I think that because so many people with chronic conditions have had negative and scary experiences of movement or physio, they may feel that if they tried one thing, with one practitioner, that didn’t work, nothing will be right for them. 

In most cases, this is actually not true. So taking time to experiment with an open mind may help you find safe and accessible forms of movement that you can actually incorporate into your life.

Within the Pain Management Service where she works, Claire uses a psychologically informed approach to exercise. 

This is because a long-term conditions impact you physically, mentally and socially.  

We cannot separate our bodies from our minds, or separate from our roles and responsibilities (to both ourselves and others), so by bringing awareness to your current experience and committing to moving forward, you can start to make progress. 

It’s important to just start wherever you are – both physically and mentally

This is not about telling you what to do, or what you should be able to do, but helping you to learn from the insights of others to discover what is best for you and your body. 

It’s also about helping you recognise when you get in a rut, so you can work out the best way to move forward.

This is very much an individualised approach, and there are some questions that you can ask yourself to help you reflect throughout this post. 

You may want to write answers to some of these questions down or discuss them with a friend or family member, if that helps you figure some of the stuff out. But, as always, it’s up to you!

Obviously, and I guess this bears repeating over and over again, everyone is different.

It seems as though understanding your condition and what is “normal” for you, though, can have a huge impact on how confident you feel about moving.

A great place to start is by bringing awareness to your current experience

It’s probably a somewhat overused meme at this point, but you are the expert in your own body, so being curious about it and the impact that your condition has on it, only builds on your expertise. 

Experimenting with movement and strategies to manage your condition is hard work, and it can be difficult to see the progress that you’re making. 

Rehabilitation has been shown to require courage, patience and commitment to keep going. 

So, if at times it feels tough, repetitive, and you notice that you need to talk yourself into doing stuff – then you’re absolutely not alone!

This approach can also give you guidance on how to listen to your body and honour your own needs. This is so difficult to do and takes practice.

Even though Claire is literally a specialist in all this stuff, she still finds it difficult. So cut yourself some slack!

Here are some questions you can ask yourself to get a better understanding of your relationship with your body and how you move.

Remember, there are no right or wrong answers here, we’re just trying to get some honest insights to give you a place to start from. 

You can work on these in a notebook, on your favourite writing app, or you can download our little worksheet that has many of these questions on to help guide you.

• Do you check in with what you are experiencing during the day?
• Do you notice what thoughts or sensations come up when you are doing, or think about doing, certain activities? 
• Have you changed the way you move because of your pain? 
• Do you adjust your breath when you do certain movements?
• Do you notice your daily intentional and unintentional activity?
• How do you manage essential and important activities? 
• Do you engage in more activity at certain times, and are you then less active at others to control your symptoms? 
• Do you keep busy to distract from the pain, but struggle to rest and sleep because of your symptoms? 

*whisper* that last one is totally me. 

One stumbling block that many people with chronic illness have identified is their inability to honestly reflect on and acknowledge their current situation. 

It is difficult to rebuild a relationship with your body and how you see yourself, especially if you’ve only really known decline and not had the support that you need. 

So, what do we mean by rebuilding a relationship? 

A good place to start is by noticing what you experience when you do movements that bother you, and recognising what your daily levels of activity actually are, not what you think you could or should be doing in a day. 

In some cases, you may actually be doing more activities than you think! 

Remember that “have done” list I mentioned last time? The one where I wrote down everything that I did in a day.

This started during times when I was like “ugh I’ve literally done nothing but be in bed.”

But often I’d still have done something, actually many things: going to the loo, getting food, brushing my teeth, talking to a friend, commenting on stuff on Instagram. 

Just because I was mostly resting and didn’t feel like I could do anything “productive”, it didn’t mean that I wasn’t still doing at least one daily activity.

The problem was I just didn’t take the time to recognise that. 

There are so many small daily activities that we discount because it’s not within our usual understanding of movement, exercise, or a work out.

But when you start, these are exactly the kinds of things that you need to pay attention to.

If noticing is a new skill for you, you may want to make a conscious effort to notice for a minute or two, a few times a day. 

Writing down what you have been doing in an activity diary, or just the Notes app on your phone, can also be a way to help you to start recognising these patterns. 

This awareness of your life experience is a solid foundation to build from.

Many people adjust their movement in response to pain and fatigue. Again, this makes total sense – you want to try and avoid feeling worse! However, this can have unintended consequences. 

It’s also well known that fear and worry about pain can lead to tension that can actually add to your symptoms of pain, fatigue, stiffness, poor sleep and weakness. 

There is no such thing as perfect posture, but sometimes adjusting your posture in response to pain can change movement patterns that may lead to more problems in the long-run. 

Common issues include bracing (which is another way of saying over-working by tensing your muscles in anticipation of something bad happening), off-loading one area of the body (putting more weight through your “good leg,” or holding your breath when moving.

All of these things can contribute to muscle tension, pain and fatigue. 

I regularly check in on this stuff throughout the day, and every single time I am doing at least one form or another! 

Learning to patiently and slowly break these habits – without getting angry at myself – has been a really helpful small thing I can do to prevent unconscious movement patterns causing me more pain in the long-run.

Even though our bodies are part of us and interconnected with our minds, people don’t always recognise these unconscious habits, which is why the very act of noticing is such an important part of learning to move with ease!

So, we’re asking you to pay attention to your thoughts…but thoughts can hurt!

It’s really common for people who experience persistent pain to feel discomfort watching or thinking about a difficult movement. 

This is a good indication that your system has become really sensitive. Equally, stress, low mood, and feelings of anxiety can increase physical symptoms. 

I think I’ve mentioned this before, but because knee dislocations were such a huge part of my childhood, seeing people on tv run or walk in the rain makes me feel physically sick. 

I’ve worked hard to start desensitising myself, but I have to talk to myself every day when walking around my flat, or going into the car when it’s raining, to remind myself that I’m ok.

Sometimes I can be lying in bed and suddenly get this feeling where I just remember my knee coming out and have to remind myself (again) that it isn’t happening right now. 

And I mean, I know it’s super dramatic, and I’ve got much much better with it.

But I also know that this is such a thing because I don’t remember a time when my knees weren’t a problem, and they really have had such a huge impact on my life. 

It does take patience and a lot of mental work to continue to desensitise yourself when that fear is something you’ve had for decades. Just even recognising when your reaction is outsized, and in my case can feel really silly, is a great place to start.

Just because something bad can and does happen, it doesn’t mean that it happens (or will happen) every single time.

When people experience long term pain, the sensitivity of their nervous system (and other systems), can result in a significant increase in pain and fatigue if over-stimulated (often, but not exclusively, if you’re doing too much, too little, or a new activity). 

This is such a fine balancing act, so if you don’t notice or acknowledge what you’re experiencing, this can result in pushing through your limitations and paying the price later. 

Over time, this can be really disheartening and can lead people to give up on certain activities, exacerbating the fear and worry about what else your condition may take away from you. 

But Claire wants people to know that it’s not all doom and gloom, despite what your mind may say! 

Your physical symptoms, like pain, weakness and fatigue are always real.

However, an increase in symptoms is not always due to an injury or tissue damage. By recognising your triggers, you can act to limit the impact that they have on your life.

A good way to do this is by facing your ‘usual pain’ symptoms

What does this mean?

Well, I think this is something that comes quite naturally to a lot of people when they’ve been living with symptoms for a long time. 

You get to know your body really well and learn what normal means to you. 

When you first develop a symptom, it’s really new and scary and you don’t know what’s going on. 

But over time, it’s something that you can kinda just…know…is there, and even if it’s really unpleasant and makes you miserable, it’s not new and scary in the same way.

You know why you’re feeling the way you do and often you have a toolkit – be that painkillers, heat, ice, and other coping strategies to help you manage. 

So, it’s really helpful, if you’ve not got to a place where you recognise what is normal for you and what isn’t, to be curious about what your most common symptoms are, and learn to understand their ways.

This can give you the confidence to recognise when you’re experiencing an escalation in pain or a new issue that may need a different approach – even if you’re an absolute pro at distracting away from them. 

So for example:

• Does eating a certain kind of food make you more fatigued than another kind?
• Are there some times of the day when your pain is less?
• Are you impacted by the weather?
• Did you inadvertently sit at a weird angle and hurt something you always hurt when sitting that way?
• Did you spend too long at your computer or playing Animal Crossing and now you’ve got severe pain in your fingers and arms that you don’t usually have?

Claire says that: “Opening up to your health condition(s) is not about giving in to your symptoms, but recognising that your current level of function is temporary.“

I think a lot of people might find that hard to hear, but even if you have a chronic condition, it’s not static. 

Symptoms generally fluctuate from day-to-day, which is why they can be so difficult to handle.

Remembering that just because you might be feeling awful today, it doesn’t mean you’ll be feeling exactly the same kind of awful tomorrow. You might even have a really great day for you!

Even the worst feelings do not last forever. 

And there are actions that you can take to improve, sustain or reduce your level of function, and honestly, I think it’s really important to remember that you can be in pain and still have a happy and fulfilled life. It doesn’t have to be one or the other.

Opening up to your symptoms can help you discover what is workable for you at this time. It isn’t easy to make these choices, and is another thing that Claire continues to work on, and she does this for a living, so it really takes practice.

It’s also important to explore other ways of thinking about and dealing with your pain. 

Being open to everything you experience, warts and all, allows you to be flexible in your approach when new issues arise or when your circumstances change. 

A super quick example: over the last few months, I’ve developed a new pain in my face. It’s like nothing I’ve experienced before, which I knew because I have a good understanding of what my “normal” is. 

This pain is, quite frankly, rather bloody unpleasant. It was really difficult at the start to figure out how to balance a new thing, but throughout I kept reminding myself that I have coped with everything so far in my life, and I have the tools and strategies to be able to cope with this too. 

No matter what it is, even if it lasts, I will be ok. And that helped me adjust really quickly and not get too caught up in panic, fear and frustration. I always give myself time for that though, because it’s a really important part of the process. 

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Oh, and something I forgot to say in the podcast: if something is new and weird and scary and not part of your normal, it’s really important to get it checked out!

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Outside of pain and new symptoms, having an awareness of your body also allows you to recognise when you have been able to do something and to celebrate the win, even if you haven’t done what you had initially set out to do.

Often, people who are experiencing chronic illness will have been told that they need to be more active, but struggle with movement and have no idea of where to begin.

But committing to moving forward is always a really good place to start

You have to do all of this stuff because you want to – not because you’ve been told you have to or because someone else expects you to. 

So, imagine your future.

I know, this can be difficult as it may bring up expectations you had of yourself, but just…bear with me here. 

Some helpful things to consider would be:

• What is important to you? 
• What do you want to spend your time doing? 
• What do you value about yourself? 

One of the big things we discussed when exploring barriers to movement was the importance of thinking about your values. 

Values are the principles you live by, your life direction, and can be the key to integrating meaningful movement into your day. 

We know that physical activity improves health, can improve condition management, and supports people to “train” for the activities that they want (or need) to do as part of their daily life. Some or all of these aspects may not be important to you, though. 

So…where do you start? 

Just by getting this far, you’ve demonstrated that you want to know more about moving while experiencing pain, so give yourself credit for that!

*imagine woohoo sound effect*

It’s worth repeating that there is no minimum amount of activity that gives you benefit, and those who are least active actually have the most to gain from being even a little bit more active. 

The most important thing is that you build a habit of activity and maintain that consistently.

It may be helpful to find your motivation for wanting to become more active, so let’s answer a few more questions:

• What do you want to be able to do with ease? 
• What do you enjoy doing?
• What things do you need to do? 
• Do you want to get fit enough to explore places you’ve never been before? 
• Do you want to return to a much loved activity?
• Do you want to have the stamina to have dinner with family or friends? 
• Do you want to find new ways of relaxing? 

Claire would encourage you to start where you are, not where you think you should be. 

Even mentally practicing the movement – imagining how your body will move and feel doing it – helps to train the movement. 

This is a well known technique in elite sports performance and has relevance in rehabilitation.

As I mentioned above, you may already be doing unintentional exercise when you wash, dress, cook, care for others, or do a hobby. 

All of these things can be counted as physical activity, and recognising this is a wonderful opportunity to bring awareness to the movement you do daily, rather than embarking on an extra programme of activity that may be too much given your other commitments. 

This unintentional exercise will be doing you good, but also provides opportunities to add a little more movement in.

Here are some examples:

• When waiting in a queue, you could do a few leg or arm movements
• You could try to put a little less weight through your arms as you stand up from a chair
• When you’re walking, whether it’s just from one room to the next or if you’re going for a walk, you could try going a little further, or go a little slower because it’s harder to control the movement that way
• When you’re brushing your teeth you could squeeze your muscles and then relax them, or you could stand on one leg, holding one arm onto the sink if you need it to help you balance

Of course, this is not exhaustive, but will hopefully give you an idea of some small changes in the wider ballpark of things that you could experiment with. 

If you want to start intentional exercise, do something that you enjoy, with someone you enjoy spending time with, or a movement that prepares you for something that you enjoy doing. 

As Claire says, “it doesn’t need to be complicated, it’s about connecting with your body and feeling safe.”

And enjoyment is key when you start, as you want it to become a habit

There are lots of different types of movement, including movements that you may want to practice, or just more general things that you do throughout the day.

For example, putting on your favourite music and having a bit of a boogie, whether you’re sitting, standing, or lying down in bed, is still movement. 

Some other examples include: 

• Marching on the spot,
• Going from sitting to standing from a chair (I started doing this using a chair in front of me for support and was super helpful because standing up from a chair is one of those things that I do everyday),
• Calf raises while you’re brushing your teeth,
• Arm lifts during a YouTube ad break,
• Even making a conscious decision to pay attention to your posture when sitting on the loo is a way to add some postural stability into your day!

Start with doing each exercise a few times. If you can do these movements consistently, you will improve your confidence in your body. Try to get others in your life involved too as that can help with motivation.

We have a running joke in my house about how I am the Queen of Fitspo…even though Sebastian’s exercise regime is obviously way more intense than mine.

Jokingly celebrating just how Fitspo I am, and making sure to recognise and celebrate improvements, is really helpful and important for keeping me motivated. 

*flexes muscle* 

Claire encourages people to experiment with the range of movement in each exercise, the number of repetitions, how fast they move, and for how long. 

For all of these things, start low…like…really low and build yourself up slowly. 

A lot of online resources recommend trying to aim for a certain number of repetitions, however Claire suggests looking at time instead.

Timing can be really helpful on your worst days, as you will likely do less repetitions than the previous day, but you will still complete your movements without feeling bad about yourself!

So, for example, if you are starting from scratch, you may feel up to doing one minute of movement. You may choose 3 movements to do: knee bends, side steps, arm lifts. 

Try and do each exercise for 20 seconds, with as many reps as you’re able to in that time without focussing on the number.

Getting into the habit of a minute of movement, once, twice, or three times spread out throughout the day is an opportunity to build confidence in your body. 

Of course, this all depends on your personality and what stage you are in your training!

Oh, and don’t forget to breathe! 

It’s so easy when you’re concentrating or nervous to inadvertently hold your breath, so pay attention to make sure that you’re not doing this. 

You may want to experiment with breathing out on the effort – that’s the harder part of the movement – and see if it’s helpful.

When talking about rehab and making improvements, as important as it is to set goals, it’s equally important that goals are actually realistic. 

So, for example, if you’re at home all day almost every day, it’d be really unhelpful to set your first goal to be walking around the block every day. 

It may sound manageable just now, but as soon as you have a difficult day or the weather turns, it won’t seem like a good idea and as soon as you stop you may feel like you’ve “failed”. 

However, that’s got less bearing on you and your abilities than it does on the goal just being set at the wrong place for where you are right now! 

Rather than thinking about doing intentional movement every day, start with 3 times a week, or whatever you think is realistic for you. 

It’s also worth thinking about when you have your highest amount of energy and motivation during the day. 

You can even put it in your diary, so you treat it like you would if you were going to an actual appointment. With, of course, the standard caveat that if you have to adapt it, that’s fine too! 

Figuring out when you’re most likely to be open to choose to do your movement practice, and having a back up plan to dial it back if you’re not feeling up to what you usually do, can really help your habit to stick. 

And if you’re having difficulty fitting in your movement, please notice what else you’re doing that day or that week. Because, as mentioned above, you’re possibly doing more movement or expending more energy than you actually realise!

So, for example, if you’re doing a lot cooking because you’ve been entertaining, or you’ve got a lot of work, or you’ve had to emotionally care for someone in your life, those are all very emotionally and physically draining things, even if they’re good things. And so your exercise and recovery time is going to be impacted by that. 

It’s really important to take all of this into consideration, rather than being overly prescriptive. And just like with pacing this will generally take some forethought and planning. 

Let’s move on and talk about short term discomfort for long term gain… 

We already know that people with long-term pain have more sensitive systems – so your body is probably already on high alert and can react to any change in your routine. 

It’s also really common for people to just generally freak out at any worsening of symptoms – but it’s really important to learn the difference between expected discomfort that is short-term and not causing you harm, and the actually unsafe stuff that you absolutely should not be doing. 

I like to call this the difference between good pain and bad pain – and I know I keep saying this – but it takes time and curiosity to learn what is good and bad for you. 

Claire explains that when thinking about how much to move, you can start by exploring the “soft edges” of the movement. 

What on earth does that mean?

Well, the soft edges are where you begin to feel tension, weakness or pain. 

Exploring this and gently seeing how far you can move can be beneficial. 

For example, if bending your back is difficult, practicing doing this when sitting, bend slowly to the first area of tension and then gently exploring that. 

Often, people find themselves pushing into the “hard edges” (as far as they can possibly go) as they believe they need to feel the exercise for it to do them good, when actually there are many “layers” before we even get to that super hard, painful part. 

Unfortunately, in the early stages, moving into the hard edges can feel like you’re out of control, resulting in increased sensitivity.

Using the difficulty with bending example, bending too quickly can cause pain and tension, confirming difficult thoughts and knocking confidence. 

In the short term, a new exercise may cause delayed onset muscle soreness (DOMS) that is felt strongly 1-3 days after exercise. DOMS may also cause a flare up for 3-7 days afterwards, but it could be even longer. 

I often found the second day after doing something I’d get a really big pushback, but sometimes because a day had passed, I’d not actually make the connection between the movement I’d done a couple of days before and how I was feeling. Recognising that pattern was super helpful because it enabled me to understand that how I was feeling didn’t come out of nowhere.

DOMS has been reported by many people living with long term pain and is something that you can prepare for using your own personal toolbox of coping strategies that we mentioned above. 

Some people actually feel like this pain is easier to deal with because it’s something that they know the cause of and is something that came from “working on their health”. It all depends on how you feel about all of this stuff and what you’re comfortable with, though!

Equally, when your health is in a bit of an upswing, it can be tempting to double up on the amount that you’re doing, to “take advantage” of your health.

But this can often be too much too soon, and for some people (well, if you’re anything like me, anyway) can lead to a boom and bust cycle that can end up doing you way more harm than good. 

For most of my life, my strategy was to do as much as I could until I dropped – but then I’d really drop, for a really long time. And that’s not ideal! 

So this is where pacing, once again, comes in. 

It can be helpful to think of increasing your intentional movement by a small amount (say 10-20%) every few days or each week. But this can be anything that you feel comfortable or safe doing.

Remember, by movement and activity, we’re talking about all of the stuff that was mentioned earlier – not going for a run or some kinda workout!

But you totally don’t have to or need to try and increase if you’re already happy with the amount of activity that you’re doing.

Often when people try to do more activity they tend to think that their current level feels good, so they double it, instead of gradually building up tolerance to this activity. 

And I just wanna take a moment to shout out mobility aids here, as they can play an important role in helping to conserve energy and allow you to engage in enjoyable activities. 

Many people find that mobility aids can bring freedom and independence, and as I said in the last post, I personally found that the biggest unexpected consequence of getting a mobility aid was that it enabled me to save energy and prevent pain from forcing myself to move badly. I was able to focus on safe, appropriate strengthening.

But also, and I think just as importantly, they enabled me to get out way more, feel safer, and to actually enjoy things. And that is valid in and of itself. 

Mobility aids are there to use as and when you need them – so it’s ok for your device needs to change too. 

Many people are reluctant to adapt a movement or use an aid for a whole host of reasons. 

That’s ok and comes back to values, society, and y’know – it’s totally normal to grieve losing an aspect of your mobility. 

I actually tend to get quite pissed off when people just reject that as a concept – because if you could do something, and now you can’t, although there is obviously still so far to go when it comes to normalising and getting rid of the stigma around mobility aids, especially for people with invisible disabilities, we can’t deny the personal experiences of loss that are also tied up with that. 

To wrap up…

There is no doubt that this work is hard. It takes courage, patience and persistence. 

Again, those of us who are fortunate enough to get help and support are at a substantial advantage when going through this process, which is why I hope that this information can help anybody who doesn’t have the support that they need and deserve right now to take those first steps towards incorporating movement into their lives.

Knowing about your condition and persistent pain can help. Being open and reflecting on your whole experience is the first step. 

Noticing when you are experiencing difficult thoughts, sensations and emotions can introduce choice, where you can decide what strategy best suits the situation you find yourself in. 

Barriers will show up for you, circumstances will make it difficult to keep going, but recognise them for the blips that they are, rather than a set-back that means things will forever stay stagnant.

I hope this has given you some tips on how to get started with a movement practice. 

Remember, It doesn’t matter how slowly you need to go. If you’re consistent, you’ll still be building habits that will hopefully enable you to do what matters in your life.

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As always, a huge thank you to Claire Campbell for working with me on the content for this series. And thank you to Lucy Dove for the illustrations and worksheet and Amit Rai for editing my podcast and composing my theme music.

In case you missed it in the post, you can download our special worksheet to help get you started here.

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