For people living with chronic pain, getting up, getting out, and moving can seem daunting. Some fear that physical activity will aggravate their pain. But in fact, researchers find the opposite: The right type of exercise can help reduce pain.
Today Emma Dene agrees. Dene is 44 years old, lives in Chapel Hill, N.C., and works as a business officer in the office of Executive Vice Chancellor at the University of North Carolina. She says her commitment to exercise is relatively recent.
Just a year and a half ago, Dane was almost avoiding any physical movement he was not supposed to do. Just going up the stairs was painful – "sometimes when I had to stick to the pond to help myself," she says, "and I couldn't even get my legs straight." At times, the ligaments in her knees were "torn".
It may seem difficult to believe that walking with painful joints can actually help reduce pain. But movement helps to alleviate pain and damage from osteoarthritis in many ways.
On the advice of a colleague, Dane joined a six-week program to learn how to walk safely to ease her pain. Now, Dan quickly goes to exercise and enjoys several times a week. Her knees, she says, "don't hurt me anymore."
Iman Quinn for NPR
Eamon Queeney for NPR
On the advice of a colleague, Dane joined a six-week program to learn how to walk safely to relieve his pain. Now Dene quickly goes for exercise and enjoyment several times a week. Her knees, she says, "don't hurt me anymore."
Iman Quiney for NPR
First, the construction of the surrounding muscles helps stabilize the diseased joint and also increases cartilage lubrication.
"Movement is essential for cartilage nutrition," says Dr. Virginia Byers Kraus, a professor at Duke Molecular University
"Cartilage has no blood supply, but it has living cells," she explains. "So the way it feeds is through dynamic movement – weight loss and movement as you walk and move. The fluid inside the joint flows into and out of the cartilage like a sponge so that all the nutrients in the joint fluid enter the cartilage. "and help delay any degradation there.
Neurologist Benedict Colbert of Ducane University in Pittsburgh says exercise can also lead to changes in the brain, which can make a big difference in pain relief. "Exercise engages the endogenous opioid system," he says, "so our bodies make opioids and use these opioids to reduce pain."
In addition to other mechanisms that are still being developed, it is believed that natural opioids bind to the same receptors in the brain as opioid painkillers, Colbert says, but without the complications or the potential for addiction. "There are some circumstances," he says, "in which your body can produce so many of these natural opioids that you actually get some sense of euphoria" – hence the term runner is a tall, phenomenon that athletes have long described.
Colbert says exercise also seems to activate parts of the brain that are involved in reducing pain. "We get pain signals that come from our hands to the spinal cord and to our brain," he says, "and then we get those control systems – parts of our brain that seem to be activated in exercise – and then it turns down in the pain system. "
Finally, Colbert says, exercise also seems to reduce stress. And stress can make people more sensitive to pain.
Dane's initial hesitation to start walking is quite typical for arthritis patients, according to physiologist physiologist Kirsten Ambrose, program manager of the Osteoarthritis Alliance at the University of North Carolina.
"Chronic pain is debilitating and many people do not want to be physically active," Ambrose says, "because they fear it will aggravate their pain or further harm their joints."
But Ambrose tells patients that gentle physical activity, gradually increased by personalized guidance from a healthcare professional, will actually improve their pain and they should "think of it as a form of treatment – something they can do safely and comfortable. "
Ambrose says that a number of factors play to make this happen, including improving sleep quality, improving mood and reducing depression and anxiety. Exercise can "simply increase one's self-efficacy or belief in their ability to be physically active," she says. And this heightened self-esteem can also help relieve pain.
Exercise walking is not the only such tool, of course, but it is a simple and accessible form of physical activity. "You just need a pair of shoes and a safe place outside!" Ambrose says.
And, she says, most people who try get some relief. After a routine exercise for a while, their pain subsides and they are motivated to move on.
"Five minutes is very easy to think about," she says, even for patients with moderate to severe pain. "Small pieces to get you started and slowly move forward is the best way."
She invites people to consult Walk With Ease, a walking program sponsored by the Arthritis Foundation. He provides resources, offers classes throughout the country, gives tips on what to wear and when and how to stretch, among other benefits.
"It is structured and gives people very clear directions on exactly how to start, how to set goals, and how to track their progress so they can learn to walk safely and comfortably and reap the benefits of their symptoms. arthritis, "she says. The idea is to make walking "a habit for life."