Do’s & Don’ts of Exercise for Chronic Pain


Arthritis affects people differently, however, the most common complained about symptom is pain – both acute and chronic. Pain can be managed a number of ways, and one of the best non-pharmacological ways is through exercise. However, it’s not uncommon for people to feel a little uncomfortable about participating in exercise because they may think it will make their condition worse or they’ll hurt themselves further. With  regards to how or what they exercise, some people don’t know what they should or shouldn’t do. The following tips will help you to pace, think about and potentially change the way you exercise for the better.

The Do’s
  1. Make exercise fun. If you are enjoying what you do, then you are likely to stick at it longer.
  2. Mix it up. Don’t be afraid to train aerobic (cardio) or resistance, participate in team sports or group fitness classes, exercise indoors or outdoors – variety is a good thing! Variety can challenge you both physically and mentally, and can address health related issues and provide more targeted benefits (e.g. aerobic exercise may enhance weight loss potential and improve sleep.  Resistance training can strengthen muscles and reduce loading on arthritic joints).
  3. Be mindful of your capabilities. Meet them where they’re at. It can be difficult to come to terms with how your body has changed and what you could do in the past. There’s no use dwelling over what was. Work within your new parameters and perhaps one day you’ll be able to move like you used to – maybe better! But one thing is for sure, if you don’t use it, you’ll lose it.
  4. Grade your exercise according to your symptoms. Adapt in case of major flare-up. You need to be in tune with and listening to your body. Perhaps you had a bad night’s sleep and you’re in pain from the get go. Perhaps today isn’t the day for heavy resistance training or high intensity exercise. Instead, downgrade the intensity and go for a walk, or use lighter weights, fewer sets or reps instead, or change the type of exercise/s all together.
  5. Use longer recovery breaks between sets. Have extra rest days if need be and, if you can, try to avoid training the same muscles groups over two consecutive days as rest and recovery is important.
  6. Allow and normalise a slight increase in pain during and post exercise. A slight increase in the experience of pain is typical during or after exercise when you have chronic pain. While difficult, try to normalise this experience. Using a pain scale is very subjective, however, imagine your 1/10 on your pain scale was no pain and your 10/10 was the worst pain imaginable, you couldn’t possibly continue, you had to stop exercise or moving. The pain you feel when exercising should be a little more than discomfort, this may translate to a 3 or 4/10- and that’s ok. The bottom line is, a little pain is ok, however, if your pain-o-meter is climbing towards the 10, then it is time to stop and reassess.
  7. Exercise should fit your needs and goals i.e. exercise frequency, intensity, duration and type needs to be individualised for you and your needs – If you are unsure what these needs are, speak with an allied health professional who will be able to help you clearly define your goals.


The Don’ts
  1. Don’t just exercise the painful body parts but don’t ignore them either. Depending on your goals, it’s best to exercise or move the whole body. If it’s resistance training for example, you may focus on one or two body parts per session, however, over the duration of a week, you’ll have trained the whole body.
  2. Don’t just use 3 sets of 10 repetitions. Don’t feel pressure to use sets and reps. Sure, let them guide you, but instead, try using a pain scale e.g., 5/10 pain or a rate of perceived exertion (RPE) scale (check out the Borg 10 scale here) and adapt to symptoms. For example, say you do as many reps until you get to a 5/10 pain/discomfort or a 3-4/10 RPE on the Borg 10 Scale. This may mean you only do 7-8 reps of an exercise instead of the 10 or 12 reps prescribed.
  3. Don’t avoid pain altogether. With chronic and persistent pain, not all cases of pain indicate tissue damage. Pain is not just a physical experience. It’s also a psychological one, driven by our attitudes, beliefs and emotions. If we start attaching threat and/or fear to a movement or exercise then we will likely start to avoid it, which alters the perception of pain for that movement/experience. Sensitive tissue can become more sensitive if you avoid pain. If you constantly avoid the movement/exercise, when you do go to it, it will likely feel more painful than it potentially should. Pushing into (not through!) pain can actually reduce threat and fear, and desensitise.
  4. Don’t keep exercising a body part if pain increases too much. Stop if something hurts too much. Have a rest, come back to it or just leave it out for today. You don’t need to push through the pain- in this case, pain doesn’t equal gains!


Navigating pain can be tricky. Some days you’ll get it right and others you won’t. Some days you’ll feel better and while other days you’ll feel worse. Adjust and adapt your approach to exercise depending on the day. The key message here, as it always will be, is to ensure you remain active within your parameters and work with an allied health professional to further refine your exercise sessions to maximise the benefits and control for potential barriers.


Reference: Nijs, J., Kosek, E., Van Oosterwijck, J., & Meeus, M. (2012). Dysfunctional endogenous analgesia during exercise in patients with chronic pain: to exercise or not to exercise?. Pain physician, 15(3S), ES205-ES213.


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