By Grayson Schultz

Nearly every person with chronic pain has been told, “You’ll feel better if you exercise.” But simply telling people to be physically active when they have untreated pain or unaddressed trauma often isn’t helpful. It can make people feel like they’re not seen and, often, the activities suggested to them by providers seem daunting and implausible.

“My experience is that a lot of people who deal with pain don’t feel as if they can exercise,” says Michael Johnson, a clinical exercise physiologist with a pain clinic in Illinois. A lot of people “feel as if they need to be flipping tractor tires, climbing rock walls, or training for marathons in order for it to be effective, and that’s just simply not true.”

Exercise is valuable for individuals living with chronic pain, Johnson says. That said, “the provider will need to understand that they will oftentimes be met with hesitation by the patient.” In some cases, exercises suggested by providers are out of reach for the patient. “Both parties need to be comfortable with the exercise or activity plan in order for it to be most effective.”

Bodyworker and pain coach Deb Malkin agrees. “People are afraid to do exercise because of pain,” Malkin says, “but exercise and specific movements can be the remedy to pain if it’s supported in the right way.”

Malkin tries to remind the people they work with that exercise doesn’t have to be extreme. “All people move,” Malkin says. “How can we recognize the movement we do during the day and lean into that?” Unloading the dishwasher, cleaning, or organizing typically aren’t considered exercise, but ramping up movements like these might just be the best way to reach a point where more traditional forms of exercise feel plausible.

Acute pain may require different approach

For those experiencing acute pain, it’s vital to explore the cause of that pain before moving forward with an exercise plan. Infections, cancers, or other issues that may be contributing to pain need to be ruled out.

Knowing the factors contributing to acute pain—such as an injury, medical procedure, or surgery—may change what types of movements should be explored, Malkin says. Acute pain may also require rest, ice, heat, or other temporary methods, and in some cases it may be best to press pause on exercise while acute pain is being treated.

Once acute pain has been taken into account, though, implementing regular exercise can have lasting health effects. According to Healthline, physical activity can boost the immune system, reduce inflammation, help improve sleep quality, and decrease stress. Being more active can also help reduce the risks of cardiovascular events, such as strokes and heart attacks, as well as lowering blood sugar, increasing good cholesterol levels, and helping with depression.

Exercise plans must be individualized

The reality is that no one exercise is right for every person or every diagnosis. There are types of exercise that are going to do more harm at certain points of your pain journey or for certain conditions. High-intensity workouts, for instance, may never be the right choice for someone with chronic pain.

Johnson says the best bet folks have is to “start off small, work with that, and build up from there.” He recommends implementing a tax for things you enjoy doing. If you like catching up on TV shows or movies, consider requiring yourself to do five minutes of some kind of movement beforehand: try combining simple exercises like taking laps around your kitchen table, marching in place, doing wall push-ups, or going up and down a flight of stairs.

Trial-and-error is an important process: “We found what doesn’t work, so let’s keep trying to find what does work,” Johnson says. A flare-up following exercise could be due to the intensity of the activity, how much time was spent doing it, or the type of movement. Try cutting down on the time you spend on an activity, Johnson says. If your body is still flaring after doing that a few times, “it may be time to find a different activity altogether.”

It’s important not to judge yourself negatively for setbacks. After all, Malkin notes, babies learn to walk even when they fall or are shaky. “Adults have a different emotional response to failure,” they say. “Oftentimes, shame stops us from continuing to move forward.”

The brain’s role

When most folks talk about exercise, they don’t necessarily think about the ways that mental health can play a role. “Some of this work is exploring our human body and mind, and understanding how they’re interconnected,” Malkin says. “Unexpressed emotions can often be experienced in the body as tension and pain.”

Sometimes the narrative that comes along with pain can make it difficult to move past it. “We don’t like mysterious things happening in our bodies,” Malkin elaborates.

People have a tendency to avoid activities they think will cause pain. To counteract that, Malkin suggests a process similar to that used by weightlifters, who gradually increase their tolerance to heavier weights and, on certain days, go back to lighter weights or take a day off. The space and grace weightlifters give themselves can translate to those living with pain.

Johnson says “exercise can be done as long as the patient does not push through additional pain.” He says that “no pain, no gain” should be replaced by a new catchphrase: “No pain for maximum gain.”

Malkin agrees: “[Pain is] not a signal to stop, but a signal to change something—like your speed, gait, or taking a minute to listen to our bodies.”