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Pilates and Pain Management

Content alert: this is an article about living with chronic pain. There are no graphic descriptions, however, I am aware that if you suffer from chronic pain it can be emotional to read about it.

Disclosure: This article does not contain medical advice. If you have any concerns about any aspect of your health you should always consult a qualified medical practitioner.

Living with chronic pain is tough: it completely changes how you approach daily life. If you don’t know until you wake up how you will feel, how can you make plans? It’s easy to shy away from the activities that cause flare ups, whether that’s exercise, cooking, or leaving the house; in your head if you avoid those activities, you won’t flare up, so you won’t be in as much pain. Of course, that’s how you handle an acute injury, you rest, let it heal, then you can get back to normality. However, managing chronic pain is about adapting to the “new normal”; how to minimise pain while doing as much of what you need (or want) to do as possible.

I have Ehlers Danlos Syndrome (also known as EDS hypermobility). This is a condition where soft tissue is too elastic, which leads to various issues including frequent joint problems and chronic pain. In many ways I’m lucky, my EDS was diagnosed relatively early and my symptoms are less severe than many people with EDS experience. Nevertheless, I have spent a lot of time taking pain killers, going on pain management courses, and in the end changed my whole life to make it easier to manage my pain – I became a Pilates Instructor.

What was the logic behind the change? This was about stress and stabilising my joints.

Stress and Pain

If you have chronic pain you’ve probably realised that when you’re worried, stressed, anxious, or experiencing low mood your pain levels usually increase. My previous job made me stressed, which increased my pain, increasing my stress… it’s a vicious circle. Pain management theory talks about the “virtuous circle”, essentially that reducing stress and increasing relaxation reduces pain. I first tried working part time from home to reduce the stress and give me more time to rest and exercise. It didn’t work for me because I was still stressed, so I had to make a bigger change to help me manage my pain.

You can also work on actively relaxing, particularly the mental aspects of relaxation, such as mindfulness, which can lead to physical (and therefore muscular) relaxation and better sleep. There are many apps you can try if you are interested in this. My own version of this is to listen to music I find relaxing (classical) or to do mindful activities. Pilates can be a mindful activity: Pilates is designed to have an emphasis on concentration, making sure you are using the correct muscles in the right ways, which can be a form of mindfulness, as well as a distraction from stressful activities and thinking about pain.

Posture, Stability and Pain

The other problem I had was that my full-time desk job was bad for my body; affecting my posture, over-taxing some muscles and weakening others, without leaving me enough time to exercise around commuting. If I had been better-disciplined I might have been able to overcome this: if I had realised earlier just how important exercise would be to managing my pain, I might have made greater efforts to get to a Pilates class (my exercise of choice) after work, to sit with good posture at my desk, and to take the regular breaks that I needed. However, my office culture was hardly welcoming to the idea of employees needing rest breaks away from their computers (it doesn’t look productive) and I was usually so tired by the time I’d got home from work I couldn’t face going out to exercise.

What I didn’t realise until afterwards was that it was my lack of exercise that had contributed to the many soft tissue injuries I was experiencing. I would get a soft tissue injury without being able to attribute it to an accident, I couldn’t get a diagnosis and therefore treatment, the injury would linger (rest wouldn’t necessarily help) and meanwhile my muscles would weaken further. When I was exercising regularly (I danced all the time at university) I experienced surprisingly few injuries, not because I was being careful (I had no idea I had a problem) but because my muscles were strengthened by my dancing and other exercise so they were protecting me from my hypermobility.

I believe that many of us forget that muscles are responsible for holding our body in the right positions and keeping our joints moving in the right way (the stability of our joints). Over time, if we use our bodies in the wrong way (like standing or sitting with bad posture) or don’t use our muscles enough in physical activity (even just walking around), our muscles start to atrophy (weaken), and this endangers our joints.

You may be aware that the recommendation for activity after surgery has changed: in general, the time you are told to rest the affected area is considerably reduced. Where once you might have expected weeks in bed at home, you might now find a physiotherapist visiting you in hospital and helping you to start moving. This is because medical research has shown the negative effects of muscle atrophy on recovery times; if you can get moving soon after surgery you’ll avoid losing too much muscle tone in your healthy muscles, making it easier to rebuild strength in those that were affected by your operation. For similar reasons, the NHS frequently advise exercise as part of managing chronic conditions, most recently new advice for managing Osteoarthritis was published to include gentle exercise.

The muscle strength I’m talking about is not visible, defined muscles: I’m not talking about weight lifting, just the ability for your muscles to hold your body together in the right way. Unfortunately, if we don’t get enough of the right forms of exercise, movement and activity, we can lose that, leading to more pain and injuries. Again, it’s a cycle.

Where does Pilates come into pain management?

The objective of Pilates is to train yourself to use your body and muscles as they were designed: for example to stand with good posture. We have this ability when we first learn to move. When babies learn to sit up they have perfect posture, they use their muscles in the best possible way, because it’s the only way they can manage to start moving. However, as we age we lose this, allowing our heads to droop forwards, slouching on the sofa to watch TV, or standing asymmetrically to balance a weight we’re carrying.

Pilates is also about moving with precision and control: ensuring that you are using the muscles you intend to use for each movement. Checking your body is in the correct alignment throughout the exercise, making sure that you only move in the way you intend. For example in many Pilates exercises you should use your core muscles to ensure that your pelvis and shoulders stay level. These aspects of Pilates exercises help you to develop the stability of your joints, which can help to reduce injuries.

One of the best things about Pilates is that every exercise comes with different options depending on your strength and any medical conditions you may be contending with. You can use easier options if you’re having a flare-up, or take more rests, while if you’re feeling strong that day you can choose to try something a little harder. If you find it uncomfortable to do an exercise in one position it’s generally possible for your instructor to suggest another way to work the same muscles. As you get stronger, you can try more challenging variations, building up gradually, so rather than “moving up” to a higher level class and experiencing a sudden and significant increased challenge, which might cause a flare-up, you can just try out one more challenging variation in your existing class.

Pilates, Pain Management and You?

If you have chronic pain, you know that learning to manage it is a marathon not a sprint. Everyone learns to manage it in their own way, and if you have been lucky enough to go on a good pain management course, you may have picked up on different things from me and you may need different things to help you manage your pain.

But finding some kind of exercise, gentle movement or activity that helps you to keep the ability to move, is something we all need. You might want to talk about it with a physiotherapist, your doctor, or other medical professional before trying something; they might be able to advise you on what would be most helpful for you. There are many possibilities, so do take time to explore and see if you can find something that works for you. I can only reiterate just how much it helps me to manage my pain and I hope it may do something to help you too.

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