Exercises and Self-management Techniques
By Judi Hunter M.D.
What are the different types of exercises?
Occupational therapists and physiotherapists use exercise as part of their treatment. They can prescribe specific exercises for you. These exercises may help improve:
- tissue healing
- range of movement
- body awareness
- motor control
- neurophysiologic patterns related to movement
- weak or fatigued muscle
- abnormal activation patterns
The therapist may prescribe exercise to stretch your connective tissues and muscles. Specific stretching exercises may help reduce your fear of certain movements. Stretching can also help counteract the effects of longstanding protective muscle responses.
Strengthening and motor stability
Some exercises help to strengthen de-conditioned (out of shape) muscles. The de-conditioning may have occurred before or after injury.
Sometimes with chronic pain, the nervous system becomes “sensitized”. With sensitization, less movement is required to produce or increase the pain. These are called protective responses. A therapist will tailor exercises so they do not cause unwanted protective responses. Strengthening exercises help to desensitize the nervous system to the forces of muscle contractions.
Motor stability exercises focus on the deep stability muscles. These muscles may be inhibited in people with chronic pain. Motor stability exercises require you to concentrate. They force the nervous system to focus on the exercise and away from the pain. In the beginning, motor control exercises are gentle. This way, the sensitized nervous system does not interpret the exercises as dangerous for the affected muscles.
Functional restoration programs are usually work-related. They are given by a physiotherapist and a multidisciplinary team. The program might be specific to the job. It includes a cognitive-behavioural approach (changing your thoughts and behaviours). It also includes intense physical training. The physical training addresses your aerobic capacity, muscle strength, endurance, and coordination.
These programmes are usually designed for specific patient groups, such as those with chronic low back pain. They have been successful in improving function. To a lesser extent, they may help in reducing pain.
Getting better despite the pain involves separating pain and suffering. “It still hurts, but I can move better now and it doesn’t bother me so much anymore.”
The components of a functional restoration program are:
- formal repeated assessments of physical problems. These help to guide, individualize, and monitor progress.
- psychosocial and socioeconomic assessments. These help to guide and individualize programs. They also help to monitor pain, disability, behaviour, and outcomes.
- multimodal disability management programs using cognitive-behavioural techniques
- psychopharmacological interventions if toxic substances need to be removed from the body. These also include psychosocial management.
- ongoing outcome assessments. These are done using standard outcome criteria. Structured interviews may be used.
- a team approach with frequent team meetings, supervised by a physiotherapist or multidisciplinary team.
Research has shown that functional restoration programs that have all of these components can reduce the number of sick days for some workers with chronic back pain.
Yoga can help people with some chronic pain conditions. Yoga is more than just stretching. It involves relaxation, body awareness, breathing, gentle movements, concentration, and meditation. When taught by a qualified teacher, yoga may address most aspects of chronic pain.
Supporting self-management techniques
You need to learn how to look after your own injuries, illnesses, or disabilities. This is called self-management. Many techniques can be used to teach self management. These include:
- biofeedback techniques: These help to decrease muscle tension. They allow you to practice a smooth coordinated movement while provoking less pain.
- relaxation and meditation: These can help you relax and ease body tension before exercise. They help you to stay relaxed during movement and exercise.
- guided imagery and mirror box interventions: These help to change the way your brain processes information about body awareness. Mirror therapy has helped some people with chronic limb pain. This involves moving the limb inside a mirror-box. The visual feedback of the affected hand is replaced with that of the (reflected) unaffected hand. Mirror therapy is thought to combine motor output and sensory feedback.
- graded motor imagery: This works in a similar way as guided imagery and mirror box, but does not initially involve movement