Welcome back to another episode of the fresh focus podcast. Continuing our discussion on pain management and inflammation, today we are going to discuss a topic that often gets overlooked in the context of this conversation, and that topic is movement, activity, and exercise, and how all of that relates to pain. Luckily, more and more people are starting to understand the wealth of benefits that comes from good movement, but we often still run into people that simply only think about activity and exercise in terms of physical fitness and appearance. And although those results are part of the puzzle, it’s really only scratching the surface of what good movement can do, and continue to do, for us across the life span.

The human body is absolutely meant to move. Many systems and processes within the body are hindered whenever we become sedentary and don’t get the adequate activity that we need. And if this continues over time, those negative effects begin to compound and cause more issues. Think about it like a rusting vehicle. After years and years of sitting, rust is going to spread, what were once moving parts are going to dry up and become immobile, pre-existing problems are going to worsen, and it’s going to be harder and harder to get that vehicle moving. And even though the body was designed to move, if you’ve been in pain for a long time, sometimes you may feel like you can’t move and that you are almost trapped by the pain.

When someone is dealing with inflammation and chronic pain, it can make it so much harder to find the motivation to want to be active or participate in certain activities. Also, the brain maps sources of the pain throughout the body. Over time, this map can spread, which can translate to pain radiation and migration to other parts of the body that aren’t even injured. Remember that any discussion about health should be a discussion about functional independence and freedom, so we have to identify ways to overcome our barriers, and reduce our pain, so that we can continue to live the life we want to live.

Exercise can be an effective treatment for chronic pain. It can help decrease inflammation, increase mobility, improve joint health, slow arthritis progression, as well as decrease overall pain levels. And that’s just the short list.

There is a wealth of good information on this topic, and we are learning more and more as we go, but for the sake of time, I’m only just to focus on a few main points that’ll help you to start thinking about what good movement can do for the body.

Now let’s dig into these topics like a massage therapist digs into those knots and adhesions (which for the record is also a good idea for helping to reduce pain).

The first thing we discuss is pain gate theory.
• The pain gate was discussed a little bit in episode 41, but it’s worth revisiting in the context of movement. We have two sets of nerves that go to the brain from the body. The small nerves are where pain travels. the large nerves are what we use for movement like walking, running, or even shaking your hand. In many ways, we are still wired for survival in the most primal sense. And luckily we can use this to our advantage. When in danger, the body is going to prioritize getting to safety more than the pain from any injury you may have. We can use exercise to replicate this response. When we're doing that proverbial ‘running from a tiger’ so to speak, the body will prioritize the signal that allows you to run to safety and will “gate out” the pain signal. Therefore, exercise can help you to reduce the perception of pain because your mind is focused on the movement you are doing.
• Pain tolerance
o Exercise also functions to increase our tolerance, or threshold, for pain.
o Feeling pain is an important part of our bodies’ defense system. It helps to keep us safe by activating the appropriate reflexes when they’re needed, as well as keeping injured body parts safe until they fully heal by producing pain when we try to do too much. But sometimes this system gets hyperreactive and overwhelmed, and we have to retrain that response.
o Exercise itself, is a stressor. But it’s what we would call a positive stressor. It basically tells the brain that movement, and some discomfort, is ok, and that we don’t need to overreact with a full pain response. The way our brains perceive information, and stimuli, from the outside world is important, and it’s great to know that we can retrain certain responses, such as pain, that may not always be in our best interest.
o And it’s important to note that pain tolerance varies from person to person. Two people with the same injuries will perceive them very differently. That all has to do with the complex interconnections within our central nervous system, as well as various other things. But regardless of our starting point, we can still use exercise to calm the brain, and what it might potentially perceive as a threat. From what we know so far, cardiovascular activity and mobility exercise, such as yoga and Tai Chi, seem to have the greatest effects, but any exercise you enjoy doing will be a great start and will provide a multitude of benefits.
o Now, keep in mind you should start any activity/exercise routine with the mindset of safe, slow, and easy. Pace yourself. But don’t worry. You will be able to progress as you go.
o Because your internal alarm system is hyper sensitive, doing too much too quickly can be a recipe for disaster.
o But even if you do have a flare-up of pain and inflammation, it’s important to remember that it is just your nervous system trying to protect you, and it’s not necessarily an indication that you’ve injured anything. Be safe and be mindful, listen to your body but don’t let it set you back or discourage you. And don’t be afraid to seek medical advice during the process, if you have any questions or concerns.
o You can also use imagery to help ease your nervous system prior to doing the movement. This basically just means that you can imagine and go through the steps needed for the movement in your head prior to actually completing the movement. Consider it mental practice. It helps to prime and prepare the brain for the movement, which can help to make the process easier.
• Here are a few other quick points to keep in mind when it comes to movement and pain.
o Activity and exercise can help you to lose weight, which can lower inflammation and stress hormone release, as well as pain.
o Exercise helps to balance neurotransmitters in the brain, as well as increase the production of those feel-good chemicals, such as those endorphins we always hear about.
o When we are active, we release growth factors for various tissues such as muscle, nerves, neurons, blood vessels, etc. These factors are not only important for growth, but also for recovery and repair.
o There is also a positive effect that happens when the body heats up from exercise. One of which, is that this increase in temperature can promote relaxation and reduced muscle tension. We also get similar effects from things such as saunas and hot tubs or even hot baths. Heat shock proteins can also be noted here. More heat shock proteins are released in response to high temperatures, and these compounds can decrease inflammation, oxidative damage, muscle loss, and increase immunity, as well as many other benefits.
o Now keep in mind, if you plan to use any type of heat therapy, you’ll want to approach it just as you would exercise. Start slow and easy, and it might be a good idea to consult with your doctor before hopping in.

Next, we have some great information provided by Ethan Blumhorst. Ethan is a recreational therapist with whole health here within the VA. He teaches exercise classes such as Tai Chi and yoga, and works with Veterans to help them ease their pain.

Yeah, I just want to start off by saying 80% of adults feel chronic pain over their lifetime. As a former paratrooper I feel along with just life, movement, and getting older myself that you get to that age where you can't lay around watching the television in your free time and expect to maintain your health. It can suck and be hard to do things with pain, but it's about finding that new norm, and the pain will subside some with movement. Compare this to doing nothing and just continuing to spiral. And it can be hard to move when you're hurt, I know, which can lead to inactivity for weeks, months, and years on end. Stopping activities, understandably, seems like the right thing to do, but lack of movement actually makes your muscles stiffer and can sensitize your brain to pain. This makes it harder to recover, and that pain can lead us to creating our suffering. But you know you're able to stymie this, and there is a technique that is very important to incorporate which is called pacing.

Pacing is the gradual return of functioning one step at a time. I'm sure we've all heard of the thousand mile journey begins with one step. Just as you would gradually work your way up to running a marathon, triathlon, tough mudder, and so on so forth, Pacing for pain simply involves that slow gentle increase in activity. You can pace for any activity, anywhere from activities of daily living like grocery shopping, favorite hobbies like hiking, cycling, dancing, or something like soccer. Research shows this technique can lead to improved functioning, less fatigue, and a lot less pain over time. Pacing not only strengthens your body, but also changes your brain. This occurs from the phenomenon known as neuroplasticity, which is the ability of our brains to form new neural connections over time. Anytime we talk about effectively treating chronic pain we always want to talk about brain rewiring. Our brain is our computer. Neuroplasticity is the reason humans are able to learn, improve skills we practice, change our thought patterns and behaviors, adjust to new environments, or recover from accidents, trauma, and pain. Our brains are capable of neurogenesis, which is the ability to create new cells, and I've seen research regarding simple exercises like moderate walking a few times a week for 20 or 30 minutes coupled with cool activities like creating music or creative writing can help you to be more productive. Also, pacing is not the same as pushing through the pain, or the concept of no pain no gain. And you don't have to be Hans and Franz from SNL. Instead, pacing is a method of gradually exposing yourself to activity that requires finding a safe, comfortable starting point. Incorporate breaks, stretch, and rest. It’s all about time, effort, and persistence. Starting out right, talking with subject matter experts, and putting in the appropriate time and effort, or workload, heart rate so on. This is so you’re not overdoing it, but you’re still doing something and persisting over time and maintaining that movement or exercise. You’re not lagging behind. And wise effort is something I’ve always pushed. You don't want to have sharp, shooting pains or have to grimace through it. I always like to say Grimace works at McDonald's, which isn't our best companion for overall health.

One of the things I love is aquatic therapy. When the body is submerged to the chest, at least 80% of your body weight is reduced from the equation, which is phenomenal. For people with chronic pain, this allows us to retrain muscles and joints in a soothing setting so the body can heal faster, and more importantly, exercise easier. A lot of places have heated pools, and I know the warmth works directly on the skin a pain reliever.
And talking about things like saunas and stuff like that as well. They allow us to warm up the body in a nice, comforting way. The pressure of the water also offers the resistance that makes these exercises sufficiently challenging, and at the same time the reduced weight also makes it easier to focus on our strength and mobility retraining in the necessary areas. Discomfort along our back, spine, and neck are the three most distressing forms of chronic pain, I believe. Back pain usually results from stress along our vertebrae or surrounding nerves, and the majority of adults are going to experience that back pain over time, usually due to age, injury, or stress. We hold a lot of our stress in our backs. Neck pain is also due to upper back injuries or stress, and it effects over half the population. Aquatic therapy is one of the most effective ways to treat pain along the back, spine, and neck. A lot of people may also suffer from loss of mobility due to that chronic pain in different areas. Water reduces the stress of the body weight, and offers the appropriate resistance to make that gradual strength increase possible. It's especially beneficial to anyone who suffers from back pain or disc issues, but there is a myriad of different things that it will help with in regards to chronic pain or different ailments and such I think it is from The viscosity of the water provides a continuous resistance to us in a way that land exercises can't. When you walk in water, you do ten times the work you do on land. It also encourages that wide range of motion, which is vital for people that want to improve that function and confidence. It's great for anybody who's had that compromised mobility issue. I worked a lot with spinal cord injury folks in Saint Louis during my internship, and actually got huge into scuba. It helped me immensely, and watching all those Veterans in the water and getting their function back was glorious. Those with spinal cord injuries get an increase in feeling and mobility. I know too that it effects serotonin, which can help with your mood. It’s great for you physically and mentally. You can have atrophy from not working off those injuries, or even just old age creeping up on us, and underwater exercises can be a great way to help achieve a new outlook and potentially extend our life with all thee different exercises.

There's a lot of classes and programming we're doing at the VA now, which is great to see that help with chronic pain via exercises such as Tai Chi and yoga, Qi gong, It's great that we're finally getting all these eastern culture philosophies and exercises to the western culture. The benefits are phenomenal. I think we're around 37th in life expectancy, and many other cultures live longer, more healthful, lives. These exercises are especially great for people with chronic pain, at any age. It supports the mind-body connection, the somatic connection, and that's important. This is phenomenal for you physically and psychologically. We focus more on the low impact, slow motion, and that breath control. And mindfulness is a huge thing that’s really made its way. The $10 word being “present,” but there’s a lot more to it. I always kind of think of Tai chi and yoga as being mindful movements. You just do a fluid series of motions that can support the mind/body/spirit connection, or chi, or energy. I also like to say your brain/body/breath connection we have. Being able to focus your attention on these different movements you're doing, and that breath that's connecting you, is the best anchor we have to the present moment. We just flow with those movements, redirecting that energy back and forth, and it's graceful. It can make something ordinary, extraordinary.
I was a bit of a naysayer at first, and if you go into something thinking it’s negative or stupid, it's going to probably be negative or stupid. But if you always come with open mind, try something out, you may find that it works for you. These exercises have been going on for millennia, and we have all of these proven benefits from research. It can improve our balance, coordination, flexibility, muscle strength, and stamina. But it can help the mental side too. It can relieve stress, lower blood pressure, pulse, help with our body awareness, and it's awesome to do in a group setting. It can help with feelings of isolation and things we get used to, especially as Veterans. It can be anywhere from gentle to vigorous depending on what style you practice. Definitely give it a try. And just remember time, effort, and persistence. The more you do it the better it gets. I get to teach it but also do it myself too at least a couple times a week, along with yoga and some strength training. Little things like that, Just take those steps and see what fits and what doesn't. Just trying something instead of nothing. If you do nothing, then nothing is going to happen, and you may just continue to spiral down.

To hit on yoga now a little bit too. One of these other great programs. Yoga is a mind-body exercise that, once again, practices the brain, breath, body connection, and can have some meditative aspects connected to movements that stretch and strengthen our muscles. There's various types of yoga as well. We do a lot of hatha yoga which is one of the main types, and you can do it anywhere. You can do different movements for different things. You can do a total body workout or you know focus on specific body parts like back shoulders. It’s just about being able to have those connections. You can do three to five breaths per movement, or holding it for three or five minutes, etc.
Vinyasa flow is a type of yoga that quickly transitions from one move into another, but it can be harder for older veterans or people with chronic pain, so we like to do the nice, slow movements. Holding for 3-5 minutes, That's also where you start to get into the deep fascia and tendons in order to release some of that stress and open up. It gives us a little more of that flexibility, mobility, function, psychological well-being, and mood boost. The brain can sort of reset itself, especially folks with anxiety disorder stuff like that. That fight, flight, freeze response. It helps us to get the autonomic nervous system to relax again. We start getting that good blood flow, and I see the benefits of that time, effort, and persistence. The more you do it, the better you are. We kind of start off with a beginning meditation, and then just do those different moves depending on what we’re trying to have the goals and outcomes be for that session. Yoga means “to yoke” or “union,” and that's the mind, body connection. Those movements are called “asanas,” or another way to say postures. Throw in various ones while you're breathing and then continue to stretch further. It’s important to push the concept of wise effort. Your body may feel different than it did this morning, or even in the afternoon. Just note those imbalances, and live in the present.

As you can you can tell from this episode, as well as the rest of this series, there is much we can do to help limit pain and inflammation in the body with our lifestyle choices. So if you are dealing with pain, be sure to listen to all of the episodes in this series, and start taking the necessary steps to reduce your pain and reclaim your life and your brain. If you enjoy this content, be sure to like, subscribe, and leave a review. Thank you for joining us today for another episode of Fresh Focus.