Exercising with Persistent Pain

Exercising with pain

When you live with persistent pain, the thought of exercising can feel scary and often counterproductive with many patients trying their hardest but ultimately experiencing setbacks.

Exercising with persistent pain is like a balancing act. The benefits of exercising with persistent pain are well researched and supported, however there are common stumbling blocks to be aware of; this information will hopefully give you clarity and confidence to pursue exercise as a pain management strategy and hopefully in the long term improve your function and decrease your pain.

As long as it is approached in the right way, the benefits of exercise will always outweigh the potential negatives. The risk of physical injury/tissue damage during exercise is very low.

Where am I going wrong?

Dose – Too much verses too little – This is perhaps the most common stumbling block. Too little means we are unlikely to produce any significant changes to our body such as increased strength or fitness. However, more commonly we see people often tend to overdo. Whether this is running before we can walk or pushing that little bit harder on our “good days”. Finding the right amount can be tough!

Thoughts and fears – A large part of why someone may choose to avoid activity and exercise when living with persistent pain can be traced back to their initial thought processes; commonly these come from a place of fear and anxiety. If an individual fears they may damage themselves by partaking in exercise it is likely they will not engage. Reassurance is key! Misinformation can feed into our fears. Common myths such as running damages the joints and bending being bad for our backs can drive up our fears as well as our pain.

I can’t exercise because I’m in pain – Having persistent pain does not stop us from exercising. There is a misconception that pain equates to tissue damage which is actually inaccurate (see our Explaining Pain lessons). There is strong evidence that shows us movement and exercise is crucial to managing persistent pain.

What is the best approach?

Tolerance – Step one is figuring out what you can currently tolerate; we see patients in varying degrees of health. Tolerance isn’t what you can do pain free (some people have constant pain). Tolerance is how much you can do without pushing your pain to an unmanageable level (remember, a small increase in pain after exercise is completely normal). Once you know what you can tolerate, aim to achieve this amount or slightly less consistently for a couple of weeks.

Graded approach – Once you have achieved a degree of consistency you can start to consider a gradual increase. Your body is incredible at adapting to demands as long as we don’t ask too much! Consider adding a few extra minutes of cardiovascular exercise, or a few extra repetitions of strength based exercise or perhaps a slightly heavier weight, progression can come in many forms.

Access – If access to a local pool is too much hassle, don’t commit to swimming. If you live near a local community centre, consider a gentle class. Use what is easily available to you, don’t set yourself up to fail. If options are limited consider a basic walking programme.

Not just physical

As well as the obvious physical benefits of exercise there are also many other reasons why exercise is beneficial in helping you to manage your persistent pain. These include:

Chemicals – The release of chemicals such as endorphins (the body’s own natural pain relief) and serotonin (our feel good hormone) are just a couple of the reasons why exercise can really help our pain but also boost our mental health and help to manage conditions such as depression.
Routine – Lack of routine can cause rises and falls in our pain as levels of activity can vary. Introducing exercise as a protected activity day to day can be a good way to gently introduce some routine.
Me time – Life can be stressful even at the best of times. It is important to have some dedicated time for your own individual headspace as a way of managing stress. Exercise can be an ideal way to blow off steam and manage stress.


All exercise is safe and good for you when done in the right way, however, these are some of the common recommendations we make to patients here in the pain clinic:

  • Yoga
  • Pilates
  • Swimming
  • Tai Chi
  • Walking
  • Chair exercises