7 (Quick) Guidelines for Exercising with Chronic Pain

We hope this article makes working out feel a little more exciting and less intimidating, and inspires you to find the workout that feels best for you.

Benefits of exercise for chronic pain

The guideline for physical activity with chronic pain used to be “just don’t do it.” But research from the last 20 years has shown that exercise can offer both physical and psychological benefits for people living with chronic pain.

One pivotal study in the Cochrane Database of Systematic Reviews analyzed the results of 21 reviews, which included data from 37,143 participants across 381 studies.1

Researchers found that exercise offered moderate to substantial benefits for1:

– Pain levels

– Quality of life

– Physical function

– Psychological function

Another study published in 2023 in the journal PAIN found that, across 7,000 adults, those who were more active were less likely to develop chronic pain 7-8 years later. Specifically, higher activity levels were associated with a 16% reduced risk for certain types of severe chronic pain.2

The good news: you don’t have to dedicate your life to fitness to see results. Even a little more activity can make a difference. According to researcher and doctoral fellow Anders Årnes, “being just a little more active, such as going from light to moderate activity, was associated with 5% lower risk” for some forms of chronic pain.

How exercise can benefit chronic pain

Aside from improving heart health, working out seems to benefit chronic pain in several ways:

1. Immediately lessens feelings of pain

Exercise has been well-documented for triggering the release of endorphins, or what many casually refer to as “the body’s natural painkillers.” These endorphins contribute to exercises’ analgesic effects, serving as a fast-acting pain reliever.3 (Just as long as you don’t push too hard, which can increase pain.4)

2. Increases pain tolerance

One study examined the pain tolerance of 24 individuals before and after either 6 weeks of structured aerobic exercise or 6 weeks of regular daily activity. Researchers found that participants in the exercise group saw significant increases in their pain tolerance compared to the group whose daily activity didn’t change.5

3. Helps keep joints healthy

Exercise enhances joint health by improving circulation, which boosts synovial fluid production. This fluid is vital to joint health, lubricating the joints, reducing friction, helping to transport waste out of the joint, and aiding in the delivery of essential nutrients into the joint that maintains joint cartilage and overall function.

7 Tips for working out with chronic pain

1. Choose non-weight-bearing physical activities

Non-weight-bearing activities, like swimming or bicycling, lessen the stress on your joints while still benefitting your cardiovascular and muscular systems. By reducing weight and pressure on the joints, exercises like these help reduce the risk of injury and make it easier for people with chronic pain to stay active.

2. Avoid high-impact exercises

High-impact exercises like running, jumping, or high-intensity interval training place a lot of stress on your joints. Instead, opt for low-impact exercises where your feet stay planted on the ground or move slowly and softly, like strength training, yoga, and tai chi.

3. Start small (and don’t overdo it!)

When you’re motivated and feeling good, it’s easy to push yourself past what your body’s ready for. So rather than diving into the deep end, build your routine based on where you’re starting from.

For example: If you take the dog on a walk every day for 10 minutes, increase your walk by 5-10 minutes. Prioritize incremental increases to your workouts so you don’t end up overdoing and setting yourself back.

→ The main goal is to spend more time moving than sitting, so you should count any extra movement you do as a win!

4. Find the right intensity level

A good guideline we use at Healing Lab, is to workout so you can talk, but not sing. This tip is designed to help you find an intensity level that challenges you, but doesn’t push you too far. If you find you’re out of breath in your workouts and unable to talk, you may want to consider pulling it back to make sure you don’t go past your body’s current limits.

5. Don’t forget to warm up and cool down!

Before you begin working out, warm up your joints with heating packs. After you finish working out, ice the affected joints to preemptively ward off potential inflammation. Make sure you apply heat or cold to your joints for no longer than 20 minutes.

6. Follow the 2-hour rule

Soreness is a natural part of building muscle and working out. But it can be hard to tell soreness from actual pain. A good way to tell the difference is with the 2-hour rule.
Here’s how it goes, according to the associate director of the University of North Carolina’s Osteoarthritis Action Alliance, Kirsten Ambrose6:

“If pain is worse two hours after finishing exercise than it was before you started, this is an indication that you have overdone it and should scale back the next time.”