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More pain than gain - when you aren't getting the endorphin rush.

I'm always banging on about the benefits of exercise.


It's what I do.

One of the best ones is how it makes you feel good when you've done it. That post exercise endorphin rush where you feel like you're the boss of everything and your body feels like a good place to be.

I've written before about how I use cardio as a way of moderating my fibromyalgia pain.



Exercise and pain relief


There's a proper word for this, it's called post exercise hypoalgesia - which literally means you get a decreased response to pain after exercising. Magic!

We know a bit about how this works. We don't know exactly what the mechanism is, but it's understood that the endocannabinoid system is involved - which is nice.

We also know that cardio exercise is great if you want a whole body pain relief situation, while resistance exercise tends to produce a localised result. This is super useful information for me as a Personal Trainer, because it helps me write really helpful programmes for people with pain issues.

Regular exercise also helps pain management in the long term. People who exercise regularly have better functioning opioid systems - which means their bodies' natural painkillers are more effective.

Essentially, exercise is good stuff if you want pain relief.

But what if exercise causes pain?

Some not-so-lucky people, don't get post exercise hypoalgesia. They get the opposite - post exercise hyperalgesia (such useful nomenclature, they actually have the same acronym...)

Usually these are people with chronic pain conditions, and in the aftermath of exercise they may experience increased sensitivity to pain, a flare up of symptoms, exactly the opposite of what you might have hoped for.

Let me give you an example.

Kim (not her real name), started training with me because she loves to lift and be active. She used to attend a CrossFit facility, but she had hit a problem. Her workouts were triggering migraines.

Nobody likes migraines. And a migraine isn't just the day or 2 of migraine symptoms, it's also the aftermath which could leave her off her game for a few days after. Basically one workout a week was all she could manage, and leaving her, a working mother of young children, unable to function in her daily life. She desperately wanted to exercise, but the consequences were too much.

The good news is, we know some things about exercise and pain flares. We know what makes it worse for most people, and we know what makes it less likely. So it was up to me to build a plan for Kim that allowed her to do the things she loved, without the fallout.

Post exercise pain flares are more likely when exercise is high intensity. They are also more likely if you aren't choosing the exercise for yourself (this also has really interesting implications for people who are active in their jobs). They are more likely if you don't choose the intensity of your training.

So Crossfit, as a workout which is unknown until you turn up at the session, planned for the group,not individual, mixing high intensity lifting and cardio with few rests, where athletes are encouraged to "push the limits", in a fairly competitive environment is the perfect place to brew up a pain flare/migraine.

I spoke to Kim and she told me she would like to continue Olympic lifting, box jumps and such like. So I built her a programme that included those, but also included rest periods between sets. She would work at her own pace and was encouraged to "leave a bit in the tank". 

I separated her cardio and her lifting, so she wouldn't be mixing two demanding training types. We started with a gradual introductory phase, getting her body back into the exercise habit. Then we moved into a progressive strength programme. Her lifting blocks were kept in the hypertrophy/strength zone (6-10 reps) so that she was neither stressing her central nervous system with near-max lifts, nor enduring long sets.

Kim never suffered a migraine after our sessions. She was able to do the fitness activities she loved, without hurting herself.

It's time for the moral of the story


It's really easy to write off the idea of a fitness programme when you have a history of pain and difficulty. Fitness isn't one-size-fits-all, the right activities for you are out there. You might just need some help to find them.

It's also really easy for a coach/trainer to write off  the idea of training someone with chronic health issues. But the purpose of a trainer is to remove/work around barriers to training. Pain is a barrier, not a dead end.

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