7 Effective Ways To Avoid Injury Exercising

Group Exercise @ Healthy Fit, Fitzroy North

Supervised group training at Healthy Fit – professional supervision is a great way to reduce injury risk whilst exercising.

There are numerous benefits to exercise, but what’s often not mentioned in all the pro-exercise publicity, is that there are also risks involved, chiefly the risk of injury.

Many people, despite their best intentions to get healthier and feel better, actually end up unhealthier and feeling worse after injuring themselves pursuing their fitness goals.

Recently, I polled my personal Facebook account for stories of injury whilst exercising.

It didn’t take too long for my notifications to start pinging like crazy. Here are some of the responses I got:

went for a 7-8km run then stupidly tried to do a back session whilst fatigued. deadlifting with no energy then gave me a slipped disc and a very shitty year ahead.

it still niggles. its probably at about 85%. back in the gym but i never lift at more than about 60%. also trying footy again this year but am a little worried about getting a big bump. long car trips are also a horrible experience if i dont have a rolled uo towel to place on my lower back.

I was doing weight training and now my knees are stuffed!

Sore left glute early on in hockey season. Hockey is a right handed game (seriously) and a lot of players tend to develop niggles on the left side.

Buggered knee from years of over exertion bad form and bad knees

Yes many times mainly due to my strength being far superior than my mobility and flexibility at the particular time.

High volume squats. Poor form with my wrist. – sprain which eventually led to avascular necrosis of the lunate.
Heavy tb deadlift pb. Not enough food tat day and lifted too heavy given a lack of conditioning (hadn’t lifted heavy in 3 months) back injury – 6 months.

Back is fully recovered, wrist is permanently injured.

 

Not all injuries are created equally, however, and there were many stories involving accidents and trauma which I haven’t shared. Whilst little can be done to eliminate accidents, setting yourself up to exercise as safely as possible can greatly reduce your risk of injuries like the ones described above.

In my years of practice, and especially now being an osteopath based in a gym, along with almost a decade of personal training experience , I’ve learnt a few things about why people get injured exercising. A lot of the time, there is the perfect storm of preventable factors that combine to result in injury.

With that in mind, I’ve listed 7 ways to prevent injuries whilst exercising:

 

1. Make sure you want to exercise in the first place

Most people don’t think things through properly before they start.

When it comes to exercise, before you start, you have to know why.

Without a good reason to exercise, you won’t put in the effort to do things properly, which is a sure-fire route to getting injured, or you will, but the effort will be such a stress that it negatively impacts other aspects of your life.

Deciding to exercise will either have a positive or negative motivation behind it.

Positive: I want to be healthy and feel strong so that I can live a full life.

Negative: I don’t want to end up weak and frail and isolated in a nursing home.

Neither is right or wrong, but from experience, negative motivation only lasts so long. If it gets you going, great, but be aware that those that stick to exercise for life tend to have positive motivations for doing so. Don’t worry though, chances are you’re reasons for starting will be different to your reasons for sicking to it.

Exercise is fantastic, most people should be engaging in some form, but it is not essential to exercise to be healthy.

So if you chose to do so, know your reasons.

 

2. Learn to move well

This was almost going to be number 1, because, even if you don’t “exercise”, chances are you move.

Learning to move well is both simple and complex at the same time.

The knowledge behind the process is actually quite complex, but what you have to do is relatively simple. The key is to seek out an expert who has the complex knowledge but can provide you with simple, actionable steps to get you to move well.

Whether it’s an osteopath, a personal trainer or both, the initial investment in learning to move well will pay you dividends for life.

 

3. Know your weaknesses (and address them)

We all have strengths and weaknesses. Naturally, we gravitate towards our strengths.

Big strong people tend to like to lift heavy things. Tall and lean people tend to like to run, row or ride.

Of course, these are just generalisations, but the point is, if we only ever focus on our strengths, chances are we will limit our potential achievements and increase our risk of injury, as our bodies become ever more efficient at compensating until they can no longer.

Identifying your weaknesses is a tough thing to do. Most of us a terrible at looking at ourselves objectively. This is where it pays to hire a professional to tell you what you need to work on.

Not only will address your weaknesses make you more resilient, but your biggest fitness gains will come from improving your limiting factors.

 

4. Progress intelligently

One of the biggest predictors of injury is the ratio of acute to chronic training volume.

What the heck does that mean?

It means when you see a big increase in the amount of work done in the short term, relative to the amount of work done in the long term, then injury is more likely.

Put another way, you have to build up your tolerance to large training loads.

That means starting well within your capabilities and progressing gradually.

The 10% rule – not increasing total training volume by more than 10% per week – is a good general guideline to go by.

Start with an assessment to work out your current abilities, and then progress gradually, using different means of progression. Intensity, volume, frequency, rest, density and even activity/exercise selection are all variables that can be manipulated to provide progressions.

You should have certain indicators that help you identify when you are ready to progress – whether they are qualitative (rating of perceived exertion (RPE) scales) or quantitative (biofeedback like heart rate or power output). (1)

This will prevent your ego getting in the way and causing you to make to big of a jump too soon, which is a massive cause of injury.

 

5. Prioritise recovery

Everyone loves to train hard, not many people like to put in the effort to recover well. However, your ability to exercise is determined by your ability to recover.

Recovering means more than time off training. It means actively taking steps to relax and regenerate both your body and mind.

That means your nutrition and sleep must be on point, but also, your workload and personal life must be taken into consideration of your exercise load.

There are a few ways you can monitor you recovery.

Old school: keep a journal, track your mood and a RPE for each session. If your RPE is going up and your mood is going down, it’s a good sign you’re not recovering enough.

New school: Heart rate variability (HRV) apps. HRV is a way to measure your autonomic nervous system activity, which is a good marker of how stressed you are. You can download various free apps which will sync up with a chest heart rate monitor, whilst at least one can use your smart phone’s camera to measure your heart rate via your finger tip.

Recommended HRV apps*: EliteHRV,  ithlete, HRV4training (iPhone only) (2)

The best approach, which is also the most effort, is to combine a journal, RPE scale and HRV data. Initially, it won’t tell you much, but over a longer period of time, you’ll gain valuable insight to your physical and mental state, which will allow you to know when to push hard and when to back off.

Even if you don’t monitor your recovery status, simply allocating time for active recovery techniques is doing better than 95% of people.

 

6. Balance your training over time

Depending on your individual goals and personal characteristics, you will train in a way which builds particular physical qualities.

However, it is important for health and longevity to build all physical qualities to some degree – flexibility, mobility, power, strength and endurance.

Even if you are a highly specialised athlete, outside of your sport, all training is general in nature, and thus you should aim to improve a range of general physical qualities to minimise injury and maximise performance. If your sport is “the game of life”, then this only adds to the need to exercise a broad range of attributes.

Balance is more than being well rounded; you want balance between periods of hard training and periods of consolidation, which goes back to prioritising recovery.

 

7. Don’t chase fatigue

Anyone can make you TIRED. It takes a skilled professional to make you BETTER.

One of the biggest mistakes people make when exercising, whatever their motivation for doing so, is “chasing fatigue”.

This is a problem, because whilst how we feel on any given day is important, it gives us no insight into whether we are actually improving.

Additionally, chasing fatigue often results in compromising your movement in order to complete a given task, which is risky business to say the least.

This occurs because people associate with certain feelings, and a common association, often perpetuated by the mainstream media is that a workout has to be hard to be effective.

Now, of course, some exercise sessions will be tiring, that’s completely okay, but fatigue should be a by product of exercise, not a goal in and of itself.

You don’t always have to improve from session to session, or even in a straight line (pro tip: neither happen in the real world anyway), but, over a long enough period of time, you should improve at what you are doing.

The best way to know this is to keep a training journal, but if that’s too tedious, having “milestones” throughout the year where you test yourself are a good way to keep track on a macro scale.

8. (BONUS) Fit the exercise to your body, not your body to the exercise

Not everyone is built to run long distances or squat heavy weights with a barbell.

This goes back to knowing your weaknesses (and strengths), but you should choose activities and techniques that suit your body type and abilities.

If you like to run, that’s fine, but maybe marathons on roads don’t agree with your body, so instead, you try shorter distances or trail running.

Likewise, if the gym is your thing, build your program around exercises that suit your body, not what some article online says is the best “butt builder”.

Final Thoughts

Injuries can still happen, despite your best intentions, but there are lots of things you can do to minimise your risk, the above list covers 7 very important elements to consider.

A lot of them have overlap – doing too much too soon and not getting enough rest – and are generally brought about by not knowing any better (forgiveable) or getting emotional/letting your ego guide your decisions (not-so forgiveable).

Exercising should be enjoyable, not a chore, and this list isn’t meant to take the fun out of exercise, but rather, help keep you injury free so that you can continue to exercise in a way that you enjoy.

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



Notes

(1) To read about a simple, easy to use RPE scale, as used by the Australian Institute of Sport, read this.

(2) I’ve only used EliteHRV, but the other two come highly recommended from other professionals I trust.

Do You NEED To Exercise To Be Healthy?

Kids Exercise

Integrative Osteopathy is situated within a gym.

Our treatment process will often include exercise or exercise advice for many patients, who are often already gym goers or exercising in another way.

Exercise has many benefits to almost all aspects of health and well being. Does this mean everybody should exercise?

Often, patients will talk about how they “should” be exercising, despite not enjoying exercise in the past.

Part of the challenge of practice is finding exercise that people enjoy doing, as this is often the biggest factor in whether someone sustains the habit for the long term.

However, for some people, exercise is not an option, either because of physical limitation, time restrictions or lack of enjoyment.

For these people, and everyone else, this post explores whether you need exercise to be healthy.

The short answer is no, but it’s a lot more complicated than that.

What is exercise?

Exercise is any activity performed with a specific physical/health outcome in mind.

This is in comparison to activity that is incidental, or part of your normal daily life (including work).

Example: going for a walk for no other reason than to move your body and maintain your health (specific physical outcome) compared to walking to the local shop to buy something you need.

Whilst both are the same activity, it is the intention that defines whether something becomes exercise.

We have developed exercise to compensate for our ever decreasing activity levels in daily life, as well as for enjoyment and to derive specific.

To add to the mix, sport is a form of physical activity, but it is not necessarily exercise.

Sport is a competitive activity played with the objective of winning. Sport can be healthy and a form of exercise, particularly when pursued recreationally, with little/no care to the outcome, but as soon as the outcome is the driving factor, it is no longer exercise, as health is often sacrificed for increased performance.

To recap:

  • Exercise is an activity performed for a physical/health outcome.
  • Sport is a competitive activity performed with the objective of winning.
  • Incidental physical activity is that which occurs when performing your normal activities of daily living, researchers call this NEAT (Non Exercise Activity Thermogenesis).

What is health and fitness?

A discussion about health and fitness is useless if everyone has their own definition of what each is. The following are commonly used definitions, found via google dictionary.

Health = “the state of being free from illness or injury.”

Fitness = “the quality of being suitable to fulfil a particular role or task.”

Using these definitions, you can see that you don’t necessarily need to be healthy to be fit for a particular task.

It’s easier to understand with an example:

In 2003, Cameroon footballer Marc-Vivien Foe died in the middle of a competitive international fixture. It was later found, via autopsy, that he suffered from a genetic condition called hypertrophic cardiomyopathy (1), which made him susceptible to sudden death during exercise. Here was a highly fit man who had a serious health issue that ultimately lead to his premature death.

There are numerous other examples of extremely fit people suffering from serious health issues, enough so, that it is fair to say that fitness does not equal health.

The Effects of Exercise on Health and Fitness

We know that exercise can improve your fitness as measured by a number of different metrics.

We also know that exercise can improve your health, also measured by a number of different metrics.

What isn’t talked about as much, is that exercise can decrease your fitness and harm your health. 

Because exercise is such a broad term, it is very difficult to be specific with claims. What is important to understand, that how you exercise is almost as important as whether you exercise, or don’t.

When we look at the harmful effects of exercise, they generally stem from two issues:

  1. Poor quality (poor technique, leading to an increased injury risk)
  2. Too much (over training, causing systemic stress leading to a multitude of issues like increased injury risk, hormone dysregulation, immune suppression and chronic fatigue)

If you address these two issues, then there are definitely health benefits to be had, but it must always be remembered that when exercising for both health and fitness gains, there is a point of diminishing returns. That is, you have to work ever harder, doing more, for ever diminishing gains.

Additionally, the are also other reasons to exercise. Most of these involve quality of life – looking better, feeling stronger or more capable etc. These factors can indirectly improve your health and help you enjoy life more.

Done properly, exercise can improve your health and wellbeing. Done poorly, at best, exercise is a waste of time, at worst, it is leading to injuries or other health issues.

“Exercise as medicine”

Much recent research has focused on exercise interventions as medicine. This is because exercise, when properly controlled and administered, tends to have numerous positive effects, crossing multiple body systems, with minimal side effects.

Although the mechanisms of action are not all clear, they are continually being explored, and more is being learnt annually.

However, when viewing exercise as medicine, we have to accept that people needing medicine are already unhealthy in some way.

Thus, in this case, exercise is akin to taking a drug – it has a specific physiological effect. This is why we have seen the emergence of Accredited Exercise Physiologists (AEP) in Australia, to administer exercise to people with various diseases/health conditions.

And, just as we wouldn’t (shouldn’t) take drugs without a prescription, using exercise as medicine can also involve risks.

The other side of the coin is exercise as prophylactic medicine. Does exercising when you are already healthy, make you “more healthy”?

Very possibly. There is a lot of data to support the reduced risk of many conditions amongst those who exercise.

If health is defined as being free from illness and injury, we can use exercise to prolong our good health, by reducing risk factors for specific conditions. This is done by optimising certain physical qualities, based on statistical averages, in essence, becoming “more healthy”.

The confounding factor here, however, is that most data uses controls the reflect the average person. Research shows that the average person does not meet the physical activity guidelines as recommended by the government health authorities.

So the question becomes, do people experience more health benefits from exercise compared to those who are simply physically active, but don’t engage in formal exercise?

All the research we have come across suggests that the most important factor is to be physically active for at least 30 minutes per day, but it doesn’t matter if this is incidental activity like NEAT, formal exercise or anything in between.

Does exercise extend your life?

We have discussed how exercise can improve your health, and as a result of this, the quality of your life.

However, one issue that seems to be misunderstood is exercise’s role in extending (or not) our lifespan. After all, it’s only natural to want to live as well, and as long as possible.

The following factors influence our lifespan (4):

  • Genes
  • Environmental
    • Year of birth
    • Socio-economic status
    • Education
    • Occupation
    • Smoking
    • Alcohol
    • Body-mass index
    • Diet (?)
    • Physical activity (?)
    • Intra-uterine conditions
  • Medicines

Quiet the list.

One accepted view is that lifespan/longevitiy is predominantly predetermined by genetic factors, which are then influenced by our environment and lifestyle.

Thus if we have a healthy genetic base, living a certain lifestyle will help promote longevity.

Perhaps the most interesting work on this topic comes from the “Blue Zone” group, which started when National Geographic commissioned an article on longevity.

Author Dan Buettner came up with 9 different “lessons” that cover the lifestyle of people in the Blue Zones. They are:

  1. Moderate, regular physical activity.
  2. Life purpose.
  3. Stress reduction.
  4. Moderate calories intake.
  5. Plant-based diet.
  6. Moderate alcohol intake, especially wine.
  7. Engagement in spirituality or religion.
  8. Engagement in family life.
  9. Engagement in social life.

Although physical activity is on top of the list, an article in The New York Times covering the Blue Zones expands a little further:

In the United States, when it comes to improving health, people tend to focus on exercise and what we put into our mouths – organic foods, omega-3’s, micronutrients. We spend nearly $30 billion a year on vitamins and supplements alone. Yet in Ikaria and the other places like it, diet only partly explained higher life expectancy. Exercise – at least the way we think of it, as willful, dutiful, physical activity, played a small role at best.

What really matters though, in relation to this post, is whether exercise makes us live longer. A recent study out of Finland sought to answer that.

Without getting too complex, the authors stated:

Based on both our animal and human findings, we propose that genetic pleiotropy might partly explain the frequently observed associations between high baseline physical activity and later reduced mortality in humans.

What this means, is that there is one genetic component that influences physical activity levels, cardiorespiratory fitness and risk of death.

So it is not that exercising makes you live longer, but rather being active and your lifespan share the same genetic link. 

All this suggests, is that there are people who exercise that live both long and short lives, and there are people who don’t exercise who live both long and short lives.

So if you are exercising to live longer, you might want to consider your entire lifestyle, and even then, reconsider.

Decide to exercise because you enjoy it and its effects, not because you want to live longer.

So do you need to exercise?

So far it has taken almost two thousand words to get to the point where we can answer the original question.

You should now have an understanding that such a question does not have a clear cut answer.

It really comes down to the reasoning, i.e. why you want to exercise, and the execution, i.e. how you exercise.

Only you can decide if you need to exercise, but our recommendations are:

You should exercise if:

  • You enjoy exercising
  • You lead a relatively sedentary life, so exercise is your main form of activity
  • You have certain health conditions that would benefit from exercise
  • You are looking to improve certain fitness qualities
  • Your quality of life improves with exercise, be it for physical, psychological or social reasons

You do not need to exercise if:

  • You do not enjoy exercising
  • You lead an active life, i.e. you incur lots of incidental activity (walking, lifting etc) in your occupation and/or activities of daily living
  • You are already healthy, and happy with your current fitness levels

You should not exercise if:

  • You have underlying health risks that may be affected by exercise (if in doubt see you doctor and ask about a referral to an exercise physiologist).

Conclusions

At Integrative Osteopathy, we believe in leading a healthy and happy life.

The definition of health is universal, and the code to healthy living has generally been cracked. Physical activity is a big part of that. What isn’t universal is the need for formal exercise, if you are already very active in your day to day life. In fact, exercise can play a part in increasing physical activity, but it doesn’t substitute for regular physical activity in an otherwise sedentary individual.

The often overlooked factor in much heath research is happiness, which is a very individual thing.

Happiness and satisfaction in life are gained from engaging in meaningful pursuits – whether it be working to create things, grow or support a family, hobbies that express your creative side, physical pursuits that challenge your body and mind or whatever else.

We know the benefits of physical activity, but the recommendations from health bodies only talk about the type and amount. They don’t mention intangibles like enjoyment and meaning, and that’s fine, they’re not meant to, they’re public health recommendations, not personal health recommendations.

Whilst your doctor might suggest otherwise, the only person who can really say if you need to exercise, is you.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

 

References

(1) Wikipedia:https://en.wikipedia.org/wiki/Marc-Vivien_Fo%C3%A9

(2) Exercise as medicine: http://www.ncbi.nlm.nih.gov/pubmed/26606383

(3) Exercise is medicine, at any dose?: http://jama.jamanetwork.com/article.aspx?articleid=2468899

(4) Determinants of longevitiy: http://user.demogr.mpg.de/jwv/pdf/Vaupel-JIM-240-1996-6.pdf

(5) Blue Zones: https://www.bluezones.com/

(6) The Island Where People Forget To Die – http://www.nytimes.com/2012/10/28/magazine/the-island-where-people-forget-to-die.html

Exercise For Low Back Pain

Fit girl lift weights at fitness gym center. Deadlift workout.

Any article about exercise for pain needs to cover one important fact before it goes on:

The body will tend towards self-correction/health/resolution, if, and that’s a big if, the right conditions are present.

The biggest challenge facing an osteopath, or any other therapist, is finding, or more likely, stumbling upon, the right conditions for the individual seeking help.

Whilst there are general guidelines to abide by, every one of us has a unique set of experiences, thus different stories, explanations, treatment techniques and movements are required to facilitate a recovery; not to mention all the environmental factors that come into play.

This article intends to discuss the general principles that should underpin your actions when exercising for/with low back pain.

Where Most Back Pain Exercise Programs “Go Wrong”

Most back pain exercises or exercise programs are based on the notion that pain is the result of specific factors, and that these factors can be specifically identified and then specifically addressed.

There are a variety of factors that can contribute to low back pain, but aside from a history of previous episodes of low back pain, nothing drastically stands out as being identifiable. (1)

As an aside, this perhaps points the finger at us, therapists and rehab professionals, who are not doing a good enough job in the first place (on a population, not individual level).

It is also highly important for sufferers of low back pain to understand, as many people decide to cease treatment/rehab as soon as their pain is gone, rather than concluding the full course of treatment and restoring “lost” function.

Unfortunately, it is very difficult to specifically assess and as a result, address them with targeted exercises.

So knowing that specific factors may be hard to identify and treat, it seems more important to build resilience with a complete mobility, strength and conditioning program.

Take home point number 1: exercise programs for low back pain should not attempt to be specific, but rather improve all physical qualities.

There Are No ‘Good’ And ‘Bad’ Exercises

Another misconception surrounding exercise for low back pain is the concept of ‘good’ and ‘bad’ exercises.

Generally, if you are reading a fitness article, the concept of “neutral spine” is mentioned quite a lot. Lifting should always take place with a neutral spine, regardless.

If you are reading a rehab article, limits might be imposed on external loading, as in, any lifting above 10 kg is bad, and must be avoided.

Or you might read a medical article which mentions you should simply avoid things that hurt.

All of these comments have a place, and are neither right or wrong without any context to define them.

A ‘good’ exercise is one that you can do safely, is suitable for your current ability, is able to be gradually progressed and fits in with your needs and wants (aka your goals).

Take home point number 2: blanket statements and absolutes do more harm than good. There are times when a moderate approach doesn’t work and more extreme action needs to be taken, but it is rarely either or. Exercise selection is based on your needs and wants, not an arbitrary definition of good and bad.

Self-Limiting Movements

This is a concept that was popularised by American physical therapist Gray Cook, in his book Movement.

Self limiting movements/exercises are those that have an inbuilt “coaching mechanism”, meaning doing them forces you to increase your awareness with movement, and often times with these type of movements you can only perform them correctly, or not at all.

Utilising self limiting movements as part of an exercise program for low back pain allows you to safely challenge your body and brain, leading to improvements, without the risk of overdoing it.

There are many different examples of self-limiting exercises. The specifics are not as important as being able to move with increased awareness and a low risk. This is a big focus of our exercise programming for low back pain, especially in the early stages.

Take home point number 3: a good exercise program will provide both a challenge and the option to “fail safely” – thus reducing the fear associated with facing more demanding movement challenges.

Our Approach To Programming

There is no one way to program exercise for low back pain. As long as the programming is underpinned by sound principles, and not “technique based”, then it should be sufficient.

We strive for more than sufficient, we strive for optimal.

As such, over the years our approach to exercise programming for low back pain has been refined to what it currently is. Chances are, in another 5 years it will be further refined, but the vast majority will be consistent, as it is all principle based.

First, we consider the body as a whole. We don’t only do “low back” or “core” exercises, but rather we devise a total body program. This is the underpinning principle of osteopathy, and is also applicable to exercise programming.

Second, we ensure that of physical qualities are developed in the right sequence.

If we start with osteopathic manual treatment in the consultation room, we then progress to mobility and flexibility exercises.

These will usually start on the ground, as this provides the most stable environment, thus is the least threatening.

Considering pain occurs when there is a perception of threat by the brain (if you haven’t already, have a read of Pain Basics), this is one of the best ways to regain movement and avoid inefficient compensation patterns taking over.

From there you are looking to build “motor control” – this is simply the ability to control movement well.

We can call this stability, but that implies static positions and discounts the movement component. This is actually achieved simultaneously with improving movement/mobility/flexibility.

We can consider mobility as “end range strength”, and we are simply progressively challenging you so that both qualities improve.

Once you have achieved adequate movement and control (adequate is based on your individual needs), if you want and/or need, we would add load. This might be in the form of external resistance, increased leverage challenge or even changing the tempo.

Only when you are moving competently under load do we add a conditioning component – that is, more volume of work. This is the challenge of fatigue to your new found movement abilities, and if done correctly, is the difference between breaking down when the going gets tough and being able to withstand (almost) anything.

Take home point number 4: whole body, principle based programming that utilises appropriate methods of progression yield the best long term outcomes (based on clinical experience and research) (2) for sufferers of low back pain.

Conclusions

There is a well worn quote:

Methods are many, principles are few. Methods always change but principles never do.

This served as inspiration for this post – there is no point showing you how to do an exercise with no context as to whether it is appropriate for you or not.

Rather, it is important to have an understanding of why you are doing something – even if you only care about the “what”.

This understanding means you will not chop and change based on the latest article in your newsfeed.

It means you will take the time to get things right, knowing that making progress is all the matters, even if it is “slow”.

It also means that you have a better chance at a good outcome and are less likely to become a statistic of low back pain recurrence.

Reducing the article to four sentences, we would end up with something like this:

  1. Do something you enjoy doing, that has intrinsic reward – there are no “good” or “bad” exercises.
  2. Ensure you take a “whole body” approach to exercise. Don’t simply focus on “low back exercises”.
  3. Start slowly, progress gradually.
  4. Vary the stimulus over time, but not too much or too often (or you won’t elicit adaptations).

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

References

(1) Incidence and risk factors for low back pain: http://www.ncbi.nlm.nih.gov/pubmed/24462537

(2) Resistance training and low back pain in active males: http://www.ncbi.nlm.nih.gov/pubmed/20093971

Exercise For Fibromyalgia

 

Couple walking on the beachFibromyalgia is a common and debilitating condition.

It affects around 2-5% of the population. (1)

It is under-diagnosed, because of the vagueness of many of the symptoms. For those who do get a correct diagnosis, it can take years.

Fibryomyalgia was originally though of as a rheumatic (joint) condition.

Now, research has shown it is mainly a problem with the central nervous system (the brain and spinal cord).

Due to the lack of understanding of the condition, there aren’t many treatments that provide good, long term, results.

Currently, the best treatments for fibromyalgia are (2):

  • Exercise
  • Stress management and relaxation techniques
  • Cognitive behavioural therapy
  • Manual and physical therapies
  • Certain medications

The Benefits of Exercise for Fibromyalgia

Of the treatments above, exercise is low cost, available to all and has minimal side effects. This makes it an excellent primary management strategy for chronic pain.

Exercise has the potential to improve fibromyalgia. It works by a combination of both specific and non-specific effects.

Some of those effects are:

Decreased Pain

We don’t know exactly how exercise helps pain. We do know there are probably a few different effects involved.

One of the main ones is descending modulation. This occurs when the brain secretes natural pain relieving chemicals. Commonly known as endorphins, they target different nerve receptors, inhibiting potentially painful messages.

 Improved Cellular Energy Production

Suffers of fibromyalgia often report increased fatigue. To make matters worse, many have difficulty getting restful sleep.

Exercise can help increase mitochondrial density (3). Mitochondria are the cellular power plants. They convert glucose into ATP, which cells use to fuel their activity.

In theory, increasing mitochondrial density should improve cellular energy production.

In practice it’s kind of like installing a bigger engine in your car. It has the potential to make it go faster, but everything else need to work well too.

Better Hormonal Balance

Regular exercise improves hormonal balance. It decreases catabolic stress hormones and increases anabolic sex hormones.

This balance is thrown off in people with fibromyalgia.

Better hormone balance leads to a more positive psychological state, improved emotions and healthier physiology.

It’s not hard to see how this could benefit a chronic pain condition like fibromyalgia.

Stimulates the Lymphatic System

Many people are aware that exercise improves blood flow. But, few know that exercise also improves function of the lymphatic system.

The lymphatic system is the body’s “waste management system”. It has a network of vessels all around the body, like arteries and veins. These vessels remove cellular and immune system “waste” from the local area.

When you are sick, your lymphatic system becomes more active, and you can often feel your lymph nodes.

Of interest to fibromyalgia sufferers, the brain, hormonal and immune systems are connected. One of the ways they communicate during an immune response is via the sympathetic nervous system (SNS). (4)

It’s a complex relationship, but the stress hormones can both improve or inhibit immune functions.

With fibromyalgia, one of the mechanisms involved is an overactive SNS.

By stimulating the lymphatic system, we can influence the SNS. However, we have to do it in a way that does not cause a flare up.

How To Exercise With Fibromyalgia

Exercise with fibromyalgia is often challenging for two main reasons:

1. Pain (both during and/or after)

Pain is an obvious barrier to exercise for someone with a chronic pain condition. Sometimes though, you need to endure the early pain to get a bigger benefit in the long term.

To deal with this, research on chronic pain suggests a pacing approach. Pacing means doing a little at a time, within your limits, and increasing that amount at a gradual pace.

A good exercise program for fibromyalgia should have pacing built in. It will also have a “plan B” for those days when you feel terrible, and don’t want to do anything, but know you should.

2. Fatigue

Fatigue is the second big issue associated with fibromyalgia.

As mentioned, exercise can potentially help reduce fatigue in the long term.

In the short term, focus on pacing during exercise. In pain management terms, pacing is where you work within yourself and gradually increase the amount over time.

Then afterwards, look to enhance your recovery as much as possible to help minimise accumulated fatigue.

If you avoid common exercise mistakes, you can get the benefits of exercise for fibromyalgia whilst minimising flare ups.

What Type of Exercise Is Best?

There are many types of exercise, which can be organised into 4 broad categories: flexibility training, motor control/skill training, cardiovascular/endurance training and strength/power training.

Each of these has potential benefits for sufferers of fibromyalgia, but overall, there is no clear consensus on which is best, so it is safe to say that the best exercise is the type that gets done and is enjoyable, while producing the least negative effects.

Cardiovascular Exercise

Cardiovascular exercise is a great place to start with fibromyalgia. The majority of research looking at exercise for fibromyalgia has studied various forms of cardiovascular exercise.

One of the downsides of cardiovascular exercise is the potential fatigue it creates. That can be minimised with careful planning and paying attention to biofeedback during and after sessions.

This allows appropriate scaling of volume and intensity, as well as an optimal rate of progression.

The beauty of cardiovascular exercise is that there are a variety of ways to perform it.

Some include:

  • Walking
  • Running
  • Cycling
  • Swimming
  • Rowing
  • Elliptical machines
  • Skipping
  • Rebounding

Remember, always start well within yourself, and progress slowly. It takes patience, but it is the best way to avoid flare ups.

Resistance Training

Resistance training offers complementary benefits for fibromyalgia. Increased strength helps to maintain function throughout your life.

Resistance training is also very scalable, making a pacing approach easy to implement.

Recent (2017) research showed that strength training is both safe and effective for people with fibromyalgia.

Strength training is safe and effective in treating people with fibromyalgia, and a significant decrease in sleep disturbances occurs after 8 wks of intervention.

Strength training can be performed at home, with body weight exercises or using home based equipment, in a gym or at a clinic. There are many forms of strength training, but the principles are the same: progressively load the muscles with increasing resistance over time.

Flexibility Training

Flexibility training is another good option for suffers of fibromyalgia.

It has a myriad of benefits, most relevant to fibromyalgia are decreased stress and increased cellular energy production.

Stretching is requires no equipment and can be performed anywhere, at any time, to varying intensities. This makes it a fantastic intervention for people with limited access to transport or those who live in unsafe environments which prohibits outdoor activity (extreme weather, crime etc).

Conclusions

A good approach, depending on your personal preferences, would be to incorporate a variety of exercise activities. This gives you benefits in multiple areas of health and function, increases enjoyment (variety) and minimises potential overloading issues.

The most important factor, is to apply pacing principles to your chosen activity.

If you do that, with activities that you enjoy, you can’t go wrong. While you may have the occasional flare ups, over the long term, the benefits are much greater.

 

 

Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 


 

 

 References

(1) RACGP – Fibromyalgia

(2) Fibromyalgia – Treatments and Drugs

(3) Exercise and mitochondria

(4) The Sympathetic Nerve – an integrative interface between two supersystems: the brain and the immune system

(5) What Is the Effect of Strength Training on Pain and Sleep in Patients With Fibromyalgia?