Working out while suffering from aches and pains doesn't sound very appealing but it may actually help, explains Anna Magee.
It's one of those things. You have a sore back, bad knees or relentless arthritis. Your doctor, your wife and all and sundry are telling you to exercise, but when it even hurts to run for the bus, surely you'll just make things worse?
Well, no. Mounting evidence suggests that finding ways to get active - with our pain in tow - can actually make the things that hurt better. In fact, an April 2017 report published in the Cochrane Database Systematic Review looked at 18 previous Cochrane reviews on physical activity and chronic pain.
"For many years, the treatment choice for chronic pain included recommendations for rest and inactivity," the review authors said.
"However, exercise may have specific benefits in reducing the severity of chronic pain, as well as more general benefits associated with improved overall physical and mental health, and physical functioning. Physical activity and exercise programmes are increasingly being promoted and offered in various healthcare systems, and for a variety of chronic pain conditions."
Startlingly, the authors found only 25pc of previous reviews included "adverse events" and the vast majority of these were increased soreness or muscle pain that subsided within a few weeks. "Physical activity did not cause physical harm," the authors concluded. "This is important as it shows physical activity, in general, is acceptable and unlikely to cause harm in people with chronic pain, many of whom may have previously feared it would increase their pain further."
Indeed, in July last year, Britain's Chartered Society of Physiotherapy launched a campaign to get people with chronic pain exercising, given that the benefits far outweigh the risks. This was after focus groups with patients with chronic conditions such as arthritis, stroke, MS and joint pain found that pain, fatigue and the fear of making pain worse stopped them from getting more active.
Never too late
"The wear and tear that comes with age can mean the protective cartilage in the middle of the joints breaks down and causes pain, especially in areas like the knee," says chartered physio Fran Hallam. "The more weight going through the joints, the more pressure you're putting on it, so just losing weight can help."
You also need to strengthen the muscles around the knee joint. "Muscles are like scaffolding around the joint, so if those muscles are weak, you have less support, so any pressure may hurt," says Hallam. "The stronger you can keep your muscles, the more you can keep moving into later life and prevent complications such as fractures." And it's never too late to start.
"Research shows people who have led sedentary lives and have weak muscles can get strong quickly after they begin regular exercise."
What to do for knee and hip pain
"Squat to strengthen the muscles," says James Moore, a chartered physiotherapist at the Centre for Health and Human Performance. "If those hurt, try wall squats with your back against the wall, with a goal to eventually get your shins 90 degrees to the floor - start higher up if that hurts - then hold for six to 10 seconds and work up to 30 seconds. These will activate strength in knees and hips."
Balance these with activities that keep the joint moving in a "reciprocal" manner, which means in an up-down motion, he explains. "Cycling is great because the joint moves through a comfortable range and it doesn't put pressure on the joint. It also pumps synovial fluid around the joint to lubricate it and increase blood supply, which is nutritious for the joints, which rarely get enough blood as it's mostly used for the circulatory system. Swimming is also great for knees," says Moore. "Freestyle and backstroke are better than breaststroke because you want to keep everything in a forward range of motion. Stairmasters and cross-trainers are not ideal as they overload the knees."
If you have hip pain, Moore suggests cycling, but ensuring the saddle is quite high so you're not jamming the hip joint to bring it to the chest, and raising the handlebars so you're not leaning over too far, which puts pressure on your spine. "Strength-wise, moves that are good for the knees are generally good for the hips. But when you squat, make sure you have hips slightly wider apart, feet turned out, in a Sumo squat position."
Taking the stairs, even if it hurts a little, carrying your shopping and walking even short distances can strengthen knees and hips, Hallam suggests. "As can simply getting in and out of chairs without using your arms for assistance, and leg raises while sitting in a chair: straighten one leg by pulling the toes up towards you and hold it for five seconds, working up to 10, before changing legs."
Lower back pain
Some 80pc of us will suffer with back pain at some point, with lower back pain the most prevalent. But movement is crucial. "The advice used to be to rest, but now we know that is more harmful," says Hallam. "Activity will strengthen the joints and muscles and improve flexibility, all of which are crucial to helping back pain."
"The best exercise for your back is walking," says Moore, "because it exercises the legs without overloading the spine. And over time, increase the incline on the treadmill or add hills into your walks. If the pain is severe, I would advise people walk in swimming pools to take all the pressure off the joints."
Moore also recommends Pilates and yoga to help stretch and work the spine gently, and increase body awareness.
Moore suggests regularly getting on your hands and knees and gently extending opposite arm to leg out, while keeping your core engaged to strengthen the back, before swapping sides.
"Build that up into doing planks, including side planks which help support the spine, especially in over-40s.
"You can start out on your knees to make it easier. But when you progress to full side plank, the key is to separate the feet and have the top leg in front of the bottom to increase the demand on the trunk muscles, whereas having feet on top of each other increases demand on the hips."
That pesky shoulder
"Most people over 40 who complain of shoulder pain will have 'catch pain', which means the joint catches and hurts during movement," says Moore. "It's important to keep the shoulder moving through its full range of movement." That could be swinging arms above the head and down again, or doing arm rotations. Using a cross-trainer is also helpful. "Push-ups, starting on your knees, strengthens the shoulders. If you have a shoulder injury, you can even start by holding a static press-up for six seconds and then build that up to 20 seconds."
"Getting mobility back to the shoulders is important if you're getting stiffness," says Fran Hallam. "Walking your hands up a wall to a point where it starts to get a little uncomfortable and then back again can help."
Expert advice for exercising with pain
Know your boundaries
“A little bit of muscle soreness that goes away is different from waking up with significant stiffness and pain that won’t resolve itself,” says chartered physiotherapist James Moore from the Centre for Health and Human Performance. Get the latter checked out by a physiotherapist.
Know the form
“Learn the right way to do big moves such as squats and dead-lifts, as these are the moves where you can injure yourself or feel more pain,” says Moore.
Leave 48 hours between heavy or high impact muscle work. If you’ve done a body pump class, give it 48 hours before working the same muscles again.
“For example, if you’re working the legs and knees one day, go swimming the next day.” A good physiotherapist or personal trainer can help you figure out a programme that allows for adequate muscle recovery.
Achy soreness is normal
“A mistake a lot of over-40s make is that, at the beginning of a programme, they get sore muscles and so they stop,” says Fran Hallam. “But that’s just your body adapting to the increased demands it’s not used to. If it’s an achy kind of soreness or a pain you normally have that gets worse after exercise and then gets better again, that’s normal.” Muscle pain after exercise — known as Delayed Onset Muscle Soreness (DOMS) — can actually hit anything from 24 to 72 hours after the activity. “But if the pain is sharp and sudden and you haven’t experienced it before, see your doctor.”
“Most of the research suggests a lack of flexibility won’t necessarily impact your injury risk,” says Moore. “But stretching is still important because it lengthens and builds up the muscle, and it’s also incredibly important for recovery. That’s where yoga or Pilates once or twice a week can help. They take the muscles through a full range of movement and help blood flow, which flushes out waste products such as lactic acid that might build-up from your exercise programme.”