In practitioner language we call it Fear-Avoidance Behaviours, which basically means not doing the beneficial thing because of the fear of causing pain even if you know long term the beneficial thing reduces the pain intensity and/or frequency. It’s one of the biggest struggles for people with chronic pain.

I think a lot of the solution to it is finding a really enjoyable activity. In my sisters situation, she started taking MMA classes last year. A weird choice for someone who is already in pain, right? But even though shes learning some serious fighting moves and coming away with some proper bruises, her long term back pain has been more under control than it had been in ages.

I explained it to her like this.
"You’re not there to slug away at a pointless activity that you don’t enjoy. You have fun, you learn, it’s interactive, the people are nice and supportive, it’s social, it’s not 100% competitive, you get to do it as a family activity with Matt and the kids. So it’s probably so much more appealing than going for a run or going to lift weights at a gym by yourself for an hour a few days a week."

And I think she got it!
"Absolutely! Ohh that all makes so much sense... it's so true though. Going to the regular gym or even working out at home is like... ugh. No thanks. But going to MMA is so easy?! Because it's just fun... I mean, it's actually a really complicated work out, and some of it SUCKS... but is somehow so damn fun?!"

While she's having all this fun kicking and punching, she'll definitely be using a lot of back muscles to coordinate and control the movements, and core muscles, hip stabilisers, all the areas that single exercise prescription focuses on. The difference is instead of doing separate specific exercises for each muscle group, it’s all just rolled into a sequence of movements and blows and dodges, mixed in with an instructor that makes her laugh and being able to spar with her partner. This is way more enjoyable for her than doing strict sets and reps of isolated exercises.

Some people love doing the specific exercises, and guess what, thats awesome too because if you love it and enjoy it, you're more likely to do it!

Lets talk neuroscience
We already know that almost any kind of exercise produces endorphins, which are these wonderful little brain chemicals (neurotransmitters) that are natural pain and stress relievers.

Endorphins act a little differently on the Peripheral Nervous System (all the nerves in your body that aren't part of your brain or spinal cord) and the Central Nervous System (the brain and spinal cord)

They work by binding to opioid receptors in the Peripheral Nervous System. Its like your own personal stash of codeine, and your body makes it in response to exercise! They also work by reducing the amount of inflammatory chemicals that the nerve produces.

In the Central Nervous System, endorphins also bind to the opioid receptors. Here their effect is to reduce another neurotransmitter called GABA. With GABA reduced, your brain is able to produce more dopamine - the pleasure neurotransmitter! Interestingly, these opioid receptors in the brain are most abundant in regions of the brain that control pain regulation.

So how is it more helpful to have a fun active hobby?
Researchers found that endorphin release varies depending on the intensity of the activity, suggesting that higher physical intensity leads to increased endorphins compared to more moderate activity.
But is the endorphin rush better from a fun activity vs an activity that you find boring or tedious?
I'm honestly not sure, but what I do believe with certainty is that most people are way more likely to actually DO the exercise if its something they find fun and enjoyable and actually have a desire to do it.

Realistically, it probably doesn't matter WHAT you do, more that you just DO IT!

What are some of the general benefits of exercise?
So first up – why do we want to exercise on a regular basis? I’m glad you asked! There are so many benefits to exercise for your physical, mental and emotional wellbeing. Some of them include:

• Reduced risk of chronic diseases including heart disease, type 2 diabetes and some cancers
• Stronger bones, joints and muscles
• Lower blood pressure
• Better weight management
• Lowered risk of depression and anxiety
• Better mood
• Increased energy levels (even if you have a condition that causes chronic fatigue)
• Boost your libido
• Improved brain function and memory
• Better quality sleep

So it’s easy to see why we’re told to move on a regular basis. But what if you’re injured or experiencing pain?

Exercise, injury and pain
The old-school approach to pain was all about rest and inactivity. But now we know that movement done correctly is one of the best things you can do for pain.
When it comes to pain and injury, research has shown that exercise can:

• Raise pain tolerance and decrease pain perception (thanks endorphins!)
• Relieve pain and improve quality of life for those who experience chronic pain
• Help with chronic lower back pain, fibromyalgia and chronic shoulder issues

There are a few different reasons for these benefits. Exercise boosts blood flow throughout the body, which can carry vital healing nutrients and oxygen to damaged areas. It floods your body with feel-good endorphins and stimulates happy brain chemicals.
But there are also the indirect benefits. For example, exercise improves sleep, which is when your body does its best healing. If you’re not sleeping well, it will take you longer to heal. But if you use exercise to improve your sleep, it can boost your recovery.

How to exercise safely after an injury
Convinced that you need to move that body? Let’s go about this with safety in mind. Here are a few tips to get you started.
Start slow. After an injury, there are a lot of complex processes going on. So the last thing your body needs is for you to try and run a marathon while it’s still healing! Begin with gentle movements, and work your way up over a period of weeks until you’re back to your pre-injury levels.
Use your non-painful joints. If you have an injured upper body, use your lower body for exercising. If you’ve got an injured lower body, do some upper body exercises. Endorphins don’t stay in the one place – they are systemic. So if you’re moving non-sore parts, the endorphins will make their way around your body to the sore parts to help relieve the pain.
Get a proper rehab program prescribed. This might not be necessary if you’ve only rolled your ankle or stubbed your toe. But if you have had a significant injury or are in significant pain, it’s best to get help. As a myotherapist, I can prescribe rehab exercises that build your body’s strength back up, and adapt exercises that might be causing pain. Your exercises will change throughout our treatment plan - we start from light, easy exercises while the pain or injury is acute, and work up to more challenging exercises to rebuild strength when your body is ready for it.
 
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