6 Common Challenges We See with Chronic Pain

The concept of a pain- and post-rehab-focused Pilates studio is novel for most and often requires an explanation. At least since the 2000 trademark case was won, most people have usually heard of the word “Pilates,” though many still think it is a variation of Yoga. In recent years, though, more and more athletes have been incorporating Pilates into their workout regimen to improve mobility and prevent injury. This has helped elevate the visibility of this exercise modality outside of its typical customer base.

The benefits of Pilates for building strength, core stability, balance, flexibility, proprioception, and mental focus have at this point been well-established. These outcomes may by themselves improve musculoskeletal pain, which is why Pilates is the primary (but not the only) exercise approach we leverage in helping our clients get active through pain. The unique Pilates apparatus–unlike those used by any other field–are particularly useful in the post-rehab space when we need the ability to selectively load or unload specific joints.

The Movement Remedies unique approach, though, is more than just its movement programming. We also work toward resolving specific client challenges that have been known to contribute to pain symptoms:

1. Lack of awareness of how and why pain happens

Though I had been experiencing low back pain on-and-off for decades, it wasn’t until I started researching pain in order to help my Pilates clients that I actually began to understand the basic mechanisms behind painful sensations. In particular, while I assumed that ongoing pain symptoms meant I was reinjuring or irritating my disc herniation over and over again, pain education taught me that acute pain becomes chronic for many people long after the tissues have actually healed. The oft-repeated “hurt doesn’t equal harm” saying was definitely a mind-opener for me. Research has shown that combining pain education with movement interventions, like physical therapy, can significantly improve pain and disability outcomes.

2. Inability to feel and accurately interpret physical sensations

A large number of lived experiences can result in changes to our interoception, or our ability to sense our internal state. For many people–such as those with chronic pain, who have experienced trauma, or who have an eating disorder–the ability to ignore physical sensations has been part of a solution to an otherwise overwhelming problem. While movement alone cannot reverse these changes in self-perception, we incorporate mindfulness activities and ongoing dialogue into our sessions to help clients reconnect to physical signals that can inform their pain experience. Without first improving self-awareness, we cannot help clients accurately discern how and why pain is happening during physical activity, which is key to progressing forward with strength, flexibility and balance.

3. Fear that certain movements may cause injury or pain

The fear-avoidance pattern in movement is a common conditioned response. Essentially, after discovering that a particular activity (e.g. side bending) causes pain, our bodies adjust by eliminating that movement from daily use. This logical, learned pattern to accommodate what was perceived by the brain to be a threat, has actually been linked to increased pain intensity and pain-related disability. For many of my clients simply tackling the fear of a particular movement (e.g. balancing on one leg) has led to dramatic reduction in pain symptoms. The more confident we are in our movement, the less danger our nervous system perceives, and the less pain signals are returned as a result.

4. Negative internal monologue about one’s body and its capabilities

The fitness industry has for years profited off the use of demoralizing language to provoke shame and self-loathing. This prompts an apologetic approach to exercise in which people come in for their Initial Movement Assessment carrying a huge burden of guilt for all the days they have not been “staying fit”. I try to help people leave all of that self-flagellation at the door because it doesn’t do anyone any good. Instead, we spend time celebrating the amazing things each person’s body does every day. When it’s pain we are tackling, we need to switch to nurturing and supportive language for our bodies. After all, the use of a gratitude and mindfulness practice alone was found to improve pain symptoms for subjects with arthritis.

5. Distorted perception of physical strength and stamina

Many of our clients have recently received a chronic condition diagnosis, gone through major surgery, or recovered from an injury. I have found that a large portion of these clients–perhaps due to a natural guarding from the nervous system– underestimate their physical abilities. From self-professed weakness to proclamations of the inability to stand on one leg, most of the physical tasks clients have told me they cannot do when they arrive do they either performed in that same session or very shortly after. Knowing that a client’s beliefs about their body’s abilities can actually affect their biomechanics, and that our fears about movement are a strong predictor of pain incidence, a key part of our approach is helping clients align their internal narratives with reality. We do this by creating challenging situations (in a subtle, non-threatening way) and then taking time to celebrate the client’s achievement of a goal they thought was out of reach.

6. Lack of internal accountability for prioritizing self care

In pain reprocessing therapy training, certain characteristics were noted as having an increased likelihood of developing neuroplastic pain. Overachievers and people pleasers–those who prioritize external validation over internal well-being–are among the personalities who have benefited most from the PRT approach. I can relate to this as I have also spent many years basing my sense of self-worth on the approval of others, and letting go of that (a long process I am still in the midst of) has been a huge part of my chronic pain healing. Recognizing this quality in many of my clients, I stay in regular contact to see how they feel after our sessions and to make sure they are holding their boundaries on their scheduled movement time. I want the importance of this journey to remain top of mind, and I am constantly reminding my clients (and myself) that we can only show up as our best selves for others when we have first committed to showing up for ourselves.