My Response to the Most Asked Question: What Exercises Will Help my Pain?

People are often seeking a particular set of exercises or some kind of transformative formula that can be applied to everyone’s pain situation. But it just doesn’t work like that. Each person will have unique obstacles, limiting beliefs and blindspots that require tailored attention. 

No matter who is in front of me, I am always thinking about how to provoke balanced muscle engagement and mobility all around the body. Even within that goal, though, there is the simple caveat that we develop motor patterns over time that serve us for one reason or another - maybe due to anatomical asymmetries or because of pain or weakness that our intelligent bodies learn to work around. I am not going to assume that negating someone’s asymmetrical movement pattern is the best thing for them in terms of functional ability. Here are the things that matter when it comes to movement programming.

Balance: Spinal movement in all planes

Taking that as a starting point, I am always looking to make it possible for any given client to experience spinal movement in all planes (flexion, extension, side-bending, and rotation), as well as most available actions in the major joints. This does not require that the range of motion is equal, in particular for the reasons named above, but I do want every client to walk away feeling that they have engaged all their muscles in all directions, with the hope of reducing pain flare-ups or spasms that often come from repeated biomechanics of favoring certain muscle groups without the assistance of others. 

This means that if a particular movement I have selected is not available for that person, I won’t skip it but rather find something else in the repertoire, oftentimes using a different piece of equipment, that achieves the same goal but with a different, more appropriate range of motion or load or balance challenge for that person. It’s for this reason that having the entire set of Pilates apparatus at your disposal is so important.

Because swan on the long box on the Reformer feels very different to swan on a loaded push-through bar, compared to swan with legs free on the seat of the chair. Each achieves the same spinal movement, but places the effort and challenge in different parts of the body and different components of the overall exercise. I use this frame of thinking whether the client is an athlete or a joint replacement candidate. 

Progression: Challenging without triggering

The other thing that is always true is that I aim to push people to the edges of their comfort zone, regardless of who they are. This is a common misconception I observe; the expectation that a person with chronic pain shouldn’t work as hard as a person who isn’t in regular pain. I have experienced many well-meaning coaches, trainers, Pilates teachers, etc., who heard that I had pain and then avoided load of any kind, thinking that it was a safety concern.

This is where understanding the physiology of the body is so important, as well as putting the responsibility on the client to own their decisions about what feels like sufficient work. I have found that taking it easy is not helpful when I am in a pain flare-up. In fact, it takes a significant level of effort to get myself out of that pain spiral, not to mention to prevent future injury or exacerbation of my symptoms long term. We all need strength and it takes increasing levels of load to bring about muscular change. This is true for every body. 

Consistency: Finding a movement “why” that matters

What will undoubtedly change from person-to-person is why they are showing up for movement to begin with. Usually, there is something that a person in pain wants from their life that is important enough to compel them into a potentially uncomfortable situation, such as a Pilates studio.

Once I know what that “why” is – maybe it’s being able to enjoy travel during retirement – I can help orient the session around the incremental steps required to progress them to that level of activity that brings meaning to their life. It’s not just movement for movement's sake, there is always something personal and powerful that brings them here.

It’s not about the programming, it’s the delivery

What I think is novel about my approach with chronic pain, is not the programming, but actually the packaging and delivery of the movement session. And most of this comes from my training in pain reprocessing therapy. When it comes to chronic pain–and please bear in mind that I am talking explicitly about pain that persists long after tissues have healed–there are certain problems I am always looking to address in session that have a profound impact on pain experience:

Problem #1: Lack of client awareness about the complexities of how and why pain happens, especially why it becomes chronic, or what we know in clinical realms as the biopsychosocial model of pain. 

Why does this matter?

Because people are often seeking a physical solution to a problem that is rooted in a nonphysical cause. Also, research has repeatedly shown that pain education, when combined with exercise, is more effective at improving pain symptoms than exercise interventions alone. 

What to do about it?

First of all, we find ways to talk about the fact that pain is a signal originating in the brain, in response to perceived threat of danger. And we have to open this subject carefully, because we don’t want clients to hear “your pain isn’t real” or “it’s all in your head.” How this shows up in my client work is really orienting around whatever causes fear for my clients.

Following the fear will usually guide us to whatever is at the heart of the brain’s perception that there is a threat. Also, fear is the fuel of pain and is typically at the root of the tendency toward movement-avoidance which makes it difficult for people to show up and believe they can even do the hard things. So we celebrate the small wins, we help them build a toolbox of movements along a spectrum from safe and nourishing to uber scary and challenging, so that we can vary the neurological load along with the physical load in programming.

Throughout sessions I am trying to help my clients unpack any negative self-talk and limiting beliefs that accompany the movement experience for them. For most chronic pain clients, there is some sort of thought obstacle, again, typically rooted in fear. Their progress in movement ability is absolutely dependent on a shift in their beliefs in what their bodies can do.

Problem #2: Most people are disconnected from their bodies and unable to sense physical sensations as they are happening.

Why does this matter?

Lacking a strong mind-body connection means limited perception of what it requires to complete a certain movement and how it makes that person feel. I find most of my clients with chronic pain struggle to even access the vocabulary to describe their symptoms and the sensations leading up to or surrounding pain, making it difficult to have an accurate understanding of what is going on in their bodies.

What to do about it?

As movement teachers, but especially in Pilates, in my opinion, we have so many tools at our disposal to really assist in this process of re-building two-way communication between the brain and body. I create space in my sessions to bring attention to sensations as they arise and remove distractions so they can focus on the movement experience as it is happening.

Visualisation is excellent for this. I also proceed in a conversational manner throughout sessions, particularly with a new client with chronic pain. I will ask how various movements feel and coax clients to be as precise as possible with their descriptions. Sometimes, I may ask a person to sit with certain sensations for a time – particularly if there is fear.

Problem #3: There’s a lot of blame and guilt in the healthcare system related to chronic pain, in particular for people in larger bodies. A pain sufferer can easily feel like somehow they are responsible for their symptoms.

Why does this matter?

Guilt is not a helpful motivator, and shame does not encourage people to start something new. It can be detrimental to a person’s confidence and self-belief to hear that their weight is somehow the cause of their pain, which of course, isn’t true. When what we need most is to help people find the hope and the determination to challenge themselves into a new movement practice, anything resulting in blame and shame is counterproductive.

What to do about it?

Again, using the right language here is absolutely essential. Our clients look to us for affirmation that they are “doing it right.” So rather than obsessing over the particular shape of a certain gesture in the repertoire, I am interested more in effort and focus and progress over time. It is so important to celebrate wins, however small they are, because this encourages clients to see themselves as capable of more. This is a complete reframing of the pain mindset. These achievements, when given attention, can mean the difference between venturing to take that long walk home or choosing to ride the bus. 

I find as many moments of positive affirmation as I can in sessions, and I address negative self-talk head-on with clients. This is usually fear talking. And so I will ask people, “what evidence do you have that you don’t possess the strength to do that thing I just asked?” And then maybe follow up with, “do you have any evidence to the contrary?” Usually, people can in fact come up with examples where they have successfully completed similar, challenging tasks. So we hone in on that evidence and try to tune out the rest.

So what do we do?

I recognize that pain-focused Pilates studios aren’t available universally. But most of this work can be done in your own home with some guidance, accountability and community. This is why I created the 7 day Meant to Move Challenge; to bring focused attention to building a lasting movement program that meets your specific needs, with the most affordable price point of any of my other offerings.