How to Move with Chronic Pain Step 2: Breathing

Building More Safety for More Movement

What do we do when knowing “moving isn’t as dangerous as it feels” is beneficial, but this only gets us so far?

Is this is the best improvement we can expect? Or maybe there are other things that will help us move with more ease?

Alex, like many people, experienced improvements in ease of movement and in pain when he focused on nudging his body to the edge of pain and repeating to himself “I hurt and I am okay”.

He found it difficult to explain the experience of progressive improvement over the first week of practicing this strategy.

He even asked his physiotherapist if this meant the pain was in his head. Thankfully his physical therapist knew how to explain this to Alex.

The explanation went something like this …

“The first thing to know is that your pain is not all in your head. It is real. And as you have experienced, there are many ways to influence it”

The PT continued, “We should talk more about how complex pain is, but first, can you show me how you are performing your exercises?”

The physical therapist could see how focused Alex was on doing his exercises. He seemed to be thinking so hard, intensely focused on getting the movements right.

At the same time the PT could also see that Alex had forgotten some of the other ways to approach movement that they had discussed the week before. The PT knew from experience how hard it is to learn and remember with pain disrupting thinking and sleeping.

Easing into Painful Movement Through Breathing

The PT went on to say:

“Before you show me more of the exercises, try this.

Slow down your breath a little. Breathe a little longer on your inhale and a little longer on your exhale. Now smooth out your breath. Make the movement of your body smoother as you breathe in and out. Keep doing this while you check in with how tense or calm your body feels.

If there are tight spots, use the feelings of your breath to bring in more softness to your body and muscles. You don’t need to make your breath perfectly long and smooth or your muscles completely relaxed, just longer, smoother and softer.

Now keep doing this while you do those same movements as before.”

As Alex continued, the PT said

“Think about calm breathing as one way to send powerful messages that it’s not so dangerous.

Calming your breath decreases fight-flight and stress responses, changes the chemistry in your blood, and alters activity in your nervous systems and immune system.

You can even use it to send messages to those tight muscles, that it’s okay to let go.”

Alex started to smile. “Now I remember you telling me about keeping my body and breath calm while I exercised. And actually, I didn’t pay that much attention because I didn’t think it was going to help as much as it just did!”

The PT suggested that Alex hold that thought – not only had the movement and pain changed, it was Alex that created the change.

“Would you agree that once again you have used your mind to change the pain?”

“This doesn’t mean that pain is in your head. It doesn’t give evidence that pain isn’t real. You just proved to yourself that you can change movement and ‘pain during movement’ in different ways. You actually have some level of control over your pain.”

Alex thought about this and said, “You sound like my mom.” The PT was initially worried where this was going.

Adding Feel-Good Treatments Together

Alex says: “Mom always says that on good days all she needs is a little warm pad on her neck and a few minutes of quiet to calm down her pain. But she has an elaborate plan for the bad days. She needs to get into the bath at just the right temperature and amount of Epsom salts. She leaves it dark and lights up aromatherapy candles, then listens to Enya. Then she gets relief. It’s just like what you just made me do without the smell and “woo woo”.

“So if I understand you correctly, being able to use my mind to change the pain doesn’t mean I have been making this pain up in my head, but that the mind is just one way to change pain…. I’ll let you know next time if any one of those things you asked me to do works as well as all of them together.”

When Alex and the PT met up next, they spent a little time discussing what science says about the different processes and mechanisms inside us that can change pain. Some have more to do with chemistry in the body, some more with movement, some related to stress and even sleep, some related to cognitive strategies and others to things like slow breathing, music and meditation.

For now, Alex was exploring the more difficult and complex path of easing a little past the edge where he would begin to feel pain to a place that felt a little dangerous.

Yet he would only move to the point at which it seemed he would be okay later and he was still able to find some calmness in his breath and his body.

In this way, Alex was gradually exploring the current limits of his body and what triggered it to feel threatened and generate pain and stiffness as a response. Meanwhile, he was gently pushing those boundaries back using breathing and relaxation techniques. It’s as if he was having a constructive conversation with his body and his pain.