The Tribune

By HANNAH FOSTER-MIDDLETON

If you live with chronic pain, the advice to “just go for a walk” can sometimes feel a little insulting.

When your back aches, your knees hurt, your hips are stiff or your whole body feels sore, the last thing you may feel like doing is putting one foot in front of the other for 30 minutes.

And yet, walking really can be one of the simplest and most effective tools we have for managing persistent pain.

The trick is understanding that walking isn't necessarily about fixing the painful body part. It is about gradually teaching your body and brain that movement is safe again.

Pain can make us afraid to move

One of the biggest problems with chronic pain is the cycle it can create.

Something hurts, so we move less. We become less active, our muscles lose some strength and endurance, our joints become stiffer, and ordinary activities start to feel harder.

That can make us even more protective of the painful area.

Before long, we may find ourselves thinking, “I can't do that because it will hurt.”

The trouble is that avoiding movement altogether can actually make our bodies less tolerant of movement.

This doesn't mean your pain isn't real. It absolutely is.

Pain is a genuine experience involving the nervous system, the brain and the tissues of the body. But chronic pain isn't always a reliable measure of how much damage is occurring. Sometimes the alarm system has simply become much more sensitive.

That is where gentle, regular movement can help.

Walking is wonderfully uncomplicated

One of the things I love about walking as a physiotherapist is that it doesn't require a gym membership, complicated equipment or a special technique.

You can walk almost anywhere. And you can adjust it to suit you.

If ten minutes is all you can manage, start with ten minutes. If five minutes is your limit, start with five.

You don't get extra points for suffering through a 45-minute walk.

For someone with chronic pain, consistency is generally much more useful than heroic efforts followed by three days on the sofa.

Walking gives the body repeated, relatively predictable exposure to movement. Over time, that can improve strength, endurance, balance and confidence.

It also gets your joints moving and your muscles working without necessarily placing them under the same load as more vigorous exercise.

But what about the pain?

This is where things can get a little confusing.

You may experience some discomfort when you start walking. That doesn't automatically mean you are causing damage.

A useful approach is to pay attention to what happens during the walk and afterwards.

If your symptoms remain reasonably manageable and settle back towards your normal level within a reasonable period, you may simply be experiencing your body adapting to activity.

On the other hand, if every walk causes a significant flare-up that lasts for days, you're probably doing too much too soon.

Think of walking as a dose of medicine.

Too little may not create much change. Too much may leave you feeling worse. The goal is to find the dose your body can tolerate and then gradually build from there.

Start embarrassingly small

This is one of my favourite pieces of advice.

Start smaller than you think you need to.

If you haven't been walking because of chronic pain, try five or ten minutes. Do it regularly rather than occasionally pushing yourself much further.

Once that becomes comfortable, add a few minutes.

You might eventually reach 20 or 30 minutes, but there is absolutely no requirement to get there immediately.

And don't assume you have to walk continuously. Three ten-minute walks spread throughout the day can still give you a useful amount of movement.

For some people, walking around the house, the garden or the workplace is the starting point.

That's fine.

Walking does more than exercise your legs

Walking is also good for your whole system.

Regular physical activity can improve cardiovascular fitness, muscle function, sleep and mood. And those things matter enormously when you're living with chronic pain.

Pain can be exhausting. Poor sleep can make pain feel worse. Stress can increase our sensitivity to pain. Being less active can affect our mood.

Walking can become a little interruption to that cycle.

There is also something wonderfully human about getting outside, seeing daylight, hearing the birds, feeling the breeze and simply changing your surroundings.

Sometimes the mental benefit of a walk is almost as important as the physical one.

You don't have to walk perfectly

Another misconception I frequently encounter is that there is one “correct” way to walk.

For most people, walking doesn't need to look perfect.

You don't need a special stride, expensive shoes or a particular posture to benefit from moving.

If you have a significant limp, balance problem, neurological condition or persistent pain that is limiting your walking, that's different. A physiotherapist can assess why you're struggling and work out whether you need specific exercises, walking aids or changes to your technique.

But for many people, the best place to begin is simply to walk.

Think progress, not perfection

Chronic pain management is rarely about finding one magical treatment that makes everything disappear.

It's usually about building a collection of things that help your body become more resilient and your life become less restricted by pain.

Walking can be one of those things. Perhaps today you walk around the block.

Next week, you make it a little further. Eventually, you realise you're no longer planning your day entirely around what your pain will allow you to do.

And that, ultimately, is the goal. Not necessarily zero pain.

More freedom. More confidence.More movement.

And a life in which pain doesn't get to make every decision for you. So if you're living with chronic pain and wondering where to start, put on your shoes and take a gentle walk. You don't have to walk far. You just have to start.

• For questions and comments, call Hannah Foster-Middleton at 356-4806, or visit www.physiotherapybahamas.com.