There are many reasons why we do or don’t exercise. We may feel we have limited time, or feel that the gym or pool is too far away, or too expensive. We may just not feel motivated.
Sometimes, however, perhaps there is also a fear of getting exercise wrong and doing harm. After more than 30 years as a physiotherapist I am quite sure that the question I have been asked most frequently is:
“If it hurts, should I stop?……………Or is it no gain without pain?”
I do have some concerns that health professionals, in their efforts to protect, can complicate the situation with warnings and instructions, to the extent that people are left feeling they don’t have the experience or expertise to make safe, effective decisions for themselves. It saddens me when people report, for example, that they have stopped swimming because they have been told that it may not be good for them as their backs will be too arched, or their heads tipped too far back. I feel that leaving such decisions to health professionals runs the risk that people may be ‘dis’abled rather than ‘en’abled by the advice they receive.
One of my favourite stories comes from a patient who had been warned about tipping her head back some years previously, on the basis of the results of an x-ray of her neck. When I looked at the x-ray and the report with her there was no sign of anything untoward. |
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Like most of us, there were the usual signs of having been on the planet for about half a century - the internal wrinkles if you like. I spent some time showing and explaining these results to her. I must have convinced her that she might be all right to experiment with exercise because, after years of avoiding tipping her head back, she started looking upwards a little, and then a little more, slowly increasing over many weeks. To cut a long story short, I was delighted to hear from her some months later that she had thoroughly enjoyed a holiday in Rome looking at all the paintings on the ceiling of the Sistine Chapel.
I don’t believe I can know if a person’s body will be able to cope with particular activities as everyone is so unique, and I certainly couldn’t have predicted that this lady would have been able to get back to such a normal level of neck movement as easily as she did, but with a bit of my knowledge of x-rays, linked with her own knowledge of her body, she was able to change her life for the better.
In some senses I think animals are luckier than we are. As far as we know, they don’t hear all these warnings and instructions. They largely make their own decisions about exercise. After injuries or operations, they sit around for a little while, and then slowly but surely begin to move around, testing out their bodies, and progressing their exercise. My elderly cat is clearly getting stiff in his shoulders, and hobbles for a while when he first gets up from a sleep. But he obviously loosens up quite quickly and manages to lead a pretty active life. He prefers not to jump down from fences, or run full tilt, but otherwise he patrols his patch as he has always done. He certainly wouldn’t be helped by me rushing him through x-rays and stopping him from going outside.
So what has happened to us humans? Have we lost the confidence to make similar decisions for ourselves? And yet we are the experts, for who can possibly know more about our own body than we do ourselves?
It is certainly not my aim here in this article to issue warnings or instructions, but to throw a few ideas around and leave you to decide if they seem to have some potential, and could be usefully incorporated, alongside your own knowledge of your body, to advance your exercise.
So what may we learn from my cat.
- He understands that the longer he is immobile, the more stiffness and pain he will get. So he moves about regularly. He knows not to wait for the pain to go in order to exercise. He knows that it is the exercise that helps ease and limit the pain.
- He understands the kindness it is to the body to do things steadily. He works to a timetable. Each day his body gets a gentle workout including some balance, some stretches and some walking. Every part of his body is included. He does not suddenly decide to take a risk and do a whole lot more. He doesn’t do as humans so often do, and let boredom and frustration run riot. In this way he prevents himself from having to suffer the consequences of major, worrying increases of pain.
- I am pretty sure he doesn’t want to develop his swimming, but if he did, because it was something he had always enjoyed, I know he would plan to put just a paw in the water the first time. If he felt all right after doing that for a couple of sessions he would create a schedule that very slowly increased his swimming over a considerable period of time. If he felt he had reached a level that was a little difficult he would be quite prepared to drop back a bit for a few sessions and then see again if he could progress. All this time he would be checking that his body was feeding back to him that it was coping reasonably well. Maybe he would note that he was a little extra sore after a session but would see that this always settled to normal quite soon. Using this method perhaps he would build up his swimming ability quite significantly or perhaps he would plateau at a level that was a bit disappointing. The point, however, is that he would have checked it out for himself and been able to see clearly that he had reached his potential, rather than taking the word of someone else, and being left to wonder if he was missing something.
If I translate into health professional jargon I would say that my cat has appropriate beliefs and knows how to use the principles of pacing and goal setting to optimise his physical condition. I think we can all do that. This is not to say that health professionals have no part to play. When situations are unusual, or there are misconceptions, some extra knowledge can be useful. However in the same way that we may ask someone the way, we don’t expect him or her to take over the driving seat. We like to keep our own hands on the wheel!!
In the work I have done in a Pain Management Programme for the last 12 years I have learned to return the decision making to the patient. It is still sometimes difficult to give information, not warnings or instructions, and then stand back and watch people work out their own way of organising and developing their exercise. They have become used to being told what to do rather than tapping into their own knowledge and experience. However, humans do like to be independent and it is usually not long before they are confident to make the decisions and plans that lead them to the satisfaction of achieving more exercise through their own efforts than often they would have thought possible.
But don’t just believe me. Learn from the animals and try it for yourself.
Penny Mortimer is a Chartered Physiotherapist working in a long term Pain Management Programme.
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