Slow movement and pain
Going slow
The photo shows the sign on the road that tells you to slow down. Did you know that slow movement helps people alleviate pain? Photo by Rayson Tan on Unsplash.
Sometimes you need to move your body and do activities when you are in pain: This is a reality for people who deal with a chronic pain situation (pain that persists after 3 months). The Centers for Disease Control and Prevention report that 1 in 5 adults in the United States are dealing with chronic pain (see the report here). Some people are dealing with high-impact chronic pain that restricts activity. You may know someone that deals with the challenges and limitations associated with pain. This person may be you. So, finding things that help you cope is a good way to respond to the pain situation. Many things can help you with pain, and slow movement is one of them.
Important: The following information is for educational purposes, and is not a substitute for appropriate pain care. Please seek the guidance of a health care professional, especially if you are dealing with pain that is new for you.
Movement and Exercise Reduce Pain
A recent meta-analysis of studies on using exercise to treat chronic pain states that exercise is moderately effective for reducing pain (read the full article here). Basically, what has been found in the research studies is that movement is good for managing and reducing pain, and movement has other non-pain/non-physical benefits like improving mood and sleep. As a health-building activity, exercise has been determined to be safe for various kinds of pain, especially musculoskeletal pain. Activities that are graduated and paced tend to have the best outcomes. The challenge is finding the appropriate amount of exercise, which can be very individual, because it is important that the whole life of the person be considered. This means respecting personal history, being mindful of social factors, and taking into account the present-day physical and biological capacity when choosing an exercise or activity.
Finding the appropriate amount of exercise and movement is a gradual process that might require you think of yourself as an athlete going through phases in training as you progress from one level to the next. Essentially, this means knowing yourself and honoring your capacities and being thoughtful of your history and sensitivity. For some of us, this is a journey of self-discovery and self-knowledge. Along the way, doing things that help you explore safe movement is a great idea. From observing and speaking with pain patients and students, I have noticed that exercise helps in managing pain if it is in the right amounts and done at the right time (the right time of day, the best days of the week). So, developing your powers of observation is very helpful in finding the right dose of exercise for you.
Motion is Lotion
In teaching Tai Chi and Qigong at the pain centers, I encourage patients to get some exercise when I tell them: “Motion is lotion,” which is to say that movement and exercise can grease the wheels of ordinary living and bring more ease into life in general. Movement and exercise also involves personal preference and making little decisions as you move. With the emphasis on slow movement and breathing, the mindbody methods of Tai Chi, Qigong, and Yoga help develop powers of observation that can help develop a sense of finding and experiencing safety in movement. The slow movements can also be done gradually and paced with periods of rest as you go. A recent meta-analysis of studies on Mind Body Exercises (including Tai Chi and Yoga) for older adults suffering from chronic pain situations show that these exercises are safe and effective for alleviating pain. The 14 studies in this meta-analysis also showed very little difference in outcomes. However, it is also true that Mind Body Exercises effects are not superior to traditional exercise, and that they are not meant to be used alone. (See the abstract here.)
Why Slow Movement is Good
What is not obvious in the studies so far is the mechanism of how Mind Body Exercises help alleviate pain. The following is a hypothesis of how slow movement that characterizes mindbody movement helps alleviate pain. Todd Hargove, author and publisher of the Better Movement blog writes about pain and movement, and is also a Feldenkrais Practitioner. I consider Feldenkrais practice to be very similar to Tai Chi and Qigong both for its slow movements and for mindfully observing self. Moshe Feldenkrais, the developer of the Feldenkrais philosophy and technique, authored a book called Awareness Through Movement, and so Feldenkrais practice is awareness practice. When I have practiced Feldenkrais exercises, I definitely have entered meditative states that have felt like slowing down time and then had a clear sense of what was occurring in the body in the moment. This kind of meditative state is also present in Tai Chi, Qigong and Yoga practice. In his book, A Guide to Better Movement (pp. 141-142), Hargove describes the benefits of slow movement, and I have taken the liberty of summarizing the characteristics of slow movement he describes as a single-sentence principle shown here in quotation marks, and then followed each statement by my notes and observations from practicing Tai Chi and Qigong.
Here we go.
“Moving slowly gives you a chance to notice details.”
It can be challenging to notice and distinguish what parts of the body are tense versus which are relaxed sometimes. Learning to notice differences in your body’s felt sense can be really helpful in learning how to relax the body, and so manage stress.
“Slow movement also gives you time to process a movement in your body. “
Having enough time for your body to process an action creates a sense of safety in your mind and body. The safety then allows you to explore the range of movement that you have. You may discover that some movements that are available to you might be completely pain-free. I have called this having enough time to tap into your sense of biomechanical genius and choosing your movements well at any given moment.
“You can gauge effort better when you move slowly.”
In Tai Chi we say you want to use four ounces of force instead of a full pound, which means you can rest the parts of the body until you absolutely need to use them.
“Slow movement is precise.”
When you train slowly, you have better control. In Tai Chi and Qigong, this requires a quiet and undistracted mind. The saying is that you “train slow to go fast,” which is to say that you have the extent of your full power if you are not in a hurry and rushing your movement.
“Slow movement expands your movement repertoire.”
Tai Chi and Qigong can be a way to explore range of motion as we said. As you relax and move your body, you free your energy to move in a more coordinated way, and this might feel and be more balanced and harmonious. The freedom in turn can then give you confidence to know when the conditions are right to try new and different movement.
“Slow movement also reduces the perceived sense of threat when it comes to exercise and exertion.”
I have witnessed some pain patients sometimes experience a sense of surprise when they discover they can move in a way that was once threatening to them. This is important in the sense of gradually increasing complexity of movement and perhaps exercising and working your way towards practicing longer. Pacing yourself is important. My Tai Chi and Qigong teachers had a great sense of graduated progression in first encouraging us to do short practice sessions, and then doing longer and more challenging forms and practices as the skill of the students increased. With the students at the pain centers, slowly doing movements that once seemed threatening creates a sense of achievement and safety, but it is a gradual progression to get there.
Other benefits to moving slowly that I add to this list:
Moving the body slowly means activating a muscle or joint sometimes using only your imagination, which can bring microcirculation to a body area to nourish that joint or muscle. In mindbody practice, moving the body slowly can make the body feel warm (a sign of circulation), because muscles are being engaged in a relaxed way that promotes circulation.
Moving slowly and breathing gently and deeply as you do so can be relaxing and meditative, leading to a quiet mind and a decoupling of stress and perception.
Further stress management can result if you practice regularly, such that stress reactivity diminishes.
As you experience beneficial outcomes (like better sleep or less anxiety) that can give rise to feelings of hope and optimism.
Practicing in a group can encourage feelings of social engagement. Readiness for social engagement after you practice Tai Chi or any mindbody practice tells you the benefits of the practice are in evidence.
According to the American College of Sports Medicine initiative known as “Exercise is Medicine” : “Regular exercise is, in fact, as effective as many pharmaceutical agents in promoting optimal health – cheaper, more fun, and with fewer side effects.” There is more work to be done in terms of measuring long-term effects of exercise, changing public health policy, and understanding the mechanism of mindbody exercise for pain and health. One thing is true on the individual level: Improving health in general may be the best way to treat pain, because improving health means improving your life (mind, body, and soul). As you personally change your activities and choices, your whole life changes. So, in addition to getting regular exercise, you might also start eating a simpler and more nutritious diet; you might also start doing things you enjoy, like getting outside, having free time, or having time with good friends and family—or perhaps even making new friends. As a result, your stress levels may go down. All these things improve the quality of life and health. When life improves, the pain situation improves.