Persistent pain

Finding the right balance between rest and exercise is a key part of managing your pain. Pacing is a way of increasing your activity levels without triggering pain or fatigue. 

It's about listening to your body, planning your activities, and sometimes breaking them into smaller parts to avoid overdoing things.

Allowing time to recover after a busy period and slowly building up your exercise tolerance will allow you to achieve your fitness goals. Think of the tortoise and the hare.

Tips

• Break activities into smaller tasks
• Alternate between active and rest periods
• Build up slowly and steadily, rather than doing too much on good days
• Keep a diary to track progress and avoid setbacks.

How to use pacing

Work out what you can manage now

Decide on your baseline - this is how much of your activity you can do on a good day and importantly, on a bad day.

This may take a couple of attempts to get right. Do not compare yourself to others or what you think you ought to be able to do.

Decide on a realistic build-up rate

Too much too soon will cause you to overdo things. Build up the task slowly and at a steady rate, regardless of your fatigue.

Write your plan down and record your progress

This will allow you to easily notice your progress and recognise if you are slipping back.

You can increase your activity level in several ways:

• Increase the time spent doing an activity
• Increase the number of times you do an action
• Increase the "hold" of an exercise
• Increase the resistance or weight you are lifting or pushing
• Reduce the rest time between each exercise or activity.

Your personal baseline measure and activity planner

Find Your Baseline

Think of an activity that causes your symptoms to start (for example, standing, cooking and gardening). Then ask yourself, "how long can I do this activity before I have a flare-up?"

Gradually reduce the time until you find out how long you can do the activity for without getting sore or having a flare-up.

This is your baseline for that activity.

For more information on pacing you can visit the Live Well with Pain website. 

Download the My Daily Pacing Plan sheet (opens in new window).

Stress occurs when life's demands outweigh our ability to cope. Pain and stress are closely linked.

Stress is a normal part of life and although we can’t completely avoid it we need to manage it in order to look after ourselves.

Simple techniques like breathing exercises are effective tools for managing stress and you can read about 5 breathing techniques to help reduce stress on the  feel better live more website.

Mindfulness is the practice of paying attention to what’s happening right now in the present moment. It can help you to become calmer and less stressed and have more control over how you respond to pain.
For more information on Mindfulness and how to practice it visit the Mind website.

Exercise is one of the most beneficial things we can do for our health. It has a positive impact on a wide range of physical health conditions and can improve our mental health and the pain we experience.

Other resources

If you are currently doing less than 60 minutes of exercise a week the your Health Notts team offers tree tailored exercise programmes to help start you on your fitness journey. Visit the Your Health Notts website for more information. 

You can also enrol in specialist health sessions which include Otago balance and strength groups, cardiac rehab, and stroke ability classes.

Or if you are interested in improving your health and joining a gym speak to your health professional about discounted gym referral schemes, including Everyone Active and Active for today in the Newark region and the Healthy Life Initiative in Mansfield.

These programs offer a 12-week discounted membership to your local gym and access to an instructor who can work with you to develop a fitness program, which can incorporate activities such as:

• Sports or groups
• Chair based exercise
• Swimming
• Group exercise classes
• Water based activities like Aqua Fit
• Gym-based exercise.

The NHS Fitness Studio has an online library of exercise videos covering aerobic and strength training, including activities like Pilates and Yoga.

View NHS Fitness Studio exercise videos.

If you’re looking for local groups and classes, Notts Help Yourself has a searchable list of local activities.

Visit the Notts Help Yourself website.

The NHS Better Health website also has some advice and tools to help you get more active.

Finally If you enjoy walking, you might be interested in joining a walking group through Walk Notts.

Evidence shows how a good night's sleep can reduce pain levels and allow our body time to heal and recover.

Good sleep also benefits many other aspects of your health including your mood, productivity, and concentration.

For most people, it is beneficial to get between six and nine hours of consistent sleep.

Tips for a good night's sleep

• Set a consistent sleep schedule. Going to sleep and waking up at a similar time each day, even on weekends, will help regulate your body clock.

• Take time to relax and avoid looking at your phone or computer before bed. Try listening to music or reading a book rather than watching television.

• Stay away from caffeinated or sugary drinks in the hours before bed.

• Avoid long naps during the day.

• Manage your light exposure. Brighten your day by allowing natural sunlight in the morning and darken your nights with blackout blinds, dimming the lights in the evening and avoiding "blue screens".

• Avoid large meals before bed as this can disrupt your sleep.

• Regular exercise helps with sleep, but avoid anything too active an hour or two before bed.

• Keep your room cool and well-ventilated, as this is generally better than a hot and stuffy one.

You can find more sleep resources on the NHS Better Health website.

Living with persistent pain can affect your mood, sometimes causing anxiety or depression.

This can cause you to lose interest in the things you usually enjoy and when this happens, your pain can often feel worse too.

Physical and mental health go hand in hand. By staying positive and having strategies in place to keep moving forward, you can improve both your pain and function.

If you are struggling with your mood, Nottinghamshire Talking Therapies is a free and confidential NHS service that can help. If you're 18 or older and have a GP, you can sign up for free by visiting the Nottinghamshire Talking Therapies website.

Visit the NHS Every Mind Matters website to get helpful advice on how to look after your mental health every day.

Further links and services are also available through the NHS Mental Health website.

The Bee Free website offers ideas to improve both your mind and body.

Finally, Headspace offers great practical resources for mediation, mindfulness, mental health coaching and sleep.

Flare-ups are temporary increases in pain that usually settle in a few days. 

Create an action plan for when symptoms are worse before slowly building up your activity levels over a week or two.

An action plan could include the following:

• Rest and reduction of activity during pain peaks
• Adapting exercises to lighter versions (such as, stretches)
• Using pain relief as directed by a healthcare provider
• Trial of heat or cold packs
• Consider walking aids to temporarily to reduce joint stress.

Setting goals helps you stay focused and motivated.

You can use the SMART framework to help with this. SMART stands for:

• Specific - make sure your goal is clear and detailed
• Measurable - you should be able to track your goal with milestones
• Attainable - ensure your goal is both realistic and achievable
• Relevant - It must be meaningful
• Timebound - link your goal to a deadline or timeframe

List the steps you’ll take to stay on track:

• Mark your calendar
• Set reminders
• Schedule check-ins
• List potential health obstacles and detail how you will overcome them

For more information and resources on goal setting visit the Live Well with Pain website.

Find out about the MSK Together services and view a list of groups and classes you can attend.