Diabetes Forecast

Exercising With Chronic Pain

It’s worth consulting your health care team to find workouts you can do

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Rate your pain on a scale of 0 (no pain) to 10 (excruciating). Stop your workout if pain creeps above level 4.

Chronic pain may seem like a good enough reason to avoid physical activity at all costs, but the benefits of staying active are too great to overlook. “With diabetes, we know you should exercise. Just about every study on every condition shows physical activity is beneficial,” says Michael Mueller, PT, PhD, FAPTA, division director of research in physical therapy and professor of physical therapy and radiology at Washington University School of Medicine in St. Louis.

While diabetes increases your chances of heart disease, exercise drops that risk. Working out can help you control your blood glucose, blood pressure, and cholesterol levels, which in turn will lower your likelihood of developing complications related to diabetes. It can also improve your mental well-being, which is important for people with chronic pain, who are at a greater risk of depression.

Countless studies have shown exercise to be one of the most important health-promotion factors in a host of chronic conditions, and the bottom line is the same: Few conditions warrant an avoidance of exercise entirely. “There’s always something you can do that won’t exacerbate the pain and in fact may help the pain,” says Mueller. “That’s where a referral to a physical therapist can be so helpful.”

Ask the Experts

There’s a fine line between helping and harming your body when it comes to exercise. Depending on your type of pain, certain activities could worsen the problem. Case in point: Running can damage the knee joint, while walking and swimming might not.

How do you know if you’re doing the right type of exercise for your pain condition? Talk to your health care provider. Your doctor may know of certain exercises you can benefit from without fear of worsening pain, or may refer you to a physical therapist.

Physical therapists are trained to help the injured work around pain and physical limitations to build muscle and aerobic endurance. They can assess the way your body moves, correct movements that could make pain worse, suggest exercises, and monitor your progress.

Push Through the Pain

The reality of exercising when you have chronic pain means you’re probably going to be aching during a workout. If the stabbing and burning pain of neuropathy (nerve damage) plagues you at rest, chances are it’ll stick around while you exercise. But pushing through neuropathic pain, while not necessarily pleasant, isn’t likely to harm you, experts say.

 That’s true, too, for other pain conditions, such as peripheral artery disease (PAD). In PAD, narrowing of the arteries causes cramping in the leg and hip muscles, which worsens while walking or stair climbing. “There’s good research that shows if people can push through that pain, they can increase their [exercise] threshold,” says Karen Kemmis, PT, DPT, CDE, a physical therapist, adjunct professor at the State University of New York Upstate Medical University, and spokesperson for the American Association of Diabetes Educators. That is, as a person with PAD takes regular walks, he or she is able to go farther before pain sets in.

Know When to Stop

The trick is to know the difference between good pain and bad pain. Achy muscles are expected after a workout—that’s good pain. But any exercise that makes your current pain worse than normal (either during the exercise or after) should be stopped. “It would be important the exercise doesn’t aggravate the underlying pain problem,” says Mueller.

Take, for instance, joint pain from arthritis. Squats intended to build leg strength may leave your thighs burning—a sign you’re getting a good workout—but are harmful if you feel pain in your joints instead. And people with frozen shoulder aren’t advised to swim laps despite piercing pain; doing so would cause further damage. That’s why it’s useful to be in tune with your body: Knowing where the pain originates can help you determine whether your workout is doing more harm than good.

Mueller suggests rating your pain on a scale of 0 to 10, where 0 is no pain at all and 10 is excruciating. If your pain hovers around levels 2 to 4, you’re probably safe to continue exercising without doing damage (provided you have your doctor’s OK). When pain gets higher than that, talk to your health care provider about other exercises you can do with less pain.

Go Slow

To prevent injury—either a worsening of your current pain condition or new damage—begin your exercise training slowly, building up to a more rigorous workout as you go. “Don’t try to undo many years of sedentary behavior with big bouts of exercise,” says Mueller. “That’s a recipe for disaster.”

Kemmis suggests dividing physical activity recommendations—30 minutes  of exercise five times a week—into more manageable chunks. Instead of a single, half-hour walk each day, take three 10-minute walks. Or try Mueller’s trick: Strap on a pedometer and note your steps per day for a week. Then set a goal to increase your steps by 10 percent over the next two weeks. Raise your step goal as you consistently meet your target.

It’s also important to pay attention to how each new workout affects your pain. “Sometimes when we’re exercising, the pain doesn’t come on during the exercise,” Kemmis says. When you add a new activity, note how it makes you feel not only during the exercise but the day after, too.

Consider Your Options

Depending on your particular pain condition, you may need to think outside the box when it comes to exercises. Walking is an ideal workout for plenty of people with chronic pain because of its ease and simplicity, but it’s not for everyone. While it might be a good option for people whose back pain lessens while standing or walking, those with back pain that worsens while walking might fare better on a bike or in the pool. People with both pain from neuropathy and loss of sensation in their feet may do better on a bike or seated step machine than a treadmill.

Other options: Kemmis says many exercise videos can be done while seated, and a workout tool called an arm ergometer (it looks like bicycle pedals for the arms) can help people with lower-limb issues—such as foot ulcers and neuropathy—who can’t pedal with their feet. While it probably won’t give you as good an aerobic workout as lower- or full-body exercises, it will make you work up a sweat. Arm ergometers are popping up in some gyms across the country and can be found in many physical therapist offices.

Knowing which exercises are best suited for your lifestyle affects more than your risk for injury. It may mean the difference between enjoying exercise and dreading it—all the more reason to seek an expert’s opinion. “The real take-home message is to work with the health care team to find exercise that is complementary to the condition,” says Mueller.

Safety Note: Talk to your doctor before making any big change in your exercise plan.

Safe and Sidelined

Exercise is generally a good idea, but there are times it’s best to rest. The following signs and symptoms should give you pause before starting exercise. During exercise they should prompt you to get immediate help.


Chest pain
Tightness in or pressure on the chest
Shortness of breath
Neck, back, arm, jaw, or stomach pain
Cold sweat

Possible Condition

Coronary artery disease with angina (lack of blood to heart) or heart attack


If present before exercising, don’t start. If present during exercise, seek medical attention.


Flushed skin
Rapid breathing
Racing heart
Nausea or vomiting
Muscle cramps or weakness
Lack of sweating

Possible Condition

Heat stroke


Seek immediate medical attention.


Sweating or chills
Lightheadedness or dizziness
Nausea or hunger
Tingling or numb lips or tongue
Poor coordination

Possible Condition

Hypoglycemia (low blood glucose)


If your blood glucose is low on a meter test or feels low, treat with 15 grams of carbohydrate, wait 15 minutes, then retest. If your blood glucose is still low, repeat the process.


Broken skin on foot
Infection on foot

Possible Condition

Foot ulcer


Talk to your doctor about safe exercises. Avoid standing on your foot. Skip all exercises that involve the feet, including walking and biking. Avoid swimming; the pool and surrounding area could introduce bacteria to the wound. Upper-body exercises, such as seated exercises, are OK.


Redness, swelling, and warmth of all or part of the foot

Foot pain

Possible Condition

Charcot foot


Avoid exercise and see your doctor.


Worsening vision
Vision loss
Worse night vision
Blurred vision
Empty spot in center of vision
Possibly, no symptoms; make sure you’ve had an eye exam before starting an exercise program

Possible Condition

Proliferative retinopathy (eye disease)


Talk to your doctor about safe exercises. Avoid vigorous exercise, heavy lifting, and bending over and exercises that raise blood pressure. Walking and moderate-intensity biking are better options.


Tingling, pain, or loss of sensation in the feet, legs, arms, and/or hands

Possible Condition

Peripheral neuropathy (nerve damage)


Talk to your doctor about safe exercises. Because loss of feeling in the legs and feet can affect your ability to stand and walk, balance exercises are good options. Biking or swimming may be better than walking for people with pain or lack of feeling in the feet or legs. Therapeutic or well-fitting shoes are important.



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