Video and Transcript: Graded Exposure to Painful Activities

Hi! Dr. Orit Hickman here from Pain Science Physical Therapy. Patients often ask me, “How do I return back to doing things that I loved when I've been dealing with pain for a long period of time?” And the simplest answer to this is what's called “graded exposure.” 

So, in order to return back to something that you really enjoy doing without having a significant flare-up in pain, it's really important to understand that you have to ease into that activity. Nudge yourself into it. So, usually what I tell patients to do is figure out what that activity is. 

So, let's -- let's take an example and one of the most common is walking. So, when you're -- you’ve had pain for a long period of time, you might not be doing a lot of walking. So, one of the first things I tell patients is, “Okay. Figure out what's the minimum amount that you feel comfortable walking where you don't feel like it's going to flare up your symptoms too much.” So, maybe it's 5 minutes. 

So, what I usually say is, “Well, start with -- start with your five minutes of walking and walk maybe let's go with two 2-3 days at 5 minutes.” During that time, you're probably going to experience some symptoms. Your pain may increase a little bit, may not be very comfortable. That's okay. I want you to stick with it. After you've been doing it for about 2 to 3 days, if you're feeling pretty sore but your pain isn’t significantly increased, I want you to add another 5 minutes.

So, now you're at 10 minutes of walking. Same thing. You want to stick with that for about 2 to 3 days. And, as long as your symptoms are not appreciably different from the 5 minutes that you started with, at 10 minutes, if you tolerate that okay, then after another 2 to 3 days, add another 5 minutes. 

So, now you're at 15. You can see how the slow progression can slowly increase you to doing something that's more than just 5 minutes. So, within a few weeks, you might be very comfortable with 20 or 30 minutes of walking. 

Now, in terms of the ranges, this varies from patient to patient. This varies from severity to severity. So, if somebody's having really, really, really severe pain, you might need to stay at more like 3 to 5 days before you feel comfortable enough to go ahead and add that extra five minutes. And, in fact, five minutes may feel like it's too much, so maybe you're going to increase it by 1 minute increments. It really doesn't matter how much you do each time as long as it's a comfortable increase in pace for you and you stick with it and do this slow progression over time. If you try to really push through and go through this very, very quickly, what you may find is that you have a significant flare-up and your pain levels increase. And then, you might get discouraged. And then, you feel like, “Oh, I have to start all over again.” If you have a flare-up, stay where you're at for a little bit longer until the flare up calms down. And then, feel free to go ahead and add the other 5 minutes. 

Hope this helps. This is just a general guideline for progression for patients when they're doing graded exposure to activities. I gave you the example of walking, but you can do this with any activity. You can do it with riding a bike, gardening, anything that you really want to be able to do for longer periods of time. Let me know how it goes. If you like this video, give me a thumbs-up. I'd really appreciate it, and good luck!