Want to exercise but have chronic pain? A dog can help.
Akii Ngo was eight years old when it became obvious to her that the pain she was experiencing wasn't normal.
Even then, she says, "it was brushed off for a number of years as women's pains, period pains, et cetera".
She finally underwent surgery at 16, after a scan revealed that a spinal injury was causing nerve pain and weakness in her legs.
It's no wonder, then, that Ms Ngo was never particularly into sport or exercise.
"I missed out on a lot of stuff at school, I didn't join in any of those [physical] things," she says.
Now a nutritionist and the executive director of Chronic Pain Australia, Ms Ngo still lives with "quite severe pain".
"I've had multiple spinal surgeries, I've gotten nerve damage, I've had surgeries in lots of areas of my body and I have a lot of ongoing pathology."
After her second spinal surgery she had to relearn how to walk — but she can now run up to three kilometres at a time.
"I'm doing so much more than I would have thought possible," she says.
Ms Ngo is quite clear about who she credits with helping her to maintain a regular exercise routine.
Their names are Ponyo and Jojo, and they are miniature long-haired dachshunds.
Finding motivation is the key
The Australian Government recommends people do at least two-and-a-half hours of moderate physical activity each week.
Campaigns like ABC Radio National's Sporty Fitness Challenge and Sport Australia's Find Your 30 encourage people to find the time to be more active.
Andrew Lavender, senior lecturer at Federation University's School of Science, Psychology and Sport, says there are "massive benefits for cardiovascular health, neuromuscular functional health, joint health, even brain and cognitive health" that come from exercising three to four times a week.
But for a lot of people, even if they don't suffer from chronic pain, that's easier said than done.
"Motivation is probably the biggest barrier for physical activity, regardless of if you have chronic pain," Ms Ngo says.
"Then you put the chronic pain on top, or any sort of pain or trauma, and it becomes so much more difficult."
Ms Ngo says many people with chronic pain will avoid exercise because they are afraid of making their pain worse.
"You're in so much pain you don't want to be doing anything," she says.
But, she says, the pain can actually get worse if you're inactive.
"Your tight joints get tighter, your tight muscles get tighter, not having the benefits of the cardiovascular aspect of heart health and the mental health and the endorphins — it then starts to accumulate in a negative way even though you're avoiding exercise because you're not wanting anything to get worse."
Dr Lavender says research in recent decades has changed how injuries and chronic pain are treated, with "bed rest" prescribed far less often than it once was.
"As long as the exercise doesn't exacerbate the problem and make the pain more severe and the injury worse, then there's no reason a person shouldn't exercise," he says.
"Exercise increases blood flow through the entire body — particularly through the muscles that have been worked — gets the heart rate up, releases endorphins, so technically it should reduce the pain."
Ms Ngo says living with chronic pain means accepting your "new normal" and developing the habit of making yourself do physical activity.
However, she says there can be mental and physical hurdles to overcome in order to take that first step, and it's important to remember that not every exercise may be right for you.
"It's also not just about getting started, it's about getting started in the appropriate activity at the pace that your body needs at the time," Ms Ngo says.
The good news is that there are health professionals who can support you.
Getting the right team together
Wendy Brown from University of Queensland's School of Human Movement and Nutrition Sciences says anyone starting an exercise routine should ask their doctor if it is safe to do so, but "the answer is almost certainly yes".
The next step, if you have a chronic condition, is to ask your GP to set you up with a plan to manage it. They can then refer you to Medicare-funded sessions with specialists — including accredited exercise physiologists.
"We've done research to show that if middle-aged people are referred to an exercise physiologist with whatever problems they have, and everybody that age has at least one health problem, you can get people to be more active," Professor Brown says.
"They're fairly effective in getting people moving again if they haven't been moving for some time."
But what happens if you don't get along with the specialist you've been referred to?
Podiatrist Daniel Monteleone has used National Pain Week to speak out on just that issue.
He spent months recovering from a broken foot, only to develop severe hip pain. He underwent surgery, and "spent the next five months trying to walk again".
"I found myself very unhappy with the healthcare system and the practitioners that were looking after me and the outcomes that I was getting," he says.
He saw no fewer than 10 health practitioners, and began to question his entire profession.
"I moved on and moved on, and I eventually did find a clinic and a group of practitioners that really helped me out," he says.
"The interesting thing was that I'd spent five months learning how to walk again — or trying to get to that point, still on crutches — and within four weeks, just having the right care and the right people around me, I was back walking again."
'You're in charge of your own health'
Mr Monteleone says health professionals need to listen to their clients and focus on helping them achieve their goals.
"If we look towards the literature, there's a lot of evidence now to suggest that the number one thing that's going to make a really big difference to your client getting the outcome that they're looking for isn't fancy equipment or your level of education or any of that," he says.
"The number one thing is that the client feels like you're aligned with them, that you understand them and what they're trying to achieve."
Not everyone can afford to pay for the best private clinics, but Mr Monteleone says that doesn't mean those experiencing chronic pain need to put up with what they see as substandard care.
He says if you're unhappy after a first visit, the first step is telling the practitioner directly.
"Give that person an opportunity to respond — sometimes there are miscommunications. If a practitioner really has your interests at heart, and they're met with that kind of feedback, you'll know by the end of that conversation whether they're still the right person."
If you're still unhappy, he says you should return to your GP and have them refer you elsewhere.
"You're in charge of your own health and that GP is part of your team — any practitioner is part of your team," Mr Monteleone says.
Ms Ngo says it can be worth doing some research before going to the doctor to get the Care Plan referral, as some practitioners will bulk bill while others will charge extra.
"Some will say, 'Actually, that plan only paid for 50 per cent of my fee, you still have to pay the other 50 per cent.'"
She says it helps if you live in a major city, as "if you're in a rural or regional setting, it becomes like a million times more difficult".
It also helps if you are able to drive a car.
"If you only use public transport like me, I don't drive and it's too painful for me to drive … that makes it difficult," Ms Ngo says.
"And I was in that position, I literally got a Care Plan and I couldn't find anyone that wouldn't charge me an arm and a leg still — an arm and a leg to me, because I don't work full time because of my chronic health issues and disabilities."
Ms Ngo says in those situations, it can be worth going back to your GP or health service as they will have contacts and networks in the local area.
It can also be worth searching out advice on social media from others with your condition.
"Chronic Pain Australia's social media is very active, very engaging, and we also have a free 24-hour online forum that you can post anonymously to," Ms Ngo says.
Ms Ngo says if you search Facebook for your condition you're more than likely to find a support group dedicated to that condition.
"And you can then ask the question, 'I'm in this area, can someone help me?'"
Dogs give a reason to walk
Professor Brown says exercise physiologists can help give you the confidence you need to get started with whatever exercise you want to do.
"And that's important — to find something that you would like to do."
Walking is often recommended as a good gentle exercise, but Professor Brown says "a lot of people find that a bit boring".
Instead, she recommends finding a reason to walk — going to the shops, for example, or catching up with a friend.
Or, as in Ms Ngo's case, you can walk the dogs.
She says getting Jojo and Ponyo as rescue dogs has helped her to get out of the house and "maintain regular physical activity".
"You need to take them out because it's only fair for them," she says.
"They're very good at reminding you and telling you what they want."
Article from ABC Radio National