We are experts at delivering evidence based clinical exercise prescription and lifestyle modification guidance. We skilfully and respectfully combine our expertise to inspire, educate and motivate our clientele as they face new obstacles and strive for change. We will achieve our goals by collaborating and developing our diverse skill sets, by being flexible in our thinking and behaviour, and being persistent. We will employ people who share our goals and who have the skills that we will support and enhance to achieve those goals.
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Return to Work & Chronic Pain

By Josh McCarthy, Accredited Exercise Physiologist


You’re constantly told that it’s all in your head or your injury is healed so you have nothing to worry about and you should be able to return to work. But despite all of that you still feel pain and its having a significant impact on your life. Understanding chronic pain and the changes that occur to the body is an important treatment strategy in return to work programs where pain is a limiting factor.

What is pain?

Pain is a protective mechanism which stops us injuring ourselves by producing a very unpleasant signal to the brain. An example of this would be when you place your hand on a hot plate, you move your hand quickly due to the unpleasant pain. If you move it quickly enough you are unlikely to have burned yourself.

In the short term, pain is very useful and serves us well but when pain is persistent and lasts more than 3 months it can become dysfunctional and be a hindrance to our wellbeing. This can be even more significant in the context of returning to work.

The impact of chronic pain on work

Chronic pain is responsible for an estimated 9.9 million absent days from work each year, which costs the economy $1.4 billion per annum, while the total cost of lost productivity is estimated at $11 billion per annum. Not only is there an economic and productivity cost associated with chronic pain, in 2007 it was estimated that there was a $7 billion direct health care costs. Implementing early intervention and adoption of evidence-based treatment could halve the economic cost of chronic pain.

How does exercise help?

All the research shows that exercise works best for chronic pain when it is delivered with education and knowledge about the individual’s condition, physical activity and pain. More specifically, exercise helps your body produces its own pain relieving medication (e.g. endorphins) that work like the pain medication doctors prescribe. After a bout of exercise your pain tolerance increases, things hurt less, and this can last for up to an hour depending on the exercise.

Additional benefits of exercise include:

  • Promote work specific strengthening to improve capacity and reduce reinjury

  • Maintain muscle mass and cardiovascular fitness

  • The nervous system winds down promoting relaxation

  • Reduced flare-ups

  • Improves mood and helps with anxiety and depression.

The most effective treatments for managing pain are active therapies rather than passive treatment such as massage, manipulation and braces. There is no ‘one size fits all approach’ that will fix pain, it’s about creating a individually tailored program. Any prescribed exercise program should be enjoyable, avoid excessive flare ups of pain and focus on consistency.

The best thing to do is to find an accredited exercise physiologist and other health professionals who understands and can explain pain. Be wary of any practitioner who claims to be able to fix your pain after treatment. It is likely that they do not fully understand the complexities of pain which will result in poorer outcomes.



Exercise is Medicine Australia. Chronic Pain and Exercise. Retrieved August 20, 2018 from http://exerciseismedicine.com.au/wp-content/uploads/2016/11/2014-Chronic-Pain-FULL.pdf

Painful Facts. Retrieved August 20, 2018, from http://www.painaustralia.org.au/about-pain/painful-facts




By Lisa Bufalino, Accredited Exercise Physiologist



What is Fibromyalgia?

Amongst today’s current population there are 3-6 % of individuals suffering from a complex rheumatic disease, 75-90% of those diagnosed are females. What is the name of this debilitating condition?  Fibromyalgia Syndrome.

The exact cause of developing fibromyalgia is currently unknown.  The condition presents as musculoskeletal pain and general body fatigue, sleep disturbance, headaches, memory impairment, anxiety, depression as well as digestive problems. This very complex disease was initially classified based on widespread pain for at least 3 months; that is, pain on the left and right hand side of the body as well as below and above the waist. Typically, fibromyalgia is known to affect 11 out of 18 tender point areas throughout the body. These areas are inclusive of the occiput, lower cervical spine, trapezius, supraspinatus, second rib, lateral epicondyle, gluteal, greater trochanter and the knee.


More recently a subjective approach to pain (the Widespread Body Pain Index and a Symptom Severity Scale that acknowledges memory issues, sleep disturbance and fatigue) has been used for diagnosis.

Living with Fibromyalgia:

Those who suffer from fibromyalgia are often left feeling frustrated and exhausted. The condition will impact levels of fatigue and muscle pain which can result in extremely reduced physical strength of the upper and lower body, resulting in the inability to complete their activities of daily living. Often the individual can have difficulty with tasks such as walking down the street, taking the rubbish out, gardening or even cleaning. Additional issues associated with fibromyalgia are as follows:

  • Sleep disorders

  • Gastrointestinal issues

  • Impaired cognitive function

  • Psychiatric disorders (e.g. anxiety and depression)

It is important to note that the debilitating symptoms of the disease can in turn affect social surroundings of family, friends and work life which may suffer as a result of the severity of their symptoms.

 How exercise physiology can help:

Quality of life for those with fibromyalgia can be improved not only by medication but with exercise. An exercise physiologist will take a physical therapy approach with a goal to manage and improve pain, fatigue, muscle weakness, sleep and overall health. In the bigger picture this will increase quality of life.

Due to the high prevalence of wide spread pain throughout the body there is often inactivity amongst this population. Recent studies have explored the effects of exercise in conjunction with connective tissue massage and found that this may be a superior way of improving pain, fatigue and sleep. Research has also indicated restoration and maintenance of strength, aerobic capacity, mobility, balance and functional abilities will all benefit from a combined exercise and massage method. Not to mention regular exercise will positively impact a depressed mood and the overall perspective of pain.

Even though exercise is probably the last thing an individual with fibromyalgia might feel like doing, if completed regularly it has the ability to work wonders.  Exercise will reduce pain and the amount of tender points throughout the body as well as increase strength and cardiovascular fitness which will improve the ability to complete daily tasks.

Appropriate exercises for those with fibromyalgia:

Individuals with fibromyalgia will benefit from a variety of regular, low impact exercise modes.  To improve fitness and reduce pain and fatigue, aerobic exercise is best suited. This includes modes such as:

  • Walking

  • Swimming

  • Water aerobics

  • Cycling

As muscle weakness is a common symptom for those with fibromyalgia, it is important to strengthen major muscle groups of the upper and lower body that are responsible for completing daily tasks.  This can be done by completing supervised resistance training with:

  • Therabands

  • Light weights

  • Own body weight

  • Cable/ gym machines

Research has also found that exercise that acts as a multicomponent intervention can be excellent for fibromyalgia. This type of exercise integrates the physical, psychosocial, emotional, spiritual and behavioral elements effected as a result of the symptoms experienced with fibromyalgia can be beneficial. This includes modes such as:

  • Tai Chi

  • Yoga


For more information and guidance on exercising with fibromyalgia syndrome please contact us at PACE Health Management and speak to one of our exercise physiologists Ph 9770 6770.



Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., ... & Fam, A. G. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 33(2), 160-172.

Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Katz, R. S., Mease, P., ... & Yunus, M. B. (2010). The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis care & research, 62(5), 600-610.

Wang, C., Schmid, C. H., Fielding, R. A., Harvey, W. F., Reid, K. F., Price, L. L., ... & McAlindon, T. (2018). Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. bmj, 360, k851.

The National Fibromyalgia Association (2018). Prevalence. Retrieved from   http://www.fmaware.org/about-fibromyalgia/prevalence/.

Celenay, S. T., Kulunkoglu, B. A., Yasa, M. E., Pirincci, C. S., Yildirim, N. U., Kucuksahin, O., ... & Akkus, S. (2017). A comparison of the effects of exercises plus connective tissue massage to exercises alone in women with fibromyalgia syndrome: a randomized controlled trial. Rheumatology international, 37(11), 1799-1806.