Why exercise needs to be a key weapon for endo pain management

Why exercise needs to be a key weapon for endo pain management

Endometriosis is a complex condition that impacts 1 in 8 women worldwide, I have suffered from stage IV endometriosis and advanced adenomyosis.

There are tons of side effects of the condition but living with chronic pain and pain flares, particularly in the pelvic, hip, sciatic and leg area. For many, it takes a lot of trial and error to find therapies, treatments, and lifestyle decisions that help sufferers manage the pain. However, I have found that strength and resistance training really work for endo management. You can also head here to learn more about my journey and how myofascial release and other therapies saved me from having a hysterectomy, but right now I am nearly pain-free by having regular NAD drips and shots as well as the supplement NMN.

Why exercise?

Endometriosis is a hormonally-driven inflammatory disease, so reducing inflammation and inflammatory markers in the body should be a priority for anyone living with the condition. In relation to heart disease, it is thought that exercise and strength training may reduce inflammatory markers in the body, and research is looking into whether exercise may also have similar benefits for endometriosis. Endo makes the pelvic region tight, it restricts blood flow and it hits your nerve endings which triggers pain in the hips, hip flexors, buttocks, sciatic area and legs. This is why many women with ends have radiating pain down their legs. 

For many, exercise is a really valuable asset to an anti-inflammatory lifestyle - but you have got to assess whether it's right for you before jumping right in, as you could do more damage than good.

Scared to exercise?

For many people, it's not just as easy as deciding to exercise and getting straight into a gym program or gym class.

The reason for that is that the pain involved with living with endo can cause a bracing or guarding response in the body to try and protect itself from experiencing further pain. Over time, this can lead to a tightening of the pelvic floor, abdominal wall, and hip flexors (sometimes known as hypertonic pelvic floor muscles). This shows up as a general over-tightening in these already painful areas. 

Understanding this bracing (particularly if you have been living with endometriosis and the resulting pain for years) is important when considering starting to exercise.

Where to start?

If you are at the beginning of your journey with endo and exercising or have intense symptoms such as intense joint and nerve pain, sciatica, or even nausea, intense exercise will not serve your body best.

It's also essential to avoid exercises that are particularly taxing on the core (like sit-ups and abdominal crunches) because these exercises can actually work to shorten muscle groups that are already tight and shortened as a result of the endometriosis experience. 

Instead, focusing on loosening, lengthening, and gently strengthening tight muscles through activities like massage, gentle stretching, yoga, and pilates, is the first place to start.

A 2017 study found that 2 x 90-minute yoga sessions a week over two months substantially reduced daily pain for endo sufferers vs. those who did not practice.

Once you've started to get the foundations of gentle movement into your day-to-day life (through things like massage, gentle stretching, yoga, and pilates), you can work with a physio to assess whether you have successfully loosened and released the tightness in your pelvic area. If you have, then you can start to work on my favorite workout modality - band work!

Band work 

Band work (using a theraband or exercise band) is fantastic for activating your glutes, activating your core, and re-connecting these two areas to your pelvis, as well as strengthening them.

If you can't make it to a band class and want to do this at home on your own or alone in the gym, focus on exercises like glute bridges (with the band adding pressure around your thighs), side-lying leg raises, and also sit to stands.

Over time, working with the glutes, core, and pelvis can help to strengthen this area (known as the lumbopelvic region) and incorporating these alongside stretching (to work against re-tightening of the areas) can help to keep a balance in the pelvic area. Over time, pain-dependent, you can then transition into lighter strength training without the risk of the area seizing up further.

Strength Training

The benefits of strength training (which means training with added weight on top of your body weight - think TechnoGym machines, dumbbells, weight plates, etc) are well documented. Strength training can help fight against the cycle of inflammation, pain, and stress in the body. Strength training has also been an essential part of my recovery and pain management journey. 

If you are considering moving into the strength training arena, get clearance from your doctor or medical practitioner, and be sure to start gently, slowly, and mindfully. It's a great idea to also get a trainer who has experience in endo-related training so that they fully understand how best to train you to help, rather than hinder your progress.

As well as strengthening the pelvic area, and wider body, there are a ton of benefits of strength training for endometriosis sufferers. 

Key benefits are as follows:

  1. Pain relieving, analgesic benefits - induced by the chemicals released by our body during exercise, this pain-relieving, and anesthetic-like benefit can help sufferers manage ongoing pain and pain flares. This can help reduce the need to rely on pain medications, which can cause additional stress and inflammation within the body over time.
  1. Decreasing estrogen dominance - even though endo is an inflammatory condition, it is also considered to be an estrogen dominant disease, meaning there are abnormally high estrogen levels in the body in relation to other hormones (often with progesterone being very low). These high estrogen levels have many knock-on impacts, including the increase of endometrial tissue, which further provokes the endometriosis cycle (and the need for operations and removals over time). Again, strength training can help to manage and even reduce this imbalance, helping to manage your endometriosis situation more generally. 
  1. Improving fatigue and reducing brain fog - a 2018 Swiss study concluded that those living with endometriosis are likely to experience fatigue at double the rate of non-endo sufferers. Manageable bouts of exercise (avoiding high intensity) can help to improve fatigue - meaning it's easier to deal with day-to-day life without being so exhausted, particularly during a flare.
  1. Reduction in associated digestive challenges - things like constipation, bowel pain, and bloating are all common symptoms of endo. Exercise has many proven benefits for bowel and digestive health, particularly with keeping things moving, reducing constipation, and reducing pain, so this is just an added benefit. Light cardio can also help here - our favorite is walking out in nature. Bonus points if you can get your bare feet on the ground and engage in some earthing simultaneously.
  1. Mood management - it's not surprising that living with a chronic illness can take its toll - and that sufferers can then become anxious and stressed out about the pain they are suffering, which can cause pain to flare more. Exercise has been proven to manage mood states, particularly anxiety and depression, by releasing feel-good hormones into the body. So sticking to a reliable exercise routine can help develop a more reliable and balanced state of mental health which will particularly help endo sufferers make it to the other side of a pain flare.

Train smart

So, exercise has tons of health benefits, and when implemented gently and with guidance, it can be a fantastic tool to balance endo symptoms too. It can be a great support to an anti-inflammatory lifestyle, but as we have mentioned, it is ultimately really important to understand where you and your body are at in your own healing / management journey, what your body needs and what is right for you.

Approach exercise with compassion and understanding, and it might just be the gentle game changer you need to help manage your pain.