Exercise and Crippling Pain

Hi everyone.

I was diagnosed with psoriatic arthritis (and Crohn’s disease) almost two years ago and had recently decided that I needed to take control of my health–I started walking almost six weeks ago. Although I track less than 10,000 steps, it feels as though I have broken bones in my feet that the front of my ankles and that my lower back is injured. I often don’t know how I will get through the last 1500 steps to make it home.

I would have thought that six weeks of walking would have led to improved conditioning. I actually feel ill afterwards and can hardly move the next day. I don’t know whether this is normal for a person with psoriatic arthritis or whether I am completely out of shape. Has anyone else experienced this?

(Oh and I’ve developed psoriasis on the soles of my feet). Feeling quite discouraged at the moment and am wondering how I will be able to return to full-time work post-COVID. This does seem to be the disease that keeps on giving.

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Hello Pixie,

wonderful that you’ve started exercising, even though it is so painful you must have accrued some health benefits so far.

However I don’t see how anybody can really tell you whether the pain you’re experiencing is something you should continue to push through or a sign that you need to apply the brakes / change to a different form of exercise. Sounds like a cop out I know, but I really think you need your rheumy’s advice on this.

Have you had any imaging of your feet, ankles, spine?

Also, why not try walking a shorter distance? You’d still get some benefit, from what you’re saying possibly greater benefit. And then hopefully you could gradually build up to longer walks again.

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Hi Pixie,

I’m a bit confused as to why you’re walking such distances if that’s horribly painful. As you know PsA loves to cause damage to all our joints and sometimes tendons and ligaments as well and it seems it especially loves feet.

Out of shape stuff doesn’t cause such pain, does it? So I think you need to have your rheumy take a decent look at the places which are causing you such pain and see if there’s any damage there.

I walk a lot - it keeps me and my dog sane. Obviously given Covid 19 I’ve done incredibly little of it, only truly starting more regularly this last week. I’m certainly out of shape, I’m slower and struggle up hill more and that’s despite losing a little weight through lockdown too. My muscles ache nicely after it but I’m not in pain or truly hobbling. I have a bit of hip inflammation going on but walking with a hiking pole supports that enough.

I don’t think any of us would persist with a level of exercise that actually makes us feel ill after it though and causes such pain.

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Is there a swimming pool near by? That is for when the COVID 19 pandemic has passed. For many years swimming was about the only exercise that I could manage without pain. The pool was heated on cooler days. It is now winter for me in the land of Oz down under and small walks is all I can manage. I had to move out of my home as I can no longer manage living on my own due to PsA and the ageing process. I moved into a cabin on the same property as my son and his family. There is a natural swimming hole near by which I plan to use when the weather is warmer. Swimming I found was the best exercise for me. Being weightless in the water makes it a low weight bearing exercise yet enough resistance to be beneficial.

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Hello Pixie!
I am so proud of you for taking control of your own health! I did the same thing 2 years ago and I am feeling so much better. We eat more plants in our diet, exercise more, and I remember my spoons! (if you dont know what that is just ask)
With exercising and PsA you have to start slow, like snail slow. For example, I wanted to start pilates. I found a class, did an assessment class, and the teacher thought I would be a good fit for pilates. After my first class I was in so much pain! It took me 3 days to feel better again before my next class, then repeat. It never got easier. I even developed inflammation in my foot and had to wear a boot!
I do not think it was pilates in general that was wrong for me, but the instructor. I needed someone who understood I needed to go slow and help me. I would try pilates again since I did like it, but with someone else.

Now I use an elliptical everyday for 30 mins. Even it its walking pace, I know I am moving my body each day and it makes me feel good. It was painful at the beginning but each day I was able to go a bit faster or farther.

Find something that works for you and go slow. Building on your progress each day. Good luck!

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In January I started an online exercise program called Age Bold, designed for those over 55, focusing on balance and functional movement. It is a progressive system, three classes each week, 30-45 minutes per class. It starts out using a chair, then increasingly more standing. There is a cost, but they offer a generous free trial period.
I just love it, and have seen improvement in my overall strength and function. The instructors are very responsive to individual needs through messaging, and you don’t have to leave the house!
Give it a try…

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Pixie, I feel like I did a very similar thing. Spent the first year with meds that didn’t work, and just doing my daily tasks (like showering and getting to work) was a huge stretch.

Then got better meds but still wasn’t even near “normal” - I was a fit 36 year old before. I only tried to walk 5km on the flat (when I would have easily done 20km as a morning stroll the year before) and was in tears. Then totally unable to do anything for 3 days. Sigh.

Eventually, I accepted that when people on here and in the doctors office were telling me to exercise, what they meant was little bits, starting very slowly. And lots of two steps forward and one step back.

For me I had to change my mindset from fixing a short term problem, to seeing this as training for the rest of my life. When you look at it that way, not getting in condition over six weeks doesn’t seem such a big deal - cause at 36 I was going to (hopefully!) be doing this for another 40 years! It’s a marathon, not a sprint.

It took me two years at the gym with a great personal trainer who was able to flexibly adjust based on how I felt that day, never comparing weights or reps to the week before, but one day at about that two year mark, I suddenly realised I felt good some (not all) days exercising. And it no longer threw out the next two days!

Fast forward another 6 years, and even now, whilst I am in a flare (which as a sideline I’m getting very sick of), I can still take my dog for a 20 min walk each day and go horseriding once a week.

It took 5 years of the tiniest incremental increases in exercise (only increasing when the previous level did not hurt or cause systemic inflammation- that fatigue you get after exercising) to get back to riding horses, but I did.

There is also some really compelling theory on chronic pain that argues strongly against pushing yourself through pain you find distressing- your brain will start to associate activity with distress which is not a good thing.

So, if at 8,500 steps you are highly distressed, you need to plan your walks to LESS than this to start. Start at 5000 (or 2000, or whatever is easy enough to be not unpleasant) and enjoy the sunshine! Keep slowly moving it up in 10% increments till it feels like a little too much, then back off by the last 10%. Then just enjoy that distance until it feels easy again, then increase it by 10%, and onwards. Consistency is the key - if today you feel awful and do less than yesterday, that’s fine, as long as it is something. My goal is always just to actually show up!

Remember, the one advantage of a chronic disease is that we have literally the rest of our lives to get good at managing it. So take it easy on yourself!

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It is important to keep a certain amount of exercise going. Stretching exercises are most important. You should have a discussion with your Specialist and organise a care plan. Swimming pool exercises can be of great benefit too.

No swimming pools are open in the UK yet and won’t be for some time. And when they do there will no changing facilities either. Covid 19 has a lot to answer for.

Speaking of pools, they aren’t open here yet either (and dang its cold in our swimming hole at the river) BUT what is open are the warm water rehab pools at the Rehab center. I love it as the water is 98.6, my insurance covers the classes and they have free Espresso every day and cupcakes on Thurs.

My favorite exercise however is my Mountain Bike. Its a 15 speed so on the flat I can greatly reduce the amount of effort to pedal it to my mood. Where as my morning treadmill routine barely gets my more than a couple miles, I can easily o 5 -10 in the evening on my bike UNLESS I miss a day or two and then its like starting over and pain levels spike>

No problem! You jump in and go numb … problem solved, until you get out. LOL Seriously, cold water isn’t the best “treatment” for PsA, is it?

Seems not and I can well understand. But somehow it does work for me. Also I got stung by a jellyfish at the weekend - hoping that’s the yet-to-be-discovered cure for PsA. I made particularly good time heading for the shore.

That is so interesting. The cold water thing, not the jelly fish. Jellyfish are HORRIBLE.

LOL, oooohhhh, no laughing matter though, jellyfish. Dear husband got “bitten” (not, it was a sting) by a sea urchin once. Doctor at the hospital treated him and then advised him of the easiest (and always available) treatment for the next time.

Urine. Yes, apparently freshly “harvested” urine works a treat.

And there you have it: don’t say I never teach you anything. ROFL!!!

Seenie

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Nothing works better for Costo for me than cold packs in front and warm pack in back then reversed. Dunno why. maybe its a “Scandahoovian ting” Out of the sauna then Roll in the snow. Seriously warm feels good but it makes things worse in the long run. \ Cold packs do numb the sore area and reduce inflammation and swelling. You might also try using a local spray such as fluoromethane (nonflammable) on your back or painful area before and after exercise.

About that urine thing. Dunno about sea creatures BUT Urine contains urea and uric acid, which is an exfoliant. The use of an exfoliant on a daily basis tricks the skin into thinking it’s wounded and boosts collagen production. When I was kid before us cousins and neighbors when skinny dipping in the creek at the farm part of the Routine was the “sacred applying of urine” before hitting the water in order to avoid sunburn. It is also good for acne and peeing on your feet in the shower help with fungus of all kinds. Dare I say its also good for Psoriasis…

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Balneum cream (best emollient I’ve found for psoriasis) contains urea.

Aw Seenie, sea urchins hurt I bet, but my sting was nothing & when I ventured back in I fell in love with the jellyfish - very beautiful blue one.

It’s all going to pot really, peeing on oneself and falling in love with plankton.

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It’s just past 6.30am here and my coffee has been dribbled all over my laptop as I’m giggling too much!

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Keep this “pee benefit” thing quiet!! If it’s a good thing the government will tax it.

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Hello everyone. Thanks for your thoughtful responses. They have been very helpful. I do apologize getting back to you so late—I have been reflecting on my current circumstances and the new medical information I received last week.

I was diagnosed with psoriatic arthritis two years ago. Having suffered a handful of life-threatening Crohn’s disease flares and bouncing back fairly quickly led me to operate under the assumption that the psoriatic arthritis would also pass—I thought patience is what’s needed . And then I thought that my newly adopted sedentary lifestyle played a significant role in my pain—this is when I started my walking program. Having been a regular swimmer not too long ago, I am familiar with muscle pain. But this was different. An exaggerated response to exercise. Sickening.

Sybil, Poo, Amielynn38, Susan2, Jen75 and Ablast—your comments have made me stop and think. I actually know very little about PA and intend to change that. I have finally figured that PA isn’t something I will bounce back from.

Sybil, in terms of imaging, I had previously had an MRI of my back and x-rays of my feet. There was no damage at that time.

Recent medical appointments have made me aware I currently have: esophageal ulcers; a nasty outbreak of psoriasis on the soles of my feet; bursitis in both hips and elbows; inflamed knees, small fiber neuropathy and alleged fibromyalgia (diagnosis based on extensive muscle and nerve testing).

The neurologist said that injections in my knees, hips and elbows would go a long way toward helping me feel better. That seems like a LOT of injections and while I am needle-adverse, I welcome the relief they might bring.

My rheumatologist had offered me a short course of prednisone to tide me over until my face-to-face appointment next week. I declined because of the bone damage years of steroid treatment has already caused. I am currently taking Simponi and Methotrexate—she said she might add a third agent.

Amielyn38, I need to start thinking about my spoons. As mentioned, I’m a swimmer and look forward to returning to the pool–some will be reopening next week. An elliptical could be a great alternative on the days I don’t swim.

Jen75, your comments about changing one’s attitude spoke to me:

It’s time for me to stop fighting the current. I need to become better informed and engaged in managing my diseases in a productive way. As you suggested, I’ll try to take it easier on myself. Having said that, the psychological journey seems more challenging than the physical.

I look forward to learning more from the knowledgeable and experienced members of the community.

Pixie

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I consider this to be the biggest challenge of learning to live with PsA. Truly I do. Because PsA changes all the time and moves around so much keeping up with it all is exhausting even just emotionally. What sore and horrid right now won’t be later, but something else might be instead.

Acknowledging this helps strangely. I got help with the psychological journey. That really did help enormously. Maybe you should consider that too possibly.

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Hi Poo.

My PSA journey has left me feeling overwhelmed. My Crohn’s disease was chronic–but, it didn’t feel chronic. I tended to bounce back quickly from serious disease. But this PSA is something else. (I’m still waiting for the horrid to resolve :slightly_smiling_face:).

I’ve only recently come to understand how challenging this journey may be and am still reeling. When the dust settles, I’ll consider next steps which could very well include psychological supports. They question is time, how to fit everything in–work, commuting, medical appointments, yoga, swimming and the most important, family.

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