Gardening When Dealing with Chronic Pain Issues

Harrison A. Linder, M.D., and William S. Raoofi, M.D., are both board certified pain management specialists with The Center for Interventional Pain Medicine at Mercy. They provide leading edge and minimally invasive treatment options for patients with disorders resulting in chronic pain. Recently, Good Housekeeping magazine, as part of a story on practical home and garden tools for people with chronic pain (like arthritis and joint pain), asked Drs. Linder and Raoofi for insights…

Can you address why it is often important to stay active if you live with chronic pain?

Dr. Linder: Staying active is extremely important to maintain function and strength. Consistent physical activity has also been shown to decrease pain scores and improve overall mental health. Physical activity promotes blood flow to muscles and underlying tissues, and it helps to keep joints loose and promote normal range of motion. While a more sedentary lifestyle may at first seem like a logical choice, as it will help avoid trigger of pain, it can lead to increasing levels of muscle tension and joint tightness, ultimately leading to worsening pain and decreasing function. In regards to my own patients, I would much rather they continue their previous activities and stay active, rather than cut back and become too sedentary. The important thing is for patients to pay attention to their bodies and how they are feeling. Low level chronic aches and pains during activity and exercise is expected and normal, but as soon as pain intensifies or changes in nature, they have likely reached their limit and it is time to take a break.

Dr. Raoofi: Staying active is important for any person’s overall health, but activity for patients with chronic pain is particularly important for their mental wellbeing and quality of life. Decreased activity can lead to things such as muscle loss or atrophy which leads to an increased risk of injury with regular activities of daily life, as well as debility. This can lead to a viscous cycle of disability and depression which reduces further movement and activity, causing more pain.

How can living with chronic pain interfere with a person's ability to stay active?

Dr. Linder: The obvious answer is that chronic pain can make activities – even simple daily activities we all take for granted – painful and arduous. Often times, patients with chronic pain develop behavior patterns that help them function, by avoiding certain activities and changing the way they go about performing others. While this is certainly helpful, and adaptation is important, it can easily escalate to the point that patients are minimally active and constantly scared “of doing too much”. Chronic pain can effect an individual’s ability to get good, restful sleep, which leads to fatigue and can further worsen ongoing pain. Pain and lack of sleep can then contribute to decreased motivation and a depressed mental state, which stops many people from making the effort to stay active.

Dr. Raoofi: Chronic pain can make activities that were once enjoyable less enjoyable because of the pain. Many people are discouraged from staying active when they find it difficult to modify their activities to make them more tolerable. This can lead to depression or a lack of motivation to engage in activity.

What kinds of features should people with chronic pain look for in home and garden tools? (Easy-to-grip handles? Comfort? Things that minimize pressure on the joints?)

Dr. Raoofi: A portable bench or kneeler can help people with chronic lower back, hip, or knee pain take the stress off of those joints by allowing them to sit or kneel on a soft, slightly elevated surface while working in the garden. If using a kneeler or bench is too difficult, a raised garden bed that can be tended to while standing is a possible alternative. Using a caddy to move plants and tools around can reduce the need for heavy lifting or walking longer distances. Ergonomic hand tools for gardening usually are lighter weight, have a softer and less slippery grip, and may be slightly larger in diameter to reduce the amount of stress on the hand and wrist joints. In some cases, an arm support cuff is needed to allow a person to use the strength of their forearm and upper arm rather than their hand and wrist to do things such as dig or cultivate. Other cases may require a garden tool with a grip that put the hand and wrist in a more neutral position to reduce stress on the joints.

Do you have any recommendations for home and garden tools that may be helpful for our readers with chronic pain?

Dr. Linder: Unfortunately, I do not have any specifics products I can recommend. However, there are some general things to look for that can greatly help people with chronic pain stay more comfortable. The biggest thing is to try and create an environment that is ergonomic and does not place the body into positions that put stress on the back and joints of the body. Buying a gardening or work mat, that would allow you to sit comfortably on the ground while working, will help to avoid the scenario where you are consistently hunched over, irritating your back. In the same way, using tools that have extended handles will allow people to maintain good posture and decrease bending or over-stretching. Products with oversized grips, padded handles, and larger buttons/toggles will make it easier to use for people with arthritis and decreased fine motor skills.

Dr. Raoofi: There is no one size fits all tool that will help reduce pain while gardening that will work for everyone. People may benefit from different modification given their individual pain generator, their anatomy, and their biomechanics. Meeting with an occupational therapist may be beneficial to help guide patients on which types of modifications may benefit their particular circumstance.

Drs. Linder and Raoofi see patients in The Center for Interventional Pain Medicine at Mercy that provides leading edge interventional pain treatment options to patients throughout the Baltimore metropolitan area. The Center works with patients diagnosed with cancer and orthopedic disorders to reduce the need for pain medications and alleviate chronic pain.