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Practical Guide to Adding Recreation Therapy Into Pain Management

Improving strength and flexibility does not have to be all work and no play. Learn how to get patients to pick up fun sports and hobbies that also strengthen their core, lighten their mood, and reduce their pain.
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Deconditioning and immobility are 2 major affects of chronic pain. Therefore, it is important for physicians to encourage patients to participate in a sport or hobby and learn to have fun again.

According to the American Therapeutic Recreation Association, recreation therapy is a treatment service designed to restore, remediate, and rehabilitate a person’s level of functioning and independence in life activities.1 The goals are to promote health and wellness and to reduce, or eliminate, activity limitations caused by a disabling condition that restrict participation in life situations.1

Recreation therapy can be conceptualized as an adult version of child “play therapy,” which has been shown to be effective.2 Unfortunately, research has shown that providers tend to give recreation therapies a lower endorsement compared to other pain management modalities due to their low practical and theoretical exposure to this type of intervention.3

The role of the recreation therapist is to “re-create” a means of activity. Intervention areas vary widely and are based upon patient interests. The following is a practical review of the different intervention areas available in recreation therapy—adapted sports, exercise programming, leisure education, and creative arts (eg, music and fine art).

What Are Adapted Sports?

Adapted sports are based on existing sports but are modified to meet the needs of people with disabilities. Some examples of adapted sports include bowling, golf, equine therapy, and archery. Bowling leagues offer patients the opportunity to learn how to bowl, to improve their skills, or to raise their averages, for example. Bowling leagues expose patients to many different styles of play and types of equipment, and provide opportunities to build comraderey and socialization skills.

Golf, another option, provides an outlet for gaining new experiences as well as reintegrating patients into the community. Golf affects patients in various ways, from increasing their social skills on and off the indoor/outdoor driving range or course, to improving their quality of life. For patients with chronic low back pain or shoulder injuries, they work with a golf professional to address swing deficits and with a physical therapist to eliminate physical limitations. Together, they can help with body and swing mechanics, which will boost enjoyment of this challenging game. In addition, golf therapy can reduce or eliminate golf-related injury pain, improve late-game stamina, develop power for hitting longer drives, and enhance the accuracy and consistency of their short game.

Less common sports include horseback riding and archery. Equine therapy has long been used for recreation therapy purposes. Bonding with a horse is a singularly buoying experience, giving patients an outlet for their fears and anxieties while promoting leadership skills and responsibility. Archery is mainly a competitive sport, but programs usually start with basic safety and then build skills.

What Physical Exercises Should Be Considered?

Exercise is performed for various reasons, including stretching, strengthening, improving cardiovascular health, and enjoyment. Exercise is an effective treatment strategy for various chronic pain disorders, including neck pain, osteoarthritis, headache, fibromyalgia, and low back pain.4 But before a patient launches into a new sport or exercise program, it is important to communicate some key guidelines (Table 1).  

Flexibility exercises, or stretching, can be good tools for managing chronic low back pain and fibromyalgia. Other forms of slow-movement exercises to consider are tai chi and yoga. Yoga has been shown to help with arthritis, back and neck pain, headaches, and osteoporosis.5-9 Regular benefits of yoga include improved sleep, strength and balance, circulation, flexibility, and physical and general well being. There is promising scientific evidence to support the use of yoga and other movement-based exercises for non-cancer pain conditions such as low back pain.10 These exercises may provide a good alternative when endurance-building or strengthening exercises are not recommended.

Strengthening exercises may help to manage chronic low back pain. Cardiovascular (aerobic) exercises can include walking, biking, and swimming, and should be done regularly for a minimum of 30 minutes each. A typical fitness facility should be equipped with a variety of cardiovascular, strength, and conditioning equipment. At times, these facilities also offer aquatic therapy. The unique physical properties of the water make it an ideal medium for rehabilitation for conditions such as lower back pain.11 Typically in aquatic therapy, a therapist attends to the patient receiving treatment in a heated therapy pool.

What Is Leisure Education?

Leisure education focuses on 3 subcategories: sports and recreation, tourism (such as travel), and leisure. Tourism commonly is associated with travel within the community for the purpose of reintegration. Examples of tourism may include trips to local park districts, attractions and tours, community events, and entertainment such as theatre or sports events. Leisure, or free time, is time spent away from other responsibilities, including activities of daily living, such as eating and sleeping. Leisure activities include a very broad range of activities, including the arts and other hobbies. Providers may want to consider encouraging patients to engage in their talents in such areas as music and fine art.

How Do Creative Arts Affect Pain?

A background in music or fine arts is not necessary to have fun. Creative arts therapists make these mediums accessible to all patients. There are various reasons to integrate these forms of therapy into complementary, supportive pain management programs, including that they enhance activity levels and creative capacity; they stimulate positive emotional experiences as well as communication and social interaction; they facilitate coping; and they stimulate imaginative experiences and awareness.12

Music therapy has been shown to help with acute and chronic pain.13,14 Music therapists primarily help patients improve their health by using music experiences such as free improvisation (eg, drum circles) and singing (eg, karaoke). Research suggests that drumming serves as a distraction from pain and promotes the production of endorphins and endogenous opiates.13 Studies also suggest that active singing may have some benefits in terms of active coping, but further research is required to fully explore such effects.14 Research also has shown that music can increase the effectiveness of medical therapies and can be used as an adjuvant with other pain-management programs.15 Music therapy is used in hospitals, cancer centers, schools, alcohol and drug recovery programs, psychiatric hospitals, and correctional facilities.16

Last updated on: August 5, 2016
First published on: August 1, 2016
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