I had a bad fall some years ago. Because of the spinal injur­ies and con­stant pain, des­pite sev­eral oper­a­tions, I can­not move very well and find any exer­cise almost impossible. Some days are bet­ter than oth­ers, but they are few. I have so much muscle and weight loss that I look skeletal. How can I break out of this rut sens­ibly? The local gym wanted hun­dreds of pounds to join, which I do not have.

Pain and injury can cre­ate a nasty down­ward spiral in which you tend to limit your move­ment because of the pain, but then find that everything gets even stiffer and more pain­ful, simply because you are mov­ing less. To break this spiral takes cour­age and determ­in­a­tion.

As I don’t know any­thing about your spe­cific injur­ies, my advice can only be gen­eral. But if any of these sug­ges­tions work for you, they should improve your qual­ity of life a little.

Ask your GP about:
* physio­ther­apy: you’ve prob­ably had some physio before, but ask your GP if they would refer you for some more ses­sions, and be sure to ask the physio­ther­ap­ist for home-​exercise advice
* tak­ing a pro­tein sup­ple­ment, if you don’t already
* “exer­cise refer­ral”: There are more than 1,000 such schemes UK-​wide, in which GPs can get cer­tain patients on to a very low-​cost gym pro­gramme, super­vised by well-​trained instruct­ors. Not all GPs know about these schemes, so if yours doesn’t, ring your nearest coun­cil leis­ure centre to find out more.

In addi­tion, con­sider:
* Joining an “IFI” gym: hun­dreds of council-​run and private gyms are now accred­ited as “inclus­ive fit­ness” facil­it­ies. They have both the equip­ment and expert­ise to train people with dis­ab­il­it­ies and major con­di­tions. Click here to search for your nearest IFI leis­ure centre. And these centres should cer­tainly not be demand­ing lots of money from you to join.
* Helping your­self: on the good days, set your­self tar­gets for gentle exer­cise, such as stretch­ing, mobil­ity and a short walk (if you are able to). Some simple back and stom­ach strength­en­ing exer­cises will help, like those in the book­let “Exercise for Arthritis”, which you can down­load from Arthritis Care
* Learning to relax: con­stant pain can be hugely energy-​sapping and causes the body to build up ten­sion. There are many help­ful relax­a­tion tech­niques, some involving noth­ing more than focused deep breath­ing. Ask your health centre for inform­a­tion on local pain man­age­ment or relax­a­tion courses

Finally, keep an activ­ity diary. When life is so up and down, it’s easy to lose track of pro­gress. Make notes on any exer­cise you man­age to do on your good days. Write down not just exactly what you achieved but also how you felt in your­self after­wards. You can use the diary as a ref­er­ence to help you plan to get through a tiny bit more the next time you exer­cise. And if you do get settled in a reas­on­ably reg­u­lar routine, you may sur­prise your­self, when you look back over sev­eral weeks, at how things are start­ing to improve.