All posts by richmondstace

13Nov/17
Whole person to treat chronic pain

It’s not your mind, it’s not your body, it’s you!

Whole person to treat chronic pain

Its not your mind, it’s not your body, its you!

Mind and body — what do we mean?

In essence it is good news. Loud messages in the media about mind and body being connected (read article by Rachel Kelly here), thereby trying to update society’s thinking from dualism to what actually happens. To philosophers, neuroscientists, cognitive scientists though, this is familiar ground. Mind-body has been the subject of discussion and investigation for eons.

Today there is further reporting upon schizophrenia research, highlighting the limitations of a dualist perspective, which continues to predominate within our health system. The system and huge swathes of society persist in divvying up the so-called ‘mental’ and ‘physical’. We even have different buildings dedicated to each bit of us, and within those buildings, and rooms that divvy us up even more. We have a liver location, a heart hub, a bones bit, and other parts of the institution that focus on a mere piece of us. Where is the room that puts it all together and acknowledges a human being who thinks, feels, moves, and perceives in distinctly human ways? Let’s talk qualia, and here’s Dan Dennett talking about consciousness.

need states

There are reasons why this maybe convenient, however the separation is not how it works in reality. And try being an end user: ‘Hello, I’m the knee patient’. Within our language and thinking must be the start point of the whole, for it is the whole person who perceives a need via a variety of bodily sensations: thirst, hunger, pain, discomfort and anxiety as examples. What do I need to do here?

‘In the past, we’ve always thought of mind and the body being separate, but its just not like that’ said Oliver Howes, professor of molecular psychiatry. Too right! Its never been like that! He goes on to say that the mind and body ‘interact constantly and the immune system is no different’. I would propose a step further that there is no connection per se because they are one and the same: me and how I experience me and the world. If you are doing a maths puzzle for example, you could argue that this is a mental task. However, there is always the ‘you’ doing the puzzle and you are there, present and embodied. Your mind does not slip out and do the job and then slip back in.

The recent schizophrenia research findings suggest that treating the immune system could be a way forward. I think that society maybe surprised by this news in certain quarters, yet people will understand how this can work. I have great faith in society;s ability to learn, grow and evolve because that is what we have always done, naturally. There is much greater ‘attunement’ to the completeness of being human, although we still have a long way to go before the scientific and philosophical understanding is mainstream in society. Again, this is not news to people who have been studying and following the work of brain-body-person-immune interactions over the past 15 years. A notable example was Dantzer’s paper in 2008 on inflammation and the brain.

inflammation is a likely biological mechanism that links up many common problems: e.g./ pain, depression

It sounds simple to ‘treat the immune system’. Of course in reality this is not the case because our body systems work as a whole and interact in many, many ways. Modern society is very familiar and comfortable with the notion of taking medication to solve a problem. Indeed this is one case when a pharmacological agent is needed. However, this still fails to teach a person how to live or to live their best. This take understanding, practice, time and perseverance. In the rush-rush world we live in, people often want the quick fix that simply does not exist. Getting real means we pay attention to the data that now tells us that certain practices or skills each day are what we need to do to be well. This is non-negotiable. You make a choice.

I finish as I start — this is good news. It is another way in which society can see the changes in understanding afoot. Our thinking needs a drastic update, certainly in terms of chronic pain and chronic health. For years we have been led to believe that pills are the answer, yet they are not. They may have a role, but the main role is the person and the choices they make in how they ‘do life’. Their life-style if you like. We have so many known ways of building health, no matter where you start, no matter whether you have a condition or not, we can decide to live our best. And to do this needs recognition of the fact that we are whole. There is no mind-body separation, instead just ‘me’.


Pain Coach Programme to get the best of you, overcome pain and live well; t. 07518 445493
12Nov/17
Overcome stress and pain to live well

The worried world and what we can do

Overcome stress and pain to live well

A recent article by Oliver Burkeman entitled ‘Anxiety bites. How to keep calm when world events are freaking you out’ highlighted the impact of Brexit and Trump upon people’s life perspectives. He states that levels of anxiety and being troubled have gone up, quoting the American Psychological Association as finding 57% of those surveyed to feel stressed by the political climate. There has also been a rise on the UK. We are, it seems, as a society, worrying about life and the future. Are we in a worried world?

We can argue that anxiety, like all perceptions, are inferred states as we try to make sense of the possible and most likely causes of the sensory information. After all, we are a bag of chemicals, and depending upon where they are and what they are doing, our brain has to make a best guess as to what they could mean based upon what we already know (priors). It is interesting that the ‘feeling’, the ‘what it is like’ of anxiety is similar to excitement. The key is the interpretation and what you tell yourself: I am excited or I am anxious. Try it.

Burkeman raises some good points. He mentions the contagion of anxiety as we are tacitly capable of sharing our emotions with others whereby both you and I feel anxious together despite being distinct organisms. Consider how quickly the atmosphere changes in an office or the mood of a football crowd. We are supposed to do something about the problems we perceive, but what should that action be? A feeling of outrage, powerlessness, isolation, and despair can prevail when we become over-focused on problems. This is some protective biology at play that results in us drifting into that state and maintaining it by continuing to attend to certain thought patterns. Burkeman also picks up on the notion of fear, with one of the therapists he interviewed mentioning the deep rooted and basic fear in life that stems from childhood. Without the safety of reliable parents, a child is destined to fend for herself, making the world appear to be a very dangerous place. Of course this can be hugely amplified if suffering or having suffered abuse when the protect systems are deeply provoked and remain active.

This is a serious issue. We have progressed remarkably as a species and the momentum is building, yet we appear to be falling behind when it comes to the so-called mental health. Regular readers and followers will know that I have an issue with this term, which I feel implies a dualist approach to the human experience. Experience is embodied (Varela et al. 2017). Everything we think and do is embodied, meaning that suffering depression and anxiety, the common and increasing problems previously identified, emerge in the bodily self. Where do you feel anxious? Most people will say in their stomach or chest.

Consistently being in a state of protect has health consequences as our resources divert towards defence rather than nourishment. This in turn raises the chance that the person will suffer a plethora of conditions, including those of an inflammatory and auto-immune nature. In my view a serious consideration for society (and policy makers), this is likely one of the reasons for the uptick in chronic pain, remembering that pain is also a mode of defence inferred from the existing circumstances.

what can we do?

This all seems a bit grim as we quickly forget the possibilities in life and the beauty that we are surrounded by in nature and human beings. So what can we do? Certainly knowing what we can control and focusing upon this rather than what we cannot control is a good start point together with a picture of what we actually want. This is the basic model of success. In terms of chronic pain, this is the first step we take when addressing the problem(s) before coming up with the principles to follow in order to achieve wins and overcome pain.

Here are a few simple tips, beginning with the creation of inner calm. Why is this so important? Because it gives us a perspective, making contact with our reality, allowing us to see things for what they are instead of being caught up in emotions that are the fabric of thoughts past and future. We learn to sense that inner calm, a feeling in the body akin to a deep peace and knowing. I would argue that this is a natural state, and one we can learn to access routinely each day, through the day, as well as when we need to be calm, clear and to see things as they really are. Biologically speaking, when we know and live this calmness, we are in parasympathetic mode, the branch of the autonomic nervous system that nourishes us.

Two simple ways to create inner calm: (1) take 3 breaths and slowly breathe out, paying attention to the breathe all the way in and all the way out. (2) take 10 breaths, following your breathing from the entry into your nose or mouth into your body and then letting go naturally, not trying to control or change your breathing at all. Note how you feel.

Further practices that can be integrated and implelemented into daily living include the practice of gratitude (Mccullough et al. 2002) and acts of generosity or kindness (Layous et al. 2014). Both are now known to be distinctly healthy and easily practiced each day, much like learning a musical instrument. We are not only considering the healthy effects, but also buffering against life’s challenges and the approach that the person takes to life–how do you do life? Possibility our problem?

Two easy ways to practice gratitude and generosity: (1) each day write down 5 things that you are grateful for in your life. (2) choosing to do something for someone else, including people you do not know, such as giving up your seat or letting someone go first. There are many opportunities through the day, however we must be aware and take note of how we feel, noticing the positive emotions as they arise. The more we notice, the more we notice, establishing the build and broaden effect (Kok et al. 2013).

Despite the world events and those closer to us in our days to day lives, it is our perception that is key–my own unique interpretation. As Shakespeare wrote: ‘there is nothing either good or bad but thinking makes it so’. These words highlight the importance of how you choose to approach life and the situations within your life. The practice of daily skills such as those outlined above are simple habits we can create to develop our thinking and our style of ‘doing’ life. Like other habits they become part of what we do with greater and greater ease, building our wellness that does not simple happen without effort and persistence.


The skills of being well are an intrical part of The Pain Coach Programme that is not only about overcoming pain, but living well, the best you can.

 

14Oct/17
Whole person to treat chronic pain

Pain is a very human experience

Pain is a very human experience

Pain is a very human experience

It is easy to take being human for granted. It is what and who we are but it is also why and how we ‘do’ life. We do it in a very human way, which is somewhat unique to each of us, yet there are patterns.

Part of being human is being conscious. Now, we don’t have to be conscious to be human, but we do have to be conscious to be having the experience of being human. We have many, many experiences, and one of the commonest is pain. There are a few exceptions, but on the whole most people will experience some pain each day. Many people will experience a lot of pain each day. This can be to the point that they feel it is continuous.

Despite pain being embodied, it is somewhat elusive. It is as complex as we are, because it is part of who we are and how we survive. To say that pain is embodied means that we experience it in our body, for where else could it happen? There has been a huge focus on the brain in recent years and this continues. However, pain is not ‘in my brain’ as some people believe and say, instead it is emergent in me, and I am a whole unique person (WUP).

What is the purpose of pain?

Despite the complexity of pain in terms of biology and experience that together are a lived experience known only to the individual, there are simple reasons why we feel it. There is also the way that we do pain. This is our style and it typically resembles the style with which I ‘do’ my life. My life-style is the approach I take to life. This incorporates the way I face challenges and address my needs.

We are aware of our needs implicitly by the way we feel and the sensations we experience. These are our need states and we must attend to them to maintain homeostasis. Failing to do so results in a shift into a protect state. Basic need states include hunger, thirst, the urge for toileting and pain. When our basic needs are taken care of we can focus on what we are doing.

Of course there is a prioritising system, so if I am thirsty but a pack of hounds are chasing me, it would not be wise to stop for a drink. Also, we don’t always get it right and so needs may not be apparent or we may feel a need but not actually require any more. An example of the latter would be food when you may have the feeling of hunger, yet you have actually eaten enough.

Similarly with pain as a human need state, when this becomes a more persistent state, we can argue that the emergent experience does not fully represent the need. I would suggest that when someone is suffering chronic pain, this is normal and what is an experience that compels thinking and action to address certain factors in one’s life. However, the frequency, intensity and intrusion is not representative of the threat. Instead, it is a summating nagging that can become extremely intense at times as the evidence continues to suggest that something dangerous could, or is happening. This is basic biology at play, maintaining our survival.

Continuously we appraise our circumstances, our brains predicting what could be the best explanation for the sensory signals. This is what we experience consciously as the world around us as well as ourselves in the midst of this most vivid film. We are the actor, the director and the pundit all together somehow. There can be a flitting from one to the next but never wholly one nor tother.

Perfection is what you are striving for, but perfection is an impossibility

As well, we can often be the most critical of each, seeking the perfect performance, which of course rarely of ever exists. As John Wooden said, arguably the most successful coach ever and a wholly decent and insightful man, “Perfection is what you are striving for, but perfection is an impossibility. However, striving for perfection is not an impossibility. Do the best you can under the conditions that exist. That is what counts”.

Pain and the way we experience it, what we do with it, how we acknowledge it as part of us like any other experience or anatomical part makes us the very human that we are. Love and how we ‘do’ it is another fine example of a conscious experience that is so very human. The repertoire of descriptions, responses, narratives, poems, paintings and expressions pays homage to something that we need not fear, only address. For that is the purpose of pain.

How we address pain, how we approach something that is not just a feeling but an action and cognition, is as part of the experience as the experience itself. There is no separation. When people try to distance themselves from ‘it’, or fight ‘it’ or resist ‘it’, they only try to do this to pain with themselves. We cannot successfully fight ourselves. Instead, accepting and understanding the need state before taking action that proves our own safety. We have to actively generate that prediction, or actively infer by new understanding and new actions within a world that we, as Anil Seth describes ‘predict into existence’.

Let us never forget that we have remarkable potential because we are human. We can choose our approach to life once we have become aware of our existing style. If it does not work, if it does not bring health and happiness, you can choose another. And like anything that is important, we have to practice and take steps and learn along the way. This is what we are doing each moment as it unfolds and we are re-sculpting ourselves to make sense of the world and ourselves, where the two are interconnected. So why not feel a sense of control and practice skills of being well, each day, every day. This you can choose to do.

07Oct/17
Royal Parks 1/2 Marathon

Why I run

Royal Parks 1/2 Marathon

Team shirts for Royal Parks 1/2 Marathon

Why I run

Recently I was chatting to a good friend who asked me why I run. I had to pause and think because naturally I don’t class myself as a runner. Instead, I am someone who goes running.

Whether I am a runner or not is not particularly important, however the purpose is. I used to go out regularly just to keep fit. 30-40 minutes would suffice, I would feel pretty good afterwards, but it was often a bind beforehand. Then the Royal Parks 1/2 Marathon 2016 was on the agenda so I had to get a bit more serious. Somehow it became more enjoyable. There was a goal and a reason. The reason was to raise awareness of the problem of chronic pain and to raise money for UP, understand pain.

Purpose and mine as an example

Having a purpose or a meaning is known to be a key ingredient for a healthy and happy life. You may or may not know what it is, so it’s a great idea to write it out. We all have a calling, or as Seth Godin says, a ‘caring’. We can have a number of these in relation to family, work and other activities in life.

My purpose, which you could also call my ‘why’ in Simon Sinek’s language, is to inspire as many people as I can, to live well and overcome pain. This is by directly working and coaching with people who suffer chronic pain to date, and delivering The Pain Coach Workshops to clinicians and therapists who choose to become inspirers, educators, enablers and encouragers.

Here is Richard Leider on purpose ~ TEDX talk

UP & CRPS UK London Marathon

Next came the opportunity to run the London Marathon 2017. I was selected to represent CRPS UK, joining together with UP, and realised the excitement of taking part in an incredible day. The experience of preparing for a marathon was something I can now look back upon with pride. Somehow you manage to fit in the regular and long runs. Undoubtedly this required the support of the people close by. The 20 mile plus efforts would consume a Saturday with the recovery on return usually consisting of walking like John Wayne accompanied by much grunting and groaning until the next day.

What has running done for me?

There have been a number of effects of long distance running beyond the obvious fitness. At a time when I was driving understand pain onwards, the regular and intense exercising helped me to focus. In part this was from organising my time, prioritising and concentrating on completing tasks. There was no choice, because I had to fit in the long runs, but now this has become a habit. We have finite time and so wise use is important to me.

The ability to focus comes into its own when you are some miles into the run and your thinking turns to stopping, the pain, and plenty of other reasons why continuing is a bad idea. To keep going and ‘just run’ as my good (running) friend advised me was gold. You can and do just keep going, suddenly inspired by something you choose to turn your attention to, fortifying the attitude I describe below, which we can take into other arenas of life.

The most significant opportunity was building upon the ‘you can’ approach to life. Building up the miles with an attitude of ‘I can do this’, keeping my attention on a picture of success that I clarified from the start and following principles that take me in that direction resulted in completing the marathon. Looking back now, this was a mindset that pervaded the UP ethos and how grown immeasurably since. The more you work that approach, the more the approach works.

you can

Undoubtedly, focusing on one’s strengths means that you get results together with the development of clarity and resilience to face challenges that crop up. This is no different with a pain challenge to overcome, which is why I encourage people to adopt the strengths approach. It works if you have a purpose, principles to follow and a picture of success to work towards based on living a healthy and happy life.

So this is why I run. Not to keep fit — that is a great side effect and not at all separate from the way we feel and think; we are whole unique individuals — but to nurture and build an approach to life that is about possibility and fulfilling potential.

approach to life: problems or possibilities?

Tomorrow I run the Royal Parks 1/2 Marathon in London. This was a great day last year and I am very excited to be doing it again. I am running to raise awareness of CRPS UK and understand pain and the work we are doing to address the No 1 global health burden ~ see below. Please support my work. Chronic pain affects each and everyone of us either because we suffer, know someone who suffers or pay towards the problem via taxes, insurance premiums and long NHS waits. This can change. This is our work at understand pain, this is my purpose.

11Sep/17
Specialist Pain Physio for chronic pain

You are supporting meaningful change in society

Understand pain for social change

Supporting meaningful change in society

Chronic pain costs us more than any other health issue

Think about all the things that hurt and can go on hurting: back pain, knee pain, stomach pain (e.g./ irritable bowel syndrome), pelvic pain (e.g./ period pain, endometriosis, vulvodynia), headaches, migraines, sports injuries, chest pain and so it goes on. Pain is a universal experience, except in a very small number of people (congenital insensitivity to pain), and so it is no surprise that it can be such a significant social problem. It is a vital part of the way that we learn and protect ourselves, or survive.

“100 million Europeans suffer chronic pain, costing up to €441bn per year

This is a massive public health issue affecting millions of people across the globe. Pain is having a huge impact on society and society has a huge impact on pain. It is in society that the experience of pain is embedded and therefore why we must think of pain as a social issue. In changing the way society understands pain, we will transform this suffering. This is the reason for UP | understand pain, a purpose-led enterprise, to reach out to as many people as possible and advance the knowledge and practices in society to transform pain and live well.

Specialist Pain Physio for chronic pain

Richmond Stace | Pain Coach & Specialist Pain Physiotherapist

How are you contributing to this work? 

When you work with me to overcome your pain, part of your fees go towards the work of UP | understand pain. Similarly, when I run a paid workshop, this is matched with a free workshop for people locally. UP is also supporting the next generation by providing 2 free places at each professional workshop for local undergraduates. This is how you are supporting meaningful change in society.

“Each of your sessions is helping society positively change. 

If you would like more information about workshops, you can click here

If you would like information about the Pain Coach Programme to live well, you can click here

If you would like any other information or to book a session, please email us ([email protected]) or use the contact form below:

04Sep/17
CRPS Conference Cork 2017

Notes from Day 1 CRPS Conference in Cork

Notes from Day 1 CRPS Conference in Cork

CRPS Conference Cork 2017

Welcome to my observations from Day 1 of the CRPS Conference in Cork last week. The notes from Day 2 will be with you shortly, but for now you can check out what went on in the room and beyond. I was there in a dual capacity: representing Understand Pain and keen to make connections with others who want to drive social change with regards pain, and as a trustee for CRPS UK.

‘no pain no gain’ — really??

There are always key moments in a day’s full programme, and there was one that stood out yesterday. More on that shortly.

We started with a walk through of the known predictors for CRPS by Dr. Andreas Goebel. Over the years, Dr. Goebel has become a well known figure in the world of CRPS, so it was good to see him kick off proceedings after an introduction from Dr Dominic Hegarty.

Risk Factors pre-trauma include age over 50 years, being female, suffering migraine, osteoporosis, asthma and taking ACE-inhibitors. Immediately post-trauma we should assess for the pain intensity (more pain, more risk), a lack of exercise, the fracture type, musculoskeletal co-morbidities and perhaps pre-existing PTSD (post traumatic stress disorder).

This is a key area for clinicians and our ability to recognise the likelihood that a person could develop CRPS. In honing the awareness and skills, this can only get better, which would translate into less suffering. Jumping ahead to the last part of the day, CRPS UK launched their new information leaflet that specifically targets the lack of knowledge and understanding.

CRPS UK Leaflet

CRPS UK New Leaflet

The morning rolled on as we were treated to performances from the CRPS pop-stars. A gig typically gets going with the headline act at the end of a day of progressively bigger bands taking the stage. We started with a ‘main event’ as Lorimer Moseley entered the room via a video link.

Lorimer’s urine

Having shown off about his white, urine coloured wine as he described it, Lorimer gave us a typically witty yet informative talk. Always entertaining, LM is equally sharp in his observations from data, thereby keeping a firm foot in science. Admirably, he emphasised one of the often neglected aspects of being human in these situations — bias. Our declarations when speaking set the scene and let the audience know who we are (a bit).

The focus of Lorimer’s excellent work is certainly the brain. He has a way of transmitting the information in such a digestible way that most presenters would pay for a few of his (brain) cells. Together with the ability to make the listener feel on a par, this makes for easy listening whilst looking at some dots on a graph. I would not make head nor tail of those dots, but LM makes it engaging and everyone comes away knowing what they mean as well as an insight into the rigours of doing science well.

If there was a criticism it would be about the focus on the brain rather than the person. However, it is up the the clinicians and therapists to gather the presented information from the different speakers and form a bigger picture. Regular readers will know that my beliefs (and there will be bias in these of course) sit with the whole person approach, which is why Tim’s (Beames) talk softened the blow of data by bringing the human element to the room.

Tim and I have emerged from a similar place and whilst we will have our unique take, our interests lie in the person and that person learning to reduce their suffering. We both know that people can do this with the right ‘know-how’.

“The whole person approach is a must”

GMI (graded motor imagery) has been a big mover in CRPS. Tim was keen to point out that this is not a method to use in isolation, which I am sure everyone would agree with. In the physio world, over the years, there has often been the search for the recipe, the one treatment mode that will help. Littered with ‘gurus’, physio education has suffered as a result. I think and hope we are moving beyond this now. Integrated education when we share platforms with different disciples must be a way forward. Certainly in the Pain Coach Programme I want a range of clinicians and therapists so that we can create super teams with a shared vision, a focus on our strengths and each person knowing why they do what they do as a minimum.

Shock of the day goes to Robert Van Dongen as he described an approach whereby the person with CRPS receives hands on manual therapy that looks agonising. I say ‘looks’ because he treated us to a video of a foot and ankle being massaged and moved with audio. The noises coming from the recipient suggest it was not pleasant. The folk on my table who have CRPS winced and looked away, I felt something in my foot. It was provocative viewing! But, this is what is happening so we should discuss the treatment philosophy and work out whether it does have any long-term benefits. I am not sure. I will not be adopting this mode readers may like to know.

“Watching someone have a painful experience triggers real emotions and sensations in me”

The patients receiving the therapy were clearly motivated to undertake the programme. The short term pain of the treatment out-weighed the ‘pain’ of trying something else. There was a reward somewhere — maybe the relief of the heightened pain easing off! A key point here with a motivated patient is that they are likely to do well with any functional programme because they have prioritised and committed to taking actions in line with getting better. Would these people do equally well with a standard programme?

The shock wore off and we settled into a solid and well thought out talk on the team approach from Candy McCabe. I am into ‘teams’ and in particular ‘super teams’ so I was very pleased to hear Candy speak about some of the important principles. Great teams do great work but this necessitates a good leader, a vision, a recognition of individual and team strengths, engagement, and compassionate communication at the very least.

Bring a touch of the real world to the end of the day, we heard from two clinicians who described their experiences. Together with Victoria from Burning Nights, these stories brought the day to a conclusion as we moved from data, science and theory to what actually happens and the phenomenon of the lived experience. At the end of the day, it is this lived experience that is important. A person suffering CRPS, do they need to know about chemicals, brains, nerves etc, or do they need to know that they can be ok and that they can get better? For me that’s a no-brainer.

Whilst I agree that people must understand their pain (of course I do!), this is a practical knowing. The Understand Pain & Pain Coach Workshops deliver the knowledge, skills and know how, with the last element a vital part of the make-up. Without know-how, we don’t know. Not knowing results in fear, worry, and a hit and miss approach versus a knowing that leads to confidence, control and an outlook of being well.

Through the day there was acknowledgement that this is a difficult condition to treat and address for the person and clinicians. Traditionally thinking, yes this is true. But as with anything, if we start by saying how hard it will be, we are pre-empting. We are creating a lens of ‘difficultness’ through which we push everything else.

There is a choice to be had. What would happen if we used the lens of possibility and opportunity? We are designed to change and have inherent mechanisms of getting better. The offerings of a whole person approach tap into our potential as amazing human beings as opposed to focusing on a body area, a brain, a particular treatment approach. The reality is that we are all unique (see blog here on WUPs) and hence there is no single way of dealing with a condition. And that is because we are not dealing with a condition, we are helping a human being overcome a challenge and how that manifests in them. The plea here then, is to stop trying to fit a round peg into a square hole. See things for what they are and address each person in the ‘personalised’ way that they need and deserve. I will write more on the ‘how’ of this subsequently.

So, with that all in mind, we move onwards into day 2……

24Jul/17

Improve staff fitness

Improve staff fitness

Call to improve staff fitness by the Chief Executive of Public Health England, Duncan Selbie

To improve staff fitness is a great idea all round. According to The Observer yesterday, the cost of staff sickness is £29 billion a year. Denis Campbell reports upon Duncan Selbie’s call for companies to encourage healthy practices. Imagine freeing up some of that cash for education, including educating the next generation to look after themselves. We may laud ‘great results’ in A*’s and A’s but at what cost? We continue to see the figures for mental health rising in kids? I would rather my kid had a D, had tried his best and was all-round healthy. What use is an A if you are suffering depression?

“To improve staff fitness is a great idea all round”

The main target for this message seems to be small and medium sized businesses. Naturally this draws responses about the costs and limited opportunities within such firms compared to bigger companies. However, this problem can easily be solved by creating guidelines and providing support ~ see below for some ideas. It would be well worth the investment.

We can look at the trend in big businesses of building gyms on-site, having physiotherapy and doctors available, bringing sandwiches to the desk and even a neck massage while your pour over your spreadsheets. However, you could also argue that this merely keeps people at their desk or in the workplace for longer, often in the very environment that is causing most of the problems!

“The skills of wellbeing easily weave into the day”

There are a vast number of different options for healthy practices and skills of wellbeing. Teaching people such practices each day, I am very familiar working with individuals who have decided to create new patterns (habits) to supersede existing patterns that cause pain and suffering. Most people I see have chronic pain together with varying degrees of anxiety, depression and other persisting ills (e.g. migraine, headache, IBS, pelvic pain, fibromyalgia, chronic fatigue). Usually this is accompanied by perfectionism (expectations are never met resulting in ‘I am not good enough’ and consequential stress) and self-criticism to a unhealthy degree.

Many people spend their lives in protect mode. Occasionally they experience care-giving mode, but not often. Biologically these people are likely to be ‘inflamed’ much of the time, which explains many of the common complaints in the modern world for which medicine has no answer. The endless search for a medical explanation leads down a slope of decreasing expectations and hope. In essence, like chronic pain, this is not actually a medical problem. Once any sinister pathology has been excluded, the biomedical model offers nothing here as the problem is embedded in society; i.e. it is a public health issue.

To address a public health issue, we need society’s thinking to change. For thinking to change, existing beliefs must be shaken as we update our understanding. Understand Pain is a purpose led enterprise that works to change society’s thinking about pain. In the same way we can build upon the strengths in society with regards to being active. The ‘already active’ can become champions, spreading the right messages about the healthy practices that they have adopted. These people are living examples of the benefit.

“Staff fitness benefits business and society”

Staff fitness

Turning this on its head as I like to do, let’s think about living well and meaningfully. In other words, what can we do and what can we focus on? What positive action can we take as individuals and society? This is not just about small and medium sized businesses creating opportunity for healthy practices. Businesses must collaborate with staff who they themselves need to be motivated to live well. We all have this responsibility to ourselves, our families and society.

There is too much knowledge to sit back now, we all have a role to play, not just the business owners. However, if owners and executives take the right steps and lead from the front, they will inspire action. Do we have good enough leaders to do this and recognise the benefits for the business itself and society as a whole? That’s another question!

What could we do at our place?

Consider how staff will engage with the business and colleagues when the right environment and ethos exists. What are the company values? This is a great opportunity for small and medium sized businesses to engage deeply with its people. Even if this means re-writing the values in an effort to keep growing.

  • Create a space for exercise
  • Create a space for meditation
  • Link with local teachers: yoga, Pilates etc. ~ also an opportunity for staff to bond by doing something together
  • Encourage meetings that are mobile ~ where can we go? Let’s walk and talk
  • Encourage conversation over email/text ~ walk to that person’s desk
  • Compulsory lunch break away from the desk
  • Education programme for the skills of wellbeing

Using your imagination, you will be able to come up with some great ideas for your place. Your people are your greatest resource. Looking after them means looking after your business.


If you would like to know more about healthy practices and skills of wellbeing, please contact us. See what we can do for you as an individual and a business

Individual coaching and workshops ~ t. 07518 445493
16Jul/17
Andy Murray hip pain

Andy Murray’s hip

Wimbledon 2017 ~ the growing injury list

Andy Murray hip pain

The Wimbledon Championship has featured a significant number of injuries this year. On the same day we lost Djokovic and Andy Murray, the former retiring through injury, the latter struggling with hip pain. Sadly for British fans and tennis fans, the intensity of the pain prevented him from progressing. Murray was obviously struggling to move normally as his body shifted into a state of protect.

Why do players breakdown at the tournament?

There are several reasons. The game has become increasingly physical together with the pressure to perform in tournament after tournament. Everybody needs recovery time, and some players may simply have figured in too little within their schedule. It is not just the game time that requires subsequent recovery, but also the training: on court, strength and conditioning etc.

One must ask about the pressures to play, both financially and to achieve a ranking. To earn money, and this is a job that pays the bills, and to be ranked, players need to play. They are also driven to be the best that they can be, which means pushing oneself. The cultural meme in sport ‘no pain no pain’ exists and anyone involved in any kind of physical activity knows that intense play hurts. So when is it normal and when is it a problem?

It is somewhat easier to make that judgement in amateur sport when the stakes are not so high. Your career does not depend on playing that extra game. In professional sport, understanding pain is absolutely key in making this all.

This week a commentator pointed out that all players have some kind of injury and that no-one is 100% fit. What is 100% fit anyway? This will mean different things to different people. Do players feel aches and pains everyday? Yes, everybody does to a greater or lesser degree. Life hurts! But in many cases, the pains come and go, and do not impact upon life or performance. If a pain repeatedly occurs and does have an impact upon performance and life, this is something that does need to be addressed.

Acute injury vs persistent injury vs persistent pain

It is interesting that most of the injuries we have seen this year have not been acute. In other words, the players knew about the problem beforehand as it has been rumbling on for some time. Murray reported that his hip has been something he has been dealing with for years.

This is with the exception of Bethanie Mattek-Sands when her knee injury happened there and then, taking everyone by surprise. This is one of the reasons it was so shocking, because no one expected it, least of all Bethanie herself.

There is a difference between an injury moment and a pain moment. Pain and injury are not the same. Pain is part of the way we are alerted to being in a state of protect, a great motivator compelling action, and an injury is when there is a disruption to our body. An injury can often hurt but it does not have to, and the extent of the pain varies enormously depending upon a number of factors.

Andy Murray's hip

Pain and injury are not the same – read here

The terms pain and injury are often used interchangeably and this is not correct. Persistent or chronic pain and chronic injury are not the same. A chronic injury would mean that the healing process has not completed, taking longer than would be expected. Persistent or chronic pain is not well related to the tissue state, instead being a reflection of an on-going state of protect. There are a number of reasons why the state of protect persists and these are a main focus for the treatment and coaching programme to overcome the problem.

Murray’s hip pain

Whether Andy Murray has an injury or a pain problem we do not know. I hope he knows because this will determine the treatment and the training needed. Undoubtedly when a player is training and playing as often as Murray, there needs to be down time. Has he had this time? Federer took time off and appears to have benefited.

No-one can keep going at a high pace in life without recharging. We all must figure in refresh and renew points through each day, learning how to switch to ‘care-giving’ mode. In this state, our body systems are doing all the vital things for long-term health and well-being. Without this we burnout: chronic pain, poor sleep, low mood, depression, anxiety, irritable bowel syndrome, fertility issues etc etc, many of the common, modern day ills.

A person who presents with a long term hip pain needs to tell their complete story. From there the key points and ‘primers’ are identified. In essence the person does not feel themselves and the aim is for them to be able to say, ‘I feel myself’. In fact, when we feel ourselves and get what we expect, we are in flow and do not really think too much about how we are doing things. They just happen. We do not normally think about walking, but if my hip hurts I will scrutinise every step, the pavement, others walking towards me, hills, steps etc. The world looks different and I feel different. Normalising these is key.

Let’s hope that the nature of the problem can be truly established and then dealt with effectively and with long-term results in mind. Hips, like any body area, are not in isolation to the whole, and typically relate closely to the back and pelvis. Murray has had back issues before, a very common problem in both athletes and the general population, so I am sure this will be considered as part of the bigger picture.

What is your picture of success?

We all have our picture of success and should know what that looks like. This vision becomes a reference point and an orientation as we follow the necessary training programme and learn along the way. One can check in and ask: ‘Am I heading in my desired direction or am I being distracted?’. For Andy Murray, I would imagine his picture involves him consistently playing his best tennis. The key is to focus on what we want rather than what we don’t want. When I ask patients ‘what do you want?’, they often reply at first, ‘I don’t want this pain’.

Whilst this is an understandable response, the pain is actually what you do not want rather than what you do. This may sound all rather semantic, however there is an important practical difference. What we focus upon, we get more of. Think about what you actually want, crystallising the image and doing your utter best to get there.

“Don’t think of red elephants

Andy Murray, like all sports people, has a coach. His coach will work together with him to tap into his ‘greatest self’ so that Murray can achieve his best results. It is no different with overcoming pain. The person suffering chronic (on-going) pain is coached to be their greatest self. They are coached to become their own coach. In other words, because the person is with themselves consistently, they need to know independently how to orientate their thinking and what actions to take to get the best results. On the strong foundation of understanding paincoaching provides a structured way onwards, carving out a fulfilling life.


Pain Coach Programme to live a fulfilling life ~ t. 07518 445493 mailto:[email protected]
09Jul/17
Andy Murray's hip

Pain and injury at Wimbledon

Why is there so much pain and injury at Wimbledon this year?

Pain and injury at Wimbledon

Seven retirements and a very painful injury on-court yesterday at Wimbledon have given the tournament a different feel. Pain and injury are part of sport, but many people have been surprised by the turn of events. Federer has called for a review of the system and several players have complained about the state of the courts. All are factors of course. The game is simply made up of the synergy of players, court and tournament. When all are ticking, we see great tennis.

The very painful moment

Bethanie Mattek-Sands was screaming out in pain this week after her knee appeared to give way. One report suggested that she could have sustained a knee cap dislocation. This can be extremely painful until relocated. Seeing the dislocation can add to the trauma. When our body does not appear as we expect, the sight can trigger feelings of aversion.

Why so much pain?

Pain is a part of the way we protect ourselves. There are many other things going on when we are in state of protect: change in movement, change in sense, altered thinking and emotion, change in perception. In other words, the world looks different and feels different as we take action in the name of survival. This is a normal shift of state in the face of a perceived threat. Pain is a lived experience when there is a perceived threat. Pain is not well related to injury. This is the common misunderstanding. Just because it hurts a lot, it does not mean that the injury is more severe. We have known this for a long time ~ see here: pain in sport, 3 key points.

When thinking about the reasons for the pain response, the context is key. In other words the situation plays a significant part in the pain experience. As well as potential tissue injury, where that possible injury occurs and what is happening is highly relevant — it always has to happen somewhere! The full picture perceived creates a learning opportunity. If this is possibly dangerous, I need to remember what happened and where so that next time I can react differently.

All of this information is processed together with sensory information from the body, based upon what is already known about injury and the situation. In essence we make a best guess about the possible causes of the sensory information on a background of our previous experiences. In effect, we weigh up the evidence: new information vs what we know, which then suggests a scenario. If this is a potentially dangerous situation, pain can then form part of the experience. The more danger perceived, the more intense the pain.

How much danger did Bethanie perceive when her knee gave way at the biggest tennis championship in the world, in front of a big crowd, when each game is career shaping?

Whatever the outcome for Bethanie, I wish her well.

Messi’s knee

In 2012 Lionel Messi was running into the box when he brushed the keeper as he came out to meet him at speed. Messi managed to get a shot away (he missed) before he hit the ground clutching his knee. He was quoted as saying that he thought his career was over because of the pain.

How dangerous was the situation to Messi? Consider: the perceived injury (he did not know about the extent of the damage at that point), the game, the crowd silent, the body part involved, how knee injuries are thought of in the culture of football, the immediate thoughts about injury and what it means and much more.

Messi was taken off the field on a cart and whisked to hospital where he was scanned. What was the injury? A bruise.

Pain and injury are not the same. The terms are often used synonymously, but this is not correct usage. A further example is phantom limb pain. The person suffers pain in a limb that no longer exists.

Pain and injury

Why have there been so many injuries?

We have seen multiple retirements during games at Wimbledon this year. Whilst some people have been frustrated, we must also consider that these players have to make choices. These are based on the culture of the sport, the system, their career, their income and their understanding of pain.

There will be a weighing up of the pros and cons, and each individual will consider different factors before deciding. We do not know what those factors are in each case, so we cannot make any specific assumptions or criticise. In life, how many assumptions are made when someone is being critical of another without knowing the full picture?

“aches and pains are part of sport

In sport, the day to day aches and pains are a well known part of the deal. Simple measures are taken to address theses responses so that the athlete can continue to perform: e.g./ physiotherapy treatment, massage, ice baths, stretching, periodisation. However, despite the level of fitness, each body needs to adapt to the demands of the training and play. Without this time, there can be a tipping of the ‘build-breakdown’ balance towards the breakdown (inflammation). A state of chronic inflammation is likely to explain a range of common problems that can become significant.

When an acute injury occurs in sport, there is pressure to resume play as soon as possible. Do players return too soon? Are they fully ready? Being ready means that the body tissue are robust to withstand the stresses and strains, movement patterns are normalised (and not guarded), body sense is acute and thought patterns focus on the game and not on the body.

“the clues are in the story

We do not know all the factors involved with each player at Wimbledon who had to retire, but the points described above are relevant and need consideration. When clinicians are assessing an injury, this is especially so. Each injury or pain moment (the two are different) occurs in a context as we have established. Nothing happens in isolation, we are on a timeline, and hence we must consider how the person may be primed by prior learning. What are the influences upon this current moment? Some will be obvious and some more hidden. This is why allowing the person to tell their story is vital. The clues lie within their narrative, so we must listen actively and be open.

This is a brief look at some of the key issues. Pain and injury are always going to feature in sport. We need to draw upon the pinnacle of our knowledge of pain and bring this into the athletic world. In other words, we need a shift in the thinking away from the biomedical model, instead looking at the wider picture: a true biopsychosocial, or sociopsychobio model. Here is a reminder of the key points:

The key points:
  • pain and injury are poorly related
  • pain is suffered by the (whole) person not a body part (e.g. tendon pain ~ the primary focus remains on the tendon rather than the person)
  • pain does change when it is understood by the person and they actively create new patterns

04Jul/17
Pain and injury

Andy Murray fit for Wimbledon ~ pain in sport: 3 key points

Andy Murray fit for Wimbledon ~ pain in sport: 3 key points

Andy Murray fit for Wimbledon ~ pain in sport: 3 key points, but first…

What does Andy Murray have in store for fans this year?

Undoubtedly Andy Murray is resilient. He declared himself fit for Wimbledon 2017 and he has just beaten Alexander Bublik to take a step closer to the final: one game down, six to go.

There were concerns in the media about Murray suffering left hip pain during the build up to Wimbledon. Apparently this is a problem he has had for many years, however he is not going to let this stop him from giving his best. We have become used to his determined attitude, one that he has had to develop towards pain and injury in particular.

Clearly performing at the elite level has an impact upon the body, which is why the conditioning must be right to check the physical stresses. But, we are more than a physical shell. We are a ‘whole person’ and hence being resilient to life’s challenges is a key skill. This is an exciting time for Andy Murray as he embarks on his defence of the title whilst expecting a second child with wife Kim. Being able to put aside the hip pain, he could even be using this wonderful news as an inspiration.

In 2013 I wrote a blog about Andy Murray, back surgery and microdiscectomy. It still gets a fair few hits, particularly at this time of year when people are reading about him and Wimbledon. I stated that the rehabilitation “is not just about exercising. It is about understanding, learning, motivating, creating the right context for movement with confidence and many more factors that can lead to optimised outcomes”. Since then Murray has had a remarkable time, currently holding 45 titles.

“rehabilitation is not just about exercising

Murray fans now hope to enjoy (is that the right word?) the next two weeks. The pinnacle would be next Sunday watching a closely fought final with a Murray victory. Who knows? Sport these days chucks out surprises that ultimately keep us all riveted. Look at the Lions last Saturday!

Now, my blogs would not be my blogs if I didn’t somehow turn the thinking to pain. One of my favourite areas of discussion is pain in sport, in particular chronic pain in sport. Yes it exists! (Some people seem to think it may not….). Many times I have given my lecture and talks on the topic, encouraging modern thinking about pain to emerge in the sporting realm. There are some simple principles to begin with, and we can use Andy Murray to illustrate the points.

3 key points

Pain and injury are neither the same nor well related

We have known this for many years. The famous lecture and paper was in 1979! So when you see Murray in pain on the TV, this does not tell you much about the state of his hip. It does tell you that his body systems are in protect mode, compelling a range of behaviours and actions that can be seen. Pain on the other hand, cannot be seen. Pain is a lived experience. Can you see funny? Can you see hunger? All these experiences are whole person, which is my second key point.

“pain has only a weak connection to injury but a strong connection to the body state

Pat Wall (1979)

Andy Murray fit for Wimbledon ~ pain in sport: 3 key points

Pain is whole person

This means when we are treating pain and overcoming pain we have to think about the whole and not reduce it to a body part or some physiology. If my knee hurts, it is ‘I’ who feel pain and not my knee. Much like thirst. It compels action by me, the agent. Think for a moment: where do you feel thirst? Some may say in my mouth or throat. Think again. That is a dry mouth, which you may interpret as a sign suggesting that you need a drink. Pain always exists in a context. The context is the person, the environment, the action, the perception, and prior experience. Of course this changes all the time, as are we, the dynamic and ‘updating’ humans that we are. This gives great hope because when we tap into our incredible ability and resource, we realise that we can chnage pain and transform our experience. And that is my third point.

Pain can and does change, beginning with truly understanding pain

This has become so important to me over the years that I have set up a social enterprise in that name: understand pain or UP. Understanding pain gives you the foundation that you need to be able to take the actions that get results. Build upon a model of success and using the tools of coaching, in particular strengths based coaching, you set out your vision. What do you want? Then you orientate your thinking and attitude towards this picture of success and do your utter best. This is the route that Andy Murray has taken and continues to pursue, just like any elite athlete or person who has achieved.

These 3 key points are fundamental and continue to feature in my talks and writings. They do so because they are vital ingredients in the clinic. There are many others, but to start with these orientates the person in the right direction. As clinicians we may think ‘treatment’ but we offer so much more. We do treat and this is important. We also coach: we coach people to coach themselves in their world and to immerse themselves in the practices that result in living as best they can. Together we create the understanding and conditions for the person to flourish and feel themselves. They live fulfilling lives with all the joys and pleasures that exist whilst developing the resilience and skills to face challenges and learn. We can do this at any age, and we should be teaching kids these skills right now in schools ~ that’s for another time.

So, good luck Andy Murray and all the others chasing the Championship! We will enjoy watching you all over the next two weeks.

RS


Pain Coach Programme ~ treatment, training and coaching to overcome pain and live life 07518 445493