All posts by richmondstace

03Mar/15
Treatment of pain and injury

Joe’s pain story

Up LogoJoe’s pain story told by his mum Jenny as part of the UP | Understanding Pain Campaign that launches this Saturday with 700+ singers performing at Heathrow – follow us on Twitter @upandsing to show your support

It was the morning of Tuesday 27th November 2012 and the usual school morning rush was well underway when my son, aged 11, lent forward and picked up his school bag. Straight away he complained of back pain, he was unable to fully stand up straight but by no means was in agony. I explained to my son that I felt his muscles were in spasm and the best thing for him to do was to keep moving. I work in a sports injuries clinic and said that I would book him in after school for a massage. I’d only been in work 10 minutes when the school called to say that Joe had ‘got stuck’ bending down at this locker and could I come and collect him. Joe shuffled out to the car in a manner that I had seen many patients at work walk and knew he must be in a fair amount of pain. On the subject of pain I would like to point out that Joe was no stranger to pain, he’s broken bones in his foot and not even muttered anything about it until I noticed the lovely purple bruise. He’s been a keen cyclist since the age of 5 and has had crashes resulting in loss of skin and friction burns; crashing at around 30 mph dressed in lycra is always going to hurt! Thinking back over Joe’s life he had never complained of pain and he was always one of those people who would rather get on with it.

Joe’s muscles where indeed in spasm and the physio treated Joe as much as he could but he recommended further investigations at our local hospital. The local hospital listened to what had happened and sent us home with paracetamol. That evening Joe’s pain became worse. He was only comfortable lying on his side and struggled to walk, I started rotating paracetamol and ibuprofen every two hours but nothing was touching the pain. We tried every distraction technique we could think of, hoping that once Joe slept he would feel better in the morning. Joe was literally screaming with pain by midnight, we had no way of moving him to the car so we called an ambulance.

To cut a very long story short this first hospital visit was the first of many. Joe would be screaming in pain day in day out. It was the most heartbreaking thing to witness as I had no way of controlling his pain. Our local hospital had no way of controlling Joe’s pain either, they had tried everything they could think of but where unable to pinpoint why Joe was in so much pain. Our experience at the hospital soon became very stressful, we became in a loop of ambulances and ward stays. One day they sent us home and within two hours of being at home Joe started screaming, ‘blacking out’ and screaming again, it was relentless and we had no option but to call for another ambulance. Thankfully by now they were used to seeing Joe so started the morphine and we thought it would just be a matter of time before the pain was under control. Three hours later Joe was still screaming non stop and my husband and myself were at breaking point. Consultant after consultant came in to see Joe, they all did the exactly the same leg lift test and left. No one except the A&E nurses seemed to care that Joe was still screaming and that nothing was helping him. Eventually one of the nurses said she had had enough. He had enough morphine to knock out a rugby player and she was moving Joe round to adult A&E as she said they couldn’t ignore him there. Within five minutes we were surrounded by consultants who decided that Joe needed to be put under so that they could perform a lumbar puncture. The relief when he fell asleep was overwhelming. I cannot begin to describe what it feels like to see your child in so much unbearable pain. Every time Joe ‘blacked out’ for a few seconds it was a relief only for him to wake again and continue screaming.

Joe was awake when we next saw him and surprisingly in no pain. The consultant said that maybe his brain had forgotten to turn his ‘pain switch’ off and going under had ‘reset him’. At the time I didn’t care why the pain had stopped I was just so glad it had! Joe was admitted and over the next day his pain started to return. His results had come back negative so the hospital decided to refer him to Great Ormond Street Hospital (GOSH). After spending a very surreal New Year’s Eve in hospital we were transferred on New Years Day. GOSH started him on a different mix of medication that started to work within a coupe of days. Their physio’s worked with Joe several times a day with his first goal being able to sit up for 10 seconds. They re-ran loads of tests on Joe but they were also unable to come up with a definite answer. They explained that unfortunately as it was 5 weeks since the Joe had injured himself, the injury could have already healed. They felt that the best course of action was to continue with the medication, pain killers and tens machine and to go to our local hospital to continue the physiotherapy.

We returned home after a week in GOSH with Joe’s pain under control with medication and plenty of telephone help from the Pain Team. After our experience with the local hospital I felt that attending physio with them would be a waste of time. I started searching on the internet for private physio’s and Richmond Stace came up again and again. I spoke with the GOSH Pain Team and they were happy for us to attend a private physio. I contacted Richmond and briefly explained our story and asked if he could help, ‘Of course’ was his reply. I remember putting the phone down half smiling and half in shock. Had I just heard right? He knew how he could help Joe. I was so shocked as apart from the staff on Koala ward at GOSH no one, I repeat no one had any idea what was going on with and how to deal with it.

Our first meeting with Richmond was such a positive experience, he listened and understood Joe’s pain. He explained that Joe was not the first person he had seen with that level of pain and it was something he could help us with. Joe started to improve over the weeks that we saw Richmond and we started to lower his medication. He was also managing more school that ever before and I could finally see a glimpse of the future and Joe being well. Richmond has this amazing ability to calm you, take the stress and worry out of the situation and just help you focus on the here and now. We learnt that our surroundings, state of mind, belief in what is wrong etc all have such a major impact on how we perceive pain and how we deal with it. For me, as Joe’s mum, I felt in control for the first time in months and I have no doubt that the feeling of being in control rubbed off on Joe. Listening to Richmond speak to Joe made me realise there was hope. I had truly started to question whether Joe would ever be pain free, how can no one know what caused the pain? How can they not know how to stop it? If we didn’t know what caused the pain could it happen again?

After everything that Joe had been through it had changed him. No longer was Joe my fearless boy, he was now cautious, carried himself differently and seemed different from his peers. In my opinion there is no doubt that pain changes you, makes you aware of your immortality and causes you to protect yourself when, most of the time that protection isn’t actually needed. Maybe our brains are too clever for their own good! Richmond helped Joe realise he was ok. In fact his was better than ok he was Joe again. Not Joe who screams in pain, not Joe who is fragile and unable to do much more than lie in bed but old Joe — Joe who loves school, riding his bike, playing football, going out with friends and playing his guitar. Richmond helped Joe see that and he helped him see that he can control his pain, giving Joe the belief in himself again, proving that he was not at the mercy of a painful back, destined to take painkillers and other medication for the rest of his life. The belief and the tools Richmond gave Joe changed his thought processes, enabling him to progress through his physio, lower and eventually stop his medication.

If anyone reading this is suffering with pain please, please see Richmond. Your life doesn’t have to be ruled by pain. Pain is exhausting and all consuming and it doesn’t have to be that way.

15Feb/15
Georgie

CRPS | Georgie’s Story

Georgie suffers with complex regional pain syndrome (CRPS), which is a condition that can feature the most severe and extraordinary pain and symptoms. Soon after starting to work together, Georgie told me that she wanted to raise the awareness of CRPS and chronic pain. For some months we played with ideas, culminating in ‘UP’ — Understanding Pain.

UP has a mission. This is to raise awareness that chronic pain is the largest global health burden and that one of the biggest problems is the lack of understanding of pain. This leads to poor communication about chronic pain, low expectations with regards to overcoming pain, and poor treatment of chronic pain. Our aim is to change this thinking by raising the level of understanding so that people can see that there is a way forward. All too often the label of chronic pain is associated with isolation, hopelessness, disbelief and being discarded with regards to recovery. If only healthcare at large, policy makers, private health insurers and sufferers were aware of the facts about chronic pain based on rigorous research and pain science, than we can go about changing this situation.

This is our purpose:

  • Facts about pain so that everyone understands
  • Practical and effective ways of overcoming pain and living a meaningful life.

Here is Georgie’s story:

‘I suffer from CRPS – Complex Regional Pain Syndrome. CRPS is a chronic systemic disease causing severe pain which scores 42 out of 50 on the McGill pain scale. CRPS has many symptoms including skin colour changes and temperature changes from hot to cold, burning pain, stabbing like pains, numbness, pins and needles to name but a few. It can often start in one limb following an injury or surgery, some cases with no known injury and the disease can spread to other limbs and in some cases throughout the whole body. CRPS has a major impact on day to day life, it is debilitating and has a negative impact physiologically for the patient, their family and friends around them.

My story

When I was young, I was always very athletic. I came first in sprinting, loved horse riding and I was very good at gymnastics. I also had an artistic streak, studying piano, singing and gained honors in grade 8 organ. What I didn’t realise then was that I had hypermobility. This is not necessarily a bad thing as for gymnasts/dancers and musicians/ singers this means you are more flexible, which can be an advantage. But it can sometimes trigger other underlying possible conditions. I was not aware of my hypermobility until recently and it now explains so much about my life.

Once I left school, it took me a while to know what I wanted to do, I was an office junior, a travel agent, and then I went to Australia for what was supposed to be 12 months on a working travel visa. I travelled from Perth to Sydney by bus taking plenty of stops until I got to Melbourne. One day I woke up in my hostel room and I was unable to see properly. I got myself to hospital and they just told me I wasn’t eating properly which was common in travellers. I then took a 4 day bus to Sydney during this time my sight deteriorated. I then went to hospital in Melbourne and I was told I had Bilateral Papillitis a swelling of the optic nerve and they were not sure what damage it may do to my sight. I am not sure if this is related to my condition but I am not ruling that out. I spent so many hours listening to music and this saw me through my time there, I made a huge life decision and decided to become a singer…what did I have to lose? I wanted to live life to the full. I quickly returned home after being in the hospital for 2 weeks. The cause was never found after a few MRI scans, CAT Scans, Lumber Punches. However the symptoms reduced over 6 months on their own.

I found a college and became a professional singer. Of course, this is not the easiest path but I loved every minute of it. However from around 2002 I started to fall regularly as my ankle would give way, I would recover from one fall then months later have another fall from the weakness in the joint. In 2005 I had a fall that changed my life forever. I had fractured my metatarsal bone and badly sprained my ankle. I spent 4 weeks on crutches and started to realize something was really not right at all. My foot was freezing cold, it was black and purple in color and was highly sensitive to touch. I had drop foot and could not move my foot at all. The pain was unbearable burning, stabbing, shooting pains, pins and needles, numbness. I went back to the hospital who immediately knew something wasn’t right and after some 12 weeks in physio and after more scans I was informed that I had CRPS – Complex Regional Pain Syndrome. The first thing my physio said was don’t read anything on the internet it will just scare you, it will be a long journey and there is no guarantee of a good outcome. I had some treatment in the Surrey hospital undergoing a 
Guanethidine Block under sedation. Then my treatment was moved to St Mary’s in Paddington under the care of Dr Jenner.

I had many Guanethidine Blocks every 2 weeks nearly, but these were so traumatic for me that after a year I was unable to take any more treatment – my body was too week and after the last procedure the doctors found it too difficult to wake me up. I was on a cocktail of tablets to ease the pain. But I had no life left. I couldn’t work, I was on crutches or wheelchair bound for 3 years and my life felt completely hopeless. Depression started to set in, it felt like the darkest and most lonely place. Many of my friends were unable to understand and completely unable to help me, I lost a few friends along the way. CRPS is completely isolating, its an evil disease and its not called “The Suicide disease” for nothing as many people give up the fight. If pain is all you feel what else is there? But I had so much to live for and I am a fighter. I loved music and in those times of darkness it saw me though.

One day I started to write music again I don’t even know what inspired me, I just picked up my pen and started to write. I thought I had lost all of my passion, but there it was again still inside somewhere and I’m so glad I found it again. I wrote every day and I still do to this day. The music, singing and writing kept me occupied and in some brief moments made me forget the pain as my mind was busy creating. The music gave me hope back, if I could bring back passion, what else could I achieve? So I decided I was going to work at trying to walk to my kitchen and back to the sofa – now in actual fact this is only a few steps these days, but back then it took me a really long time, shuffling and holding on to everything I could find to hold me up, hopping, but I made it there. Now all I had to do was get back to the sofa with a cup of tea, this I hadn’t quite thought through and by the time I made it back to the sofa most of the tea was on the floor. I suffered a flare up after this attempt but I decided not to give up and little by little I found a way to make this small journey. Once I had achieved this, I started to make longer journeys to the bathroom and I even attempted the stairs. Going out without crutches was really scary, after 6 months I thought now is my time to try. Every week my friend Pete would pick me up for a jazz gig. He knocked on the door and I was stood there without my crutches, he asked me “Where’s your crutches” and I said “look…” I walked myself to his car (only a few feet away) with no aids. He started to cry. He said he couldn’t believe it and he was so proud of me. Pete is such a loyal and close friend he was there for me in some of my darkest times. From there I decided I had to try more and I wanted to find more to do in music. I saw an ad for Rock Choir leaders and I went for an audition, I tried to hide my limp and I got the job! (although, now that I know the Rock Choir team, I shouldn’t have been so worried about my limp). It was one of the happiest days of my life and I have never looked back.

When I started Rock Choir 5 years ago I ran 6 choirs. Before I started the job I was never sure how my body would cope – but it did and slowly I got used to my schedule and I loved every second of it, from training to rehearsals and shows. The adrenaline for me was the best part of it as it helped cover the pain I had and the music was so uplifting it always made me happy and lifted my spirits, I had never been happier. I was writing more than ever and started my own original band The Big Bads! Then just over a year ago my CRPS spread up my leg and into my arm and hand. This was devastating as it made it so much harder to play piano and do the one thing I love so much, conducting my choirs and getting to all my rehearsals and writing. I quickly realized that I would have to give up my morning choirs so that my body could recover and so that the CRPS would not spread to other limbs. I found it so hard to adapt and I felt so very low. It felt like all that I had fought so hard to have back could just be taken from me again.
I went back to my consultant who put me in touch with Richmond Stace, a specialist pain physiotherapist, to help me overcome the spread of the condition. He explained the condition so that I understood my role and what I could achieve, and taught me techniques including mindfulness, breathing, motor imagery and specific exercises. We talk about how I will get through some of my conducting, right down to visualizing and practicing the moves before I see my choir. I use nourishing techniques and try to remember to pace myself and move every so often into a different position. We talk though the schedule I have coming up and how best to manage it and every time I start to have a flare up we nip it in the bud before it develops. This year will be the first year in 10 years that I have not had a major flare up that has lasted longer than a couple of weeks!

I can see a future now; a future that means I can deal with the condition I have and co- exist with it. I would like to help others now to regain their lives from pain. I know how hard it is, but if I told you it was possible would you try too? I don’t want people to give up. There has to be a better way and if we can help more people find their path through the pain by understanding their symptoms, using music and techniques that work such as mindfulness, imagery, graded exercise, then that would make me even happier!

05Feb/15
Persisting sports injuries

Today’s talk at QMUL | pain in sport

Today’s talk at Queen Mary University of London (QMUL) for the MSc Sports & Exercise Medicine group focused on modern concepts of pain, in particular the problem of persisting pain. Using plenty of clinical examples and anecdotes, we explored a range of topics including:

  • The enormous (global) issue of pain
  • The dimensions of pain (physical – cognitive -emotional)
  • The importance of the whole person as much as the condition
  • The relevance of the meaning of pain to the individual and how this flavours the pain experience
  • The vital early messages when we talk to someone with pain, and how this can shape their thinking and actions
  • The importance of using the science of pain in dealing with sports injuries.

Richmond holds clinics for pain and chronic pain problems in Harley Street, Chelsea and New Malden

If you would like Richmond to come to your practice and talk about pain and chronic pain, please contact Jo on 07518 445493.

28Jan/15
The Chelsea Consulting Rooms

Specialist treatment for pain

Richmond M. Stace Specialist Physiotherapist & Pain Coach

Richmond M. Stace
Specialist Physiotherapist & Pain Coach

Pain is the largest global health burden. Those who suffer persisting pain will understand why, as the impact of pain creeps into every corner of your life. Fortunately we have a far greater understanding of the science of pain now, and hence increasingly effective ways of tackling the problem.

My background is in pain neuroscience and physiotherapy. I have also studied rehabilitation and general nursing, and the blend of these four disciplines has led to my modern approach to dealing with pain, and in particular chronic or persisting pain. The treatments, the rehabilitation strategies and pain coach concept have been created on the basis of the latest sciences and my experience in healthcare for over 20 years.

The treatment, training and coaching programme

I focus on working with people who suffer persisting pain. This is not limited to musculoskeletal pain, but any chronic pain problem, for example irritable bowel syndrome and migraine. Together we comprehensively explore how you have come to be in a state of persisting pain, identify the pain mechanisms and the factors in your life that influence the pain. This creates the opportunity to tackle the pain at a number of levels. This is important as we know that pain is multi-system (pain involves all body systems) and multi-dimensional (the dimensions are physical, cognitive and emotional; these interact and are not exclusive). To fully address the pain problem, all of these factors must be considered, which is why your programme is detailed and bespoke according to your needs and circumstances.

Change your pain and live your life

Change your pain and live your life

You may have decided to deal with an on-going problem or you may have tried different approaches before. Whatever your start point, the over-arching aim is for you to understand your pain and to learn how you can overcome the problem with a range of strategies, treatments, and training. The programme is built for you, allowing you to become your own ‘coach’ so that you think clearly about your pain and make decisions that lead to long-lasting and transformational changes to your life. You will be inspired and motivated by the work we do in your sessions to take the healthy choice, creating a sense of wellbeing so that you live a meaningful life.

Call us now to start your programme: 07518 445493

Richmond’s clinics are in Harley Street, Chelsea and New Malden.

 

26Jan/15
Richmond M. Stace
Specialist Physiotherapist & Pain Coach

About Specialist Pain Physio

Richmond M. Stace Specialist Physiotherapist & Pain Coach

Richmond M. Stace
Specialist Physiotherapist & Pain Coach

In 2006 I started the Specialist Pain Physio Clinic concept in London and Surrey to deliver innovative, neuroscience-based physiotherapy to tackle chronic pain and injury.

The treatment, training and pain coaching programmes are based upon the latest sciences and understanding of pain. The biopsychosocial approach that I use is the contemporary way of addressing persisting pain and suffering — considering the biology, psychology and social impact.

About Richmond

I am a Chartered Physiotherapist and registered with the Health Professions Council. Originally training as a Registered General Nurse, I developed an interest in pain whilst observing the varying responses in recovery after operations. I continued to train as a physiotherapist, I have a further degree in Sport Rehabilitation and a Masters Degree in Pain Science. My passion is in providing the best journey for you by using the latest therapies for chronic and complex pain. Seeing and hearing about your relief from symptoms, your development of healthy habits and sustained change is my aim for you.

Outside of the clinic, I write and talk about how we can globally change pain by understanding it, communicating about pain accurately, creating a definite plan and how to implement the plan in the most effective way.

I am part of the editorial team for the Physiotherapy Pain Association (PPA), a member of the International Association for the Study of Pain (IASP), The Royal Society of Medicine and the Acupuncture Association of Chartered Physiotherapists.

09Jan/15
Bono's injury

Bono’s arm

Bono's injuryAnyone who has read Bono’s recent post will know that he believes that he may not play his guitar again. As a rock and roll icon, this is a strong message that reveals the mortality of man.

Many times I have heard people tell me that they cannot do what they used to do. This is usually because of pain or a physical limitation. Often this pain and limitation has been in existence for some time before they come to see me, and hence the body has physically adapted, thinking has narrowed and avoidance assumes the default position. For this reason, the early messages about pain and injury are a vital because they set the scene for the action taken.

I do not know the full details about Bono’s arm aside from reports in the media. The injury sounded complex and nasty, requiring surgery to fix the damage. Healing always ensues, pain usually accompanies healing as do a range of other biological mechanisms such as change in movement, change in thinking and responses to different environments. Additionally we can feel unwell (the sickness response), our mood can vary, sleep is disrupted with knock-on effects, appetite may change and thinking can lose clarity. There is a very individual response to an injury, especially when it affects something very important to our self.

When helping patients to understand their pain I often tell them about the pain threshold differences in violinist’s hands — lower on the left because of the meaning of the left hand in terms of playing. If a carpenter cuts his finger, this may not be a great problem. It is certainly not unexpected. If a violinist cuts his left index finger, this could be a significant problem in terms of being able to play. Same type of injury, different meaning, therefore a different outcome: more pain, more negative thinking, more worry. This would be similar for a professional vs an amateur footballer who injures a knee ligament — the financial consequences, the loss of a place in the team etc.

The way in which Bono’s body responds to the injury will be unique to him, will reflect his health and the way he views his situation. This is the same for everyone. The uniqueness of the injury, the context, the environment and the person. For treatment and rehabilitation, this is how it must be viewed to optimise the outcomes.

Hypothetical case study

When a patient comes to see me with a complex injury, I focus on the person as much as the problem (this is one of my overarching principles). This is because it is the person who tells and lives their story, and it is the whole person I am treating, training and coaching back to a state of well-being.

Assessment would include:

  1. Exploring the narrative: gathering all the information about the injury — e.g./ the circumstances, how it happened, health status, lifestyle status, past experiences, beliefs about pain and injury
  2. Pain types: e.g. nociceptive inflammatory (possible neurogenic), neuropathic
  3. Protective measures that have been adopted: e.g./ guarding, avoidance
  4. Adaptations: e.g./ altered body sense, altered movement patterns
  5. Influences upon pain: stress, thoughts/beliefs, fatigue, emotions, other health factors, rumination

Then —

Pain understanding:

  1. This is the start point. Making sure that the person understands their pain, relevant to their condition and the action needed to overcome the pain.
  2. Getting their thinking in alignment with what we really know about pain and what it means to them to overcome pain. Achieving success is about the meaningful return to living; what is this to the patient?
  3. Cultivating the belief that their pain can be overcome and that they CAN do things with the right knowledge and ‘know how’. This is the pain coach concept.
  4. Develop the growth mindset — you may not be doing things YET; NOT YET rather than ‘I will never’. Never say never. Give it your best shot. Dedicate yourself to the fullest recovery and a return to wellbeing. Sign a contract stating this is need be, and know that you will be supported and motivated at every step.

Treatment & rehabilitation:

Depending upon the pain types (biology) and the influences upon pain, specific training is designed to achieving normal body sense, normal movement and confidence in being active and engaging in life again.

If playing the guitar is what they want to do, from word go that is how the training begins; even in plaster! Sensorimotor training begins immediately, or even before an operation. Working the sensorimotor areas is vital from a top-down perspective with specific exercises and can be started whilst immobilised with a range of imagery and visualisation techniques that work the motor centres.

When the immobilisation period ends, actual movement begins to nourish the stiffened, healing muscles and joints. After immobilisation it is normal for the area to appear different — perhaps red and swollen, a different skin quality, hair and nails can change too. Movement and sense of the area is altered and needs specific attention in the early stages because a normal perception of the body is key for healthy movement.

An early focus on function for a guitarist would include thinking and training dedicated to the fine control required to play. The actual movements are part of a sensorimotor feedforward-feedback loop that must be addressed. Adopting the right mindset is key for rehabilitation and should be practiced from the outset: a coaching model for a growth mindset.

We often do not know our full potential, so until you have given it your full dedicated attention, never say never.

05Jan/15
Richmond M. Stace MCSP MSc (Pain) BSc (Hons)

Richmond Stace | Specialist Pain Physiotherapist

Richmond Stace | Specialist Pain Physiotherapist

Richmond Stace | Specialist Pain Physiotherapist

About Specialist Pain Physio Clinics

In 2006, I started the Specialist Pain Physio Clinic concept in London and Surrey to provide contemporary and innovative physiotherapy for chronic pain and injury.

I believe and know that pain can and does change when the right conditions are created in both thought and action. Blending the latest neuroscience of pain with tried and tested mentoring techniques, together we comprehensively address the biology of your pain and the influences upon your pain.

Let’s aim high and target success with the right thinking, a vision of where you want to be and a definite plan of how to achieve your success.

Effective treatment, training and mentoring for health and performance — it is time to change..
My physiotherapy treatment, proactive training and mentoring programmes are based upon the latest sciences and understanding of pain. The biopsychosocial approach that I use is the contemporary way of addressing enduring pain and suffering — considering the biology, psychology and social impact.

Richmond Stace MCSP MSc (Pain) BSc (Hons)

I am a Chartered Physiotherapist and registered with the Health Professions Council. Originally training as a Registered General Nurse, I developed an interest in pain whilst observing the varying responses in recovery after operations. I continued to train as a physiotherapist, I have a further degree in Sport Rehabilitation and a Masters Degree in Pain Science. My passion is in providing the best journey for you by using the latest therapies for chronic and complex pain. Seeing and hearing about your relief from symptoms, your development of healthy habits and sustained change is my aim for you.

Outside of the clinic, I write and talk about how we can globally change pain by understanding it, communicating about pain accurately, creating a definite plan and how to implement the plan in the most effective way.

I am on the editorial team for the Physiotherapy Pain Association (PPA), a member of the International Association for the Study of Pain (IASP), The Royal Society of Medicine and the Acupuncture Association of Chartered Physiotherapists.

24Nov/14
Sturridge thigh injury

One injury, and then another…and another….

Sturridge thigh injury

Sturridge | more thigh troubles

It is a common scenario sadly, both in professional and amateur sports. One injury, then another and another, each demoralising further. It is noteworthy that the science of pain would say that expectations and other thoughts about the pain and injury will affect the pain itself, potentially increasing the overall threat value — recall from previous writings that pain is a response to threat, and not to just that of the actual injury itself. We must consider any threat to the whole person, and this includes thoughts about oneself and one’s career.

When the body is sensitised by an initial injury, despite healing this sensitivity can persist subtly. In other words, at a certain level of activity there is no problem, no defence. But reaching a new level of training may then reach the current threshold that is not yet back to normal. The threshold is the physiological point where messages are scrutinised by the neuroimmune system that is already vigilant to potential threat. There does not need to be an actual threat, just a perceived one by these vigilant body systems, which then triggers a biological defence: pain, altered planning of movement, altered thinking etc.

The continuous journey back to full fitness requires a complete integration of physical and mental preparedness. As well as tissue strength, endurance and mobility, the controlling mechanisms must switch back to normal settings rather than protect — i.e. the upstream: muscles do what they are told by the motor system that originates in the motor areas of the brain, and the motor system plans and executes movement. The planning of movement not only occurs when the ball is about to be kicked or a run begun, but also when thinking about the acts or watching another. As well as these influencing what is happening, these are also great rehabilitation tools to fully prepare the system for the rigours of the game as well as ensuring completeness of recovery: the player resumes the right thinking, decision-making, motor control as well as fitness.

 

23Nov/14
Persisting sports injuries

Why do Arsenal and MUFC have so many injuries?

Football injuriesArsenal Football Club have apparently reported 30 injuries since August, and Manchester United 37 injuries. Why so many?

Injuries are more complex than perhaps initially thought. It is not simply that a player runs out onto the field, clatters into another player, changes direction or bursts into action. There is a huge amount of multi-system activity, both conscious and unconscious that biologically underpins every injurious situation.

For example, a seemingly ‘simple’ ankle sprain is this: a disrupted ligament releases inflammatory chemicals that excite the normally quiet danger receptors on nociceptors; nociceptors send danger signals to the spinal cord to communicate with secondary neurons that are influenced by a flow of signals coming downwards from the brain. The sum of this give and take reaches the brain. According to whether a threat is determined or not, the appropriate response is pain, drawing attention to the affected area so that the right behaviour can be assumed, promoting recovery and survival. Pain is a need state, driving and motivating action.

The danger signals, for there are no pain signals or even a pain centre in the brain, are chemical messages until given meaning by the emotional centres of the brain. This is based on the context of the situation, beliefs, immediate thoughts, previous experience and the environment to name but a few. The injury is deeply embedded within all these factors, none of which are stand alone.

To illustrate, a professional footballer who sprains his ankle could think: ‘how will this affect my career?’, ‘how long will I be out?’, ‘will this affect selection?’, ‘is this the end of my career?’, ‘what will this cost me?’ etc. The question to ask is how is this thinking likely to affect pain? Are those thought threatening? Of course they are, and hence affect the way in which the body protects. As well as promoting the right environment for healing (bottom up), one has to create the right conditions in all body systems (top down) by cultivating the right thinking and with definite action. Until thoughts and beliefs flavour nociceptive signalling, there is no meaning, and without meaning there is no pain. We need pain to survive, but we also need a logical and rational meaning.

Within the culture of football, there are certain beliefs and memes around injury. This will be the case regarding ankles, hamstrings and groins. Just listen to the pundits to hear their comments on these injuries to know this fact. How much of it is fear-based rather than being based on pain science and basic biology? Tackle this and you are more than half-way towards creating the right conditions for recovery.

Injury is incredibly complex because we are incredibly complex. Drawing upon this modern way of thinking about pain and injury and I believe we can tackle this increasing problem of recurring injuries in sport more effectively.

Persisting sports injury? Recurring injury? Football injury? Call now 07518 445493

18Nov/14
Caring for our carers

Caring for our carers

help concept, special toned photo f/x, focus point selectiveMy simple message with this blog is that we need to care for the carers. Undoubtedly the individual with pain or ill-health is suffering, but so are the carers who may be partners, family members and friends. They may also be professional carers who are not immune to the stress of looking after someone.

In brief, here are some of the reasons why carers will suffer:

  • Seeing a loved one in pain
  • Feeling helpless
  • Mirroring pain — it is not uncommon for someone to feel pain in their body having observed another person in pain. Biologically this may be quite useful as a learning tool, similar to learning that touching the oven causes a burn injury; ‘I won’t do that again’.
  • Becoming absorbed in negative thought patterns
  • The physical demands, including the number of hours dedicated to caring and what it involves; e.g./ helping to move the patient, household chores — this often in addition to their own needs
  • Disturbed nights
  • A lack of respite
  • Feeling a lack of support
  • Financial worries
  • Own relationship issues

There are many other reasons, however the key point is that the demands upon carers are immense. One of the biological consequences is inflammatory activity in the body due to chronic stress. This inflammation underpins and affects the widespread aches and pains, the compromised health (feeling under the weather), limited resilience and motivation, varied and unpredictable emotional responses and difficulty thinking with clarity — see the interesting study below.

Carers are vital for both the person in pain but also for society at large. There are not enough resources to provide for all those with chronic pain and health issues on a day to day basis and hence we need to care for our carers.

For this reason, I offer treatment, training and mentoring sessions for carers. Ranging from the treatment of aches and pains to creating ways of constructively adding to the therapy for their charge, we also work upon resilience, problem solving and motivational techniques. These strategies are for that person to cultivate their own wellbeing, but also that of the person they are caring for at home. Partners commonly ask how they can be involved in helping the patient move forward, and I gladly reach them about pain, health and what they can do to contribute in a potent way.

If you are a carer, or would like your carer to be more involved, contact me to book the initial session: 07518 445493

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Greater inflammatory activity and blunted glucocorticoid signaling in monocytes of chronically stressed caregivers. Miller et al (2014).

Abstract
Chronic stress is associated with morbidity and mortality from numerous conditions, many of whose pathogenesis involves persistent inflammation. Here, we examine how chronic stress influences signaling pathways that regulate inflammation in monocytes. The sample consisted of 33 adults caring for a family member with glioblastoma and 47 controls whose lives were free of major stressors. The subjects were assessed four times over eight months. Relative to controls, caregivers’ monocytes showed increased expression of genes bearing response elements for nuclear-factor kappa B, a key pro-inflammatory transcription factor. Simultaneously, caregivers showed reduced expression of genes with response elements for the glucocorticoid receptor, a transcription factor that conveys cortisol’s anti-inflammatory signals to monocytes. Transcript origin analyses revealed that CD14+/CD16- cells, a population of immature monocytes, were the predominate source of inflammatory gene expression among caregivers. We considered hormonal, molecular, and functional explanations for caregivers’ decreased glucocorticoid-mediated transcription. Across twelve days, the groups displayed similar diurnal cortisol profiles, suggesting that differential adrenocortical activity was not involved. Moreover, the groups’ monocytes expressed similar amounts of glucocorticoid receptor protein, suggesting that differential receptor availability was not involved. In ex vivo studies, subjects’ monocytes were stimulated with lipopolysaccharide, and caregivers showed greater production of the inflammatory cytokine interleukin-6 relative to controls. However, no group differences in functional glucocorticoid sensitivity were apparent; hydrocortisone was equally effective at inhibiting cytokine production in caregivers and controls. These findings may help shed light on the mechanisms through which caregiving increases vulnerability to inflammation-related diseases