All posts by richmondstace

12Sep/16
Mindful commuting

Mindful commuting

Mindful commutingMany people commute to work creating a great opportunity to create calm, focus and prepare for a top performance, simply with mindful commuting. In London, a huge number of commuters use the tube, which is rammed with people (in a rush), often smelly and particularly hot in the summer. How can one create calm and focus in those circumstances you may wonder?

As a commuter you join thousands of others, some of which push you, breathe on you, lean on you, rest their paper on you (I once saw a woman rest her newpaper on a man’s back, which she quickly moved when he turned, only to put it back when he looked away — it was quite amusing), stare at you and nudge you. Today there was a small space next to me and a man forced his way into it creating discomfort for everyone, including himself. So there are just a few incidences that could challenge one’s patience and yet what a great opportunity to develop the skills of patience and compassion towards others. In doing so, you feel better versus feeling anger, frustration or annoyance. We can choose.

Over and above developing a compassionate outlook for the day ahead by looking deeply at a situation (we can consider that the other person may be suffering for a range of reasons and hence behaving in a certain way), we can use the following practices to orientate ourselves towards positive emotions. Being aware of and acknowledging positive emotions broadens our thinking and receptiveness as well as enhances our resilience in the face of a challenge, all of which impact upon our performance at work based on how we communicate with ourselves and others.

  • each time you find yourself becoming irritated on your commute, take 3 breaths and in particular notice your out-breath
  • walk mindfully, paying attention to each step and just be curious as to what is going on around you. Notice how it makes you feel and return your attention to your walking
  • if you cannot get through the crowd because it is busy, return your attention to your breathing to create calm and then walk mindfully
  • be aware of those around you and wish them well in your thinking, noticing how this makes you feel and how the world then appears
  • as you pay attention to your breathing, think kindly about your colleagues and boss so that when you encounter them, you communicate with skill and not on a background of feeling stressed and anxious
  • if you feel stressed and anxious it is because your thinking (embodied) has drifted into the past or future, thereby flavouring the present. Take 3 breaths and see things for what they are; be aware of this moment
  • listen to a mindful app on the journey
  • practice mindful breathing when you simply pay attention to your breath that holds you in the present moment

There are many more ways of practicing but in essence just using one or two will help you create calm and focus. Try it and see!

Mindfulness is a very practical way of being that creates calm, peace and allows you to to see things for what they are as you are consistently aware of the present moment, you listen deeply and speak with skill to communicate understanding and compassion. This is transformative in all situations and achievable for all.

Mindfulness practice forms part of the Pain Coach Programme for pain and chronic pain | t. 07518 445493

29Aug/16
New thinking in dystonia

New thinking in dystonia

New thinking in dystoniaWe need new thinking in dystonia because the treatment of this very troubling condition must improve. This means that people suffering dystonia feel that they are getting better. The same can be said for all conditions that are viewed as persistent, as our understanding moves forward, creating new approaches that must be based upon science. One areas of particular interest that I believe will be highly influential, is the science of consciousness — what is it to be conscious? What is it to be like something?

The patient’s lived experience is something we seek to gain insight into as clinicians so that we can shape a forward trajectory characterised by less suffering. I would argue that this is an approach that we should be taking for all conditions. We may have an injury, a pathology, a disease or a pain yet we can always seek to reduce suffering in a number of ways by taking a broader perspective and look at the causes of suffering that are not directly related to the condition. This could be termed a whole person approach or a sociopsychological approach with a minor contribution from the biological dimensions — is it useful to understand the molecular biology of pain or to know what action to take to feel better? I would argue the latter. To feel better we may need to foster relationships, communicate, move, create a new habit, consider financial or occupational matters, just to name a few. Being able to determine which receptor is being activated is not particularly helpful in this light.

Once a person is diagnosed with dystonia, they may be offered botulinum toxin injections. In some locations, physiotherapy may be recommended but the content of the treatment programme tends to vary. There is no standard set of treating principles resulting in mixed results borne out in the literature. However, as far as I am aware there is scant attention given to sensorimotor training according to the latest understanding of ‘how we work'; a unification of action-perception-cognition, our experiences are our brain’s best guess about the possible causes of sensory information for which we seek confirmation with action.

Exercises alone are not enough. The understanding, the engagement with the programme (meaning), the expectation (what you are thinking will happen as a result of the training in that moment — the tape you play of what will happen with your embodied mind; a prediction) and the focus are all important. The complete programme must incorporate these elements as the person living the dystonia (the twists, the pulls, the tension, the jerks, the imprecision, the inconvenience, the pain, the second arrow that is the way you think about yourself and the condition) needs to be able to coach themselves in any given moment, day to day in order to be successful. There are a number of simple ways of facilitating this mindset.

Identifying with one’s strengths, those characteristics that have led to successes in the past, and employing them in this arena results in resilience, self-motivation and the necessary perseverance. Practice is key in creating new habits of body awareness, movement control and sense of self. Alongside a focus on strengths, one learns to manage weaknesses and distractions so that the direction of travel remains toward the desired outcome. Creating a clear vision of that desired outcome is an important start point to which one can check orientation.

Remaining open with a broad mindset tends the individual towards greater feelings of satisfaction and happiness. It is the the moment to moment emotions that cultivate how we feel and hence to purposefully notice positive emotions and triggers of our positive emotions both maintain a steer towards feeling open. When we are open, we experience the full opportunity that life presents, engaging with people and activities far more effectively, which in turn promotes more consistent positive emotional states. Both of these simple skills form a strong foundation for the sensorimotor training necessary to develop precision of movement, a core change needed to feel better and closer to how one feels one should be feeling in this moment. A further practice is that of mindfulness, which is being aware of what you are feeling, thinking and doing right now in this moment; being present, which by definition removes the suffering caused by our thoughts drifting into the past or future. In so doing, we are robbed of what is really happening right now.

As we understand ‘how we work’ more and more with the unfolding story of the science of the sense of self — who we are, how we function (move and act), how these unify into the lived experience, and how we can reduce suffering by creating the right context for healthy action-perception-cognition with a comprehensive training programme that addresses the lived experience. That is our role as clinicians.

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Sensorimotor training programme | t. 07518 445493

 

28Aug/16
simple skills

Simple skills

simple skillsThere are a number of simple skills that can be practiced to become a better clinician. In essence, when we are fully present and engaged, we are communicating this to the patient thereby creating a nourishing environment. This environment sets the scene for new understanding and new habits, beginning the transformation of the suffering person.

We are not separate from the environment in which we reside and hence we, the clinicians, have a role in how the environment supports the person getting better. Arranging the treatment space is important then, enabling the patient to feel welcome, heard, comfortable and free to express themselves. This expression is the story to which the clinician must listen deeply as all the information is contained within the narrative. Allowing the person to speak in their own language with occasional prompts and guidance is the basis of the onward journey towards their vision of a desired outcome.

For the clinician to practice mindfulness is a simple way of maintaining presence and engagement with the patient. This simply means that you are listening deeply and using insight to see the causes of suffering that are revealed as the person speaks freely. Add to this compassionate speech and the communication facilitates the way forward. Communication is part of the treatment as the clinician helps the patient understand their pain and suffering — what has happened so far, what is happening now, what is influencing their pain, what they can do, what the clinician will do and how they will go about it.

Practicing mindfulness is a simple skill. As a starter, the clinician can take 4-5 breaths between patients, paying attention to the rise and fall of their chest. On the out-breath you can consciously let go of unhelpful and distracting thoughts. As soon as your mind drifts into the past or future, you are no longer present and your engagement dissolves. During the session, recognising this happening and bringing your attention back to your breath is a way of re-engaging once more.

Taking a break midway through the day to move, breath and nourish is an important refresh and renew point. A period of deep relaxation for 10-20 minutes gives us energy to be present once more and focus on the patient: their words, their gestures, their messages. We must develop our abilities to gain insight into the causes of the patient’s suffering so that we can guide and treat, enabling them to get better and ease their pain and suffering. In fact, by gaining insight ourselves, we can then help the patient to develop their insight into the causes of their own suffering and create new healthy habits around their thinking, choices and actions to actively infer new experiences.

Practical point: start by taking 4-5 breaths between patients, and at the start of the day express gratitude for the opportunity to help people get better.

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Pain Coach 1:1 Mentoring Programme — develop yourself and your insights to coach people overcome their pain | t. 07518 445493

27Aug/16
Busy

Busy

BusyEveryone is busy. We are busy doing all sorts of things: working, cleaning, gardening, studying, exercising, reading, watching TV, listening to music. In fact, when we are occupied, we are busy doing whatever is occupying us, even if this is lying on the sofa; ‘I am busy lying on the sofa’. So it is a given that we are all busy, even if someone else deems us to be doing nothing, because I am still busy; busy doing nothing. When I am asked if I am busy, I always think about how to answer because in essence it is like being asked whether you are breathing. We are always breathing, we are always occupied with something.

Naturally, some occupations require more energy that others. The exertion of exercise or the concentration upon a piece of work would be deemed effortful, utilising our finite energy resource that is built from our intake of nutrients and rest, including sleep. Good sleep is fundamental for health so it seems — we know what it feels like the day after a bad night’s sleep. Building up our energy reservoir is important for engaging effectively with life: moving, thinking, focus, performance, communication. What fills our consciousness is impacted upon by how much energy we have in that moment. Tiredness tends to cause our attentions to drift towards the negative. How do children react when they are tired? Adults are not necessarily very different!

Sleeping well does not come easily to many people. Crafting a good sleep habit takes time and perseverance, and not just on the way to bed, through the day. With so many people suffering the effects of stress, which switches their biology to survive instead of thrive, night time continues to be a period of alertness, on the lookout for danger. Of course there is no danger, except thoughts that pass through the embodied mind as past is re-lived and future anticipated. Being present is the antidote, and there are simple practices to achieve this (next blog: simple skills).

Sleeping at night is not the only time we need to refresh and renew. We also benefit from regular bouts of relaxation during the day that allow us to recharge. Recharging underpins performance, as to perform optimally we must engage and focus, which we can only maximise if we have energy. Every 90 minutes, taking a break and refreshing with simple practices is a good start point, diarising if necessary. Additionally, each day a period of 10-20 minutes of deeper relaxation is important. Some people will have a longer bout of rest between 12pm and 3pm — the siesta is a great idea. You may be thinking that you don’t have time for all this rest, however, the gains in energy allow you to perform with greater efficiency. Multi-tasking is a red herring; it simply means we are doing several things without our full focus. In summary, without refreshing and renewing, energy levels dwindle and performance fades so in fact we cannot afford not to factor this into our day.

Athletes periodise their training. This is a habit we can adopt day to day to optimise performance as individuals: e.g./ work, relationships, activities, communication. It is easy creating a new habit. It just needs practice. So, be busy, but make sure you have enough energy.

Pain Coach Programme to overcome pain problems and to optimise performance | t. 07518 445493

27Aug/16
If pain

If pain

If painIf pain was understood, there would be less suffering.

If pain was understood, the right messages would be given from a young age, sculpting behaviours based on what needs to be done.

If pain was understood, there would be no fear about it.

If pain was understood, we would focus on what we can do to feel better.

If pain was understood, it would be known that listening deeply is the first step to help someone transform their pain.

If pain was understood, it would be known that understanding pain changes pain.

If pain was understood, there would be an enormous amount of money available for a better society.

If pain was understood, it would sit in the realm of public health and not medicine.

If pain was understood, there would not be the reliance on medication.

If pain was understood, what would the world be like?

— this is the mission of UP | understand pain; to globally change the understanding of pain, because put simply, the world would be a better place if pain were understood.

www.understandpain.com

23Aug/16

Inequalities in pain relief

A brief article in yesterday’s Guardian highlighted one of the inequalities in pain relief. The author, Grace Rahman, focused on the question why black patients are given less pain relief in the light of recent research. With pain being the most common cause of Emergency Room visits, there is plenty of data to analyse. This is likely to be the same in the UK, pain being the primary vehicle that takes people to seek help. As a significant aside, it astounds me that pain is so low on the public health agenda in terms of funding for research as well as overall recognition.

Depression and chronic pain take the first two positions in global health burdens — they cost us the most. Yet where are the campaigns? Where is the TV coverage? They do not exists despite the fact that pain is a universal experience, except in an unlucky few with a rare genetic disorder, which is normal and necessary for survival but so deeply troubling when it persists. Therein lies a major issue contributing to the question penned by the journalist: why are black patients given less pain relief?

Previously, young babies may not have been given pain relief and older people may still not receive adequate pain relief, especially those who are cognitively impaired. The aggression seen in someone suffering dementia may well be due to pain that a simple analgesic would relieve. The misunderstanding of pain underpins all of these contexts, resulting in poor treatment that is based on the wrong thinking. The lack of pain education is incredible when you consider it in this light.

A study quoted by the author highlighted the knowledge gaps of white medical students who rated pain levels to be lower in black people when looking at case studies. Why would this be the case? It was thought to be due to ‘entrenched ideas’ about how people differ biologically and about how they behave in relation to using medication.

Each person is unique with their own personal experiences and narratives of their life to date. This makes an individual’s pain unique, and at any given moment our lived experience that could include pain, is also unique. I have never had this moment before and never will again. So even in the individual, the pain is never the same. We are always changing as we build up prior experiences with every passing moment in time. Understanding this is important and also delivers hope, because when combined with a working knowledge of pain and what we can do to actively steer a desired course within realistic parameters, we actualise change.

Therefore, as clinicians and as a society we must appreciate that each person’s experience of pain is unique and just as they person says it is — listening deeply is vital to gain an understanding with the required compassion. Just spending those moments with the person, allowing them the time and space to describe their experience allows a calming. We must certainly appreciate culture, gender and beliefs as we impart the truth behind someone’s pain, giving them knowledge and skills to overcome their pain and what fuels the sensations. This is the same for every person — whatever the colour of your skin, age or sex. Deep listening, compassionate speech and a focus on what action to take in this moment.

Much suffering comes from how we think about our pain, which is why we feel better when we understand pain and the fear dissolves. When the fear and worry decrease, so the pain eases and we can focus on what we need to do to get better. Fear, worry and depression are based on the contents of our thinking from the past or the future, neither of which exist except in our embodied minds. The only real moment is this one, now. Practicing being present and seeing what is actually in front of you by using the breath for example, allows the person to let go and concentrate on this moment. This is the foundation for moving onward in a chosen direction.

Medication is part of overcoming pain. It can be useful when used wisely within a plan that includes how and when the drugs will be reduced. Of course this is individualised to the person, their condition and their needs. Many people choose not to use pain relief, and certainly the opiate based drugs. Everyone wants relief and this should be a primary aim of any treatment programme, however, the person needs to understand how they themselves via their own thinking, perceptions and actions can change their pain. This is the main bulk of the work for that person as they need to be able to coach themselves at any given moment, each day. The strategies and exercises become healthy habits formed through practice that interweaves into the day. Continuing with normal activities in tolerable chunks maintains a sense of living a life and I often say to people that they can only get only get back to living by getting back to living — doing the things you want to and starting doing the things you have not been doing, bit by bit; thinking ‘can’ instead of ‘cannot’. It is just that you need some ways and means to do so as you build up tolerance by following a programme. A simple analogy is all the background work that an athlete would do in order to perform their sport. The programme is the background work.

Bearing this in mind, there is only one way and this is to consider and treat the unique person as much as the condition. In doing so we learn about their suffering and guide them forwards with treatment that gives the person working knowledge of their pain and skills so that they can coach or mentor themselves forward by thinking and acting in such a way as to take them forwards.

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Pain Coach Programme for persistent and chronic pain | t. 07518 445493

 

22Aug/16

Learn from the Olympics

Whilst we have witnessed some magnificent feats of athleticism, there is always an opportunity for humanity to learn from the Olympics. The humble winners stand out but of course behind each victorious performance is dedication, focus and pure hard work. Nothing is achieved without effort and practice regardless of talent. Let us practice and encourage effort.

There is often a desire to believe in natural talent, and although an individual requires a certain aptitude, without effort there will be limited success. We must work for all that is worthwhile and encourage this attitude. Telling a youngster that they are brilliant or gifted will not necessarily encourage the right attitude. Let us encourage the right attitude.

In particular, watching sports that do not receive the coverage of others is a pleasure. The Olympics was an opportunity to see athletes at the top of their game, performing on the biggest stage. They took their opportunity by mustering every cell in their body, fuelled by a passion and a desire to achieve their dream. The dream is always a medal, but there is a huge chunk of pride that must be taken from being there and taking part. This is also something to consider, being part of something that by and large is positive and inspiring. Let us encourage participation.

This last point is important on a number of levels including the health of society. Witnessing the Olympians will hopefully inspire people from all backgrounds to participate in activities far and wide. There are many so sports to choose from, suiting different individual strengths. Society and policy makers can take note and create opportunities, regarding the benefits of more and more people engaging in meaningful activities. We have land, water and many facilities. Making best use on the back of what has been in Rio over the last few weeks and with what is to come with the Paralympics.

Let us use the examples we have seen and will see soon to inspire us to work hard, to be humble, to support each other and create a better society for all.

 

18Aug/16
Trauma

Trauma

TraumaAll injuries have a degree of trauma, but some more than others. The moment of injury is just that, a moment. Part of the experience is an urge to do something in a way of protecting the self both in thought (what shall I do here?) and action taken. The thoughts and actions, unified into a lived experience of action-perception, are based on prior knowledge and situations as we try to make some sense of what is happening now. As humans, we have a tendency to flavour the present moment with thoughts of the past or future, neither existing beyond the thought itself. The problem lies in the fact that the thought is embodied, resulting to a greater or lesser degree from the current body state, which we then fully experience with sensations in the body, feelings and emotions; embodied. For example, purposefully thinking about a prior happy occasion usually fills you with the same feelings of joy and pleasure as if you were there again. The same is true for thoughts of an unhappy situation in the past. However, this body state is continually updating and hence we are in a position to steer our change in a desired direction by thinking-acting in a way that aligns with our values and vision of how we want to be. We purposely put ourselves into situations to get better.

Understanding the state of the individual before the trauma and at the time of the trauma provides important insight into the subsequent unfolding of events. A person experiencing persistent pain continues to suffer despite the tissues (body) healing, which they do to the best of the body’s ability, because the systems designed to protect us continue to be vigilant to potential dangers. These potential dangers soon become normal day to day situations, now regarded as posing a threat to the individual’s survival, hence the pain to motivate defensive thoughts and behaviours. The longer these habits persist, the more suffering. But, this is not set in stone and indeed the practice of new, healthy habits steers a new course. We are designed to change and we can decide on the direction, using new habits to get there. Not always a smooth route, it is the one that takes you towards a meaningful life as you overcome the challenges with new understanding of pain and the best course of action. Maintaining this course also relies upon recognising distractions (unhelpful thoughts that affect mood and motivation — old habits) and re-orientating to the desired route.

Healing is not simply about the muscles, bones and other tissues repairing. It is about the person resuming their sense of self — ‘I feel like me’. This is a process of understanding, adapting, gaining insight into the causes of suffering, the practice of new habits and gradually engaging once more in normal activities including socialising. I think about this as getting back to living, by getting back to living instead of waiting for pain to subside before re-engaging. The re-engaging itself has a role in getting better and pain easing. This comprehensive approach, or whole-person approach, is key to success.

A pure focus on tissues means that the person living the experience is neither acknowledge nor addressed. There is the pain, the injury (the two are not well related) and the person’s appraisal of both, which if not validated and considered, means that a huge source of suffering is neglected. This does not mean in-depth psychological assessment, instead recognising that there is an individual with a story that needs guidance towards getting better. We are more than an injured leg or back. Insightful and compassionate clinicians will work in an egoless way as they focus on the person getting better by helping them to understand how they create the conditions for their health — environment, surrounding and influential people, their programme. We often use the phrase ‘I want to go back to how I was’, but of course this is impossible as we cannot go back in time. What we can do is adapt and focus on getting fit and healthy, and in so doing the body, the self, predicts less and less need to protect and hence the pain changes as we get better.

On first seeing a person who has experienced a trauma and on-going suffering from their persistent pain, we must consider prior health, pain experiences and beliefs about how we overcome problems. It is common to have had or to have other sensitivities, sometimes for many years, which exemplify a pre-existing state (or pain vulnerability) that has been primed by painful episodes over the years. This means that a new injury or situation deemed in need of protection will arouse a more vigorous and potentially prolonged set of protective responses, vigilant and fear-based behaviours. Knowing this from the outset means that the new issue can be addressed fully. Examples of common prior conditions include irritable bowel syndrome, migraines, jaw problems, persistent aches and pains (e.g. back pain), pelvic pain or period pain. These sensitivities can have arisen as part of an overall protect state following early traumas in life that have triggered the protect state, which has continued to emerge in many circumstances including normal ones. We learn to avoid and look out for trouble and can see it in the face of day to day activities, resulting in persisting pain and anxiety. However, with change occurring every new moment, we are able to transform this suffering by seeing things for what they are as opposed to being lost in thoughts about the past or future that arouse unpleasant sensations and emotions (in the body — we are embodied).

In discussing emotions and thoughts, this does not mean that we only focus on these dimensions. As stated earlier, we must focus on the person and their unified experience that is constructed by their brain, mind, person, body etc. On shifting a thought purposefully, inferring something different, we immediately feel differently about that situation. ‘How are you choosing to think about this?’, you could ask yourself. ‘Is there another way I can look at this?’. Recall the experience of where you feel emotions. It can only be in the body as thoughts are embodied. They are not ‘out there somewhere’, they are here, in me. My body state determines my thinking as much as my thinking determines my body state. Sit up for a while and notice how your thinking and feeling changes. You can gain insight into how someone is feeling by observing their posturing and manner. Imagine going into a business meeting to find the person you are about to discuss a deal with, sprawled across his chair with his feet up on the table. He has not said anything yet you gain insight into his approach, character and manner. Will you do business with him? Further, force a smile by gripping a pencil longways between your teeth, look in the mirror and notice how your feelings and emotional state change.

We are complex, predicting what needs to be experienced in any given context based on what we know. There are a huge number of variables that we cannot account for as we are only aware of a very thin slice of what is going on in any given moment — what we are conscious of, making many assumptions from prior learning. In terms of persistent pain, the intensity, the impacting nature of the experience usually far outweighs any signs of ‘damage’ or injury. Often there is evidence of natural degeneration that slowly evolves, quietly informing body systems which predict the meaning of the information, eventually reaching a point of conscious protection when it hurts. This is a slow burner with a point in time when pain is noted. 

In trauma, there is an obvious incident, which is embossed upon the person at that moment in time. The reverberating effects from there on depend upon that person: what they have experienced before, how their body systems predict the causes of the sensory barrage, urges manifesting as behaviours and actions taken, thoughts about the situation (meaning, attribution of causes etc.), emotions that emerge and the onward unfolding of these experiences unified as the story. Naturally the time frames vary according to the conscious awareness of the person, wherein a head injury would impact on memory of the event. In an emergency situation, clearly there are priorities for the medical team to protect the person and maximise the chances of survival and sets the scene for recovery and healing.

From the earliest possible time point, the right messages about what has happened and what needs to be addressed should be purported. The person needs to understand their pain and problems so that they can focus on the right action to get better. This is day to day, moment to moment as the advice and education are taken, internalised and become second nature as new healthy habits are practiced. The notion of the Pain Coach emerged from this thinking, blended with a strengths-based approach. Strengths-based coaching focuses upon developing a person’s existing strengths and managing their weaknesses. On the basis that we are seeking to focus and perform to the best of our ability, the strengths coaching method offers an effective modus operandi stretching across recovery from injury to sports and business performance. Strengths are many, and can include perseverance, attention to detail and compassion. People often realise that they use these strengths in other areas of their life but not in relation to getting well again.

Experiencing trauma in life presents the person with a challenge in many different ways. It also presents a challenge to those around them including family and friends as we are not in isolation to others or the environment in which we reside. There may be a region of the body that has been injured or affected, however, it is always the person who has to deal with the situation and recover. This is a key point that can often be missed, particularly when the injury is complex and multiple parties are involved in the treatment planning. Whilst we discuss the incident, the injuries, the symptoms and the impact upon that person’s life, they are living that life and only they know what that experience is like. This is the reason why deep listening is so important from the outset. It is the person who heals and recovers. It is the person who gets better, and hence it is the person we must know and treat as much, if not more, than the condition because each of us will experience our life events in our own unique way.

The Pain Coach Programme to overcome persistent and complex pain | t. 07518 445493 

15Aug/16
simple skills

Get the most out of your exercises

get the most out of your exercisesIt is highly likely that when you visit a physiotherapist you will be given exercises and hence here is a brief guide to how you can get the most out of your exercises. The training is important, setting the scene for a desired change, but in order to be successful, we need to think about how we will be doing the exercises. In the Pain Coach Programme, we look at this in the necessary detail so that the individual can achieve the best outcome. Usually the exercises themselves are very straightforward, with the most complicated piece of equipment being the person, followed by a mirror. That’s it. We need to set the scene, focus, attend to what is happening now, practice, put in maximum effort, perform and learn. Sounds easy!

1. Create the right environment

Where do you do your exercises? How does that environment affect you? Are you doing some of the exercises at home, at work or outside. Notice where you can concentrate with ease and where makes you feel good about what you are doing. We are not separate from the environment in which we find ourselves and hence it can work for us well in creating the conditions to get better. It should be light, spaceous enough to move freely and as calming as possoble without stimuli that trigger survive responses. This includes phones, computers etc that can grab your attention and make you think about something else.

2. Take a moment to be present

To truly concentrate you must be present and aware of what you are feeling, thinking and doing. From there you are able to learn by gathering insights into what you are doing versus what you want to do, making corrections to movements for example. Mindful presence means you are present and aware, rather than being lost in thoughts about the past or the future that are embodied. In other words, our thinking is affected by our body state and vice versa as there is no separation. As an experiment recall a happy time: where you were, who you were with and what you were doing. This is a thought, but how do you feel in your body? So, how to be present? Simply take a breath and notice the in-breath and then notice your out-breath. We can only breathe now so gently concentrating on the breath is a simple way of being both mindful and present. Anytime you notice your attention drifting away, kindly bring it back by noticing your breath.

3. Connecting it all together

We must be fully aware of our mind and our body as a unified experience. How can you learn about your body and how it moves if you are thinking about a meeting yesterday or dinner tonight? You can bring your attention to your breath, saying to yourself ‘I am breathing in’ as you breathe in and ‘I am breathing out’ as I breathe out. Notice how you become aware of this moment, which is the creation of the right conditions for recovery and for learning. You can then expand your attention out to your whole body, thereby connecting it all together in a nourishing way. This only takes a few moments, but without the right attention, the exercise will have a limited effect as you will not realise what you have done.

4. Write a learning diary

‘What we focus upon we have more of’, is a useful way of being. When we notice our positive emotions, which can be subtle, and purposefully attend to them, our thinking broadens. There has been a good amount of research looking at this effect. Keeping a diary is a way of documenting the way we feel and what we have achieved so that when we look back and read what we wrote, we have an accurate view of what was happening at that time. Our memory of what happens is poor, but we do convince ourselves that certain things happened or we felt a particular way. Whether or not it happened like that becomes irrelevant as it is the memory we think we remember that counts. On this basis, writing down each day something that we have learned from our practices of training is a useful insight that motivates further learning as we focus on our achievements and strengths. This is encouraged by positive psychologists as well as featuring in mindfulness practices and strengths based coaching, and for good reason — focus on your strengths and manage your weaknesses, but you have to know what they are first!

5. Accepting where you are now as a stepping stone towards a desired outcome

To accept that I am here in this moment allows you to focus on what needs to be done right now that is in alignment with your desired outcome. Being really great at all the things that you need to do now will naturally allow you to move to the next step as you continue to transform. We are changing all the time and hence need to ensure that our change is in a desired direction. For this we need a vision of where we are going; a vision of a successful outcome that we visit often to ask the question to ourselves: ‘is this taking me towards my desired outcome or am I being distracted by thoughts of the past or future?’. Acceptance does not mean giving up, instead just saying ‘here I am right now’ and ‘this is what I need to think and do to keep myslf going in the right direction’.

The Pain Coach Programme to overcome chronic pain and injury | t. 07518 445493

09Aug/16
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Refresh and renew

seaRefresh and renew is one of the most important strategies that I teach individuals who have been suffering persistent pain. Within the refresh and renew there are a range of techniques that can be used dependent upon place, time and context, all of which are important ingredients making a whole. We are in no way separate from where we are, what we are thinking, what we are doing and what we are feeling. These are merely the conscious elements and of course there are the vast subconscious elements including our biology in the dark.

Being in pain is exhausting, usually added to by feelings of anxiety and concern. There can often be a cycle of pain and sleep disruption, one begetting the other as time moves on. It seems more and more probable that sleep is fundamental for our health, which is why creating the conditions for a consistent daily rhythm of activity and rest is vital. Most people know what it is like to ‘survive’ after a bad night’s sleep, but imagine the effect when this is on-going.

Refresh and renew is needed throughout the day by everyone. Every 90 minutes we may feel an urge to do something: move, take a few breaths (4-5 is good), have a healthy snack or a glass of water. This is certainly the case when one’s health is below par as we need to create the conditions for our biology in the dark to switch into health mode rather than survive mode. The person suffering persistent pain spends much of their time in survive mode as they are both consciously and subconsciously protecting themselves from perceived threats. Consider the person with back pain who walks into a room to survey for the closet chair, whether it is likely to be comfortable or if they will be able to have a conversation because their pain maybe too distracting. The thought processes, predictions, anticipations and expectations that are embodied, will prime the coming experiences. The good news is that creating new habits can change this routine for the better, beginning with being aware that this is what you are doing.

All the extra monitoring and thinking is tiring as you use your resources, along with imprecise and guarded movements that require more energy than normal. Too much muscle activity for example, has a huge energy consequence, which is why refresh and renew is so important through the day. Setting reminders and alarms can be effective in the beginning, but as the new habits take hold and the internal messages become second nature, you increasingly make the choices that orientate you to getting better; your desired outcome.

Pain Coach Programme to overcome persistent pain | t. 07518 445493