30Mar/18
Persistent pain and injury in football and sport

Persisting football injuries

Chronic pain, Pain, Pain Coach, Sports Injuries, , , , ,

Persistent pain and injury in football and sport

Persisting football injuries are the scourge of the dressing room. Whilst everyone accepts that injury is ‘part of the game’ and part of sport, this does not necessarily make it any easier for the player, whatever the level, or the treating clinicians. A range of pressures and expectations exist, which impact upon the experience and the outcome. Managing these in the best way is one of the key components of a successful approach. Kieron Dyer, in his new book, describes the suffering he endured as a result of his recurring injuries and pain, which certainly had an impact upon the longevity of his career.

“Even though I knew I was injured, there was a lot going through my mind when I was celebrating with the fans…..I couldn’t cope with a career that had become a continuous cycle of hope and despair. If there were an end in sight to it, it would be different, but no one could seem to cure the problem” ~ Kieron Dyer

Addressing an acute injury is a well known and understood process: diagnose the problem, administer the right messages and treatment, start rehabilitation as soon as possible, build fitness and sport specific training with a gradual return to play. So why is it that some plays become besieged by persistent and recurring injuries and pain?

The broad brush answer is the same for any person experiencing chronic pain and injury. There are a number of vulnerabilities and contextual factors at play, meaning that protective measures rightly kick in, but do not necessarily ‘reset’ to an appropriate level of vigilance. As a consequence, this loss of differentiation means that more and more moments are perceived as potentially threatening. It only needs to be a possible threat for a protect state to be initiated, with the perception of pain being part of this state.

The first step of understanding, especially for the player, is that pain and injury are neither the same, nor well related. We have known this for many years:

“The period after injury is divided into the immediate, acute and chronic stages. In each stage it is shown that pain has only a weak connection to injury but a strong connection to the body state.”
  ~ Wall (1979) Co-founder of Textbook of Pain

To fully describe the complexities of an emergent chronic problem is beyond the scope of this blog — we cover many of the important dimensions in the Pain Coach Workshops. Chronic pain and injury is a specialist field requiring a broad knowledge of a number of areas together with experience of working with suffering individuals. These include science pertaining to pain and survival, philosophy, cognitive science, psychology, sociology, anatomy and physiology to name but a few. This knowledge then has to be applied phenomenologically with meaning and effect. We need a means to deliver treatment and provide practical tools that allow the person to pursue a purpose and achieve results. The means that I propose and offer is that of coaching, pain coaching, which is all about getting the best of an individual.

A brief insight into the vulnerabilities for developing chronic pain is useful. We are essentially on a timeline, which means that every episode in our lives is logged as an experience with a learning effect. Significant events in particular will shape us as we journey through the ups and downs. We know that early life stressors have a particular effect as the biology that protects us is evoked at a young age, at a time when the person is maturing and reliant upon others for safety and security. When this secure base is compromised, there is a vulnerability to suffering a range of complete person problems from depression to irritable bowel syndrome to chronic pain states. The sensitivity manifests in different ways in different people of course. In recent times we have heard about terrible situations, which will impact upon brain, body and behaviour ~ the 3 come as a unified package of course, the person. Dyer has bravely described his early experiences, which will have been a huge factor in how he subsequently sensed himself and the world.

In terms of pain, as a perception in the face of a perceived threat, the responses and actions become increasingly prevalent as the range of threats increases. For the player, these threats come in the form of their own thoughts (inner dialogue) like any other person, but also from the pressures of performing, from the club, from the fans, from not understanding their pain and why it persists, as well as other day to day influences. Peak performance emerges from a focused approach, from having energy, from being in flow and from minimising distractions. It is the inner dialogue that forms the greatest distraction.

Players must understand pain as the first step. It is their pain, and they can be given knowledge and tools to manage and overcome the problem. They understand that the experience is also affected by distractions that come in the form of old beliefs about pain and injury together with the aforementioned pressures. As Dyer realised, “So I hadn’t been pulling my hamstring at all. It just felt like it. Fans and others see an injury prone player but do not know the reality of pain”.

“So I hadn’t been pulling my hamstring at all. It just felt like it. Fans and others see an injury prone player but do not know the reality of pain” ~ Kieron Dyer

Chronic pain and injury in football and sportFor anyone to manage and overcome a pain problem, an encouraging environment must be created in which the knowledge and skills are put into practice. This would include alleviating the pressures in the best way so that the focus can be on recovery within a realistic time frame. This time frame may not suit everyone, but the risks of ignoring this for the sake of a hasty return are high. A player clearly has the strengths of focus and perseverance to enable him or her to reach the professional level. They will also have overcome a number of challenges and set backs along the way. Drawing out examples of these helps the player establish the characteristics they hold, which they can use to address the current challenge of pain and injury. Maintaining a focus upon the right steps and managing the consequences of drifting off course is the route to success, encouraged and enabled by skilful clinicians who share the picture of the desired outcome. This is no different to clarifying where you are sailing your boat, setting sail in that direction and using skills and strengths to maintain course, manage the boat in tricky waters and get back on course as quickly as possible.

A programme to address persistent pain and injury (the two are different as you will know) must be complete. The clinician establishes the full story, the back story, the context and the circumstances before confirming with the player where he or she is going. This is why knowing your players is vital, and being able to have open conversations that are more likely when we practice deep listening and create an encouraging, compassionate environment. The biopsychosocial model is one that offers a framework to consider all of the factors, but of course it is how they all come together as the experience of the person that is important. It is the person who feels pain, not the body part, and hence ‘how the person is’ becomes highly relevant together with their approach to life and challenges. This style of doing life, possibility or problem, opportunity or obstacle, will often play out when it comes to pain. And this is where we deliver new choices that are the basis for moving onwards.

There are many challenges to managing and treating a complex, chronic and persistent pain and injury problem in football, especially in the professional game. Dyer describes the experience from the player perspective, delivering a stark insight. Players at the top level may receive vast rewards for their abilities, yet they are under a range of pressures that have a huge impact on pain and injury that need to be understood and addressed skilfully, to maximise the potential for recovery and return to play. This is always the goal.

Richmond delivers The Pain Coach Workshop for Football ~ a 1 day workshop for medical teams who want to build on their skills to be able to effectively manage the range of factors that need addressing in persistent and chronic cases of pain and injury. The Pain Coach Workshop for Sport is a more general experience for problem pain in sports. Call us now to book your workshop t. 07518 445493

Persistent pain and injury in sport

07Mar/18
Persistent injury in sport

The toll of persistent injury

Anterior knee pain, Chronic pain, Chronic pain in sport, Chronic sports injuries, Knee pain, Sports Injuries, Sports medicine, understand pain, , , ,

Persistent injury in sport

Rugby player Dave Attwood talked about the toll of persistent injury in The Guardian today. This is likely to be one of the greatest fears of any sports person, particularly for professionals with a career at stake, and who identify with their game.

The physical nature of the training and the sport itself, particularly considering the extent of contact in rugby, both present a risk of injury. This would be accepted by players, with pain being part of the deal. It is expected and perhaps even revered as a demonstration of commitment. No pain, no gain continues as a philosophy.

Then we have pain that persists, which gradually begins to intrude into the player’s attention at inappropriate times. Thinking about pain rather than the game will inevitably affect performance and outcome. Beyond the white lines, the pain seeping into day to day life takes the suffering to a new level. This is a typical story for chronic pain. A sequence of priming events akin to a kindling fire, building and building along a timeline.

Not only does the player need to deal with the pain itself and the day to day rehabilitation, he or she also has to cope with a shift in their role. All of the above are ample causes of suffering, which can take its toll on anyone. We are all vulnerable to a greater or lesser degree. And this is why the modern understanding of pain and injury is so important across society, including professional sport. The biomedical model does not provide any long-term solutions to persistent pain, yet it continues to predominate in both arenas. This must change.

In sport, acute care is usually very good. However, identifying players who could be at higher risk of developing chronic symptoms should be a routine part of screening. Medical teams in sport need to be armed with knowledge allowing them to identify the factors the pre-exist but also be aware of characteristics of the acute injury that may heighten the risks; early, uncontrolled pain for example.

Dave Attwood: ‘Compulsory counselling for long-term injuries will stop stigma’ 

Attwood suggests that counselling should be compulsory. He acknowledges that not everyone will persist with this kind of input, however relevant it might be for that person. The opportunity to talk about the effects of an on-going injury would offer a non-judgmental arena of safety for players to express fears and worries. If players were also educated about persistent pain and injury, they would realise that a change in emotional state and thinking is typical, thereby reducing the stigma. Of course, the stigma arises from the existing culture that is misinformed when it comes to pain. Much of the education enabling pain to be understood would be very similar in content to that of a modern pain management programme.

To see a high profile player speaking out about the issue of persistent injury will hopefully encourage others to seek the right kind of help. Dealing effectively with on-going pain is a specialist area that requires a comprehensive approach that addresses all aspects of the experience. Medical teams may need to call upon external specialists to work with them for particular players. This is something that I have done and it works very well, particularly because professional clubs typically have great facilities and staff who you work with to cover all angles: strength and conditioning, diet, sports doctors, physios, massage therapists etc. But, it all starts with understanding pain.

‘Pain and injury are not the same and they are not well related’

To understand pain means that you know what you must focus upon, without fear, to achieve results. In managing painful moments and seeking to overall overcome the pain problem, it takes dedicated practice, encouraged by positive coaching. The content of the practice varies according to the nature of the problem and the necessary approach. That is for the specialist to decide and communicate with the player and medical team.  The Pain Coach Programme that I designed is commonly a blend of sensorimotor training, mobilisations of different types, skills of being well, and practices that bolster resilience, focus and hence performance. This sits in with input from other fields, very much embracing teamwork with the player’s best interests at the heart. A typical aim is to achieve greater than pre-injury performance.

The coverage of on-going injuries is typically negative from the press, fans, the team and the club. Instead there must be understanding, compassion and encouragement. The right conditions for recovery must be created, easing the pressure off the player so that he or she can truly focus on their job of the moment, getting better. So, well done Dave Attwood and The Guardian for raising the issue, another example of chronic pain in society. It is time for change.

  • Pain Coach Programme — for players suffering persistent or recurring injuries and pain
  • Pain Coach Mentoring & Workshops for clinicians and therapists who want to build their skills and knowledge in chronic pain
  • Pain Coach Workshops for medical teams

t. 07518 445493 or e. [email protected]

Richmond M. Stace MSc (Pain) BSc Phty BSc (Hons) PGDN | Specialist Pain Physiotherapist, Pain Coach, Clinical Lecturer (MSc Sports Medicine @ Queen Mary’s University London) & Entrepaineur. 

Blended with my clinical work and workshops is the Understand Pain social enterprise that has the purpose of driving social change with regards pain, the number one global health burden.

28Jan/18
Motion in e-motion

motion in e-motion

Chronic pain, Pain, Wellness, , , ,
Motion in e-motion

motion(less) https://flic.kr/p/o4jG5d | C Frenzl

There’s no mistaking the word motion in e-motion. The two are inextricably bound. The way that you feel, your emotional state, is governed by what you are focusing on in this moment. And what you are focusing on is an affordance, or opportunity within the context–the opportunity to act or think in a particular way.

What you are focusing on appears to pop in to one’s awareness. Sometimes it drifts off, and sometimes we toy with it, so it seems to stick around. If it is a thought about something pleasurable, you embody a sense of joy, excitement and a desire to repeat the behaviour. If it is a thought about something unpleasant or scary, you embody other emotions such as fear or anger. All are based upon what you are focusing on and the interpretation of that focus, or the meaning to you.

Your state is governed by what you focus upon

Nothing is anything until you give it a meaning, and that really comes from our conditioning over many years–beliefs that you have gathered through life and what you have been told. Were they right though?

Our state is characterised in one sense by how it is embodied. How do I experience that state in my physical body? Noting a particular feeling or sensation in the body brings us to the conclusion that we are feeling a particular way. Contemporary neuroscience research is revealing fascinating relationships between our internal body sense (interoception) and our perception, cognition and decision making ability. Fundamentally, we all know that the ‘mood’ we are in affects the way we operate in the world: what do I notice? How do I move? What choices do I make? etc.

We can easily notice how someone is moving and posturing to gain an insight into how they feel. Add facial expression and language, and we have a fuller picture, yet the quality of motion is usually enough if you are observant. Likewise, we have a sense of our body as part of an overall assessment of ‘how I am’. Once we have established our state, we can decide whether this is one that affords us healthy opportunities or not. Do I need to change state?

motion in e-motion

It does not take long to change state of course. We do it all the time. One of the simplest ways to change state is to use motion–move around! Shifting our posture and facial expression result in feeling better together with actions that benefit others as we focus outwards instead on inwards. The challenge in the modern world is that we are encouraged to suit ourselves at the expense of others.

Motion is in e-motion, yet this is a two way street. We may use movement to feel better or build wellness, but we also move better when we feel well and in a positive state.

Here’s a fun game to play, especially if like me you are a commuter: look at your fellow travellers and see if you can work out what kind of state they are in right now. It maybe best to avoid asking them! As a bonus, you may also like to try the smiling game. See how many people smile back when you smile at them. Whilst you are smiling, use this as an embodied wishing them well, even saying to yourself ‘I wish you well with this smile’, just to generate the authentic smile that you can when it fronts the feeling. There you go, another example of motion (smiling) in e-motion.

These are some of the simple skills I teach and coach people in pain to learn to change state. I also teach clinicians who come on the Pain Coach Workshops how to build their own wellness and self-compassion with practical tools that get results in them and their patients. It is a matter of replacing old conditioned ways of being with new and better ones!

RS

Pain Coach Programme

Pain Coach Workshops

Pain Coach 1:1 Mentoring 

22Jan/18
loneliness is embedded in society

Politics of loneliness

Chronic pain, Depression, Happiness, understand pain, , ,
loneliness is embedded in society

loneliness by Alice Popkorn (https://flic.kr/p/a6RWak)

We have a new ministerial post in Britain: the minister of loneliness. Tracey Crouch was recently appointed to continue the work of Jo Cox and following the recommendations of a cross-party report. This is a positive move to address a problem that is embedded within a society that has championed individualism at others’ cost, a rat-race, and a ‘me-first’ model of economics (The Guardian editorial, 20th Jan, 2018). Happiness does not emerge from such a context, instead isolation for many, with very real effects upon health.

Of course this approach is not just evident in the marketplace and the workplace. It has been encouraged in schools where grades are the measure of success, and being better than everybody else is a driver. The reality is that no-one is better than anyone else, and on continually feeling that they must look a certain way, be on a certain social media channel, have certain material things and strive to be better than the others, the pressure builds. This is one of the main reasons for the ever-growing issue of childhood and teen ill-health. Loneliness is almost certainly in the mix. How lonely must it be to always be thinking about oneself?

“You are no better than anyone else and no one is better than you

~ John Wooden

Yet this is a society of our making. We must all wake up to this and build structures that promote collectivism and connection in line with our design to co-operate. It will not be enough to try and minimise suffering downstream by picking up the pieces. We need top down change in attitudes and beliefs, because what we are doing at the moment is not working. The next generation needs this desperately. They need to be prepared for the modern world: creativity, critical thinking, communication and collaboration — the 4Cs.

Suffering is part of life. How we address our suffering and support others who suffer determine what it is actually like. Suffering affords opportunities to learn and transform experiences. To try and wrap people up in cotton wool will not work. Giving them practical tools to roll with life’s ups and downs together with know-how, creating opportunities to pursue a purpose, to master chosen skills and feel a sense of autonomy are all part of a healthy, evolving society.

Those who are familiar with the scientific literature on loneliness know about the biological effects. There are several key points to consider. Firstly, it is the perception of loneliness that is the governing factor. Secondly, in the case of perceived loneliness, we switch at a gene level to being inflammatory. This makes sense because being isolated means that if we are bitten by the sabre-tooth tiger, our healing responses are ready to go. That’s basic biology at play. If we perceive ourselves to be part of a community and connected, we are pro-viral because we are more likely to pass viruses to on another. Great system, but being pro-inflammatory for a prolonged period has health consequences: e.g./ chronic pain, depression–the two largest global health burdens.

Tracey Crouch has a job of huge importance. This is not just about people who live alone. This is about how society functions to enable people to connect with purpose, to support and trust each other and to share a planet. Now that’s a job worth doing well!

A brief note on loneliness and pain

Chronic pain is often described to me as being a cause of loneliness for several reasons. Firstly because of the limits that the pain can seem to impose until the person learns skills and has tools to change his or her experience, and secondly because no-one else can actually feel that pain.

Pain is a shared experience however. Each person will suffer their own pain of course, and for different reasons, yet it is a conscious phenomena that most will feel. Being that it is unavoidable, it becomes essential that people understand pain so that they can address their needs with effect.

One of many actions that can be chosen and committed to, is that of making connections and ensuring meaningful interactions as often as possible. These practices and others can easily be interwoven into life as a means to address the effects of loneliness.

22Jan/18
Living well

Get back to living by living

Chronic pain, Pain Coach, Pain Education, , , ,

Living well

It’s raining today (Monday 15th Jan). Not unusual for January but how does it make you feel when you look out of the window? Do you see possibility or problem? A wet day or a chance to jump in puddles? Most kids love jumping in puddles to see what happens and because that exploration is fun. As an adult, life is much more ‘serious’. To spend time splashing about many not even occur to you.

Having fun is a fundamental part of living a healthy and fulfilling life. Carefree movements and silliness in all their shapes and forms makes us feel free and easy, together with laughter, smiles and joy emerging from such acts dotted through each day. There is time for serious stuff, but this can be addressed with more focus, clarity and resilience when we are well. We learn, we bond, and we foster wellbeing through fun. However, this can all seem to be lost when our health and sense of self is threatened, so how can we get back to living when suffering chronic pain? Do we wait to feel better? Or do we actively do something to feel better? I would strongly argue the latter, but we need a way; the ‘know-how’.

Do we wait to feel better? Or do we actively do something to feel better?

Many people suffering chronic pain and other complex health problems are merely surviving or getting by. There is no sense of living. Instead, they are struggling through each day, perhaps with the occasional pleasure. There do not appear to be many choices because of the seeming limitations imposed by the pain, and even if there is some sunlight breaking through the clouds, it is short lived through the expectation that pain will soon return.

As with many of chronic pain’s associated consequences, to understand it informs new thinking, new decisions, new behaviours and hence new experiences. When the fears and worries diminish, opportunity arises. The fears naturally ease when pain is understood. Here are a few simple examples of what is known about pain:

  • pain and injury are not the same
  • pain and injury (damage to tissues) are poorly related
  • pain is part of the way we protect ourselves together with changes in thinking, feeling, movement and perception; all in the name of defence just in case the perceived, or predicted danger really exists (based on what we know, or ‘priors’).
  • pain is much better an indicator of the person’s state — i.e. in a state of protect; this is why tiredness, anxiety and perceived loneliness increase the likelihood of being in pain as all of these are potentially threatening
  • pain is embedded in our society
  • pain changes — when you monitor your pain, you realise the ebbs and flows; the notion of impermanence is useful here, as life would not be possible without our ability to transform and learn. All experiences come and go.

There is much more that we know about pain, and we are learning rapidly alongside the ever-deepening understanding of consciousness.

There is no way to happiness. Happiness is the way ~ Thich Nhat Hanh

With insight into the way we think, the way our mind works and being in touch with reality by being present and aware, one can begin to craft a way forward, step by step. This is the practice of being mindful, which is a way of living life, and really being here and now. These are not just words or concepts, but a reality. The past has gone and the future never comes; there is only this moment to live. Indeed this moment may be filled with suffering as this is unavoidable in life — this is the truth. But it may also be filled with joy and pleasure — this is also the truth. Rolling with the natural ups and downs of life then, becomes a skill that we can develop together with the practice of the skills of being well so that we build wellness and resilience.

In this sense, we need to go out into the world to ‘sample’ the sensory opportunities. In doing so we ‘update’ our perceptions and experiences. This is work in progress, so we take steps to build the effect as we become more skilful, just like learning a musical instrument. This is living by living.

There are likely to be parameters to work to if you are suffering chronic pain. One of the modern tenets for managing and overcoming chronic pain is that of creating a sense of safety (pain is about perception of threat, hugely involving the person’s interpretation of the situation, consciously and subconsciously). Understanding pain forms the basis of feeling safe to move and ‘act’, which then become the next prior experience(s) or reference point(s) (consciously and subconsciously); i.e. a building effect.

Along the way we associate with the success of the little wins, rewarding oneself at each step; rewarding the fact that you took action as you may not ‘see’ much change day to day. Think about dental health. You know that you must clean your teeth twice a day for 2 minutes. Not just once, but every day if you want to maintain a healthy mouth. Consider getting fit. Going to the gym once will do little. Going 3 times a week will build health and fitness, although you may not see much change for a few months.

Living by living

The start point with the principle of ‘living by living’ is to think about what you can do, even for a short time. This maybe walking, meeting friends (social interaction to counter perceived loneliness), simple movements or stretches to nourish the body tissues, reading, going to an event. Immediately you may think of the reasons why you CAN’T, but remember that these are the thoughts informing your decisions that you can change by associating with pleasure rather than ‘pain’. When you update your beliefs by truly understanding pain, you realise that you CAN do certain things, which you can build up, just like getting fit.

As you gradually fill your time with chosen and meaningful activities, the pain rents less space in your thinking and experience of life. The wheels start turning in the right direction, and you begin to associate more and more pleasure with your successes, even if you feel your pain at times. Pain is an action, a perception, a feeling, an emotion, a thought, all together as a means to make oneself safe. Whilst more complex that the (wrong) belief that pain resides in the tissues, this understanding means that we have a huge number of ways to transform the experience. Pain is embodied; we feel it in our body. But ‘I’ feel it, the person feels it, not the body part where I feel it — back pain: it is not my back that is in pain; I am in pain, feeling it in my back. Pain is ‘whole person’ and hence needs this approach.

*Action: think about something you CAN do, especially if it is fun. Picture it, visualise doing it and notice how you feel. Then try it, perhaps just a little to begin with so that you have a good experience that becomes a past experience to draw upon. We create these past experiences by living, hence getting back to living by living. Write down what you have done and how you feel that sense of success and achievement. Then build.

The Pain Coach Programme is a comprehensive approach to managing and overcoming chronic pain and easing the suffering of chronic health conditions. Contact us to book your initial conversation to learn about reaching your potential to live well. We look forward to hearing from you. t. 07518 445493

* You should always discuss new approaches with your healthcare provider.

29Nov/17

Getting the best of Christmas ~ top tips if you’re suffering pain

Aches and pains, Chronic pain, Pain Coach, Wellness, , ,

Top tips to enjoy Christmas

Christmas top tips to thrive rather than survive!

Getting the best of Christmas ~ here are some top tips if you’re suffering pain so that you can maximise your enjoyment and create some great memories!

“get the best of you

Christmas is not an easy time for everyone. There are numerous challenges that include preparing a lunch, buying and wrapping gifts and seeing relatives. Add a layer of persistent pain, and these and other challenges are somewhat amplified. Having a plan helps you to organise your part in the festive season, allowing you to enjoy the time in the best possible way.

How are you framing the Christmas period?

The inner dialogue or script we are running has an enormous impact on how we have that very experience. If I keep telling myself that it will be tough, or tiring, or painful, then it usually is and more so. In essence we are feeding the prediction plus our choice of behaviour will enact those thoughts. So, write a positive script that is rich with all that you want. This does not necessarily mean that it turns out exactly this way, but it will be much better than if we anticipate the worst. What we focus upon we get more of!

My Christmas will be ______________. Fill in the blank and keep focusing on this picture and how you can go about doing your best to achieve it. This is the basic model of success used by anyone who has achieved results, including you! Clarify the picture of what you want and then decide upon the principles to follow to do your best to get there.

Make a plan

For each day of the festive period make a plan. You will need to prioritise your activities and create space for ‘refresh and renew’ time. To prioritise you can make a list of all the things you want to do. Then categorise them A-C (A the most important), before numbering 1, 2, 3, 4 etc (1 the most important).

Your plan is flexible, meaning that if it does not turn out exactly as you wished, you can accept the changes. It is useful to have a set of principles to follow, which allow for flexibility within the plan. Here are some examples;

  1. Knowing that wherever you are, you can create calm by using breathing or imagery, either because you are aware of a more intense emotional state or just because you wish to plug in and recharge.
  2. Motion is lotion is a way of nourishing yourself with simple movements that you know are safe, despite how they may feel at the time. Pain and stiffness are both need states that we perceive in order to choose an action that will satisfy the need. This is much like hunger and thirst.
  3. Refresh and renew time is when you deeply relax, engage in something pleasurable, have a conversation, listen to music, look at a scene with awe, practice gratitude.

Write your plan out so that you are much more likely to commit. You may like to share your plan with someone as a further way of cementing your intended actions.

Motion is lotion

Movement is fundamental for our health as it is the way we nourish our body and our brain (the two are not separate–we are whole). Movement is part of the way we are and the way we represent ourselves to the world. Consider how you can recognise a friend from far away by the way that they walk.

Motion is lotion is the consistent practice of moving, little and often through the day. Stiffness is a common bedfellow of pain due to the guarding (overactive) muscles that become tense and tight. The feeling of stiffness is inferred as a way to make us move, much like pain is an inferred (whole person) state to make us protect ourselves and meet the impending need.

Repeated simple movements that are tolerable or feel good will build the evidence that we are actually safe. This momentum creates a new back story that informs the next moment in such a way as to drive easier and easier movements. This is a practice and must be used through the day, every day. As a guide, when sedentary, change position every 15 minutes, and stand up every 30 minutes. Part of your planning (see above) will be how you can integrate movement into your day.

Be aware of what is happening right now

Being ‘in the moment’ is not just a phrase. There is no rehearsal for life; this is it. ‘Life is long if you know how to use it’ is Seneca’s classic title. Using our time wisely maximises the opportunities we have presented to us each day, together with an openness to experience. The beginner’s mind illustrates this well, whereby we maintain a wonder about our perception of the world that unfolds each moment, much like a small child walking into a grotto, experiencing the impact of the lights and aromas of Christmas.

Mindful practice is about being present, aware and open to all experiences without judgement. Noticing emotions, feelings, thoughts and sensations as they come and as they go is at the heart of the practice, however they appear. Quickly we can become familiar with the impermanent nature of things, so no matter what you are feeling right now, it will pass. We can easily integrate mindfulness into our day with a simple ‘formal’ practice of 10-15 minutes together with moment to moment awareness through the day. The latter is achieved by paying attention to a few breaths, which bring you to the present moment rather than dwelling and embodying the past or an anticipated future.

A further practice is to notice positive feelings and emotions through the day as they arise. ‘What we focus on, we get more of’, is a phrase I repeat to clients, as they train themselves to build awareness of all perceptions, in particular those that feel good. The broaden and build effect of noticing positive emotions has been well studied by Barbara Fredrickson, and it only takes a short period of practice for the impact to grow. Good feelings can often be subtle and pass by quickly, whereas negative emotions often hit us hard and linger for long periods. Paying attention to each moment as often as you can, permits the awareness of the positive in its many forms, building your wellness and ability to notice more. There will be plenty of good feelings to notice if you choose to create a positive approach to Christmas, pay attention and address your ever changing needs (see below).

Meeting your needs

We can strongly argue that feelings arising in the body are the conscious emergence of need states. I feel thirsty, I feel hungry, I have an itch, are all common examples. Pain and stiffness are also need states that motivate us to take action to meet the need, perhaps more urgently that some of the others.

When we feel thirst, this is a user-friendly representation of complex biology (sub-personal), which we only need consider as a percept to address by drinking. Pain can be considered in the same light to a degree. The variance comes from the desire to know why we are in pain. Is it something really dangerous? Clinicians must do their best to answer this question for the person.

Much of the suffering comes not from the pain itself, but the way in which the person interprets and thinks about the pain. This is why understanding pain is so important, and why many people feel immediate relief on knowing the answer. If you consider that pain is based upon the perception of threat, understanding pain is a way to reduce this threat together with knowing what can be done.

On feeling thirsty, we drink until the feeling appears to pass. On feeling pain, we must keep using our practices to create the conditions of ‘safety’ until we start to sense an easing, which will come. This may be repetition for a good period of time along with consistent practices we are using to get better overall. We must also address the reasons why, if we know, the state may have arisen. For example, a situation that is perceive as stressful, tiredness, anxiety, different or new movements, or a change of environment to name but a few. Pain is embodied and embedded in the context of your life, hence all factors need attention and new approaches engaged where existing ones fail.

An example to illustrate: I have neck pain sitting at my desk. I must move and stretch to nourish, and keep doing so until there is a sense of relief (this may need to be consistent through the day). I must also address the reasons why it could be painful. For example, I have sat here for a long time repeating the same posture and movement, I am feeling anxious about this piece of work or a forthcoming meeting, my mind is wandering, I am tired. Without considering all influences as well as the actual perception, there is not adequate reason for your body systems that protect you to shift gears. We actively shift gears with new thinking and new actions.

Summary

Here I have outlined some simple practices and approaches that you can decide to adopt for not only the Christmas period, but in a way to overcome your pain. The Pain Coach Programme is a practical approach to living life and building wellness as a buffer to the challenges that arise for each person. We can choose our style of ‘doing life’, and this has a significant impact upon whether we reach our potential or not. The Programme is about getting the best of you, or peak performance in different areas of your life. Each day presents a range of opportunities. Which will you engage with?

Here’s an equation:

(My current physical ability – my tolerance) + my approach = what I achieve

“How can I be the best me, and enjoy the process? 

** Please note that these practices should not replace your existing treatment or therapy programme. You should always check with your healthcare professional if unsure.

To start your Pain Coach Programme, to organise a Pain Coach Workshop or for clinician 1:1 mentoring, contact Jo 07518 445493

25Nov/17
Overcome dystonia and live life

Why mindfulness can help dystonia

Cervical dystonia, Dystonia, Mindfulness, , , ,

Overcome dystonia and live life

There has been huge hype over mindfulness for the past few years. It is important that now we establish what we really know and what has been shown to be true. There are a couple of very important effects that are of great benefit. I will talk about these shortly, and in particular how these can be useful as part of a training and coaching programme to overcome dystonia. Before we look at how mindfulness can help dystonia, let’s consider mindfulness and a key feature of dystonia.

What is mindfulness?

Mindfulness is simply being aware, being present, yet not judging. You are not trying to get anywhere, be anything different or trying to achieve anything. Mindfulness just is. This may sound a little vacuous but this is the truth. In trying to get somewhere or be something, you are missing what is actually happening right now. To be mindful is to accept all thoughts, feelings and emotions as they arise and as they pass. We spend a lot of time in the past or future in our thinking, which is entirely embodied, instead of seeing and being aware of what is really happening in this moment, the only moment.

In being mindful, we often feel a sense of calm and clarity because we are not embroiled within the emotional state. Instead we are aware and feel the feelings but they do not control, or hijack us. This clarity permits us to make best choices with full awareness and to see things as they really are instead of through biased lenses.

A key feature of dystonia

Attention plays a significant role in dystonia, and pain. The more attention we put upon the feelings, the torsions, the jerks, the more it builds. When we think that someone is looking at us, our ability to assume we know what they are thinking adds to the mix in the form of self-consciousness. Commonly this amplifies the unwanted movements as we shift deeper into a protect state.

Movement is not separate to our sense of body, our emotional state and our environment. There are always potential actions in a particular place, and the brain is continuously hypothesising which movement best explains our intentions. A lack of control of sensorimotor function, or a loss of precision, means that movements emerge involuntarily. We play out, or actually move as a fulfilment of a prediction that the brain has already made. This is a forward moving (time) loop, whereby we continue to play out a prediction in the form of dystonia experienced by the person. In other words, their particular style, which is unique to them.

So, how we feel, which is based upon where our attention lies, affects our movement and hence dystonic movements. Building our control over our attention then, becomes an important skill and not just for dystonia. Being able to focus is now known to be an important skill of being well (Davidson, 2016), as is self-control (Moffitt et al. 2011).

Why is mindful practice good for dystonia?

We know that mindful practice helps us to develop out attentional ability–to keep a focus upon what we want to focus upon. A recent study entitled ‘A wandering mind is an unhappy mind’ identified the problem of attention, and in the modern world we are continually being stimulated by potential attention grabbers. Take phones as a starter. It is not only the ring, the beep, the song tune, the vibration but the fact that the phone by its very presence offers an affordance. There is a very definite effect of a phone being on the table during a meeting, or being by the bedside at night. We are taking on the device as part of our sense of self, meaning that when left behind, it is akin to leaving a leg behind. The state of panic that emerges when you realise that it is not in your pocket and you may have to spend the day not checking for notifications. 

Mindfulness develops our ability to pay attention and hence impact positively on the experience aforementioned. When we can focus, we can exert a measure of self-control. We understand the importance of self-control, which has been amply decisive by the marshmallow test. Kids who were able to exert self-control and restrain themselves from eating the one on the table, were found to be healthier and more financially successful later in life. Further studies upon self-control have added to the understanding of this important skill. This is most certainly something we can get better at with practice. 

Mindfulness helps us to focus and pay attention

Undoubtedly, mindfulness is a practice that is best begun on a 1:1 basis. It is not inert, it needs to be practiced in the right way and questions will need answering. Commonly people think it is all about stopping the mind from working, or stopping thoughts. This is not true at all and becomes a problem because this is unachievable. The mind is not meant to ‘stop’. Instead, we learn to observe our thoughts and feelings, fully experiencing them but not being controlled, or hijacked. Books can be helpful, but they are not themselves teachers or encouragers. And when you are seeking to overcome a condition, mindfulness is part of the approach, which can be very useful, but it is not the only practice in most cases. 

“A simple practice to notice how your mind wanders and how you can bring your attention back is to pay attention to 10 breaths and see what happens. If your mind does drift away, each time you come back to your breathing as a focus. There is no problem with the mind wandering, and resuming attention upon the breath can be thought of as a ‘rep’, just like any other exercise”

The ability to focus one’s attention in dystonia has several benefits. Firstly so that you don’t become over-focused on the bodily sensations, which results in certain thoughts and feelings that perpetuate your vigilance. Breaking that cycle is empowering as you learn to put your focus where you want to, or need to, depending on what you are doing. Combine this with the emotional control and you gain an ability to see things for what they are instead of being victim of an emotional response that controls you. For instance, a common description of the effect of thinking that someone is looking at you: makes me self-conscious of the movements, I second guess what they are thinking (and this is usually something quite unkind and threatening), I become more aware and the involuntary movement builds and so on. 

Secondly, as referred to above, there is a dampening effect upon high emotional states, giving us greater control over emotions and hence ourselves and our ability to make best choices. To address dystonia, which in many ways is similar in principle to overcoming chronic pain, requires understanding that informs practices that are used each day to head in a desired direction. In a way this is about peak performance, getting the best from an individual as they focus on what they need to do right now, doing this in the best possible way that they can, considering the circumstances. To achieve this requires focus and control, both of which emerge from the practice of mindfulness. 

Other work has demonstrated further benefits of mindfulness including feelings and actions of compassion, a reduction in inflammation and the generation of a feeling of calm. The number of published papers has grown enormously and we will see this continue as researchers explore what we really know.  

Training for dystonia

Mindfulness is a part of the programme for dystonia. Mindful practice helps the person to focus, to be less distracted by the sensations and to reduce emotional hijacking. In essence, we are in more control and experience the full richness of life as we see things for what they really are instead of through a range of biased lenses. To get the best of ourselves we must be able to focus and be in control of emotions. Of course we are human and hence this does not always happen. But we strive to do our best as much of the time as we can. This is one of the principles of the programme for dystonia, and for overcoming pain. 

There are a number of other practices, which I will not be fully describing here. But just to mention a few is useful. Other training would include specific sensorimotor training to develop precision of movement and positioning in the environment of the body, a fundamental skill. We need good body sense and an implicit understanding of my boundary—where I end and the environment begins. Without this, it is both hard and potentially threatening to the individual, the latter evoking a range of protective measures including altered movement planning and execution. We would seek to nourish the areas that are overworking with simple movements and treatments, to have a plan for day to day activities and to make sure that life is being lived in the best possible way. One accepts and acknowledges the current parameters for living life, but with a view that this will change—we are designed to change of course. Finally, the skills of being well are used and integrated into each day so that the person can build wellness, the greatest buffer we have to life’s challenges. 

For further information click here

Or call Jo on 07518445493 to book your appointment

 

13Nov/17
Whole person to treat chronic pain

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

Chronic pain, Research, Treatment Philosophy, Wellness, , , , , ,

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

Anxiety, Chronic pain, Health, Pain Coach, Stress, , ,

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

Chronic pain, Pain, Pain Education, understand pain, , ,

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.