Pain Coach Programme

Art of living

Pain Coach ProgrammeWe like to be good at things. Sport, work, parenting, music are all common examples. We practice, note what goes well and what does not, making changes, and essentially practicing to get better.

But what is common to all of these and everything else in our lives? What overarches all of these? Living. Living itself. There’s an art to living a life of content—and this does not mean that there is no pain or suffering. A life well lived is one of moment to moment skill, and this includes what we tell ourselves and what we do. The moment to moment experiences. These determine overall how content we are rather than the ‘biggies': new car, new iPad, and the so-called life events. Now, these are all significant (if they are significant to you) yet they make up fleeting moments much like anything else. They are passing through, like other moments. It really depends on how you are framing it; what do you think about it? That’s what makes it what it is, for you in this moment.

So, there is an art to living well that depends on what you are telling yourself over and over. A situation is just a situation until you rate the situation and then feel it and live it. Until that point, it is nothing. We create our reality in any given moment and this is an art form. And art forms need good quality practice just like sports, music, how we communicate etc. The great thing about this is that we have every moment to practice and get good at it. You don’t need to go anywhere or any kit to get good at the art of living. So what do you need? Nothing.

Whilst you are seeking to be somewhere else, you are missing what is happening now. And that is all that is happening. Have plans, have aspirations but see them for what they are—plans and aspirations. Work out how to get there, but see that for what it is—a plan for how to get there. Be excited, be nervous, be anxious, but see these feelings for what they are—feelings, emotions that will pass as everything else does. Impermanence.

Here’s a simple tip of how to enact this: cultivate the habit of standing or sitting talk, taking a normal breath in and paying attention to this breath. Do this every time you feel tense, anxious, happy, excited, angry, sad…… Try it and see what happens.

UP | understand pain

CRPS UK 2015

CRPS UK Conference 20154 years ago I came down to Bath to speak at the CRPS UK conference and so I was delighted to be asked to return and talk today. To take listeners beyond the theory, I asked Georgie and Jo to join me as a triple act, to illustrate and to enliven what I was saying by describing their lived experiences. Chatting to people afterwards, it appears that this gave an insight into the potential that everyone has for changing in a positive and constructive way; a way that is meaningful for them.

UP | understand painFor those who could not be there and for those who are there who would like a summary of my key points, this blog is for you.

The talk was entitled ‘Understand pain to change pain’, the message being that by understanding your pain, you think and act in such a way that you can go about overcoming your pain.

Establishing how we think about our pain is a key start point — how do you think about your pain? Why do you think it hurts? Why do you have persisting symptoms? These are some of the questions that need answering in order to move forward. Pain is a protective response to a perceived threat, and it is the person who does the ‘perceiving’ as well as embodying the experience of pain. We are the producer and the experiencer of our pain that is felt in the body, in a location that is deemed needy of protection in that moment. For reasons to be fully understood, our bodies can become very, very good at this response, and create many habits of thought and action that influence the likelihood of pain. Remember though, pain is a response to a perceived threat, so changing one’s perception begins to change the pain experience; reduce the threat, reduce the pain. Some may wonder why then, do they still feel pain despite having eradicated fear of the pain and other conscious threats? This is because there are many, many subconscious cues in the environment, in what we think and do, that can be perceived as being threatening. Whilst we cannot account for each and every variable, and how these change in combination with other variables, we can alter the perceived threat of the most obvious ones: movements, places, people, thoughts.

CRPSIt is the person who feels pain, not the body part. I may experience pain in my knee but it is not my knee that is in pain, I am. This may sound strange initially, but think about it for a minute. Who is thirsty? You or your mouth? Who is hungry? You or your stomach? Who is in pain? Your or your knee? Therefore, who needs treatment, training, coaching etc? You do, the person who feels pain and lives the pain. Any treatment programme must address the whole person and their lived life — this is them and their life in which the pain is embedded. It also has to make sense, engaging the person so that they continue to create the conditions for change.

To overcome pain we must firstly understand pain, much like a farmer would plough his field before sowing seeds–a vital start point. Having a working knowledge of your pain allows you to engage with your programme, focus on your vision of how you want your life to be and how you are going to get there whilst dealing with distractions. Distractions usually come in the form of negative thoughts, which deflate, demotivate and actually intensify pain responses by increasing the threat value. Understanding pain also helps to reduce and eradicate fear that also impacts on how you experience your pain. Fearful thoughts and avoidance both contribute to on-going pain and hence are necessarily addressed.

UP | understand painThere are many strategies, techniques and exercises that can be used, but for these to work, our thinking needs to be straight and based on a working knowledge. This is useable knowledge that can be considered at any given moment to ensure that the inner dialogue is based on truth and not on fearful opinion–think about what you tell yourself every day; what do you convince yourself? The Pain Coach Programme over-arches the specific strategies employed. The Pain Coach delivers the knowledge and skills to the person so that they become their own coach at any give moment, deciding on the best and healthiest course of action; towards the vision. A blend of the latest thinking in pain science with strengths-based coaching gives the person everything that they need to overcome their pain. What does overcoming pain mean? It means that you live your life in a meaningful way according to you, and that there are always opportunities to grow and develop.

UP | understand painI ran through some of the strategies that I use within the Pain Coach Programme including UBER-M, which is one that I give to people so that they may choose the wise and healthy option, taking them towards their goals; this as opposed to being distracted by negative (embodied) thoughts and unhealthy actions.

  • U–understand: a working knowledge of my problem; what do I know? what do I do now? This is about clarity, not fear
  • B–breathe: mindful practice and breathing to cultivate awareness of the bodily aspects of the pain experience and how thoughts manifest in the body, and then what you can do to change these habits
  • E–exercise: specific sensorimotor training and general activity
  • R–re-charge: we need enough energy to engage with life!
  • M–movement: to nourish the tissues and the body maps in the brain to have a sense of normal

Normal = no threat; no threat = no pain

Pain is all about perceived threat. Reduce the threat consciously by understanding and knowing what to do (that’s the easy bit!), and then go about reducing the perceived threat that occurs via habits and subconscious processing. This includes environmental cues, contextual cues and habits of thought; the so-called ‘autopilot’. Persisting pain is characterised by many habits, automatically learned responses and attentional biases. These must be addressed by constructing a programme that works with the person, not just their painful body part –> it is the person who is in pain, not their foot, arm, back etc. My back, to use an example, cannot feel pain. I feel pain. I experience pain, and I experience my pain in my back. There is an enormous difference in the underlying thinking and hence the approach. The whole person approach is vital for pain and any other condition having said that! If healthcare at large adopted this way of thinking, we would be far more successful with persisting conditions; this to the point where the suffering lessens and lessens. Reducing the impact results in a meaningful life, and this is achievable for all by developing understanding and then choosing wise actions.

My emphasis throughout the talk was on understanding pain to change pain. How can just understanding pain change pain, you may ask? Put simply, by understanding pain you are changing the way that you think about it, the meaning that you give to it and what you then do about it. If you do not understand your pain, like any problem, you cannot solve it, and the erroneous thoughts that one has can lead down a route of perpetuating fear, avoidance, beliefs that pain will not change. This route is one of on-going suffering. Understanding pain creates the way forward to overcoming pain; overcoming pain being the return to a meaningful life as defined by the person. When you know what you are dealing with and how to deal with it in any given moment, then you are creating the conditions for healthy change. This is the essence of Pain Coach, creating those conditions as often as possible, becoming aware of certain habits, learned behaviours and associations, compassionately correcting and moving onward with a selection of strategies. This is about getting back to life by living that life. Keeping that in the forefront of your thoughts, and letting go of distractions leads you towards your success. Let us be positive with good reason, because we are always changing, and with positive strategies.

For more information or to book an appointment, please call 07518 445493 or email [email protected]

Georgie at T5 for upandsing

Georgie at T5 for Understand Pain

Georgie at T5 for upandsing






Georgie at T5 for Understand Pain (click image for video) for UP | understand pain awareness campaign with Rock Choir.

UP aims to change the way we think about pain, because to overcome pain we begin by understanding it. With this knowledge and a range of skills, you can successfully move forward and resume a meaningful life; Georgie being a prime example — read her story hereBec’s story here and read Jo’s blog here.

With the money we raise at our @upandsing events, we will be running Pain Coach workshops for people suffering pain and their carers, and workshops for clinicians who wish to develop their knowledge about persisting pain — keep an eye on the UP website for dates. We also aim to develop and mature the website into a high quality resource.

UP | understand pain

What’s next for UP?

UP | understand painAfter last week’s huge success once again, we know that we are on the right path! The support from the members of Rock Choir and the public was incredible, demonstrating that people recognise the scale of the problem. They also acknowledged that the situation is changeable, and we will certainly be driving this change with both our messages at events and with the Pain Coach seminars. Pain Coach is an approach to persisting pain that incorporates the latest pain sciences, the latest thinking in pain and strengths based coaching for successfully overcoming pain and resuming a meaningful life — watch out for the dates. This is all about the individual understanding their pain and knowing what action to take at any given moment to take them towards the life they envision.

UP | understand painHere are our immediate objectives that we are now working upon:

  • Achieving charity status
  • Pain Coach seminars for people suffering persisting pain and their carers
  • Pain Coach seminars for clinicians and others who need to understand pain (e.g. lawyers, human resources, occupational health, managers within business)
  • Develop the website as a high quality resource for pain information
  • The next events that will always include music and song; simply because it makes us feel great!!

UP | understand painOur aim is to develop and mature UP, widening our net gradually as we support and educate society about pain and how we can go about changing and overcoming pain. If you would like to help us grow, please do get in touch: [email protected] and visit our website at www.understandpain.com and on Twitter @upandsing

UP | understand painWe will announce Pain Coach dates and the next event very soon. Please tell your friends and colleagues about us and ask them to join our journey — a fun way of delivering a serious message and taking definite action.

We look forward to seeing you at the next event!

r.nial bradshaw |https://flic.kr/p/fBm85W

Repetitive strain injury (RSI)

r.nial bradshaw |https://flic.kr/p/fBm85W

r.nial bradshaw |https://flic.kr/p/fBm85W

Repetitive strain injury (RSI) is one of the office blights so it may seem. Of course you do not have to work in an office to suffer on-going arm or hand pain, or as some call it: WRULD (the rather clunky ‘work related upper limb disorder). You may have tennis elbow or golfer’s elbow, of course without playing either sport — then it should be lateral or medial epicondylalgia! Words aside, this is a big and costly problem for individuals who bear the brunt of the pain, symptoms and their consequential limitations, and for businesses that have employees on light duties or off sick. So how does typing cause an injury?

Well it may not. We are not really designed to be sat, hunched over a desk (as I am now I have just realised), poking away at small buttons, getting quicker and quicker so that we don’t even have to think about where our fingers are going in order to produce a document. The ‘noise’ created by all these small, precise movements of the fingers (signals flying up from the joints and muscles about movement, pressure, touch etc) can be difficult for the brain to gather into a tangible meaning. We start to develop different sensations, perhaps a change in temperature, some tingling, numbness or a sense of size difference (my hands are now warm and a bit tingly). If you interpret this as strange or mildly worrying because you have heard of RSI and you don’t want it because your job involves typing all day…..you can perhaps see how the worry and concern and vigilance and responses begin to amplify and amplify; this without any notable injury. However, the tension that builds, the stress responses that affect tissue health, the change in blood flow and nerve function when anxious, all impact and can create a threat value that is perceived as dangerous and hence the body systems that protect kick in — this may well mean some pain. And pain is useful and normal, even without a significant injury, because pain is a need state, motivating action: maybe I should take breaks? Perhaps I should type less at the moment? Maybe I need to work at changing my thinking about a  situation that is making me stressed? Maybe I should start exercising regularly? Maybe I should seek some help and advice?

On-going use without adequate recovery can lead to an imbalance between tissue breakdown and rebuild, the natural state of change that is constantly occuring to all of us. The inflammation that results can of course add to the level of sensitivity or activate it, leading to aches and pains that can begin in specific locations but with time expand up and down the limb and even be noted in the neck and shoulder. This is not the spread of a ‘disease’, but rather the volume switch being turned up, meaning that increasingly normal stimuli (touch and movement, thought of movement, particular environments) can result in pain. Associations build with stimuli, and we get better and better at certain habits of thought and action that can perpetuate the problem — e.g./ avoidance, expectation, changes in movement, extra muscle tension unbeknownst to us.

There comes a point when the symptoms can begin so quickly that it becomes difficult to type, text, hold light objects and even gesticulate. This makes work life and socialising very challenging as well as frequently occupying much of our thinking, planning and our mental resources from the emotional impact. A comprehensive approach is needed to change direction and begin recovering, from wherever your start point. Certainly if you are feeling a few aches and pains that are becoming more frequent, you would be wise to seek advice. Or if you are struggling, then the right treatment and training programme can help you to resume meaningful activities.

Due to the biology of RSI, like all persisting pains, being upstream in the main, i.e. away from where the pain is felt, any programme must address this as much as improving the health of the tissues locally with movement and use (gradually). Once you undertand your pain, you realise that pain is not an accurate indicator of tissue damage, and that there are many things you can do to take you towards a better life. Asking yourself why you want to get better gives you the answer as to where you want to be going; your direction. We need direction and then the know-how to get there, dealing with distractions on the way, so that we remain focused on the right thinking and actions.

You will have been successful before, using your strengths (e.g./ concentration, empathy, dedication, motivation) and values. Using these same strengths and values to perform the training and to think in the right way leads you to a better outcome. What are your strengths and values? The exercises, training and treatment are all straight-forward, but their effectiveness is impacted upon by the way you think about your pain and your life. There are many factors in your life that are affecting your pain: e.g. tiredness, stress, anxiety, people, places. Understanding these and your pain puts you in a position to make changes and groove healthy habits and in so doing take the focus away from pain and worrying about pain to the doing and enjoying and living. There is only so much you can attend to in a passing moment, so why not focus on the good stuff? And if you are in pain, you can learn how to create conditions for ‘pain-off’ over and over whilst you get healthier and fitter generally as well as specifically training to resume meaningful activities: common problems are typing, texting, carrying etc.

This is an insight into modern thinking about pain and how to overcome pain. We understand so much more and this knowledge is ever-expanding. Passing this knowledge to you with practical ways of using it to overcome pain is our role, and treating you with techniques that calm and ease symptoms whilst you get fitter and stronger. Together we can use your strengths to resume a meaningful life.

Call now to start your programme if you are suffering RSI or if you are a business wanting to reduce risks or develop a programme for your staff: 07518 445493


| https://flic.kr/p/d5cPyA

Andy Murray wins despite back pain

karlnorling | https://flic.kr/p/d5cPyA

| https://flic.kr/p/d5cPyA

Andy Murray wins despite back pain, a classic example of how the meaning and situation flavours the lived experience. Simon Briggs of The Telegraph said: “Not many players are capable of winning three points in a Davis Cup semi-final, as Andy Murray did to put Great Britain into the trophy match against Belgium in late November. But to do so with a bad back – an issue that Murray revealed only once the combat had finished – was a different story again: a quite exceptional feat of courage and stamina”. Pain is not well related to the state of the body tissues (joints, discs etc) but instead the perception of threat detected by body systems that protect us: nervous system, immune system, autonomic nervous system, endocrine system, sensorimotor system — one only has to consider phantom limb pain to realise this fact. One of the biggest reasons why persisting pain is feared is the belief that the severity equates to more damage or something more serious. You may also consider that some cancers remain painless and this is certainly serious. Pain is a protective device that motivates thinking and action to reduce the threat and restore normal physiological activity (homeostasis); it is a need state lived by the whole person — with ‘back pain’, it is the person who is in pain, not their back.

In Murray’s case, he was quite capable of focusing on the game, his body allowing this due to the context and the significance. There are many stories of sportsmen and women sustaining injuries and only knowing when the game is finished. We also had the scenario a few years ago when Messi collided with the keeper and experienced such pain that he thought his career was over. It was a bruise and he played the next weekend. The pain was still severe at the time though, reflecting the situation and the need as deemed by his body systems that protect. It works both ways.

Between games Murray may well have felt some stiffness, but he was able to re-focus. A few simple movements to nudge fluids around, ease off the muscular tension that is initiated and executed by the brain sending signals down via the spinal cord, perhaps a few reflexive messages contributing alongside the immune and autonomic activity. Context remained king though, as it was wholly more important to put all his attention on what was required to win than to start worrying about his back. That could be dealt with later, and indeed this is what happened as Murray did what he knew he needed to do to be victorious. All those top down signals, cultivated and delivered from a neuroimmune system, which countered those danger signals coming from his back (not pain signals — there are no pain signals or pain centres) — top down signals generated from his beliefs, expectations, mastery of focus and attention, as he hit flow, that state of being utterly in the moment. That’s a wonderful place to be and not a room where pain can enter.

Now that the game has finished, familiar aches and pains will flood Murray’s consciousness. There maybe additional and new feelings that evoke new thoughts and a need for re-assessment for the next best steps. These steps will need to include consideration of how Murray’s neuroimmune system and other systems that protect have learned to react (priming or kindling), the possibility of sub-conscious and environmental cues, expectations and of course an assessment of tissue health and function. From thereon in, a comprehensive treatment, training and coachng programme can address movement, body sense, neuroimmune-sympathetic-sensorimotor interactions to name but a few. It is worth pointing out here that such a programme is not unique to elite sports people, but a modern approach to pain and injury that should be accessible to all.

Richmond is the co-founder of a pain awareness campaign called UP | Understand Pain. Together with Georgie, they are using music and song to deliver the right messages about pain, particularly chronic and persisting pain; which are:

  • Pain can and does change
  • You can overcome pain and lead a meaningful life when you really understand it and know what you can do

** Pain Coach Programme for chronic pain, complex pain, persistent pain — t. 07518 445493




VulvodyniaVulvodynia is a painful condition, often exquisitely so, located in the vulva, which is the skin surrounding the vagina. Usually unexplained, this troubling condition can arise seemingly from nowhere, interfere with intimate relations and hence attempts to conceive. Vulvodynia is also known as a functional pain syndrome–these are painful problems that lack a pathology of note that explains the extent of the pain and include irritable bowel syndrome, fibromyalgia, TMJ dysfunction, migraine and pelvic pain. Functional pain syndromes are often concurrent with hypermobility, anxiety and depression, a further common character trait being perfectionism and a tendency for the person to be hard on themselves thereby creating a cycle of chronic stress.

The pain of vulvodynia is often very localised and triggered by direct contact. Naturally this occurs during sex and touch, but sometimes sitting position can bring on the pain. As with any sensitisation, there is a primary location of pain but there can also be a secondary area surrounding that is due to central nervous system (and other systems) involvement. Suspected vulvodynia or other pains in the pelvis should be assessed and examined by a gynaecologist as a first step before beginning treatment, and by a consultant who knows and understands both the condition and the impact — Miss Deborah Boyle at 132 Harley Street.

With vulvodynia often being part of an overall picture of sensitivity, it means that there is a common biological adaptation that is upstream of the range of seemingly different conditions (the functional pain syndromes). As soon as the individual understands that pain is not an accurate indicator if tissue damage, but rather a reflection of the perceived threat and prioritisation by the body-person, there is a realisation that the pain can change. Pain can change because perceptions can change as we take on board new information and consequently think and act differently, creating new habits. The new habits set the conditions for on-going and sustained change that includes overcoming pain.

We have limited attention and hence can only be aware of certain amount of stimuli in any given moment. If pain is consuming much or all of your attention and consciousness, then this is all that is happening in that moment, with all other possible experiences being disregarded–it is a matter of prioritisation. When the perception of threat is reduced by a constructive thought or action, the pain moves out of our attention span and we become aware of other thoughts, feelings and experiences. How we respond to pain is unique and learned through our lifetime right up until that point; all those bumps and bruises as a child, how our parents reacted, more serious injuries or illnesses and the messages we received from doctors, teachers and other ‘big people’, then through adult life, moulding our beliefs about ourselves, the world, health and pain each time we feel it. The sum of all this activity, most of which we are unaware of, sets up how you respond to the next ache, pain or injury, blended of course with genetics. It seems that some people are genetically set up to be more inflammatory, meaning that responses to injury are potentially more vigorous and go on for longer. Understanding this means that the right messages and treatment can be given, thereby appropriately addressing the injury or pain. One of the big problems is that this does not happen, and the explanations are structural and based upon the body tissues. This ignores the fact that we have body systems that protect and these systems have sampling mechanisms in the tissues and organs but largely exist elsewhere–e.g./ nervous system, autonomic nervous system, endocrine system, sensorimotor system, immune system. We have to go upstream as well as improve the health and mobility of the local tissues.

Going upstream is vital in overcoming vulvodynia, and this is where the Pain Coach Programme works–this is my part of the treatment programme. You may also choose to work with a women’s health physiotherapist who will work more locally. So what is the Pain Coach Programme?

The Pain Coach Programme is a a blend of the latest neuroscience of pain with a strengths based coaching approach to success. Understanding your pain and that you have the biology and strengths to overcome your pain is a vital start point. You have been successful in the past using these strengths, and you can do so again by drawing on these characteristics and using them to develop your health in terms of how you think and act. Overcoming pain is all about resuming a meaningful life, engaging with activities and people as you want to, in a way that allows you to flourish. The Pain Coach Programme provides you with the knowledge and skills that you need to in effect become your own coach, moment to moment making clear decisions that take you towards your vision of how you want to live. This alongside treatment and specific training to develop normal movement and a healthy body-mind. The skills you learn also help you to fully engage in life, whether this be at home, at work or at play.

If you suffer vulvodynia or other painful problems, call us now to start your programme: 07518 445493

Jan-Joost Verhoef| https://flic.kr/p/6qqqCU

Sports injuries that don’t go away

Jan-Joost Verhoef| https://flic.kr/p/6qqqCU

Jan-Joost Verhoef| https://flic.kr/p/6qqqCU

There are many cases of sports injuries that don’t go away. They linger on and on, becoming increasingly impacting as the sensitivity builds, often accompanied with varying patterns swelling and stiffness. Understanding what is happening is the key to deciding upon the right action to change course and recover. The way that your body and you respond is determined by the circumstances of the injury, prior experiences (injured the area before? previous injuries?), beliefs about pain and injury, genetics, the immediate thoughts and messages given by others and the action taken at that point, including pain relief. Here are some of the reasons:

  • The circumstances of the injury: how healthy you are, how you are feeling at the time, where you are, how the injury happened (your fault? Someone else’s fault? An accident? In fact, it is how you perceive it that is important, not the actual reality), your first automatic thoughts, the time of the game, the importance of the game — all of these factors come together, physical-emotional to create a memory of that moment, the pain intensity determined by the perceived level of threat, and not the extent of the tissue damage (consider the player who has a break but does not realise until later). The way you and your body respond to an injury will be very different if you are stressed vs relaxed for example.
  • Previous injuries leave their mark in terms of how you think about them and the associated pain. If you have injured the area before, then there is a greater likelihood that it will hurt because the body will protect more readily. If you have had a good or a bad experience before, this affects how your body systems that heal and protect will kick in.
  • Your beliefs about pain and injury that began to be sculpted in the early days of bumps and bruises and in particular how people around you reacted — too much mollycoddling by parents/teachers is perhaps not great for how we learn to deal effectively with injury; that’s both in the way we think but also how our biological systems work. What you are thinking will impact upon the pain (‘I must get up and play on in this cup final’ vs ‘it is the end of my career’ = very different biologies), and hence the early messages given by the clinicians and therapists must be accurate and calming.
  • It seems that we can have a genetic predisposition to over-responding to injury, with inflammation kicking in as it should but more vigorously. Some people are more inflammatory that others so it seems.
  • The early actions after an injury, including the messages as mentioned above, are really important to set up healing. It is normal for an injury to hurt, however in cases of severe pain, this needs to be addressed with the right analgesia. Early high levels of pain can affect the trajectory of the problem.

For these reasons and others, some injuries appear to persist or recur, which is highly frustrating for the individual, and for the therapists. Sometimes the factors mentioned above set into place a level of sensitivity and certain protective behaviours that mean protection is vigorous — this in terms of the way the person thinks, acts and their biology plays out. This needs to be identified as quickly as possible so that the right treatment can be administered alongside working with the player to developing his or her thinking. Whatever is playing out in their minds will be affecting their biological responses, in a positive or a negative way, so we must intervene or encourage depending on the predominant thought processes.

When an individual is experiencing an on-going issue there are a range of factors to consider and address, some relating to the points above. Hearing their complete story is a vital start point, including an understanding of their perception of the events to date, as well as prior experiences that will flavour what happened then and what is happening now.

Here are some examples of the common features:

  • Often the body continues to try and heal, squirting inflammatory chemicals into the area periodically or in response to movement. This is neurogenic inflammation and sensitises just like inflammation from a fresh injury and is part of the sensitised state, but co-ordinated by higher centres
  • Rarely does the person understand their pain, which creates worry and concern. Remember that chronic stress can make us more inflammatory — also consider other life stresses as these will impact; if the body/person is in survive mode (fright-flight), then resources for healing and recovery are limited.
  • Altered movement patterns, in part from fear/lack of confidence but also as part of protect mode. These must be re-trained from the right baseline (often people start too far down the line and fail)
  • A belief that there is a re-injury when in fact it is a flare up, or an increase in sensitivity, not an actual injury

In brief, we must ensure that the individual’s thinking is right — understand pain and injury, their pain and injury — and that they are taking the right actions towards recovery (a negative thought or over-training will not take you towards recovery); but they need to be able to think clearly about this themselves, because they are with themselves all the time whereas the therapist is with them periodically. They need to become their own coach, which is why I developed the Pain Coach Programme — not only are we coaching them, but also teaching them to become their own coach. When the understanding and thinking is in place, the training and exercises are all straightforward. I use no fancy tools or kit to coach and treat, except of course the most fancy piece of kit we all possess, our brains! But let’s not be all brain-centric; we are talking whole person. It is the person who is injured, not their leg or arm; it is the person who feels pain in the context of who they believe they are and in their life, not a leg or an arm. The person feels hungry, not their stomach. Remembering this when educating, coaching and treating creates the right thinking platform.

Pain Coach 1:1 Mentoring Programme for Clinicians — see here or call us 07518 445493

Keoni Cabral | https://flic.kr/p/9EVhyB

Cervical dystonia

Keoni Cabral | https://flic.kr/p/9EVhyB

Keoni Cabral | https://flic.kr/p/9EVhyB

Cervical dystonia (CD) is a movement disorder that is characterised by unwanted and involuntary spasms of the muscles in the neck and shoulder region. It can also affect the facial muscles. There is a genetic aspect to cervical dystonia but frequently, people who come for the treatment and re-training programme will describe a period of stress when the problem really took off.

It is not uncommon to hear that the diagnosis eventually came some years after the problem began. Typically a neurologist will diagnose dystonia, although an informed GP or physiotherapist may also identify it from the twitching, pulling and sometimes writhing movements that are cleary involuntary.

Cervical dystonia can be a distressing condition for a number of reasons: the pain and discomfort from the constant tugging, the continuous battle between opposing muscles and attempted conscious corrections, the awareness of others looking, the way that the movement patterns and body sense affects how you feel and your sense of self, your self-esteem and confidence in social situations, perhaps hopelessness in the face of the persisting symptoms; all impact on the condiiton itself and your hopes and expectations.

In conversation with people with CD, we usually identify certain traits such as perfectionism, obsessiveness and a lack of compassion towards oneself (self-critical). In addition, there can be a heightened awareness towards the body, including aesthetically–how do I look? Combining the desire to look a certain way with the manifestations of CD and there is a great deal of angst created.

Modern treatment is often led medically, once diagnosed, 3 monthly injections of botulinum toxin are typical. With the right dose and careful placement of the injections, this creates a great opportunity for sensorimotor re-training. Whilst the training is the mainstay of improving movement, there are a number of other considerations, the so-called non-motor factors. These must be addressed within a treatment and training programme. Merely focusing on the senses and movements is simply not enough, and indeed when we purely attend to a problem at the expense of all else, it will increasingly dominate our thinking. So in a way, to treat a problem, we should not always treat the problem!

Sensorimotor training develops normal body sense and movement, the two being absolutely interrelated. Without good body sense, you cannot move with normal precision, and when we move abnormally, or what is deemed abnormal by the motor system, then our bodies can feel different. When our bodies feel different, the way in which we engage with the world changes and so on. Specific exercises and techniques are used on a ‘little and often’ basis, which are simple and do not require equipment except a mirror on occasion. They necessitate practice like any training that is designed to improve performance, in this case precise movements for everyday life.

Where there has been and is on-going tension from overactive muscles, these body tissues and the underlying joints that are limited in movement by the tension, require nourishment with easy and regular movements. This often works best after a period of relaxation from breathing exercises or mindfulness, both of which promote better blood flow and oxygen delivery. I call this ‘motion is lotion’, a term that I did not coin but use with everyone I see to encourage healthy movement, whether for chronic pain, dystonia or both.

The way we move and the way that our brains plan movement based on predicting what we may do in a given environment, is affected by many factors: e.g./ how you are feeling, what you are thinking, who you are with, what you have been doing, how tired you are, what you plan to do, what your brain predicts that you may do, what you have done before in that environment, to name but a few. You will not be aware of many of these, but you’ll be aware that your spasm or pulling worsens or eases depending on certain circusmstances. Identifying these circumstances and situations allows you to begin dissolving these associations and habits, creating new patterns of movement. Remember that we are designed to learn and change, with opportunities to do so existing at all times.

Spending some time doing something that is meaningful to you is a great way of focusing on something else. Many people with dystonia find that when they are in full flow, the spasm and pulling ease off. This can be when painting, speaking, reading or listening to music. Even if during a meaningful activity you notice the symptoms, you can practice and improve, acknowledging the symptoms and returning your attention to the favoured activity. The pleasure that you gain and the realisation that you can attend elsewhere is part of overcoming the problem.

Mindfulness practice and relaxation play a significant role in changing the brain state, immune state and dampen down other systems that work to protect us including the sensorimotor system. When we perceive a threat, the muscles tense up in readiness to fight or run away. This is a basic biological function that does not help the already overactive muscles of dystonia. Mindfulness is not a spiritual or religious practice but rather a practical way of looking your thinking rather than becoming embroiled in thoughts and living out the past or future in your head. The techniques are simple and can be practiced anywhere.

This is a brief insight into both the condition and some of the ways that we go about changing your experience with a training and treatment programme. As ever, it is the person who needs treatment as they are living the experience of dystonia (it is not the neck experiencing dystonia), much like it is the person who feels hunger, not their stomach that feels hunger. Thinking widely and individually is key to successfully changing the unwanted movement patterns and easing the symptoms, allowing for the resumption of a meaningful life.

For more information or to book an appointment, call 07518 445493

Licorice Medusa| https://flic.kr/p/Hu2gG

Neuroplasticity and impermanence

Licorice Medusa| https://flic.kr/p/Hu2gG

Licorice Medusa| https://flic.kr/p/Hu2gG

I was asking myself whether neuroplasticity and impermanence are related and how this dynamic would work on a practical level. Concluding that there is some usefulness in relating the scientific neuroplastic characteristics to the Buddhist philosophical construct of impermanence, I have briefly shared my thoughts here.

Neuroplasticity refers to brain cells’ (neurons) ability to change at synaptic and non-synaptic levels. The synapses are where neurons communicate and hence the communication can change, whereas non-synaptic changes occur in the axons and dendrites (structures of the neurons). Impermanence is a fundamental part of Buddhism whereby it is agreed that nothing is permanent. In other words, change is constantly afoot as each moment passes to the next and so on.

On the basis that we are continually learning and changing with each and every new experience, moulding our reality in that given moment, it is highly probable that neuroplastic changes are underpinning our lived experience. We are of course on a continuum, begining with a blank slate to be filled as we progress through our life, genes being appropriately sculpted through exposure and meaning and creating what is a rich, textured existence. The fact that no moment is the same and each is so fleeting, fundamentally means that change is a constant and a definite and hence nothing about existence can be permanent.

Whilst we like to attach ourselves to various things such as our partner, our body, our beliefs, all of these are constantly changing too, alongside the changes that we are making. This constant dynamism is what makes life so fascinating, piquing our curiosity at each and every turn with the unfolding of events. It is worth considering for a moment (that has just passed) that the past does not exist anymore, except in our unreliable memory, and that the future does not exist, except in our minds that attempt to anticipate and guess what may happen. You can argue the usefulness of predicting the future in order to make plans or indeed the recall of a past event to learn. Whilst this may have some use in certain situations, the large problem remains that when we ‘re-live’ a moment passed or project ourselves forward, the whole person responds as if actually there with all the same emotions, physiological responses and on-going thoughts–we feel it and live it. Through these lived experiences, which are invented and illusory, we then further sculpt our biological machinery, priming ourselves for what is to come.

Think about someone who bumps into you on the train. If this annoys you, do you carry on thinking about it or do you let it go? What mood were you in when it happened? In a tired, grumpy state, you may retort with anger; whereas a compassionate mood would see you forgive or even laugh. And what happens next when you arrive at work? How has that moment framed the next? With ever passing moments, impermanence at play, the realisation of this moving film in which you are the author, director and the star who can make choices moment-to-moment is a potent one.

So, let us enjoy being plastic and discovering the full impact of neuroplasticity (much is said about this nowadays, yet there is a great deal to learn about how changes in synaptic activity translate into real-time experience, learning and behaviour) and impermanence as these are characteristics we can use to grow and develop to take on challenges. Certainly in terms of pain and chronic pain, to understand that we are constantly changing creates realistic hope that pain can also change. Pain does change when you understand it fully and take healthy actions based on sound thinking.

Much of my time is spent with people suffering chronic pain, coaching them and treating them, harnessing their own ability to grow and change with new knowledge and skills that are employed to overcome their pain. Witnessing their change is an incredible priviledge as well as a wonderful example of neuroplasticity and impermanence.