31Jan/16

Ellen’s CRPS story

CRPSHere is Ellen’s CRPS story in her own words, kindly sharing her experience for you to read:

My name is Ellen Williams and I have had CRPS for 5 years. My CRPS story began 6 months after I had an arthroscopy on my left knee after a sporting injury. Being told I was suffering from an incurable disorder, which is also invisible to everyone apart from me, was a rather daunting prospect at the age of 15. For the first 2 years I was told that I had a good chance of it disappearing, as I was young and fit enough to “fight” it like it was some sort of infection. 18 months of intensive physiotherapy, on a weekly basis helped to a certain extent but not enough to click my brain back. When the physical physiotherapy stopped working, I began asking questions. My doctor was the one to give me the news I did not want, telling me that now it was unlikely to go for a long time, if ever. As a 17 year old, hoping to go to university, beginning to think of what the future it felt like nothing mattered anymore because I was never going to be able to live the “normal” future I had been planning since I was 10. Needless to say this was the first time I had got very depressed during my battle with CRPS. However this is when I began to see Richmond. He gave me and my family the answers we needed but had never been given before, that yes I may have to live with this disorder for the rest of my life but that does not mean that life cannot be as good as it was always going to be. Learning to manage my disorder has had its difficulties along the way however every bad moment was worth it when I look back at how much I have managed to achieve since the first time I saw Richmond. My family has been there the whole time, through the tears, pain and happier times however I have always wondered about how hard it is for them. I struggle to see my mum unwell so I cannot imagine how she feels having to see me in agony and knowing there is nothing she can do to stop it. The one piece of information I would give to anyone with CRPS is that it is not just the person who suffers, so if you cannot try for yourself, maybe try for the ones who love you. Needless to say I am now 6 months away from finishing my degree and am doing what I love on a daily basis. I am happy. I never thought I would be able to say that 3 years ago and that does not mean I do not have bad days, some worse than others however my daily life is happy and is “normal” for me.

06Jan/16

Onwards in 2016

UP | understand painOnwards in 2016 is my thinking. This is not a New Year’s resolution, but instead a commitment to developing the work thus far, upon raising awareness of the vast problem of pain across the globe. Whilst many organisations, governments and charities are focusing on particular conditions, and fine work many are doing, there is an overarching problem that needs addressing — the problem of pain: what it is? What it means to the individual? What is the impact? What can we do to overcome pain? This leads on to simple questions that we must answer swiftly: why am I in pain? What can I do? What are others going to do? How long will it take?

Pain appears in injury, in stress, in anxiety, in cancer, in heart disease, in diabetes, inUP | understand pain schools, in homes, in workplaces, on the playing field, in men, in women, in children, in the existence of disease, in the absence of disease, it comes in a moment and passes in a moment. Pain is everywhere, and whilst it plays a necessary role in our learning and survival, in many cases the pain is prolonged, amplified and causing on-going suffering when it need not. We have an obligation to change this situation because we can. We have the knowledge, we have the skills and we have know-how and it needs to be used across the board. This is a societal problem that we can tackle together, starting with understanding pain.

The UP campaign that we started last year has gathered great momentum, capturing our imagination and those who were touched by the events at T5 Heathrow, and creating a platform for our plans in 2016 and beyond. This year we will gain charity status and be taking our message as far and as wide as we can — each new person who knows about UP and that pain can change will be a messenger, and this way we can reach out across society. The facts that I give people each day, the knowledge and skills that we work upon together to create the conditions for change in a direction that the person desires, steers them towards sustained health and a life well lived. We are changing all the time, every moment is new and an opportunity, so we can learn to embrace this and keep moving onward!

Onward for me is continuing to develop the blend of pain sciences, philosophy and coaching to get the best out of each and every individual. We all have great potential that is to be realised, and this includes people overcoming their pain. There are too many negative messages given, wrong messages given and subsequent self-talk that predicts poor outcomes. This is not necessary at all and needs to be reversed. Let us talk of health and feeling good as much as we can! There are always challenging times, yet we can view these as difficult or as an opportunity to learn. We will not always be happy, but we can learn how to recognise thought viruses and old beliefs that we can update and change perspective upon in order to view things differently and hence feel differently as our embodied mind evolves.

So, with great gusto, onwards and UP!

07Dec/15

Central sensitisation and higher centres

Important Message by Patrick Denker | https://flic.kr/p/a9iUAG

Important Message by Patrick Denker | https://flic.kr/p/a9iUAG

There is a difference between central sensitisation and higher centres. In recent months I have seen people confuse the two, so I thought it best to differentiate in brief.

Central sensitisation is actually a laboratory based phenomenon that describes changes in the nervous system that result in modulation of the signals from the periphery. In addition, the inhibitory processes are dulled with consequential increases in sensitivity. This can mean that things that hurt will hurt more, and things that would not normally hurt now do. This can be transient but in some people with these mechanisms at play, they experience on-going pain as there is a predicted on-going perception of threat.

The role of the higher centres in pain include interpresting the meaning of the signals from the body (all body tissues and systems) and the brain makes a best guess. This best guess is our perception of reality at any given moment. What translates biological activity within hierarhical systems (networks, processes etc) into what we perceive, we do not understand–this is consciousness. We need the higher centres to convert biology to a lived experience, and the two are different, much like a scan does not tell us about pain. The scan is obective, pain is subjective. It is the person who brign spain to life and flavours it with their experience that is made of bodily sensations, thoughts and feelings culminating in what is.

So, whilst there may not be central sensitisation at play in all cases of chronic tendon pain, if you are feeling pain in that location, the higher centres are doing a protective job that is your lived experience; it hurts in the area where the tendon occupies — we have established that pain occupies a space and not a tisse; e.g. phantom limb pain. And because any pain experience requires higher centre activity, we must address this as much as the health of the body, the tissues, the person.

Pain Coach Programme for persisting and chronic pain. t. 07518 445493

Science | Compassion | Sense

07Dec/15

Pain Coach for vulvodynia

VulvodyniaPain Coach for vulvodynia and other persisting pains is an approach based on a blend of the latest thinking in pain science and strengths-based coaching. What does this mean?

Modern thinking about pain considers that the lived experience of pain is ‘whole person’, in other words, it is ‘me’ who is in pain and not the body part/area. By addressing the person, in effect steering thoughts, feelings and behaviours towards health, pain is overcome and a meaningful life is resumed, as defined by the individual themselves. Bearing this in mind, we can seek to achieve this with strategies that parallel the lived experience, becoming new habits that nurture change in a way that is healthy. Pain is embedded with the person, their life, their reality and how this is created by their whole self — body systems (including the brain, immune system), their body and the environment.

With pain being part of who we are at that moment, we need to be able to think clearly and logically about that moment, seeing it for what it is, and then respond in the best and wisest way. We are continually updating, with a fundamental design that means we change with every passing moment. The brain predicts what will happen next and the sum of the best guessed meaning to all sensory information is what we perceive in that moment. Each moment is of course in passing, with a new one on the way. Nothing is permanent, and this is also true for pain. Having a baseline understanding creates a new layer of thinking, which creates a new layer of lived experience each moment, and this is how we can overcome pain. You may ask why, if we are always changing, has my pain persisted; and this is a great question.

Why does pain persist? On one level, it is because there is on-going prediction of the need for protection against a perceived threat. The range of cues and triggers widens over time, as does vigilance and habits of thinking that underpin and flavour the lived experience. The sensory and sampling systems adapt and suggest threat, and the prediction goes on and on, until you take decisive action and create new thinking and behaviours to take the continual change in a new direction. To do this, as I said earlier, the new awareness and habits need to match the lived experience, and be employed moment to moment–in any given moment you need to be able to be witness to your thinking, emotional state and bodily sensations, then using this awareness to decide upon the best action (UBER-M is one of my self-coaching strategies that I have previously written about).

Putting this into practice for vulvodynia, we begin with the development of a working knowledge of the individual’s pain and what influences their pain (e.g. stress, anxiety, context, environment, anticipation, expectation, attentional bias, catastrophising, hypervigilance — to name but a few). Using this working knowledge, the person creates a sense of safety that is the foundation of the precise actions taken: specific exercises, training, general exercise, breathing/mindful techniques, re-charging (energy), movements that all form the healthy actions. This is becoming your own coach, so that at any given moment you can think and act to cultivate healthy habits, and in so doing, replace those that have been predictive of the need to protect.

The most frequently described pain experience is during intercourse with the clear impact upon the person and potentially affecting relationships and an ability to conceive. All are greatly emotive. There is often, rightly or wrongly, a sense of wanting to be healthy once again for their partner’s sake. Within this thinking, there can be a sense of guilt with the individual being hard upon themselves, the latter being a common characteristic, and one that needs to be addressed by developing kindness towards self.

UP | understand painAnticipation that a movement or activity will hurt sets up a cycle of protection — priming, expectant thoughts that drive tension and changes in perception, predictions of the need for protect then predominate and sure enough, the experience is painful and the cycle maintained through habit of thought and action. There are many points when new habits can be created from the moment of initiation of intercourse to during intercourse at different points (an anticipatory thought, a sensation of pain) and developing new thinking and reactions by practicing at other times — in essence reconfiguring the whole experience to resume the intimacy rather than fear of pain.

Pain Coach ProgrammeWe are designed to change, and we are changing continuously — it may not always seem like it, bit if you stop for a moment and note how your thoughts, feelings and body sensations shift and move like Constable’s skies, even within a minute or two, you will be aware of this in action. This awareness opens an opportunity to consciously decide to make changes in a direction of health, and in so doing, change your pain with new realisation and action. This all begins with the understanding of pain so that you can take wise action at every moment. The skills that you develop for overcoming vulvodynia you have probably noticed will be transferable to many areas of life because this is about your lived experience, moment to moment. Many women report feeling calmer, noticing more, responding and thinking with greater clarity and generally feeling well and healthy.

Pain Coach Programme to overcome persisting pain problems — t. 07518 445493

05Dec/15

Henderson’s heel

40+60 Feet | Bark |https://flic.kr/p/7rvmbB

40+60 Feet | Bark |https://flic.kr/p/7rvmbB

Henderson’s heel has captured the front page of the Guardian sports supplement today. The article claims that he has been told to play through pain as there is no cure for plantar fasciitis–the plantar fascia is a strip of tissue spanning from the heel to the forefoot.

In the general population this problem exists and is typified by first steps soreness on getting out of bed. The pain is often noted on walking, standing and running, in some cases being sore and stiff to begin with before easing and then building again.

The usual explanation is overload, but there is more to it than that. As with any persisting problem, it is not just about the blamed tissue, but much, much more. Similar to tendon problems, when the focus is merely on the structure, the outcomes are limited as are expectations:

“…with my heel there isn’t a timescale, there isn’t really a cure….”, said Jordan Henderson, continuing to describe how he feels, “There have been times when I’ve been pretty down because we couldn’t find the answers”.

Pain problems need to be addressed in line with our modern understanding of what pain really is, a protective device in the face of a perceived threat. The point in time when something hurts is not in isolation to what has been learned or believed beforehand, the meaning, the context and prediction of what may happen. Consider the footballer who attaches great importance to the state and health of their body and their legs and feet in particular. Also think about how these problems are discussed and viewed within the culture of football; all the views and opinions and what they are based upon. An injury deemed to be chronic or long-term has great consequences for the career of a footballer and hence the meaning of this pain is different to an amateur player or someone who does not play football. Much like the violinist who cuts their finger, this is more pertinent when they are about to play a concert — we know that pain threshold is lower in violinist due to the meaning and context. There is no reason to think this is different in footballers and their legs. What is the relevance?

Our pain experience is determined by the extent of threat and not the extent of tissue damage. How threatening to the footballer is the notion of a chronic foot problem? Very. Does this impact on the experience of pain, definitely. Pain tells us little about the tissue state, but much about how the brain is predicting what the sensory input (about the body and the environment) is meaning based on what is thought and believed. Already you should be seeing how the ‘treatment’ of such a problem needs more than local interventions to change the way in which the body-brain-environment interactions are manifesting as pain, in this case in Henderson’s heel.

We are designed to change and hence pain can and does change when you understand it and take the wisest and healthiest action. This action goes upstream of where the pain is felt.

Where do we feel pain? In our body, because this is where we perceive our actions, largely created by brain networks and body systems, yet none in isolation and none predominating. All are vital to have a sense of what is happening right now. And what is happening right now? Our reality in any given moment is created by the sum of all the activity in our body and brain within a certain context. This incorporates habits and associations that create the backdrop for prediction; e.g./ Henderson arrives at the training ground, and even at the thought of running around, the systems that protect us are engaging and priming in preparation so that when he begins to run, threat is assumed based on what is known, what has been and what could be. Result, pain in the heel.

Now, of course there can be an inflammatory response as well, and this may well have been detected on various scans. However, there are different inflammatory mechanisms, the one we know well from injury: think of a sprained ankle; and then neurogenic inflammation that is a feature of on-going sensitivity, when the peripheral nerves are stimulated from on high to release inflammatory chemicals into the tissues they supply, thereby maintaining the cycle. Again, predicting that healing is required, the higher centres trigger this response, and it needs addressing, but not just locally. This is the big problem with tendon treatments currently, the focus on the periphery. There must be an interpretation of what is happening in the tissues and concurrent thinking and feeling to make the experience of pain a conscious one. There is not always central sensitisation at play, but there are always higher centres involved with a conscious sensation.

There is much more to discuss and note in relation to the points raised, but for now we can look at the principles that are important for overcoming an on-going pain problem in relation to Henderson’s heel. Considering that pain is about threat value, the over-arching aim is to reduce the perception of threat and hence the prediction of required protection. This begins with understanding pain so that the individual’s thinking is based on the working knowledge that they are safe. Safe that is, to perform specific and general exercises to nourish the body and move for health. The specific desensitising techniques are tailored to the person who feels the pain, considering the existing associations and triggers. A sensorimotor training programme works to normalise movement from the planning level to the actual execution, thereby creating a new layer of experience that forms the basis for the next prediction; the prediction of safety. Building the tolerance gradually, allowing for adaptation is key. There are a number of ways to go about this, but in essence, the programme is to be lived through the day, moment-to-moment to match the lived experience that is pain.

It is the person who feels pain, not their foot or their tendon. Their tendon or fascia is not a separate entity seeking help. They are merely the place or space in the body where the pain is felt. The biology of the whole experience sits within that that creates who we feel we are, and the richness of that experience in that moment. Hence, we must always work with the person: their body tissues, their environment, their neuroimmune system and how the sum of all of this creates their lived experience. Within each dimension, there are a number of actions that influence the whole. This is how people overcome pain — not their foot; the person. And who are these people that overcome their pain? What do they look like?

They look like you and me. They have a working knowledge of their pain that allows them to exercise and re-train on a basis of the true meaning of their pain, a feeling of safety, diminished threat, the creation of safety in situations once deemed threatening, and they match their lived experience of pain with a programme that is likewise lived, health based, strengths-based and they have a clear vision of where they are going based on their values.

Pain can and does change, beginning with understanding it.

Pain Coach Programme for persisting pain — t. 07518 445493

 

23Nov/15

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.

19Nov/15

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]

03Nov/15

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.

30Oct/15

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!

23Sep/15

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