28Jan/15
The Chelsea Consulting Rooms

Specialist treatment for pain

Richmond M. Stace Specialist Physiotherapist & Pain Coach

Richmond M. Stace
Specialist Physiotherapist & Pain Coach

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

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

The treatment, training and coaching programme

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

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

Call us now to start your programme: 07518 445493

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

 

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

About Specialist Pain Physio

Richmond M. Stace Specialist Physiotherapist & Pain Coach

Richmond M. Stace
Specialist Physiotherapist & Pain Coach

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

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

About Richmond

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

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

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

09Jan/15

Bono’s arm

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

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

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

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

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

Hypothetical case study

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

Assessment would include:

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

Then —

Pain understanding:

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

Treatment & rehabilitation:

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

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

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

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

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

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

Richmond Stace | Specialist Pain Physiotherapist

Richmond Stace | Specialist Pain Physiotherapist

Richmond Stace | Specialist Pain Physiotherapist

About Specialist Pain Physio Clinics

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

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

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

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

Richmond Stace MCSP MSc (Pain) BSc (Hons)

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

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

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

24Nov/14

One injury, and then another…and another….

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

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

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

 

23Nov/14

Why do Arsenal and MUFC have so many injuries?

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

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

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

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

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

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

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

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

18Nov/14

Caring for our carers

My simple message with this blog is that we need to care for the carers. Undoubtedly the individual with pain or ill-health is suffering, but so are the carers who may be partners, family members and friends. They may also be professional carers who are not immune to the stress of looking after someone.

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

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

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

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

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

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

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

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

15Nov/14

5 facts about repetitive strain injury | RSI

 

Repetitive strain injury (RSI) usually refers to pain and other symptoms felt in the hands, wrists and arms, often gradually becoming more noticeable. Unfortunately, many people continue in the same vain at work without seeking advice or changing their habits, resulting in a persisting sensitivity that can become very limiting — often in relation to typing and writing, but this can extend to any activity involving the arms and hands. RSI is also called a work related upper limb disorder (WRULD).

1. Despite the pain and other symptoms (e.g./ pins and needles, numbness), there can often be no significant tissue damage or injury. Hence, debatably it is not actually an injury or even a ‘strain’.

2. It is common for the pain and symptoms to be noted on both sides. Despite the problem beginning on one side, communication within the neuroimmune system gran underpin ‘mirroring’.

3. There can be an altered sense of the hands — feel cooler (the brain perhaps not recognising the hands as self and changing blood flow), bigger, detached. You should report any experience to your healthcare professional because these are important features that guide the type of treatment and training you need.

4. Hypermobile joints are common within the overall picture — BUT, hypermobility is not a problem per se. Just look at all the top athletes. They are hypermobile! You may be a bit clumsy and walk into furniture. Body sense should be re-trained or developed if so.

5. RSI or the like can be embedded within other painful problems such as IBS, migraine, widespread joint and muscle pain. It is not just office workers, text-maniacs and computer users that suffer, new mums are commonly affected with the host of repetitive (new) chores.,

If you think you are suffering with RSI or a similar persisting pains, come and see me to find out how to overcome the problem — RSI clinic in London, call 07518 445493.

If you are a business that is keen to prevent RSI and other persisting pains (e.g./ neck pain, back pain), come and talk to learn about strategies that you an put into place to save money and increase productivity: 07518 445493

14Nov/14

5 facts about complex regional pain syndrome | CRPS

 

Thanks to modern pain science we know a huge amount about complex regional pain syndrome (CRPS). Of course there is much more to know, and the way in which we think and take action to tackle the problem will evolve accordingly.

 

Here are 5 facts that I believe to be important:

1. The pain is not directly related to the extent of the injury or damage — the pain in CRPS can be unimaginably horrendous without any great change in the tissue health. Remember that pain is part of the way that the body protects itself, and not an indicator of tissue damage.

2. The affected limb can feel very different to the way it looks; size and temperature included.It can even feel like it does not belong, being described as detached or ‘not mine’. The loss of sense of ownership is because the brain provides this sense, but can also modulate it.

3. The symptoms can change according to your mood and the way you feel — stress can often make the pain worse. This is due to the perceived threat to the whole person triggering protection.

4. Seeing someone else move their corresponding body part can hurt. The brain starts to plan the same movement and will also protect at this stage, causing actual pain.

5. The limb changes colour because of blood flow changes. The autonomic nervous system (ANS) controls blood flow. This is the system that responds to perceived threat — ‘freeze, flight or fright’. In essence it is a system that responds to how and what we think. When we are embarrassed, we turn red (blood flow). This is because of the way in which we think about the situation:’ I have said something that I now think is silly’, ‘Is he looking at me?’ The ANS can also become sensitive, and is very involved with CRPS — colour change, altered sense of size, sweaty palms etc.

Suffering complex regional pain syndrome? Visit my specialist CRPS clinic in London to start your programme: call 07518 445493

09Nov/14

My top 5 pain myths

In my view, it is the lack of understanding that causes so many problems with pain in terms of how pain is viewed, treated and conceived as being changeable. Pain can and does change when you understand it and think about it in accordance with the modern (neuroscience-based) view and have a definite plan that is followed with big action towards a vision of where the you want to be. Having seen many individuals put this into practice, I am confident that the start point is always how we think because this is from where the action emerges. The right thinking begins with understanding your pain.

In the light of this, here are my top 5 pain myths:

1. Pain comes from a ‘structure’ in the body — e.g./ a disc, a joint, a muscle.

2. The amount of pain suffered is related to the amount of damage or the extent of the injury.

3. Pain is in your mind if there is no obvious cause in the body — i.e./ via scans, xrays etc.

4. There are pain signals from the body to the brain.

5. Pain is separate from how you feel or think.

There are many others.

Now, this all sounds rather negative and I like to turn this on its head and look at how we can positively influence health in order to change pain. The programmes that I create with individuals for them to follow are all about creating the right conditions in the body systems, all beginning with the right thinking that often challenges existing ideas and notions about pain.

Struggling with pain? Persisting pain? Call me 07518 445493 | Specialist clinics for pain and persisting pain in London