Category Archives: Andy Murray back pain

04Jul/17
Pain and injury

Andy Murray fit for Wimbledon ~ pain in sport: 3 key points

Andy Murray fit for Wimbledon ~ pain in sport: 3 key points

Andy Murray fit for Wimbledon ~ pain in sport: 3 key points, but first…

What does Andy Murray have in store for fans this year?

Undoubtedly Andy Murray is resilient. He declared himself fit for Wimbledon 2017 and he has just beaten Alexander Bublik to take a step closer to the final: one game down, six to go.

There were concerns in the media about Murray suffering left hip pain during the build up to Wimbledon. Apparently this is a problem he has had for many years, however he is not going to let this stop him from giving his best. We have become used to his determined attitude, one that he has had to develop towards pain and injury in particular.

Clearly performing at the elite level has an impact upon the body, which is why the conditioning must be right to check the physical stresses. But, we are more than a physical shell. We are a ‘whole person’ and hence being resilient to life’s challenges is a key skill. This is an exciting time for Andy Murray as he embarks on his defence of the title whilst expecting a second child with wife Kim. Being able to put aside the hip pain, he could even be using this wonderful news as an inspiration.

In 2013 I wrote a blog about Andy Murray, back surgery and microdiscectomy. It still gets a fair few hits, particularly at this time of year when people are reading about him and Wimbledon. I stated that the rehabilitation “is not just about exercising. It is about understanding, learning, motivating, creating the right context for movement with confidence and many more factors that can lead to optimised outcomes”. Since then Murray has had a remarkable time, currently holding 45 titles.

“rehabilitation is not just about exercising

Murray fans now hope to enjoy (is that the right word?) the next two weeks. The pinnacle would be next Sunday watching a closely fought final with a Murray victory. Who knows? Sport these days chucks out surprises that ultimately keep us all riveted. Look at the Lions last Saturday!

Now, my blogs would not be my blogs if I didn’t somehow turn the thinking to pain. One of my favourite areas of discussion is pain in sport, in particular chronic pain in sport. Yes it exists! (Some people seem to think it may not….). Many times I have given my lecture and talks on the topic, encouraging modern thinking about pain to emerge in the sporting realm. There are some simple principles to begin with, and we can use Andy Murray to illustrate the points.

3 key points

Pain and injury are neither the same nor well related

We have known this for many years. The famous lecture and paper was in 1979! So when you see Murray in pain on the TV, this does not tell you much about the state of his hip. It does tell you that his body systems are in protect mode, compelling a range of behaviours and actions that can be seen. Pain on the other hand, cannot be seen. Pain is a lived experience. Can you see funny? Can you see hunger? All these experiences are whole person, which is my second key point.

“pain has only a weak connection to injury but a strong connection to the body state

Pat Wall (1979)

Andy Murray fit for Wimbledon ~ pain in sport: 3 key points

Pain is whole person

This means when we are treating pain and overcoming pain we have to think about the whole and not reduce it to a body part or some physiology. If my knee hurts, it is ‘I’ who feel pain and not my knee. Much like thirst. It compels action by me, the agent. Think for a moment: where do you feel thirst? Some may say in my mouth or throat. Think again. That is a dry mouth, which you may interpret as a sign suggesting that you need a drink. Pain always exists in a context. The context is the person, the environment, the action, the perception, and prior experience. Of course this changes all the time, as are we, the dynamic and ‘updating’ humans that we are. This gives great hope because when we tap into our incredible ability and resource, we realise that we can chnage pain and transform our experience. And that is my third point.

Pain can and does change, beginning with truly understanding pain

This has become so important to me over the years that I have set up a social enterprise in that name: understand pain or UP. Understanding pain gives you the foundation that you need to be able to take the actions that get results. Build upon a model of success and using the tools of coaching, in particular strengths based coaching, you set out your vision. What do you want? Then you orientate your thinking and attitude towards this picture of success and do your utter best. This is the route that Andy Murray has taken and continues to pursue, just like any elite athlete or person who has achieved.

These 3 key points are fundamental and continue to feature in my talks and writings. They do so because they are vital ingredients in the clinic. There are many others, but to start with these orientates the person in the right direction. As clinicians we may think ‘treatment’ but we offer so much more. We do treat and this is important. We also coach: we coach people to coach themselves in their world and to immerse themselves in the practices that result in living as best they can. Together we create the understanding and conditions for the person to flourish and feel themselves. They live fulfilling lives with all the joys and pleasures that exist whilst developing the resilience and skills to face challenges and learn. We can do this at any age, and we should be teaching kids these skills right now in schools ~ that’s for another time.

So, good luck Andy Murray and all the others chasing the Championship! We will enjoy watching you all over the next two weeks.

RS


Pain Coach Programme ~ treatment, training and coaching to overcome pain and live life 07518 445493

 

 

21Sep/15

Andy Murray wins despite back pain

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

karlnorling
| 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

 

23Sep/13

A few thoughts on Andy Murray and his ‘minor back surgery’.

The news that Andy Murray is to have a minor back operation hit the back pages last week. It is understood that he will undergo a microdiscectomy, a technique that minimises the tissue trauma in order to access the injured disc and the nerve that is being impacted upon by this structure.

Microdiscectomy – what is it?

For the decision to be made, it is likely that a disc has been seen on a scan to be affecting the health and physiology of a nerve root (where the nerve emerges between the vertebrae). In some people this will occur without causing pain but if pain and sensitivity does arise, then it is due to a gradual change in disc health over many months. Of course, it is very possible that repeated movements and in particular rotations with force will impact under certain circumstances. In fact, with any injury that is gradual, one has to consider the combination of circumstance (‘environment’) and genetics–termed epigenetics.

It seems that Murray has been experiencing back pain for several years. Many people who I see are in a similar situation having had pain for some time, often punctuated with more acute episodes. These acute bursts of pain are highly unpleasant and can make moving, working, sleeping and functioning very difficult for a few days and sometimes longer. When it comes to sports people, we can think about the injury or pain as threatening their career, however this is the same for others who plan to return to work following a back operation. Clearly the end point is different but the preparation and early rehabilitation need not be.

Preparing for surgery – see here

I make a point of encouraging a proactive approach to pre-op preparation both physically and mentally. Where possible, you want to be fit and healthy with ‘prehabilitation’, which is a structured programme of exercises to maximise tissue function. Picking up on the rehabilitation after surgery can be far easier if this is done in an orgainsed manner.

Equally, dealing with the mindset and fears that can encroach on one’s ability to train is as important. Understanding the pain, procedure, goals of the surgery and the recovery process will go a long way to reduce the stress and anxiety of an operation – or rather, the thought of an operation prior to the procedure. Using techniques such as mindfulness and relaxed breathing can be potently effective in reducing stress that occurs as a result of negative thinking. Certainly catastrophising about pain can lead to greater inflammation and thereby affect the healing process. We are seeking to optimise healing and therefore dealing with thinking that is overly worrisome can impact upon the immune system in the right way.

Early recovery

This will vary from person to person but in the initail stages it is all about allowing the tissues to go about their healing process, orchestrated by the neuroimmune system and certainly affected by other body systems. Beyond the gradual increases in movement, and tissues certainly need this for good healing, considering factors such as adequate rest, relaxation, good nutrition and a positive outlook are all key ingredients in creating the best possible conditions for moving forward. A range of strategies and techniques can be used including simple mobilisations but alongside motor imagery,  mindfulness, movement of other body areas, the use of music and motivational techniques and cognitive tools to fortify resilience and coping to name but a few.

Rehabilitation is not just about exercising. It is about understanding, learning, motivating, creating the right context for movement with confidence and many more factors that can lead to optimised outcomes.

* Naturally, you should take the advice of your health professional when it comes to your treatment and rehabilitation.

If you are about to have an operation or are recovering, contact us now to learn about our comprehensive treatment and training programmes: 07932 689081