Category Archives: Chronic pain


Getting the best of athletes at the ACPSEM Symposium 2018

getting the best of athletes

Getting the best of athletes

Yesterday I was excited to speak at the ACPSEM Symposium 2018 at The Imperial War Museum — an inspiring place to inspire our best selves! Having been asked to talk about sensorimotor training, mindfulness and using hands for treatment, I shifted the title slightly: getting the best of athletes. To prepare the participants, not passive listeners, I wrote a brief premise: problem pain in sport.

Starts with the best of you

Getting the best of athletes and patients necessitates you getting the best of you. For athletes to reach peak performance they need those around them to also be at their peak. For physiotherapy this means delivering the best care, which we can only be doing in our own way when we are top of our own game. How can we achieve this?

Self-coaching is something we do all the time, primarily featuring what we tell ourselves — our inner dialogue. Now of course just because it is your dialogue based on your thinking and beliefs, does it mean that it is right? The art of self-coaching requires us to be skilful with our mind from where our actions follow. It seems easy to convince ourselves of something through simple repetition together with cognitive dissonance. Becoming familiar with the way your (embodied) mind works is a most valuable skill, as it is in the athlete to focus on performance.

You have probably noticed how the skills of self-coaching are the same as those we can use to get the best of our athletes and patients. In that we are also practicing makes it authentic.

What do you want?

What is your picture of success? We need to know where we are going and what we want to achieve. To really embed this within our thinking and actions, we must take the time to picture and feel it. Otherwise it is a mere doff of the hat and off we go again in a vague direction leading wherever.

Take a moment to write down your picture of success — what does it look like? What are you doing? Where? Who with? 

What are your strengths?

When you use your strengths you achieve results. Do you know your top 5 strengths? One way to clarify your strengths is to think of an example of when you were successful. What did you achieve? How did you achieve it? What part did you play?

Further useful questions to ask yourself could be, when am I in flow? When do I feel at my best? When do I quickly see the answers and a way forward?

Take a few moments to write a list of your strengths on a blank piece of paper. You can then establish your top 5

Like working a muscle, you can choose a strength each day to flex and practice.

Strengths-based coaching

Blending strengths based coaching with the latest understanding of pain is an approach to working with people suffering chronic pain, which I devised and continue to sculpt. This work will never be completed as we continue to develop our understanding on a route of mastery. To truly understand pain takes a working knowledge of neuroscience, biology, cognitive sciences, social sciences, consciousness, perception and more. This is not enough for then we need the wisdom to best use this knowledge.

Wisdom + knowledge = best actions

The essence of this approach is to focus on an individual’s strengths, whilst managing the consequences of their weaknesses. This is always about getting results by aiming to get the best out of the person and their circumstances. It is also about concentrating on what we can control and not what we cannot control.

What is pain?

We touched on this most vital of topics. Not in the detail of a full day Pain Coach Workshop, but to highlight the pinnacle of current thinking. I always emphasis the size of the global problem of pain as a backdrop. The understanding of pain must move forward in society where the problem is embedded in terms of personal suffering and the enormous cost.

There is no adequate brief explanation of pain. Pain is the greatest example of a conscious experience flavoured by individual stories, past experiences, expectations, emotions, context and meaning. Love is another. To understand a person’s pain to help them to understand their pain is to understand them and their style of life. How do they do life? How do they do pain?

ACPSEM Symposium 2018 at The Imperial War Museum

The question to ask, having listened deeply and compassionately to the narrative, is why have they not got better? Why the hold up? What is limiting their progress? We are always moving onwards, it’s the direction that is key. Which direction is the person going in and why? Establishing this allows us to create a new way forward together.

Pain is part of the way we protect ourselves. It is a perception and like all perceptions, can be thought of as an inference. Or our brain’s best guess based on a need to protect us, often just in case. Like anything that gains momentum, this builds over time as the perceived threat builds and the range of cues, triggers, contexts widen. Some may assume we are assuming that because of this understanding we are saying it is somehow unreal. This is definitely not the case. Pain is always real. Pain is always embodied. Pain is always individual, and what the person says it is. Let us never confuse this again.


The examples I used to demonstrate the Pain Coaching approach were those I was asked to discuss: sensorimotor training, hands on and mindful practice. Now of course these are not exclusive to Pain Coaching, which is the arching way of getting results. Pain Coaching is not a technique in itself so to speak.

Here is a short summary of the important points. Each example is about changing the person’s state. We practiced bounding and breathing in the session as a way of experiencing and feeling state change. Such change is always happening, but we are often unaware. The body is ever-present, yet our minds are often elsewhere. We can never be truly ourselves or well without being whole and connected, which is one of the reasons for being mindful.

As clinicians we are state changers, encouraging and inspiring others to change in their desired direction, day-to-day, moment to moment. This is why self-coaching is so important. The person has to be able to encourage and enable themselves in their world to get results.


To be mindful is to be present in yourself, in this moment whilst being open to what is happening, whatever that may be. Mindfulness is accepting, non-judgemental and seeing things for what they are instead of being biased by the mind’s presuppositions. So often we worry about things that never happen that way.

How do you look after yourself? Each day?

Mindful practice enables us to become familiar with our mind, to face our suffering and transform it with compassion rather than try to avoid it or cover it up, which leads to more suffering. Change is what someone in pain wants, and to do so takes awareness, understanding and focus, all of which mindful practice nurtures. This can be through mindful breathing, mindful movements and body scans as examples.


Movement is fundamental for survival. In persistent pain, protect and survival states predominate, usually just in case as opposed to true need. This is one reason why being in touch with reality is so important. To be in touch with reality means you can perform a more accurate risk assessment, considering that we have no direct access to our biology, just inferred states (what I experience as my perception and reality).

Movement enables us to create our reality. The brain needs movement to actively gather sensory information from the world, thereby creating my perceptions. Anything that threatens my ability to move and act in the world is a threat and will maintain a state of protect. The perceived threat could be restriction, a thought (anticipating pain) or a lack of control due to altered body sense.

On moving we are fulfilling a prediction that has already been made. To re-train normal movement that features ease, action in perceiving (rather than thought about) and flow, is a necessary part of the programme. This starts with body sense training and re-establishing the clear boundary of me and the world, gradually building towards meaningful movements and activities, bringing in elements of control, strengths, endurance and flexibility.

Hypnotic hands

I jokingly talk about hypnotic hands. But in essence we are talking about the use of meaningful touch to bring about a state change. We can see and feel the change in someone when we use touch skilfully. This is a most useful state change that creates a new and pleasurable experience in an area of the body only ever thought of negatively. We also see changes in engagement with the body, re-interpretation of experiences, reduction in threat, and parasympathetic states. All of these are important steps in the right direction. We explore this is detail, creating experiences for each other, in the workshops.

Wrapping up

I like the talks I give to be interactive and experiential.This is one way to emphasise messages. Making it real. Being told something and experiencing something are completely different. Immerse yourself!

As physiotherapists we are pattern breakers, disruptors, state changers, perceptual sculptors. That is the reality and we must forge forward in the profession as we are in a great position to encourage and inspire people to achieve success and live their best lives.

On a route to mastery we seek to grow and develop ourselves as the knowledge tree ever-blooms. We must match this with wisdom, which is why I suggest kaizen and the beginner’s mind at the top of the session. We are each following our own MAP: mastery, autonomy and purpose.

‘Make each day your masterpiece’ John Wooden

If you are looking to develop your practices, to get the best of you and your patients and athletes, The Pain Coach Workshops give you the knowledge, skills and know how:

London 20th October

University of Central Lancashire, Preston 3rd November



#ThinkBIGSundayWithMarsha and why I post encouragers on a Sunday

Tweet Real Marsha Wright Twitter

This blog is a brief look at #ThinkBIGSundayWithMarsha and why I post encouragers on a Sunday.

Using Twitter

The Real Marsha Wright has gathered momentum behind her social media presence on Twitter. You cannot argue with over 563,000 followers. It makes sense then, to post using Marsha’s hashtag on a Sunday, #ThinkBIGSundayWithMarsha.

I am a regular Twitter user. There are of course pluses and minuses of social media. We must dose ourselves and control our device checking. We know that too much time spent on social media impacts negatively upon our wellness. When I discovered the Sunday conversation dedicated to whipping up encouragement and positivity, I was in. There are some particular reasons why this is a good idea for both the sharer and the readers and retweeters (is there such a word?).

Being an encourager

I was introduced to the concept of being an encourager by a true encourager. Mike Pegg is a true encourager. Spend a few moments in his presence, listen to him speak, read his website or his excellent book, and you’ll understand.

So I have adopted this approach, in my own way (encouraged to do so by Mike of course!). There are many outlets to encourage others: with colleagues, with family and friends, with strangers and via social media. We can do so verbally, using all the skills of deep listening and language use, and the written word. On Twitter, this demands brevity with the limited characters. This forces the tweeter to consider the message he or she wishes to convey in its shortest form, without losing the point.

It’s not just positive thinking. It is positive action that makes a difference

Being an encourager is not just about positive thinking. There are issues with positive thinking in that I can sit in a chair thinking positively yet achieving nothing. Positive action is the key, based on wise thought. And this is not to deny the fact that there are ups and downs in life. However, you can always choose a positive approach to a challenge. This means you look for the best possible outcome for all involved with clarity.

The benefits of encouraging using encouragers

We all share the desire to live a healthy and happy life, free from suffering. Yet suffering is part of life. We can seek to ease our own and others suffering by the way we choose to live life. Being an encourager is one such way.

The multitude of tweets using the hashtag #ThinkBIGSundayWithMarsha demonstrates the engagement with mutual encouragement. Think about how you feel when you have encouraged someone, or you have been encouraged. That is a boost of wellness you have experienced, as there is a very real biology going on. Everything has a biology: a thought, a feeling, a sensation, a perception, a movement. Being you is biology in action.

We know that to notice positive feelings and emotions through the day results in greater wellness. The secret is to build momentum by practicing. You may need to set some reminders. Especially if you have a tendency to be attuned to what is wrong rather than what is right. This is biology at play of course, and one of protect when one habitually notices things that could be threatening. As momentum builds in that direction, the world looks more and more dangerous. Many people experience this, resulting in chronic illness and pain.

Standing talking with a screen

Talking at the ACPSEM Symposium ’18 at The Imperial War Museum

Simple practices

Here are a couple of simple ways of engaging in the encourager’s way of sharing encouragers:

  1. Start purposefully noticing when you feel positive emotions. They happen each day, but often we don’t realise. Examples include that first sip of your morning coffee, the feeling of warmth from the sun, someone smiles at you, you remember a funny moment. The key is to feeling it then and there, and acknowledge it. A little secret: when you notice the feeling in you, rather than the thought, you will experience how the feeling grows and continues.
  2. Make a point of encouraging someone each day, and feeling it.

As you practice, like anything you repeat, you get better and the feelings build.

There are many ways you can be an encourager. I enjoy the practice with the people who come to see me for their pain and health issues, seeing the results as they engage with their programmes to overcome their suffering. I also enjoy using social media to reach out to as many people as possible across the globe.

How can you be an encourager?

The Pain Coach Programme to get the best of you ~ overcome pain by living life


Problem pain in sport

Persistent pain and injury in sport

As a premise to the ACPSEM symposium on Saturday, attendees may find this brief blog useful before our session together. Problem pain in sport exists as a challenge, which we must face and address. Some still argue that pain in sport and exercise is somehow different to that of mainstream life. This can only be a limiting belief.

There’s a lot to get into the session, but we’ll give it a good go. It’s interactive, so be ready to get stuck in to get something out of it. This is not a lecture on how to do it. Whatever ‘it’ is. This is about getting the best of your athletes and patients. And there’s only one start point to that: you.

You and pain

What is your approach to chronic pain? Does it excite you or turn you away? What are your beliefs about chronic pain? Do you really understand it? Do you suffer? What do you do with your own pain? What are your biases? What are your limiting beliefs that hold you back? There are many more questions to work out where you are on this one. I’ll let you ponder for now.

We are going to look at your strengths. This is no different to your athletes who seek results. This is coaching, which you are using as a means to encourage and inspire the people who come to see you. How can we build on what works? We self-coach, moment to moment, keeping ourselves in a peak state to perform as a clinician. We are following our MAP: mastery, autonomy & purpose.

What’s your MAP? Why do you do what you do? Is it clear in your approach, attitude and actions? It should be

A task, if you like, is to write down your personal philosophy in 25 words or less ~ challenging?

The ways we get the best of ourselves each day are the same as those we encourage our patients to use to get the best of themselves. We coach them to coach themselves. There are many ways to do this and numerous practices and tools we fill their toolbox with as we create a programme for them to follow. We will look at a couple of important ones in the session as examples. We will also have a go at a few practices that I interweave into the session, just like I do in the full day version. This has to be immersive for you to learn — having the experience and feeling it fully.


Pain physiology won’t feature in any detail, but the modern thinking about pain and what we can do is a theme from start to finish. It’s worth considering that the more we focus on pain, the worse the outcome. The more we focus on the person, disrupting what is holding them back and creating new patterns and habits that head towards their picture of success, the better the outcome. The bigger picture is key. To understand pain is really delving into what it is to be alive, to be human, to be conscious and how we generate perceptions, which are our reality.

My hope is to give you a flavour of this rather huge but exciting area. Much needs to change if we are going to reduce the enormous global suffering (pain is the No 1 global health burden). Are you up for some disruption?

See you there!

Following this will be a Pain Coach Workshop in London on Sat Oct 20th and at The University of Central Lancashire on Sat Nov 3rd ~ if you want a whole day because you are looking to build your practice and understanding of pain, come along!


Remarkable people

This is a short blog about importance of remarkable people for the world and for individuals such as you and me.

Remarkable people inspire us

We all know of, or know remarkable people. They may be your gran, your teacher, your wife, a mentor or someone you read about or listen to in person or on the web. On looking closely you will often notice that such people don’t consider themselves remarkable at all. They just do what they do and love it.

A couple of life’s rules

Immediately I can think of five remarkable people who I know. As soon as I visualise them individually or as a group I notice how my emotional state changes. There are two reasons that follow a couple of life’s rules. Firstly, that what you focus upon determines how you feel, and secondly that we adopt the standards of those around us. What can you learn from this?

There are a few things you can take away.

  1. Choose carefully what you decide to focus upon — what is your picture of success?
  2. Choose carefully who you hang out with and are influenced by

A simple exercise

Try it now. Close your eyes and think of a remarkable person that you know. Someone who inspires you. Feel what happens in you. Now ask that person a question. Something you are puzzling over or tangling with. What do they say and how do they say it? Are they kind and warm? Listening deeply and understanding? They should be if they are remarkable people. Don’t worry if the image is fragmented or unclear, it is the intent and purpose and awareness of the feelings that are important.


Building upon this we can simply express gratitude for such people, aspiring to take on their qualities in us. Again, notice what happens when you do this. Feel the state of gratitude emerge in you. There is a potent biology at play. Everything has a biology.

Further, you could choose to write to the remarkable people who you know and express thanks for the way that they inspire you.

Enjoy and be wise in who you spend time with in person and in your (embodied) mind.

These are two of many practices and tools you learn in The Pain Coach Programme to live life and overcome pain, or on your road to mastery as a clinician 


Fibromyalgia causes Kirsty Young to take a break

Kirsty Young on front page of The Guardian takes a break

Kirsty Young on the front page of The Guardian today

Fibromyalgia is a painful condition that may affect more people than is realised

It is unusual to see chronic pain hit the front pages, but today Kirsty Young announced that she is to take a break from Desert Island Discs because of fibromyalgia. The popular Radio 4 presenter says that she is likely to be away for a number of months.

Fibromyalgia is predominantly a painful condition, but accompanied by a range of other issues and characteristics. These can include headaches, migraines, irritable bowel syndrome (IBS), jaw dysfunction, pelvic pain, anxiety, fatigue, sleep disruption, the so-called brain fog (poor concentration, memory and ability to think clearly), depression and perfectionism to name but a few. The pain itself can often be widespread. Together this makes for a miserable time, frequently with great suffering due to the impact upon the person’s life.

Fibromyalgia and the neuroimmune system

The debate about fibromyalgia continues. Once ignored, there are still quarters who doubt and contest the existence due to a lack of biological markers. Slowly this has been changing and we know that there are likely to be neuroimmune changes that underpin the range of sensitivities.

With the neuroimmune system being very responsive to the way we live, think and act, this explains why many people who suffer fibromyalgia begin their story at, or soon after a period of emotional turmoil or stress. This need not be something huge in life, instead the drip, drip, drip of perceived pressure, the perfectionist need to reach unobtainable levels of performance, the self critic that triggers biological protect states and a lack of self-acceptance are easily enough to trigger such an episode. They are often slow-burners over time when you look back in the story. Each person has their own story that we must hear.

This is indeed why the figures of children and youngsters currently suffering is so alarming. When you listen to the narratives of people, often women, who suffer fibromyalgia, the patterns emerge. The same patterns that we are seeing in these kids who are being encouraged to be self-focused, to be competitive, to get top marks etc. And at a time when their biology is being sculpted and so vulnerable, this is a disaster on the way unless we wake up and changes the way society is going. I’m not even touching on the contribution of social media either!

Let’s be optimistic…because we can

As with other chronic pain problems, the mainstream thinking is out-dated and rather glum. Tacked onto the end of most articles are the same old ‘treatments’, wheeled out as an after thought, with a bit of a yawn. Exercise, talking therapies, medication (usually that’s first — as if dulling the symptoms will ever teach you anything about overcoming the problem!), relaxation and mindfulness are the common ones. Yes, they can be helpful, but there is so much more to it!

The first step is to understand fibromyalgia and the pain and the other symptoms. There is an over-arching biology at play, a level of sensitivity that is manifesting as the lived experience of the person. With understanding we shed fears and limiting beliefs, and put energies into focusing on the steps to overcoming the challenges. We need a direction: what is your picture of success? What do you want, I ask people who come to see me, asking them to frame it in terms of what they want, not what they don’t want (I don’t want this pain is a common start point that soon becomes, I want to go to work, I want to play with the kids, I want to sleep etc etc.).

The clear picture of success is a daily reference point as you create new habits to change state. We seek to generate the best states as often as we can: pleasure, joy, resourceful, excitement, love, compassion, gratitude and many more. We can do this in a number of ways including focus, movement, breathing, a shift in approach and visualisation. These states are accessible to all because they exist in us and are the way we build wellness; and there’s one thing we need to build when we suffer chronic pain, and that’s wellness.

What is pain?

This is a huge question so I shall be to the point here. Pain is all about protection, and forms part of the way we survive. The brain is only interested in survival, so if there is an actual or possible threat, we will respond just in case. Of course we are more than a brain and this amazing organ needs a body to act upon the world. Hence we must always think about the whole person, which is the purpose of the biopsychosocial model. It is the person who suffers, not the body part or system.

Pain is well related to the perception of threat, but is poorly related to tissue damage or state. We have known this for many years, yet much of society still acts according to outdated thinking. Many people and much of healthcare continues to try to explain pain by pictures on a scan. This is not the way it works.

Pain is very much tied into how the person is in their life and their style of life. How do you do life’s challenges is usually reflected in how you do pain and the choices you make. They may not be the best choices and could well need a new approach based on truly understanding pain.

Survive mode ~ constant protection

One of the features of fibromyalgia is the constant state of protect. The systems that look out for us maintain a level of alert and increasingly the world looks more and more dangerous. Remember that we work on a just in case basis. 9 times out of 10 there is no lion behind the bush, but there may be, and that’s all we need to trigger another defensive reaction. This is done automatically in the main, orchestrated by the sympathetic nervous system (fright or flight).

So, one primary job is to restore some balance and the ability to discriminate between real and possible and no danger. As a clinician I share the knowledge, we practice certain skills together and then the person takes them into their own world to use independently. This creates new experiences and reference points for moving on. At all times we are keeping our picture of success in mind — am I thinking and acting in line with my picture or am I being distracted?

Moving forward

The firm grounding of understanding forms a foundation to create a daily practice of rituals and new habits to build wellness. Shifting out of protect to other states is like changing gears in a car. We have to coach ourselves in each moment, nurturing the positive states that biologically are congruent with survival, and change state when we are suffering. Of course there will be a reason why we are in a suffering state and this is not to be ignored. There is a need to be met, which could be reassurance to self, or a need to address a difficult emotion, a need to nourish the body with movement, or more often a range of needs. With understanding and practical tools we can begin to consistently meet our needs and forge a way forward, transforming our suffering moment by moment, day by day.

We are a whole. Each moment is made of thoughts, feelings, perceptions and actions unified as our conscious experience. That is all we have as our biology is in the dark and there are many hidden states that we do not have access to. Same with the brain that has to guess what the signals flowing in may mean. The mind is best thought of as embodied, which has several important implications.

Firstly, the way our body is experienced impacts on our ability to think, decide, and remember. All are grounded in our physical presence., which we must care for and nourish in a compassionate way. Secondly, our body is how we enact our thoughts, feelings and decisions, so it must work for us. Movement is key for survival and hence anything that could affect our ability to act in the world is deeply threatening. And thirdly, for these to happen we must be connected with our bodies. Many people appear to be disconnected or ‘avoid’ their bodies because they don’t like how they look or feel. Simply, you cannot address this unless you are engaged with your body.

Understand pain (and your condition) to understand your potential

I wish Kirsty Young well. It can appear to be a tough road, especially when many of the messages are doom and gloom. However, I would say that we are now in a time of disruption; disrupting this kind of dated thinking. Disrupting is what I am doing (Understand Pain social enterprise), because we do not need to suffer the way in which we are. We have many ways to reduce and transform suffering.

There are numerous practices and tools that can support and encourage a way forward for each person, but they need the know-how. That’s the key bit. The practices must address all the dimensions of a pain experience. And this is why I brought strengths-based coaching together with pain science using the true biopsychosocial model. To use what we know about pain with an approach that gets the best of people so that they can achieve their picture of success. Tools are just tools, but with know-how we add wisdom to their use to get results.

On we go!

For more on The Pain Coach Programme to manage and overcome pain, see here 

Understand Pain Social Enterprise 

Having fun and practicing the art of joy balancing by the sea

The art of joy

the art of joy balancing by the sea

Our approach to life flavours the moment. As time unfolds, my experience rolls out as a unified sense of my body, my thoughts and my dialogue within an environment that I am shaping, all likely through prediction. So where does this approach, or set of rules come from? What is the effect? And how can I use my approach to be successful and live the life that I want? How can I choose to practice the art of joy?

Simply put, my beliefs and convictions about myself and life are sculpted from an early age by parents, care-givers, teachers, friends and society to name a few. Of course this is on-going as we update our beliefs with new knowledge and experience. What I practice then, are conditioned patterns that I don’t really think about as I am living the experience of those patterns as they come to fruition.

You may feel hence that there’s little control over these patterns. I would argue not. Instead, on realising which beliefs are limiting and which empower, I can practice and fortify the latter having disrupted the former. Overcoming chronic pain is all about this, whilst focusing upon what you want in life.

Many people continue to use the same patterns over and over. That’s when life feels the same everyday. Groundhog Day. But, on discovering that you have a potent skill that can transform your life, you realise that this does not need to be the way. What is that skill? You maybe surprised to learn about this amazing resource that you already have!

What is it that affects the quality of your life? It is the decisions you make, moment to moment through the day, every day. Not the big ones, the little ones. Here’s a question. What decision could you make right now to change your life? Pause for a couple of minutes and think about this before reading on.


Here’s an example: I decide to commit to a programme of daily exercise and movement to build my body’s strength, resilience and mobility. Would that change your life? Of course! This decision of commitment you then follow by taking action and gathering momentum by deciding each day when and how you will exercise, together with how you will integrate movements into your day to nourish your body at regular intervals.

Decision-making is one of our greatest powers. When you decide that you want to transform your suffering into a life of joy, everything changes. How? You may well ask! I’m in pain all the time, I have hardly any money, I have no work and all the other reasons why we can suffer. The problem lies in the fact that when we focus on these thoughts and the dialogue is littered with words that magnify the suffering states (pain, anxiety, worry, anger, frustration), then we use all our energy on the very things we don’t want. On deciding to focus on what we do want, we can start taking the steps to get results.

I want to be able to walk to the shop. I want to play with the kids. I want to play the piano. I want to play football. I want to bend over and put on my shoes. I want to feel joy. I want to go back to work. When we make it clear, carving out a vision of success, we have a direction.

This is what we can decide to do before creating a plan that we follow each day, taking steps in that direction. Of course we will have moments of suffering when there is pain, anxiety or things go wrong, but the more we can build resilience and choose an approach that is driven by the notion of life happening FOR me, rather than to me, we take the ups and downs as opportunities to learn, persevere and grow. One of our needs in life is growth without which we stagnant. And that’s not a good place! So, I can decide that I am going to drive growth in my approach. You can decide that right now. But where are you going?

What is your picture of success? Write it down in the following space:

** Remember that this is what you want, so use positive language and feel it whilst you are writing; make it real.

My picture of success is:




Another human need is giving. In particular the giving of ourselves and time to those we care about, which has such a huge effect upon both the self and the receivers. Generosity has also been named as one of the skills of being well by Richard Davidson, the neuroscientist who has been studying wellness.

The art of joy, which is the title of this brief blog, most certainly incorporates giving and generosity from which flows joy amongst other great states. How does the world look when you are feeling joy? How does your body feel when you experience joy? What decisions do you make when you are in a state of joy? Who creates the state of joy? You! We can decide that whatever each day presents to us, we will face it with joy together with compassion (including self-compassion), love and other potent states.

Suffering states inevitably arise. That is normal in life. Yet how we approach life determines what it is like and how long we stay in that state. Deciding to use an approach whereby we recognise the triggers of a suffering state and then change gear using breathing, gratitude, or movement. There are many ways to change state, but these are common ones I teach people who come for coaching and treatment to overcome chronic pain or achieve peak performance.

The art of joy then, is about what you put into life. As a general rule, what we put out there with purpose and intent comes back. A simple example: when you predominantly smile at people, how do you feel? How do they respond? What is life like? When you put a scowl into the world, what comes back? The art of joy and joyful living is all about your approach, which in turn emerges from your beliefs or set of rules. This is why important work involves identifying your beliefs, both the ones that cause us to suffer and the ones that enable us to thrive.

Depending upon your start point, this can of course be a challenge. If your health is compromised, if you are out of work, if you have lost someone close or perhaps just not reached your potential, it can seem impossible to be grateful for the world, nature, your breath, your eyesight or whatever. However, it is possible and with a picture of what you want to achieve, with steps to take, practices and tools to use, you can decide right away that you want something different now. You have suffered enough and its time for change.

I am very privileged in that each day I get to work with people who want to transform their lives and fill it with joy, love and compassion instead of suffering. As I’ve said, of course we will suffer for a range of reasons, but we just don’t want to stay in that state too long. We want to be able change gears as quickly as possible because shifting into a high energy or joyful state means that our decisions are made with clarity, purpose and in line with our picture of success. It becomes clear what we CAN do.

The Pain Coach Programme is designed to give people the (working) knowledge, skills, tools and treatment to overcome their pain and suffering by living life. Results driven, the programme is all about gaining momentum behind progress and growth from pain to purpose to performance. This is a solution for people who want to make changes, who want to live well and perform their best in life whether it be overcoming pain, achieving success in exams or work or on the sports field by using your resources and strengths.

Call us now to book your first session: 07518 445493 ~ Jo will make all the arrangements for you


Stuck in pain


Overcoming chronic pain

Stuck in pain and how to move on

People suffering chronic pain will often tell me that they are stuck: stuck in pain. They feel that their life and their pain is the same, day in and day out. This is their story, and it is the story, based on our beliefs, which influences all our decisions and experiences of life. In the case of chronic pain, it is commonly a story of limitation and avoidance for fear of the consequences.

To feel happy and well, we need to be growing and progressing. Think about a relationship or a business that is stagnant. What does that tell you? You would be concerned most likely if a friend told you that their marriage was stagnant! To grow we need continual conditioning and practice of specific skills, driven by empowering beliefs. In fact, the first step to feeling empowered is to decide to make a change, and the second by clarifying what you want. This orientates your brain and you in the right direction.

are you stuck in pain?

When we are stuck in life, we need a change. A lack of growth often brings suffering at some point in the form of a pain persona, which can be literal pain or that of a challenge in life, or both of course. Something in our pattern must budge, but many people are either caught up in their protective habits and conditioning or simply don’t know what to do. We make a change when we are either inspired or we are desperate and can bear it no longer. Being held back by fear is many people’s experience, yet what of the fear of not doing something? What is the worst that can happen if we continue in the same way?

Taking that first step and deciding what you want in your life, clarifying that picture and feeling it, starts to get your resources behind it driven by a sense of purpose and a clear direction. Everyone has strengths and resources at their disposal: think of an example of when you were successful and experienced an achievement. How do you feel? What strengths did you use? (I recommend you pause and experience this practice).

To engage with daily practices that enable us to achieve the wins along the way to the picture of success, we need energy. Our energy levels are determined by a number of factors including how we feel (what am I focusing on?) and how we live (e.g./ diet, exercise, physical activity, sleep). These choices are vital in our experiences: low energy = low engagement; high energy = high engagement!

The daily practice of the ‘skills of being well’ build our health and energy. Both are fundamental for peak performance in relationships, at work, with family, friends and in sporting situations is needed each day if we want a fulfilling life. This is no different to cleaning our teeth 2-3 times a day for life. This is mastery, and there’s nothing more fulfilling than seeking to master your life. Pursuing mastery is all about focusing on giving our very best, having set a high standard, pushing ourselves to the next level. And when we reach that level, we know that there is another ahead, and so on.

we need a plan

For the practices to be used, we need a plan that is in line with our picture of success. What is your picture of success? What does it look like? How does it feel when you picture success? It’s energising!

So, we have decided to get the wheels turning once again. In fact, the secret is that they were turning, it’s just you may not have noticed because the predominant dialogue and focus has been on the pain and consequences. Remember that what we focus on governs how we feel, and what we focus on, we get more of because that is what we become attuned to and look out for. You can decide that you want to focus on something else and just like a muscle, train your mind to concentrate more and more on what you want: your picture of success. It’s about momentum.

Stop, sit up and breathe, deep. Repeat this three or four times — feel your change in state if you decided to do this; you’ve changed your chemistry

What are you going to decide to put your momentum behind? This is the power of choice, and feeling great about it, because you can. We build momentum by using repetitions, just like anything we practice. Creating a daily routine helps you to groove new habits that are in line with your picture, whatever that may be. If you write this down in a journal, you will find that this helps you to commit and achieve results. And this is what coaching is all about, results that you measure because you are aware of the effects of what you are doing. Pain Coaching is specifically designed to encourage and enable you to achieve results in your chosen direction, away from the suffering by filling your capacity with high energy states: joy, compassion, determination, excitement, love, passion and the many others.

choose to be unstuck and then take it to another level => high energy states

The Pain Coach Programme is all about getting the best of you. The positive approach means that you have a clear picture of success and the tools to use to take the steps in that direction. Being positive is about making clear decisions and taking action to get measurable results. Once you have the knowledge, the skills, the practices and the know-how, we keep the momentum going and your energy high as you build your wellness and live your life.

So if you’re stuck in pain, and you have decided to commit to action get back to living by living, The Pain Coach Programme is for you. My purpose is to deliver coaching and treatment, knowledge and skills to as many people across the world as possible to reduce the global suffering.

Call us now to start your programme ~ Jo 07518 445493
Persistent pain and injury in football and sport

Persisting football injuries

Persistent pain and injury in football and sport

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Persistent pain and injury in sport

Persistent pain and injury in sport

The toll of persistent injury

Persistent injury in sport

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

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

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

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

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

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

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

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

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

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

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

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

t. 07518 445493 or e. [email protected]

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

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

Motion in e-motion

motion in e-motion

Motion in e-motion

motion(less) | C Frenzl

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

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

Your state is governed by what you focus upon

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

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

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

motion in e-motion

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

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

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

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


Pain Coach Programme

Pain Coach Workshops

Pain Coach 1:1 Mentoring