Category Archives: Pain Coach

Living well

Get back to living by living

Living well

It’s raining today (Monday 15th Jan). Not unusual for January but how does it make you feel when you look out of the window? Do you see possibility or problem? A wet day or a chance to jump in puddles? Most kids love jumping in puddles to see what happens and because that exploration is fun. As an adult, life is much more ‘serious’. To spend time splashing about many not even occur to you.

Having fun is a fundamental part of living a healthy and fulfilling life. Carefree movements and silliness in all their shapes and forms makes us feel free and easy, together with laughter, smiles and joy emerging from such acts dotted through each day. There is time for serious stuff, but this can be addressed with more focus, clarity and resilience when we are well. We learn, we bond, and we foster wellbeing through fun. However, this can all seem to be lost when our health and sense of self is threatened, so how can we get back to living when suffering chronic pain? Do we wait to feel better? Or do we actively do something to feel better? I would strongly argue the latter, but we need a way; the ‘know-how’.

Do we wait to feel better? Or do we actively do something to feel better?

Many people suffering chronic pain and other complex health problems are merely surviving or getting by. There is no sense of living. Instead, they are struggling through each day, perhaps with the occasional pleasure. There do not appear to be many choices because of the seeming limitations imposed by the pain, and even if there is some sunlight breaking through the clouds, it is short lived through the expectation that pain will soon return.

As with many of chronic pain’s associated consequences, to understand it informs new thinking, new decisions, new behaviours and hence new experiences. When the fears and worries diminish, opportunity arises. The fears naturally ease when pain is understood. Here are a few simple examples of what is known about pain:

  • pain and injury are not the same
  • pain and injury (damage to tissues) are poorly related
  • pain is part of the way we protect ourselves together with changes in thinking, feeling, movement and perception; all in the name of defence just in case the perceived, or predicted danger really exists (based on what we know, or ‘priors’).
  • pain is much better an indicator of the person’s state — i.e. in a state of protect; this is why tiredness, anxiety and perceived loneliness increase the likelihood of being in pain as all of these are potentially threatening
  • pain is embedded in our society
  • pain changes — when you monitor your pain, you realise the ebbs and flows; the notion of impermanence is useful here, as life would not be possible without our ability to transform and learn. All experiences come and go.

There is much more that we know about pain, and we are learning rapidly alongside the ever-deepening understanding of consciousness.

There is no way to happiness. Happiness is the way ~ Thich Nhat Hanh

With insight into the way we think, the way our mind works and being in touch with reality by being present and aware, one can begin to craft a way forward, step by step. This is the practice of being mindful, which is a way of living life, and really being here and now. These are not just words or concepts, but a reality. The past has gone and the future never comes; there is only this moment to live. Indeed this moment may be filled with suffering as this is unavoidable in life — this is the truth. But it may also be filled with joy and pleasure — this is also the truth. Rolling with the natural ups and downs of life then, becomes a skill that we can develop together with the practice of the skills of being well so that we build wellness and resilience.

In this sense, we need to go out into the world to ‘sample’ the sensory opportunities. In doing so we ‘update’ our perceptions and experiences. This is work in progress, so we take steps to build the effect as we become more skilful, just like learning a musical instrument. This is living by living.

There are likely to be parameters to work to if you are suffering chronic pain. One of the modern tenets for managing and overcoming chronic pain is that of creating a sense of safety (pain is about perception of threat, hugely involving the person’s interpretation of the situation, consciously and subconsciously). Understanding pain forms the basis of feeling safe to move and ‘act’, which then become the next prior experience(s) or reference point(s) (consciously and subconsciously); i.e. a building effect.

Along the way we associate with the success of the little wins, rewarding oneself at each step; rewarding the fact that you took action as you may not ‘see’ much change day to day. Think about dental health. You know that you must clean your teeth twice a day for 2 minutes. Not just once, but every day if you want to maintain a healthy mouth. Consider getting fit. Going to the gym once will do little. Going 3 times a week will build health and fitness, although you may not see much change for a few months.

Living by living

The start point with the principle of ‘living by living’ is to think about what you can do, even for a short time. This maybe walking, meeting friends (social interaction to counter perceived loneliness), simple movements or stretches to nourish the body tissues, reading, going to an event. Immediately you may think of the reasons why you CAN’T, but remember that these are the thoughts informing your decisions that you can change by associating with pleasure rather than ‘pain’. When you update your beliefs by truly understanding pain, you realise that you CAN do certain things, which you can build up, just like getting fit.

As you gradually fill your time with chosen and meaningful activities, the pain rents less space in your thinking and experience of life. The wheels start turning in the right direction, and you begin to associate more and more pleasure with your successes, even if you feel your pain at times. Pain is an action, a perception, a feeling, an emotion, a thought, all together as a means to make oneself safe. Whilst more complex that the (wrong) belief that pain resides in the tissues, this understanding means that we have a huge number of ways to transform the experience. Pain is embodied; we feel it in our body. But ‘I’ feel it, the person feels it, not the body part where I feel it — back pain: it is not my back that is in pain; I am in pain, feeling it in my back. Pain is ‘whole person’ and hence needs this approach.

*Action: think about something you CAN do, especially if it is fun. Picture it, visualise doing it and notice how you feel. Then try it, perhaps just a little to begin with so that you have a good experience that becomes a past experience to draw upon. We create these past experiences by living, hence getting back to living by living. Write down what you have done and how you feel that sense of success and achievement. Then build.

The Pain Coach Programme is a comprehensive approach to managing and overcoming chronic pain and easing the suffering of chronic health conditions. Contact us to book your initial conversation to learn about reaching your potential to live well. We look forward to hearing from you. t. 07518 445493

* You should always discuss new approaches with your healthcare provider.


Getting the best of Christmas ~ top tips if you’re suffering pain

Top tips to enjoy Christmas

Christmas top tips to thrive rather than survive!

Getting the best of Christmas ~ here are some top tips if you’re suffering pain so that you can maximise your enjoyment and create some great memories!

“get the best of you

Christmas is not an easy time for everyone. There are numerous challenges that include preparing a lunch, buying and wrapping gifts and seeing relatives. Add a layer of persistent pain, and these and other challenges are somewhat amplified. Having a plan helps you to organise your part in the festive season, allowing you to enjoy the time in the best possible way.

How are you framing the Christmas period?

The inner dialogue or script we are running has an enormous impact on how we have that very experience. If I keep telling myself that it will be tough, or tiring, or painful, then it usually is and more so. In essence we are feeding the prediction plus our choice of behaviour will enact those thoughts. So, write a positive script that is rich with all that you want. This does not necessarily mean that it turns out exactly this way, but it will be much better than if we anticipate the worst. What we focus upon we get more of!

My Christmas will be ______________. Fill in the blank and keep focusing on this picture and how you can go about doing your best to achieve it. This is the basic model of success used by anyone who has achieved results, including you! Clarify the picture of what you want and then decide upon the principles to follow to do your best to get there.

Make a plan

For each day of the festive period make a plan. You will need to prioritise your activities and create space for ‘refresh and renew’ time. To prioritise you can make a list of all the things you want to do. Then categorise them A-C (A the most important), before numbering 1, 2, 3, 4 etc (1 the most important).

Your plan is flexible, meaning that if it does not turn out exactly as you wished, you can accept the changes. It is useful to have a set of principles to follow, which allow for flexibility within the plan. Here are some examples;

  1. Knowing that wherever you are, you can create calm by using breathing or imagery, either because you are aware of a more intense emotional state or just because you wish to plug in and recharge.
  2. Motion is lotion is a way of nourishing yourself with simple movements that you know are safe, despite how they may feel at the time. Pain and stiffness are both need states that we perceive in order to choose an action that will satisfy the need. This is much like hunger and thirst.
  3. Refresh and renew time is when you deeply relax, engage in something pleasurable, have a conversation, listen to music, look at a scene with awe, practice gratitude.

Write your plan out so that you are much more likely to commit. You may like to share your plan with someone as a further way of cementing your intended actions.

Motion is lotion

Movement is fundamental for our health as it is the way we nourish our body and our brain (the two are not separate–we are whole). Movement is part of the way we are and the way we represent ourselves to the world. Consider how you can recognise a friend from far away by the way that they walk.

Motion is lotion is the consistent practice of moving, little and often through the day. Stiffness is a common bedfellow of pain due to the guarding (overactive) muscles that become tense and tight. The feeling of stiffness is inferred as a way to make us move, much like pain is an inferred (whole person) state to make us protect ourselves and meet the impending need.

Repeated simple movements that are tolerable or feel good will build the evidence that we are actually safe. This momentum creates a new back story that informs the next moment in such a way as to drive easier and easier movements. This is a practice and must be used through the day, every day. As a guide, when sedentary, change position every 15 minutes, and stand up every 30 minutes. Part of your planning (see above) will be how you can integrate movement into your day.

Be aware of what is happening right now

Being ‘in the moment’ is not just a phrase. There is no rehearsal for life; this is it. ‘Life is long if you know how to use it’ is Seneca’s classic title. Using our time wisely maximises the opportunities we have presented to us each day, together with an openness to experience. The beginner’s mind illustrates this well, whereby we maintain a wonder about our perception of the world that unfolds each moment, much like a small child walking into a grotto, experiencing the impact of the lights and aromas of Christmas.

Mindful practice is about being present, aware and open to all experiences without judgement. Noticing emotions, feelings, thoughts and sensations as they come and as they go is at the heart of the practice, however they appear. Quickly we can become familiar with the impermanent nature of things, so no matter what you are feeling right now, it will pass. We can easily integrate mindfulness into our day with a simple ‘formal’ practice of 10-15 minutes together with moment to moment awareness through the day. The latter is achieved by paying attention to a few breaths, which bring you to the present moment rather than dwelling and embodying the past or an anticipated future.

A further practice is to notice positive feelings and emotions through the day as they arise. ‘What we focus on, we get more of’, is a phrase I repeat to clients, as they train themselves to build awareness of all perceptions, in particular those that feel good. The broaden and build effect of noticing positive emotions has been well studied by Barbara Fredrickson, and it only takes a short period of practice for the impact to grow. Good feelings can often be subtle and pass by quickly, whereas negative emotions often hit us hard and linger for long periods. Paying attention to each moment as often as you can, permits the awareness of the positive in its many forms, building your wellness and ability to notice more. There will be plenty of good feelings to notice if you choose to create a positive approach to Christmas, pay attention and address your ever changing needs (see below).

Meeting your needs

We can strongly argue that feelings arising in the body are the conscious emergence of need states. I feel thirsty, I feel hungry, I have an itch, are all common examples. Pain and stiffness are also need states that motivate us to take action to meet the need, perhaps more urgently that some of the others.

When we feel thirst, this is a user-friendly representation of complex biology (sub-personal), which we only need consider as a percept to address by drinking. Pain can be considered in the same light to a degree. The variance comes from the desire to know why we are in pain. Is it something really dangerous? Clinicians must do their best to answer this question for the person.

Much of the suffering comes not from the pain itself, but the way in which the person interprets and thinks about the pain. This is why understanding pain is so important, and why many people feel immediate relief on knowing the answer. If you consider that pain is based upon the perception of threat, understanding pain is a way to reduce this threat together with knowing what can be done.

On feeling thirsty, we drink until the feeling appears to pass. On feeling pain, we must keep using our practices to create the conditions of ‘safety’ until we start to sense an easing, which will come. This may be repetition for a good period of time along with consistent practices we are using to get better overall. We must also address the reasons why, if we know, the state may have arisen. For example, a situation that is perceive as stressful, tiredness, anxiety, different or new movements, or a change of environment to name but a few. Pain is embodied and embedded in the context of your life, hence all factors need attention and new approaches engaged where existing ones fail.

An example to illustrate: I have neck pain sitting at my desk. I must move and stretch to nourish, and keep doing so until there is a sense of relief (this may need to be consistent through the day). I must also address the reasons why it could be painful. For example, I have sat here for a long time repeating the same posture and movement, I am feeling anxious about this piece of work or a forthcoming meeting, my mind is wandering, I am tired. Without considering all influences as well as the actual perception, there is not adequate reason for your body systems that protect you to shift gears. We actively shift gears with new thinking and new actions.


Here I have outlined some simple practices and approaches that you can decide to adopt for not only the Christmas period, but in a way to overcome your pain. The Pain Coach Programme is a practical approach to living life and building wellness as a buffer to the challenges that arise for each person. We can choose our style of ‘doing life’, and this has a significant impact upon whether we reach our potential or not. The Programme is about getting the best of you, or peak performance in different areas of your life. Each day presents a range of opportunities. Which will you engage with?

Here’s an equation:

(My current physical ability – my tolerance) + my approach = what I achieve

“How can I be the best me, and enjoy the process? 

** Please note that these practices should not replace your existing treatment or therapy programme. You should always check with your healthcare professional if unsure.

To start your Pain Coach Programme, to organise a Pain Coach Workshop or for clinician 1:1 mentoring, contact Jo 07518 445493

Overcome stress and pain to live well

The worried world and what we can do

Overcome stress and pain to live well

A recent article by Oliver Burkeman entitled ‘Anxiety bites. How to keep calm when world events are freaking you out’ highlighted the impact of Brexit and Trump upon people’s life perspectives. He states that levels of anxiety and being troubled have gone up, quoting the American Psychological Association as finding 57% of those surveyed to feel stressed by the political climate. There has also been a rise on the UK. We are, it seems, as a society, worrying about life and the future. Are we in a worried world?

We can argue that anxiety, like all perceptions, are inferred states as we try to make sense of the possible and most likely causes of the sensory information. After all, we are a bag of chemicals, and depending upon where they are and what they are doing, our brain has to make a best guess as to what they could mean based upon what we already know (priors). It is interesting that the ‘feeling’, the ‘what it is like’ of anxiety is similar to excitement. The key is the interpretation and what you tell yourself: I am excited or I am anxious. Try it.

Burkeman raises some good points. He mentions the contagion of anxiety as we are tacitly capable of sharing our emotions with others whereby both you and I feel anxious together despite being distinct organisms. Consider how quickly the atmosphere changes in an office or the mood of a football crowd. We are supposed to do something about the problems we perceive, but what should that action be? A feeling of outrage, powerlessness, isolation, and despair can prevail when we become over-focused on problems. This is some protective biology at play that results in us drifting into that state and maintaining it by continuing to attend to certain thought patterns. Burkeman also picks up on the notion of fear, with one of the therapists he interviewed mentioning the deep rooted and basic fear in life that stems from childhood. Without the safety of reliable parents, a child is destined to fend for herself, making the world appear to be a very dangerous place. Of course this can be hugely amplified if suffering or having suffered abuse when the protect systems are deeply provoked and remain active.

This is a serious issue. We have progressed remarkably as a species and the momentum is building, yet we appear to be falling behind when it comes to the so-called mental health. Regular readers and followers will know that I have an issue with this term, which I feel implies a dualist approach to the human experience. Experience is embodied (Varela et al. 2017). Everything we think and do is embodied, meaning that suffering depression and anxiety, the common and increasing problems previously identified, emerge in the bodily self. Where do you feel anxious? Most people will say in their stomach or chest.

Consistently being in a state of protect has health consequences as our resources divert towards defence rather than nourishment. This in turn raises the chance that the person will suffer a plethora of conditions, including those of an inflammatory and auto-immune nature. In my view a serious consideration for society (and policy makers), this is likely one of the reasons for the uptick in chronic pain, remembering that pain is also a mode of defence inferred from the existing circumstances.

what can we do?

This all seems a bit grim as we quickly forget the possibilities in life and the beauty that we are surrounded by in nature and human beings. So what can we do? Certainly knowing what we can control and focusing upon this rather than what we cannot control is a good start point together with a picture of what we actually want. This is the basic model of success. In terms of chronic pain, this is the first step we take when addressing the problem(s) before coming up with the principles to follow in order to achieve wins and overcome pain.

Here are a few simple tips, beginning with the creation of inner calm. Why is this so important? Because it gives us a perspective, making contact with our reality, allowing us to see things for what they are instead of being caught up in emotions that are the fabric of thoughts past and future. We learn to sense that inner calm, a feeling in the body akin to a deep peace and knowing. I would argue that this is a natural state, and one we can learn to access routinely each day, through the day, as well as when we need to be calm, clear and to see things as they really are. Biologically speaking, when we know and live this calmness, we are in parasympathetic mode, the branch of the autonomic nervous system that nourishes us.

Two simple ways to create inner calm: (1) take 3 breaths and slowly breathe out, paying attention to the breathe all the way in and all the way out. (2) take 10 breaths, following your breathing from the entry into your nose or mouth into your body and then letting go naturally, not trying to control or change your breathing at all. Note how you feel.

Further practices that can be integrated and implelemented into daily living include the practice of gratitude (Mccullough et al. 2002) and acts of generosity or kindness (Layous et al. 2014). Both are now known to be distinctly healthy and easily practiced each day, much like learning a musical instrument. We are not only considering the healthy effects, but also buffering against life’s challenges and the approach that the person takes to life–how do you do life? Possibility our problem?

Two easy ways to practice gratitude and generosity: (1) each day write down 5 things that you are grateful for in your life. (2) choosing to do something for someone else, including people you do not know, such as giving up your seat or letting someone go first. There are many opportunities through the day, however we must be aware and take note of how we feel, noticing the positive emotions as they arise. The more we notice, the more we notice, establishing the build and broaden effect (Kok et al. 2013).

Despite the world events and those closer to us in our days to day lives, it is our perception that is key–my own unique interpretation. As Shakespeare wrote: ‘there is nothing either good or bad but thinking makes it so’. These words highlight the importance of how you choose to approach life and the situations within your life. The practice of daily skills such as those outlined above are simple habits we can create to develop our thinking and our style of ‘doing’ life. Like other habits they become part of what we do with greater and greater ease, building our wellness that does not simple happen without effort and persistence.

The skills of being well are an intrical part of The Pain Coach Programme that is not only about overcoming pain, but living well, the best you can.



Improve staff fitness

Improve staff fitness

Call to improve staff fitness by the Chief Executive of Public Health England, Duncan Selbie

To improve staff fitness is a great idea all round. According to The Observer yesterday, the cost of staff sickness is £29 billion a year. Denis Campbell reports upon Duncan Selbie’s call for companies to encourage healthy practices. Imagine freeing up some of that cash for education, including educating the next generation to look after themselves. We may laud ‘great results’ in A*’s and A’s but at what cost? We continue to see the figures for mental health rising in kids? I would rather my kid had a D, had tried his best and was all-round healthy. What use is an A if you are suffering depression?

“To improve staff fitness is a great idea all round”

The main target for this message seems to be small and medium sized businesses. Naturally this draws responses about the costs and limited opportunities within such firms compared to bigger companies. However, this problem can easily be solved by creating guidelines and providing support ~ see below for some ideas. It would be well worth the investment.

We can look at the trend in big businesses of building gyms on-site, having physiotherapy and doctors available, bringing sandwiches to the desk and even a neck massage while your pour over your spreadsheets. However, you could also argue that this merely keeps people at their desk or in the workplace for longer, often in the very environment that is causing most of the problems!

“The skills of wellbeing easily weave into the day”

There are a vast number of different options for healthy practices and skills of wellbeing. Teaching people such practices each day, I am very familiar working with individuals who have decided to create new patterns (habits) to supersede existing patterns that cause pain and suffering. Most people I see have chronic pain together with varying degrees of anxiety, depression and other persisting ills (e.g. migraine, headache, IBS, pelvic pain, fibromyalgia, chronic fatigue). Usually this is accompanied by perfectionism (expectations are never met resulting in ‘I am not good enough’ and consequential stress) and self-criticism to a unhealthy degree.

Many people spend their lives in protect mode. Occasionally they experience care-giving mode, but not often. Biologically these people are likely to be ‘inflamed’ much of the time, which explains many of the common complaints in the modern world for which medicine has no answer. The endless search for a medical explanation leads down a slope of decreasing expectations and hope. In essence, like chronic pain, this is not actually a medical problem. Once any sinister pathology has been excluded, the biomedical model offers nothing here as the problem is embedded in society; i.e. it is a public health issue.

To address a public health issue, we need society’s thinking to change. For thinking to change, existing beliefs must be shaken as we update our understanding. Understand Pain is a purpose led enterprise that works to change society’s thinking about pain. In the same way we can build upon the strengths in society with regards to being active. The ‘already active’ can become champions, spreading the right messages about the healthy practices that they have adopted. These people are living examples of the benefit.

“Staff fitness benefits business and society”

Staff fitness

Turning this on its head as I like to do, let’s think about living well and meaningfully. In other words, what can we do and what can we focus on? What positive action can we take as individuals and society? This is not just about small and medium sized businesses creating opportunity for healthy practices. Businesses must collaborate with staff who they themselves need to be motivated to live well. We all have this responsibility to ourselves, our families and society.

There is too much knowledge to sit back now, we all have a role to play, not just the business owners. However, if owners and executives take the right steps and lead from the front, they will inspire action. Do we have good enough leaders to do this and recognise the benefits for the business itself and society as a whole? That’s another question!

What could we do at our place?

Consider how staff will engage with the business and colleagues when the right environment and ethos exists. What are the company values? This is a great opportunity for small and medium sized businesses to engage deeply with its people. Even if this means re-writing the values in an effort to keep growing.

  • Create a space for exercise
  • Create a space for meditation
  • Link with local teachers: yoga, Pilates etc. ~ also an opportunity for staff to bond by doing something together
  • Encourage meetings that are mobile ~ where can we go? Let’s walk and talk
  • Encourage conversation over email/text ~ walk to that person’s desk
  • Compulsory lunch break away from the desk
  • Education programme for the skills of wellbeing

Using your imagination, you will be able to come up with some great ideas for your place. Your people are your greatest resource. Looking after them means looking after your business.

If you would like to know more about healthy practices and skills of wellbeing, please contact us. See what we can do for you as an individual and a business

Individual coaching and workshops ~ t. 07518 445493


Headache is a leading cause of suffering

Headache and migraine are in the top 12 of the Global Health Burden of Disease Study (2011)



If you watched Doctor in the House on BBC recently, you would have gained an insight into the terrible suffering caused by cluster headache. This is one of the many conditions characterised by chronic pain. In this case, there was significant improvement as the family made some important changes. More on this shortly.

Chronic pain is the number one global health burden, costing more that cancer, heart disease and diabetes put together. There are millions of people across the globe enduring chronic pain states. They have little or no understanding of why they continue to suffer and no knowledge of how to overcome their pain. This can and must change, and to do so means that society needs to understand pain ~ this is the reason for UP | understand pain. Pain is a public health problem of huge significance.

The programme hosted by Dr Rangan Chatterjee highlighted the impact not only upon the brave lady Gemma, but also upon the family. It was their shift in thinking that resulted in new habits, which create the right conditions to get better. That was a choice made based upon new understanding. Realising that we have a choice is a key first step. We can make the decision to commit to doing the things that will change our health, our relationships, our performance and our pain.

Pain always occurs in a context and involves life’s habits. On realising the range of influences upon pain, the person can instigate changes that make a huge difference. In the family setting, this involves all members, including children. There are huge numbers of children who suffer pain (1 in 5) and huge numbers who support a parent. This is a vast problem in itself.

A brief look at pain ~ what is it?

Pain is a whole person state of protect based on the existing and prior evidence that there is a threat or possible threat to the person. Much of the processing is subconscious, our biology in the dark (e.g./ you don’t know what your liver is doing right now), emerging as a lived experience or perception. Anything that poses a possible threat can result in pain. It is important to consider that something only becomes a threat when we think it so, and hence the meaning we choose to give a situation makes it what is it.

It is not only when we are thinking that something is a threat to us of course. Our biological systems interpret sensory information and predict that it indicates possible or actual danger. Working on a just in case basis means that we can get it wring. When we are sensitive,m this can happen more often than not, which is why pain can become so dominant. The range of contexts and situations widen and we notice the pain moments over and over. This does not have to continue. We can actively infer something else with new understanding, new actions, new habits and new patterns — that’s the programme.

Pain and injury are words often used synonymously, but they are simply not the same. Pain is part of a protect state, very similar to that of stress, and injury is something you can see. The former uniquely subjective and a perception constructed by the whole person

What can we do about pain?

The short answer: a lot!

The first step with any change is to make the decision to commit to practicing new habits that lead towards your desired outcome. This decision comes off the back of understanding pain because then you realise that there is plenty you can do to change and overcome your pain.

This always starts with developing a working knowledge of your pain so that you can coach yourself: the right thinking and the right actions to get the best outcome. Initially you are likely to need advice, treatment and coaching to ensure you remain on track.

When you understand pain, you do not fear it or try to avoid it, instead you face your pain, learn about your pain and overcome your pain. This is different to taking a pill or having an injection, which circumnavigate the issue. Only by facing the challenge can we transform the experience of pain. Many messages in modern society encourage us to avoid the difficult things in life but they are unavoidable. We are not typically taught skills to face the challenges that will come up, and so when we do have something to deal with, we suffer. This does not need to be the case, certainly when it comes to pain.

This is not to say that pain is not unpleasant. Of course it is, but we can learn how to minimise the impact and work to create a happy and meaningful life, by living and practicing the skills of well-being. By living I mean that you try to do the things that you want to as much as you can. More dated thinking about pain suggests that you have to get better in order to resume living, however I have turned this on its head and said that you get back to living by getting back to living. Getting back to living IS the way to get better.

In a sense there is a template of how your life and you should be, and there is no real separation between the two. When the template of what is actually happening is different to the expected one, this mismatch creates a drive to bring them together. Pain is one of those drivers. So, if we try to live as best we can, we are in fact bringing these two templates together. Of course there will be a certain tolerance, even perhaps a few moments in some cases, but this is the start point or the baseline. Working from your baseline, you can get ‘fitter’ and healthier with the practices you commit to, and thereby point yourself in a desired direction.

“what is your vision of success?

A treatment programme is therefore weaved into your life. You are in the driving seat. This is an important concept as healthcare often puts you in the passenger seat, or as one patient told me, ‘in the boot’. This is not right and will certainly not help the person to get better. The modern understanding of pain tells us a very different story, which is exciting, but must be told as far and as wide as is possible, which is the reason for UP | understand pain.

If you are suffering headaches, you should consult with your healthcare practitioner as a first port of call. You will want to know the possible reasons why you have headaches, but then you will want to know what you can do, what they will do to support you and roughly how long this will take. With an understanding and a direction, with a decision to commit to practices of well-being and determination, it can be transformative.






Are you ready for clinic?

How do you get ready for clinic?

Prepare for a successful performance

Are you ready for clinic?


Remember the excitement of those first clinics? The anticipation of that first patient, the challenge of working out their story and coming up with a solution. The opportunity to practice those skills. The fascination with the narrative blending with the body language and phraseology used by the patient. The feeling of pride wearing the uniform. And so on. All great feelings!

How do you feel now? Are you aware of how you feel now before clinic? Do you make time to notice or do you walk in on autopilot and crack on without any awareness?

When we fall in love, we will do anything for that other person. Take the bins out — yes please! Clear the dishwasher — anything for you!! Six years later…. take the bins out — you gotta be kidding! I’m not your servant! Wash up — no chance, why can’t you do it….. How about acting like the first few months, always? How about acting like those first years of clinic, always?

“have you warmed up?

You go to watch your favourite team. The excitement builds, the crowd are singing, you can’t wait for the whistle to start the game. Then you see the players wandering in aimlessly, not paying attention, just moments before the kick off. Have they prepared before the game? Have they warmed up? Got their thinking in the right space? Attuned to the situation? Players prepare. Musicians prepare. Actors prepare. Should we prepare? Of course!

Let’s create a routine of warming up for our performance today. Let’s get our thinking aligned with our values; what’s important right now? Let’s get focused. Let’s be the best we can be and notice when we are distracted and come back to the focus. In clinic, we are performing. This is our centre court, our pitch, our stage where we work with a person to present them with the opportunity to commit to change to improve their life.

“what’s your kindset?

What were the reasons you went into this job? Why did you choose this career? What is your ‘WHY’? Think about this each day to refresh and renew and drive yourself to be the best you can be. It’s a choice. Feel motivated, feel great about it!

It’s a mindset that you choose. It’s a ‘kindset’ for the people coming to see you — what a privilege that people come to see you. That is an opportunity to practice gratitude as well. What is a kindset? It’s a mindset driven by kindness!


1:1 Pain Coach Mentoring for Healthcare Practitioners and Clinicians: practice the very skills that you present to patients to improve your life, improve your relationships, improve your performance. Feel inspired because you CAN! See more here

Exams, stress and pain tips

Exams, stress and pain tips
Exams, stress and pain tips

Exam exhaustion | Felix Neumann

Exams, stress and pain tips ~ It is that time of year again when kids are preparing for their exams. With the emphasis on high grades reflecting success, the pressure on youth has increased. There is the sense that if they do not achieve all those ‘A’ grades, then somehow they are a failure. What a terribly damaging way to go about it, and indeed one of the major influences upon kids health. Levels of pain, anxiety and depression are on the rise. Social media also has a part to play, not the channels themselves per se but the way in which it is used and relied upon as a source of temporary reward ~ ‘likes’ etc. We can and must change this as a society.

One of the most respected and successful sports coaches of all time, John Wooden, made the key point that each person should be focusing upon what they can control and to do their very best. If your attentions are on doing your very best, you will be successful, for you. If you thinking drifts towards the grade ‘you must’ achieve, then your focus is not on doing your best, it is on the grade. Re-focus on doing your very best: maximum effort. Besides, if you are focusing on and doing your best, there is no worry or anxiety because you are doing. Those feelings only appear when we are thinking about being somewhere else, whilst embodying the feelings and hence suffering. That somewhere else is the past or future, and neither exist.

We can realise that this is not necessary as we learn to make other choices. Ask yourself: How am I choosing to feel? Could you choose to think about the situation in another way and feel better or good? Yes you can. Try it and see!

Read hereJohn Wooden ~ Wooden: A Lifetime of Observations and Reflections On and Off the Court

You could choose to think about something in life you face as a problem, that it is difficult, perhaps impossible or that your efforts are doomed to failure. How are you likely to feel? Or, you could choose to view the situation as a challenge, an opportunity to learn something and seek to find and practice ways to overcome the challenge. How would this feel? Very different. We feel better when we have understanding and a plan that we action because we are actually doing, and this includes writing a new inner dialogue or script. How are you pre-empting or expecting things to go? How often do they actually turn out that way? Well if so, why not water the seeds of positivity rather than anticipate the worst outcome or a miserable outcome? Re-frame your thinking that is always embodied, i.e. we experience our thoughts with our whole self including our bodies — where do you feel the feelings that you label as anxiety? They are remarkably similar to the feelings of excitement but which label are you choosing? Choose another and see what happens.

Here are some exercises from Mike Pegg on Positive Scripting: click here
The inner dialogue

What are you telling yourself? Are you listening? The two are different. You cannot stop thoughts popping in but you can choose what you do with them. The practice of mindfulness is a way of achieving this as you are aware and open to the different thoughts, feelings and emotions as they pass through rather than become embroiled.

Self-confidence relies upon the inner dialogue. No matter what you have achieved before, what you are telling yourself and listening to now is what determines your confidence. Create a positive script about what you can do and what you can control: my own thoughts, my own actions, where I focus, doing my best.

Developing insight into your own mind creates the opportunity to choose your direction. We are always changing, but which way do you want to go?

Some great reading on how to communicate with yourself and others: Thich Nhat Hanh
Movement and posturing

Movement and exercise are healthy. During periods of revision we need to move to nourish the body but also our thinking — the two are NOT separate but parts of you. Changing position, using some exercises, walking, jogging and other activities punctuated through the day help to keep the focus. Some exercise in the morning before starting, changing posture and position every 30 minutes or so and having a good break every 45-60 minutes can help to keep a certain freshness and concentration.

This is about performance and to perform we need to focus in the present moment. Refresh and renew then, are key ingredients.

Recharging and sleep

You need good sleep patterns for healthy functioning. Make sure you have a routine that you stick to through the exam period. Many important healthy activities occur during sleep, including a kind of physiological cleaning in the brain. When this does not happen we can feel groggy and moody the next day.

If you are tired, focus on mantras such as ‘I need energy’ rather than ‘I am tired’. We notice what is on our agenda and therefore by telling yourself that you need energy, you’ll be orientated towards this as a goal: regular healthy snacks, fresh air, movement, mindful practice, periods of relaxation.

Through the day we need to plug in. Refreshing yourself allows you to focus well for bursts of time.

Pain and stress are body (whole person) states due to a perceived threat

People come to see me because thus far they have not been able to recover from their pain problem. This is inherently stressful, which adds to the biological and behavioural mix resulting in on-going states of protect.

~ pain and injury are poorly related and are definitely not the same

Pain is about protection and not a precise guide for tissue health or state. This is the common misunderstanding that leads to ineffective treatments. Pain and injury are not well related and they are definitely not the same. Pain is a unique perception emerging in the person and belonging to the person. This is one of many we experience but it is a dominant feeling, as it should be, to motivate action in line with getting better.

Persistent pain involves many adaptations that include those in the brain (emotional, reward and emotional centres in particular), the way we perceive the world and ourselves, the way we make decisions, behave and the way we act. The world appears to be far more dangerous than it really is and the rating of threat is applied in normal circumstances, just in case. For example, sitting is not dangerous yet it is often associated with back pain. The body systems in weighing up the evidence and based on prior experience, deem sitting in a chair to be actually or potentially dangerous. It is the result of the weight of this evidence that manifests as pain in the area of the body deemed to need protection and awareness.

Overcoming pain is about changing this weighting of evidence by taking new actions (habits) based upon new thinking (understand your pain), beliefs and expectations.

During exam times there is usually a change in routine. More sitting, less exercise, and potentially more stress depending upon how the individual views the situation. For optimising performance, this must be addressed whether there is pre-existing pain or not.

It is common for pain to increase during times of stress and pressure. This is not because the tissue state changes greatly but instead the perception of threat is raised and hence protection more likely. We can also tend to anticipate certain relationships. For example: ‘sitting will hurt’, which can become a predominant thought pattern unless we work to create a new way forward. We are always changing, it is a matter of which way you choose to go.

Simple practices during exam times can make a significant difference. Starting with understanding your pain, you can choose to use the strategies mentioned previously that include regular movement, appropriate exercise, practicing a positive script, refreshing & renewing, together with mindful practices (that actually enable many of the others), deep relaxation, imagery and visualisation. Making a plan of which to use and when through the revision and exam timetable can make all the difference.

Pain Coach and Wellness Coach ~ to overcome life’s challenges, live well and perform

For appointments or enquires about Pain Coach Mentoring and speaking events, call Jo on 07518 445493

High Performance Sport Knowledge Exchange 2017

High Performance Sport Knowledge Exchange 2017

~ some comments following a really engaging day when I was delighted to be asked to speak at the High Performance Sport Knowledge Exchange 2017 held at the Sport Ireland Institute last week.

I was fortunate to share the speaking platform with Dr Brian Cunniffe, Performance Lead from The English Institute of Sport, and Jason Cowman, Strength & Conditioning Coach of the Irish Rugby Football Union.

It was a great day of discussion amongst people involved with optimising performance, both their own and athletes ~ S&C coaches, elite performance coaches, physiotherapists, support staff, doctors, military personnel and more. I say ‘their own’ because the success of an athlete or sportsperson is intimately related to the way in which the coaching and support staff operate. We are all seeking to do our very best, every day.

Here is a brief summary of some of the points that were raised and talked about in relation to my talk and Q&A. Some great questions were asked.

~ Make each day a masterpiece ~ John Wooden

Despite the talks appearing to be very different, there were in fact some common themes. The emphasis was upon how the team can best function to deliver results, considering communication, facing challenges, developing relationships and trust, and creating a team that delivers. At the heart of this of course, are people with differing backgrounds, views, beliefs, experiences, knowledge, cultures and professions. Everyone has strengths and something to bring to the table, which is where the potency arises once these are clarified.

** As you read and take note, consider that these skills of performing and well-being are as relevant to the coach, physio, doctor, support staff as to the athlete.

Language & the inner dialogue

Language is powerful ~ the language we choose to use with others as well as the language we use to ourselves, the inner dialogue or script. Certainly in my talk and in the Pain Coach day on Tuesday I put an emphasis on developing skilful use of our inner dialogue. So much of what we experience and how we experience it comes from what we are telling ourselves. Realising this and harnessing the potential from running a positive script is hugely empowering. This is a skill that a performance coach, a strength and conditioning coach and a physiotherapist (anyone actually!) can foster and nurture in themselves and those they work with, the athletes and colleagues. Here are a couple of great questions to self that allow you to calibrate and make a new choice:

How am I choosing to feel? How am I choosing to think?

What you are telling yourself right now impacts upon your emotional state and quality of life. Which seeds are you watering? The ones that foster positivity, understanding, compassion, openness and patience or the ones that harness anger, frustration, impatience, and resistance? Developing one’s awareness of the workings of the mind and how thoughts are embodied creates a great opportunity to live increasingly well. This includes the ability to focus and hence perform. There is only this moment in which to focus and perform, whereas the inner dialogue can tend to take us off into the past or future. Of course this will happen but there is a difference between the drift away from the now with awareness and on autopilot. We do not have to be slaves to the wanderings of the mind. Simple attentional training and mindful practices help to develop this skill. We know that a wandering mind is an unhappy mind, so this kind of training is a key skill.


Super-teams can be created to nurture the abilities of the athletes. One of the problems of chronic pain is that people can fall in the cracks between different disciplines. This need not happen with a super team in place that has a clear vision of success that has been clarified and stated. This is known by all team members who have identified their strengths, their reason and purpose and their individual roles. Communication is effective, regular and uninhibited. Strengths are developed and areas of improvement identified and worked upon with a complete focus upon growth together. Naturally this includes the athlete ~ there is no separation between team and athlete, athlete and team. Regular meeting and clarification maintains momentum. The team is steered by a leader who is prepared to truly lead and inspire action by exhibiting courage, authenticity and compassion. This takes time but is of course worth the effort in terms of outcomes.

The problem of pain & pain in sport

Pain is a huge global health burden. Pain costs society because of investigations and treatments, many of which are unnecessary or ineffective, and loss of productivity. The suffering for individuals is immeasurable and of course those close by also suffer the consequences.

The existence of such a significant problem in society means that this is a public health concern of major proportions. Without new thinking this will likely worsen. Arguably we are seeing this in the younger generation as they grow in a world that validates materialism, unhealthy communication (e.g. social media), thinking that the individual supersedes everything (i.e. selfishness), success based on ‘A’ grades or income and pressures to conform to practices that do not nourish self-compassion. 1 in 5 children suffer chronic pain and the statistics on mental health are horrific. I do not use that word by mistake.

I do not believe that the term mental health does justice to the reality that the ‘mental’ condition is embodied, which is why in most cases chronic pain and depression or mood changes come hand in hand. Thoughts are embodied, which is why practices that develop healthy use of the inner dialogue are vital. 

This problem reaching across society means that it does exist in sport. One of the challenges is to differentiate between the pain of being an athlete, the pain of a new injury (expected and understood) and the persistent pain that is due to a range of biological and behavioural factors. This will need athletes and coaches to learn about pain and communicate together with the athlete to establish what is happening and what needs to be done. The super-team vision will include these scenarios in the planning.

~ pain and injury are poorly related

There is no single clinician or therapist for pain. This is a problem and indeed perhaps part of the wider problem (the misunderstanding of pain in society), as the person suffering receives many different ideas about the possible causes and suggested solutions. This is the reason for Pain Coach, which is a blend of the latest understanding of pain together with known coaching methods that work to maximise learning and potential. The over-arching aim of the Pain Coach Programme is to change the way society thinks about and hence addresses pain. And there are exciting times ahead on the basis that we need to be talking about and enacting overcoming pain, not just managing and coping.


In relation to sportspeople, we can focus upon an understanding of pain that works for performance coaches, S&C coaches, clinicians as well as the athlete himself/herself. Working together to understand will be key and there is no reason why workshops cannot be run with the super-team that includes all these people. In fact, everyone needs to understand pain ~ the reason for UP | understand pain.

Chronic pain in sport is a blight upon the careers of many. Open discussion and an open forum for athletes to talk and express their fears is important as this provides an opportunity to face the problem, or rather the challenge, learn and overcome. Only by facing our challenges can we truly surmount them and move on. Distracting, avoiding and circumnavigating do no good in the long-term. I acknowledge that there is a place for a ‘patch up’ before an event if need be, but thereafter the challenge must be addressed. Again, the super-team creates the environment and context for this to happen.


Language and the content of the inner dialogue has been mentioned but what about delivery: Who? When? How? And there’s the vital part, active or deep listening. Only through listening deeply can we truly hear what is being said. Paying the fullest attention (there’s the practice of paying attention again!) to this moment and what the other person is saying creates a trusting bond and an opportunity to gain insight. This insight delivers all you need to know right now. Sometimes just listening is all that is needed right now. The gifts of ‘you’ and time are two of the most valuable in life. This is easily practiced both at work and at home and soon enough you find yourself to be proficient and increasingly effective.

Some good questions for self:

~ after a training session, who speaks first? Who does the most talking? Who has the key information? 


There was much more discussed through the day and in the Pain Coach day on the Wednesday before. Hopefully this has provoked some new thinking and realisation. The beginner’s mind is open to possibility and opportunity. We are designed to change and grow as each moment passes. It is a matter of choosing which direction, which begins with realising that we have a choice. The awareness of choice is empowering and exciting but comes with responsibility.

All of us in the room have great jobs that we are passionate about and feel inspired to perform each day. We have meaning and purpose. This drives us to be successful because we always strive to be the best that we can be. That is exciting and fulfilling.

Choose to feel excited.


For further information about Pain Coach training and mentoring, please do get in touch: [email protected]

Facebook & Twitter @painphysio or frequent updates


5 ways a partner can help you

Chronic pain can be the source of huge strain upon a relationship. Partners and other people close to the suffering individual can be at a loss as to what they can do to help. Sometimes their assistance is welcomed and other times not. It can be confusing and stressful. There are many ways that a partner can help and some will be individual to those involved. Here are 5 ways a partner can help you:

Be an extra pair of ears and eyes

During consultations with specialists or therapists, it can be useful for a partner to come along. Beforehand you can decide upon their role. The possibilities include:

  • listening and note taking
  • offering observations about what has been happening
  • watching and learning exercises so that they can provide feedback at home
  • just being there for moral support

Sometimes having someone else in the room, even a loved one, can be distracting depending upon what is being practiced. So do discuss this with your clinician for the best outcome.

Understand pain

When your partner understands pain they will be able to further empathise and act through compassion rather than fear and worry. We do respond and are influenced by the people we are close to, meaning that if they have a working knowledge of pain they will better provide support and encouragement.

Pain can and does vary as each pain experience is as unique as each unfolding moment. Knowing that pain is related to perception of threat rather than tissue damage or injury, along with some of the main influences (e.g. emotional state, context, tiredness) helps to navigate a way forward. To overcome pain the person learns to coach themselves, making best choices in line with their picture of success. Sometimes we need help or someone to listen to us whilst making these choices.

A hug

Touch is healthy, especially from a loved one. Someone recently told me about how a hug from her children relieved her pain. Why? The release of oxytocin for a starter. The feelings of compassion and love can cut through all other emotions and feelings, which is why the development of self-compassion is one of the key skills of well-being.

Sometimes a hug can be painful of course, depending on where you feel your pain. If this is the case, then simple touch somewhere else is enough. Seek to notice the good feelings that emerge in you: what do they feel like? Where do you feel them? Concentrate on them. And if you are not with that person, just imagine a hug or a loving touch. This triggers similar activity, just like when you think about that beautiful scene in nature, your body systems respond as if you are there ~ our thinking is embodied.

Practice the skills of well-being together

A good example is metta or loving kindness meditation that cultivates self-compassion. It is best to gain instruction 1:1 to start with and then use a recording as a prompt until you are familiar with the practice. Group practice is also good when the collective or community creates a soothing atmosphere in which to practice.

At home, practice metta with your partner. Doing it together, you form a bond as you spend meaningful time together. You can also practice the exercises together. These are nourishing and healthy movements with the purpose of restoring confidence as well as layering in good experiences of activity to overcome pain.

Spend time together doing something meaningful

We are designed to connect. The chemicals we release and experience as that feel-good factor, do so when we have meaningful interactions. Pain all too often appears to limit choice and our tolerance for activity. However, on thinking about what we CAN do rather than what we cannot, we begin to build and broaden the effects of choosing positive action.

Positive action is all about focusing on what we can do: e.g./ I can go for a coffee with a friend for half an hour to gain the benefits of connecting, moving, a change of scene etc. and I will concentrate on these benefits. Make some plans, working within your current tolerance level, knowing that you are safe to do so, and follow them through by keeping yourself pointed towards the picture of success*. You can then gradually build your tolerance by pushing a little with increasing confidence.

There are many other ways that a partner can be involved. The key is to communicate openly and make plans together ~ here is a great insight into communication by Thich Nhat Hanh.

* Clarifying your picture of success gives you a direction and the opportunity to check in and ask yourself: am I heading in that direction or am I being distracted?

Please note: Whilst the practices above can appear to be straightforward, you should always discuss your approaches with your healthcare professional


Charity quiz night

Charity Quiz Night

On Thursday 20th April we are having a charity quiz night at Wags N Tails in Surbiton to raise money for CRPS UK and UP | understand painclick here for the event link — please come along and support us! 

Richmond is running the London Marathon this year to support CRPS UK and UP — please donate here

Chronic pain is the number one global health burden

Chronic pain costs us the most of all the health problems that exist. One only has to think of all the conditions that are painful and consider the expenditure on investigations and treatment. This is in addition to the loss of productivity. Some 20% of the population suffers chronic pain, including 1:5 children, which begins to provide insight into the immeasurable suffering. People from all corners of society are struggling to understand why they are in pain, do not know what they can do and feel isolated as their plight continues. This does not need to be the case.

UP | understand pain

At UP, we have a vision of a world where people understand pain and know what they can do to live well. This begins with changing the way society thinks about pain, truly understanding the facts, in which case they would know that there is a way forward. We are constantly changing and learning meaning that we have the resources and the potential to get better. People need to know how.

UP is to be re-launched this year as a social enterprise that will deliver the latest knowledge about pain and how it can be applied. The know-how is vital as are the skills of well-being and self-coaching. The programmes will be delivered to people suffering pain and to healthcare professionals who work with people in pain. This includes trainees who are the new generation of clinicians and therapists. We also plan to take our message to the policy makers to create changes ‘top down’.


The CRPS UK charity supports people who have been diagnosed with complex regional pain syndrome (CRPS — sometimes called RSD) and their families. The most recent diagnostic guide is the Budapest Criteria.

CRPS is poorly recognised and understood. This means that diagnosis and the right treatment can be delayed, resulting in on-going suffering. The pain of CRPS can be unimaginable with the impact upon the person’s life being enormous.

We can and must do better with CRPS and all pain conditions. The right messages early on and the right actions taken by both the individual and clinicians will make a huge difference.

The work being done by both CRPS UK and UP will be instrumental in the forthcoming changes that must happen in society. Pain is a public health issue of the utmost importance — the costs and the suffering. Pain must be addressed in this way, which is what we are doing at UP. This massive problem affects us all and we can do so much to transform the issue.

Please support our work by coming to the charity quiz on Thursday 20th April or donate here.