Category Archives: Pain Education

20Feb/17

Pain is whole person

Pain is whole person

There is only one way to approach the problem of chronic pain as it emerges in the individual, and that is by addressing the whole person. This way demonstrates a true understanding of pain: the lack of any pain system, pain signals or pain centres and that the vast majority of the biology of pain is not where we actually feel it in the body or body space in the case of phantom limb pain. Much like when you watch a film in the cinema, most of what you need is not on the screen.

With pain being absolutely individual, coloured by the context, the environment in which it is being phenomenologically experienced, prior experience and beliefs (about pain, health, danger, ‘me’, the world etc.), the action we are motivated and compelled to take, existing health and level of threat perception to name but a few. In short, this includes activity in the brain and central nervous system, immune system, endocrine system, sensorimotor system, visual system, and the autonomic nervous system. Most of this is not where the pain is felt.

Pain and injury are notorious for being poorly related. There are countless stories of people suffering great trauma (tissue damage) and reporting minimal or no pain, some sustaining minor injuries and describing agonising pain and a huge variation in between. Considering the factors in the previous paragraph, one can start to understand why. In essence it is due to pain being a better indicator of the level of perception of threat; i.e./ more threat, or existence of threat = pain.

Bearing this in mind, and this is the current understanding of pain, you can see why the whole person approach is necessary. It is as much about the person as the condition, as Oliver Sacks wrote and practiced, and indeed this is a vital principle to work to. Understand the person and their circumstances and you go some way to seeing a way forward. Listening deeply in the first instance creates the opportunity to gain insight into the reasons for the person’s suffering — the reasons for pain and what is influencing that experience. From this foundation, one develops a rapport, not just as a clinician or therapist but as a trusted advisor, giving the person the knowledge and skills to overcome their pain and live a meaningful life.

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Pain Coach Programme to overcome chronic pain ~ t. 07518 445493 or email: [email protected]

 

01Feb/17

The inner dialogue

The inner dialogue ~ what do you listen to and what do you tell yourself?
You are beautiful by La Melodie https://flic.kr/p/99ACEa

You are beautiful by La Melodie https://flic.kr/p/99ACEa

One of the things that makes us human is the inner dialogue or inner voice that is fairly continuously ‘speaking’ to us. Of course the voice is part of each and everyone of us and is not an outside agent. To some people it can appear to be coming from somewhere or someone else as in the case of psychiatric disorders. That must be frightening.

The inner dialogue is part of the workings of our mind. Our minds play a significant role in our actions and perceptions but it is not a one way street. The physicality of our existence can impact upon the way in which we think. The branch of philosophy named embodied cognition has much to say on this matter, addressing the notion that our thinking is embodied. A simple example is when thinking about hunger and food, we would typically feel that in our body, interpreting the sensations as being in need of food. A further example is the way we gesture with our hands to demonstrate a point, freeing up resources for further thinking. Consider how you feel when you think of a loved one or a difficult situation in the past — where do you experience it? Certainly not ‘in the head’.

There is a skill in choosing whether to listen to and act upon our inner dialogue or our thinking. It is true that we do not choose the workings of our mind, however we can learn about how it works, our habits of thought and realise how we embody these thoughts. In so doing, we have the opportunity and responsibility to become increasingly skilful in deciding whether to pay attention or to let go of thoughts and the inner dialogue. Being mindful is just that. We are aware of the thoughts, noticing their impermanence, recurrent nature, the way they create feelings in the body, but we are not engaging or becoming embroiled. There is a monumental difference between being in the film and watching the film. You are still experiencing the full richness of the feelings and emotions but with curiosity, with compassion and with an intent to only act with kindness, towards self and others.

Learning to be observant of the inner dialogue allows you to make choices. We have choices and often need to realise them. How am I choosing to feel or think about a particular situation? Even asking yourself that question gives you space to decide what you can do. Shifting the thinking to take another perspective can give a very different feel to the experience. Knowing that you can do this is very empowering, as you know that you can face challenges with skill and insight.

The story we tell ourselves can be so impacting upon our reality, lived experiences and ultimately our health and sense of well-being. If you persistently tell yourself that you are not good enough, have not tried hard enough or blame yourself for all sorts of things that may not actually be your fault, this will create a range of unpleasant feelings in the body as well as paint a bleak picture of life. Being hard on oneself causes our protect systems to switch into action. A range of common ailments manifest if these systems are ‘on’ too much without adequate refresh and renew time. Such problems include chronic aches and pains, sleep disturbance, gut issues, mood variance and exhaustion; very common presentations in my clinic. This need not be the case by learning some simple skills of well-being and day to day practices that stoke up our healthy systems. This is the bulk of the work we do to overcome pain and health problems — see here.

The inner dialogue and pain

Pain and the inner dialogueThe inner dialogue can tell us our story; the story of me. The self that I experience moment to moment, which is continually updating. Our implicit ability to change creates great hope as we can transform our suffering by gaining knowledge and insight into our existing habits. From this awareness we can choose to create new habits that are based upon our value system (what is important to you in life) and are by design all about sustainably living a meaningful life.

Many people with chronic pain have received messages that suggest pain must be managed or that they must just cope. This lowers expectations and hence our story and the inner dialogue is based on this belief. We can and must do better. Changing our story, and this is applicable to any story we tell ourselves, creates a new way onward. This begins with understanding pain. Countless people have told me how much better they feel on starting to understand their pain when we discuss their experiences at the first meeting. There is no magic here. We feel better when we have understanding of a problem and insight into how we can address the issues — feelings of agency, choice and empowerment feed and motivate us to take action; the right action. The Pain Coach Programme is all about the right action based on the right thinking. Understand your pain, write and see a new story and then live it. This is the story of your success, whether it be overcoming pain, setting up a business, writing an essay, doing an exam or playing a game of football. Use the story wisely, make it count and use every moment in a way that encourages and motivates more and more great action.

The Pain Coach Programme is a blend of strengths based coaching and pain sciences for your to achieve your success | t. 07518 445493

 

18Jun/16

Biology of pelvic pain

Pain nowMost of the biology of pelvic pain does not exist in the pelvis. The same is true for any pain — back pain, knee pain, neck pain etc. Much like the screen turning blank in the cinema, the problem itself is not the screen but instead the projector or the power source. In other words, to think about pain requires us to go well beyond the place where it is experienced.

Pain is of course lived and whilst it must have a location, the relationship between pain and injury is unreliable. With a huge number of factors influencing the chances of feeling pain in any given circumstance, there is a requirement for a perception of threat that is salient and exceeds other predictions in terms of a hierarchy. Once felt, pain compels action much like thirst and hunger. Again, like thirst and hunger, context and meaning we give to the sensations influence that very experience, which clarifies to a greater extent the difference between on-going (chronic) pain and that of labour.

To feel pain we need a concept of the body, which itself is constructed elsewhere as the sensory information flowing from the body systems is predicted to mean something based upon what is already known and has been experienced, we need a nervous system, an immune system, a sensorimotor system, a sense of self and consciousness to name but a few. Where in the pelvis do these reside?

This is not to ignore where we may feel pain as this is an ‘access’ to the pain experience that should be used in terms of movement and touch. However, it is the person who is in pain and not the body part. My pelvis is not in pain, I am. My pelvis does not go and seek help, I do. My pelvis does not ease its pain, I do. So when ‘treating’ a person, we must go beyond the place where the pain is felt to be successful. And it is vital that the person is considered a whole; there is no separation of mind-body. The notion of physiological, body, psychological division etc. etc., just does not fit with the lived experience; I think, and I do so with my whole person — embodied cognition.

Locally one will usually find evidence of protection and guarding, which themselves manifest as the tightness, spasm, painful responses to touch and movement. This is all manifest of an overall state of protection, co-ordinated largely unconsciously accompanied by a range of behaviours and thinking that quickly become habitual — they are certainly learned from priors, our reference point. This is simply why delving gently into the story is important, as we can identify vulnerabilities to persisting pain such as previous experiences of pain, functional pain syndromes, stressful episodes in life; all those things that put us on alert when the range of cues and triggers gradually expand so now I am vigilant and responding to all sorts of normal situations with fear.

The start point is always developing the person’s working knowledge of their pain, which also validates their story. So many people still report that they feel that they have not been believed, which I find incredible. How can someone work in healthCARE and not believe what a person says? Baffling. Once the working knowledge is being utilised and is generating a new backstory, new reference points emerge. We create opportunities for good experiences over and over, moment to moment, day after day, in line with their desired outcome, the healthy ‘me’ that is envisioned from word go. This strong foundation that opens choices once more then permits exploration of normal and desired activities supported by sensorimotor training and other nourishing movements, alongside techniques in focus, relisience and motivation. Realising and actualising change in a desired direction must be acknowledged as the person lives this change knowing that they can.

Pain can and does change when you understand it, know where you want to go and how to get there, quickly getting back to wise, healthy action when distracted (i.e./ flare ups, mood variance, loss of focus etc). The biology of the pain is one aspect, hidden in the dark within us, and the lived experience is another. The two are drawn together to give meaning and to develop an understanding of the thinking and action that sculpt a new perception of self and pain, resuming the sense of who I am, as only known and lived by that person.

14May/16

Kids know about pain distraction

Pain distractionI overheard an interesting conversation this week that demonstrated kids know about pain distraction.

Driving my kids to swimming, my eldest daughter was giving us an update on her wobbly tooth and the fact that it hurt. She was concerned that it maybe too painful to go swimming. My youngest daughter, 6 years, then piped up with an insightful suggestion: don’t worry about your tooth because when you are in the cold water you will forget about it’.

To me, as a pain-head (a term sometimes used to describe someone who is obsessively interested in pain and what it is), this was fascinating. Life in action, a natural comment based on some experience that my youngest must have had at some point, or at least heard about. I would think the former is more likely as the message surely stuck with her to the extent that her model of the world in relation to safety-threat has been updated to consider distraction as a way of changing pain and reducing the threat value — pain is a lived experience, compelling action in the face of a prediction of a perceived threat based on the hypothesised causes of the sensory information in relation to prior experience.

RS

11Apr/16

Hands-on treatment for pain

Hands-on treatment for pain should form part of the therapy programme for painful conditions including chronic or persisting pain. A line of thought exists that the hands-off approach for chronic pain is best yet there are some clear ways that clinicians can use their hands with great effect. It is also expected when a person goes to see a physiotherapist that they will receive manual treatments as a way to feel better, and indeed people often do feel better when such therapies are used wisely.

There is no certainty as to why hands-on treatment works but it is safe to assume that touch has an effect that is likely to be underpinned by a change in the interpretation of sensory input from the body. Modern concepts of brain function suggest that what we experience is the brain’s best guess about what the sensory information in that moment means, based on prior experience. This based upon probability that the sensory information infers something, i.e. something pleasant and hence the touch feels good, comforting, soothing etc., or something unpleasant and therefore the touch can feel painful or uncomfortable.

Touch is deemed important for healthy development and is certainly an act that is used commonly to communicate. In the same way then, touch can be used to communicate in the therapeutic setting as well as create an opportunity to change pain and sensitivity. We are changing constantly with each moment being fresh and new — in fact, this is one of only a few definites in life, is that we change. We are designed to change and hence the feeling we are feeling now is only temporary. The sense of ourselves, ‘me’, is something that we feel is constant yet it changes as time passes and we gather new experiences, learning and developing.

It is worth pointing out that the mention of brain does not mean that we are only a brain. I am a whole person made of my body, brain, mind and environment, none of which is any more important as it is the sum that makes me and who I feel I am at any given moment. The false division of mind and body certainly does not hold up. My mind is not in my head or my brain, I ma my mind, which is why when I think I use my body and my brain together as ‘me’ within a particular context (environment) in a particular moment (that has just passed). This may seem like play with words, yet it is fundamental to successfully addressing pain because this understanding gives both hope and a practical way forward as we use this knowledge to create a programme of treatment, training and movement to overcome pain so that it does not dominate but instead has its place as a survival mechanism. Briefly, pain is a motivator to take action on the basis that I am predicting the need for protection against a perceived threat. More threat, more protection, more pain — not more pain = more damage as was traditionally thought. Hence, the reduction of threat is our aim.

Now back to touch: how we can use it and how it plays a role in reducing pain. Preparing the recipient of the hands-on treatment is important, priming them with an explanation and positive expectations. This can be done by simply describing why it is useful, saying that it is usually a pleasant experience to ease symptoms whilst dropping in calming, soothing words into the conversation. Addressing concerns, especially if they have had a painful treatment beforehand, is also part of the preamble, in essence ploughing the field before sewing the seeds. Then the contact begins.

The clinician can do a few things to prepare him or herself so that the first contact is felt to be compassionate and soothing from the outset. This is of course the aim — to be soothing and to create calm, changing the way that the recipient’s brain is predicting what the sensory information means, i.e. it means safety. And safety in turn means less, or no need for protection, and no protection = no pain.

  • Prepare clean, warm hands
  • Take a breath or two and let muscles relax on the out-breath (we are not always aware of how much tension we are holding, especially if we have been using manual therapy often through the day)
  • Let go of any distracting thoughts and be entirely focused on the touch and responses of the person; again, the out-breath is good for focusing on the present moment

On starting the hands-on part of the session, having prepared the recipient and being present oneself, the first touch allows the therapist to note how guarded and protective the person is in respect of the body. The image of pushing a cork in a barrel of water is a useful visualisation of how to ease into, and respond to the person. It is worth considering that it is the person experiencing the touch and not the body part itself. It is the person who is conscious and gives meaning to the touch, and hence it is the person to keep in mind as you lay hands on. The treatment then becomes a dance or an art form as the hands and the body form an alliance that aims to transform sensory signals into the experience of relief; soothing, calming and peaceful. This would be the same whether the technique more soft tissue (the many forms of massage) or mobilising a joint.

  • Prepare the person
  • Prepare yourself
  • Apply the treatment
  • Conclude the treatment, making it obvious with the hands before uttering a few soothing words (consider tone, volume etc) that allows the person to realise the completion
  • Give a few moments for orientation and shift of state before inviting them to sit up or change position

Of course, hands-on forms only part of the programme with the other facets addressing the different dimensions of pain in an integrated manner: addressing the whole person. However, a key point made here is that in order to be as effective as we can, recognising our role as individual clinicians with our own characteristics and style, we must pay attention to the person, ourselves and the context in equal measure.

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  • Pain Coach Programme — complete care for persistent pain
  • 1:1 Pain Coach — mentoring for clinicians
  • t. 07518 445493

 

03Apr/16

Knowing about your condition

Knowing about your condition can be a double edged sword, as illustrated by Ian Jack in @guardian yesterday — read here. Jack describes his experience of anosmia, the loss of the sense of smell. However, he goes on to describe how reading an article about anosmia made him consider ‘that I was in fact a member of a disabled and neglected group’, which he was ‘happier not to think about’.

The piece raises a number of important issues. Firstly that losing one of our five senses has an impact on our ability to predict the world and hence our lived experience, secondly that this impact can be underestimated by the individual in some cases and by society looking in, and thirdly that knowledge about a problem does not always help per se. Everyday people are learning that they have a condition, generally more accurately from a diagnostician and more precariously via the Internet. The latter is of course quite able to ‘diagnose’ in response to a list of words (symptoms) but the danger is that the list of possibilities still require adjudication, and it is the same person choosing an answer. It is a little like your doctor giving you a list of conditions to choose from when you tell him your symptoms, and you then choose the most sinister. Oh yes, and the computer, device, phone etc. does not examine you or try to understand you as an individual.

I write and speak regularly on the fact that people need to understand their pain in order to know that they can overcome their pain, with an emphasis on both the quality of the explanation (teaching – learning scenario) and the context in which the information is delivered. Reading an article as did Ian Jack, or finding some information online, or someone else sharing their experiences must all be put into context. These are other people’s stories and not yours is the first point, so extrapolating to your unique story has its dangers unless you have someone to clarify and provide perspective — that’s my job. Spending time giving meaning to the person’s story is important, identifying the key points and explaining what can happen in order to arrive at the present moment. Nothing happens in isolation because we have had a prior experience to flavour this one. Looking back, however, can be done in an objective way, recognising the limits of the reliability of our memory, yet it is the question ‘what do I think and do now?’ that is important.

A common scenario in modern healthcare is the interpretation of the scan result for musculoskeletal pain. Back pain for example, frequently leads to an MRI scan to look for a structure to explain the pain. Yet pain cannot be seen. You can see the state of the discs and joints according to a picture taken in a moment (a snapshot), but what does this tell you about the person’s lived experience of pain? One is objective (a picture) and one is subjective (pain). But how often is the disc or joint used to explain pain as the healthcare professional shows the person (patient) the picture, pointing to the culprit on a screen? Now that the person has ‘seen’ the picture, it becomes part of the story with the solution becoming the need to do something to that disc or joint. They have new information that is now influencing their outcome, yet they will not be thinking this as it is all part of the subconscious processing that shapes our thinking and experiences. However, when a scan result is used within the context of modern pain science, we can use the information to sculpt a positive outlook but this relies upon time with the person to fully explain and answer questions as opposed to finding an article online or in the media when thoughts arise with no-one to qualify or ask. Thoughts interpreted as threatening have protective consequences from pain to feelings of stress and anxiety.

In summary, we need to be judicious about the information we expose ourselves to and use rational thinking to determine the relevance to ourselves. We are all utterly unique with our own stories and lived experiences, so when you pick up an article, bear this in mind. You would also be wise to write down any concerns or questions and ask a trusted adviser to put perspective on those thoughts so that they form part of how you overcome your problem.

Pain Coach Programme for overcoming pain | t. 07518 445493

07Dec/15

Central sensitisation and higher centres

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

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

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

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

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

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

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

Science | Compassion | Sense

23Nov/15

Art of living

Pain Coach ProgrammeWe like to be good at things. Sport, work, parenting, music are all common examples. We practice, note what goes well and what does not, making changes, and essentially practicing to get better.

But what is common to all of these and everything else in our lives? What overarches all of these? Living. Living itself. There’s an art to living a life of content—and this does not mean that there is no pain or suffering. A life well lived is one of moment to moment skill, and this includes what we tell ourselves and what we do. The moment to moment experiences. These determine overall how content we are rather than the ‘biggies’: new car, new iPad, and the so-called life events. Now, these are all significant (if they are significant to you) yet they make up fleeting moments much like anything else. They are passing through, like other moments. It really depends on how you are framing it; what do you think about it? That’s what makes it what it is, for you in this moment.

So, there is an art to living well that depends on what you are telling yourself over and over. A situation is just a situation until you rate the situation and then feel it and live it. Until that point, it is nothing. We create our reality in any given moment and this is an art form. And art forms need good quality practice just like sports, music, how we communicate etc. The great thing about this is that we have every moment to practice and get good at it. You don’t need to go anywhere or any kit to get good at the art of living. So what do you need? Nothing.

Whilst you are seeking to be somewhere else, you are missing what is happening now. And that is all that is happening. Have plans, have aspirations but see them for what they are—plans and aspirations. Work out how to get there, but see that for what it is—a plan for how to get there. Be excited, be nervous, be anxious, but see these feelings for what they are—feelings, emotions that will pass as everything else does. Impermanence.

Here’s a simple tip of how to enact this: cultivate the habit of standing or sitting talk, taking a normal breath in and paying attention to this breath. Do this every time you feel tense, anxious, happy, excited, angry, sad…… Try it and see what happens.

23Sep/15

Repetitive strain injury (RSI)

r.nial bradshaw |https://flic.kr/p/fBm85W

r.nial bradshaw |https://flic.kr/p/fBm85W

Repetitive strain injury (RSI) is one of the office blights so it may seem. Of course you do not have to work in an office to suffer on-going arm or hand pain, or as some call it: WRULD (the rather clunky ‘work related upper limb disorder). You may have tennis elbow or golfer’s elbow, of course without playing either sport — then it should be lateral or medial epicondylalgia! Words aside, this is a big and costly problem for individuals who bear the brunt of the pain, symptoms and their consequential limitations, and for businesses that have employees on light duties or off sick. So how does typing cause an injury?

Well it may not. We are not really designed to be sat, hunched over a desk (as I am now I have just realised), poking away at small buttons, getting quicker and quicker so that we don’t even have to think about where our fingers are going in order to produce a document. The ‘noise’ created by all these small, precise movements of the fingers (signals flying up from the joints and muscles about movement, pressure, touch etc) can be difficult for the brain to gather into a tangible meaning. We start to develop different sensations, perhaps a change in temperature, some tingling, numbness or a sense of size difference (my hands are now warm and a bit tingly). If you interpret this as strange or mildly worrying because you have heard of RSI and you don’t want it because your job involves typing all day…..you can perhaps see how the worry and concern and vigilance and responses begin to amplify and amplify; this without any notable injury. However, the tension that builds, the stress responses that affect tissue health, the change in blood flow and nerve function when anxious, all impact and can create a threat value that is perceived as dangerous and hence the body systems that protect kick in — this may well mean some pain. And pain is useful and normal, even without a significant injury, because pain is a need state, motivating action: maybe I should take breaks? Perhaps I should type less at the moment? Maybe I need to work at changing my thinking about a  situation that is making me stressed? Maybe I should start exercising regularly? Maybe I should seek some help and advice?

On-going use without adequate recovery can lead to an imbalance between tissue breakdown and rebuild, the natural state of change that is constantly occuring to all of us. The inflammation that results can of course add to the level of sensitivity or activate it, leading to aches and pains that can begin in specific locations but with time expand up and down the limb and even be noted in the neck and shoulder. This is not the spread of a ‘disease’, but rather the volume switch being turned up, meaning that increasingly normal stimuli (touch and movement, thought of movement, particular environments) can result in pain. Associations build with stimuli, and we get better and better at certain habits of thought and action that can perpetuate the problem — e.g./ avoidance, expectation, changes in movement, extra muscle tension unbeknownst to us.

There comes a point when the symptoms can begin so quickly that it becomes difficult to type, text, hold light objects and even gesticulate. This makes work life and socialising very challenging as well as frequently occupying much of our thinking, planning and our mental resources from the emotional impact. A comprehensive approach is needed to change direction and begin recovering, from wherever your start point. Certainly if you are feeling a few aches and pains that are becoming more frequent, you would be wise to seek advice. Or if you are struggling, then the right treatment and training programme can help you to resume meaningful activities.

Due to the biology of RSI, like all persisting pains, being upstream in the main, i.e. away from where the pain is felt, any programme must address this as much as improving the health of the tissues locally with movement and use (gradually). Once you undertand your pain, you realise that pain is not an accurate indicator of tissue damage, and that there are many things you can do to take you towards a better life. Asking yourself why you want to get better gives you the answer as to where you want to be going; your direction. We need direction and then the know-how to get there, dealing with distractions on the way, so that we remain focused on the right thinking and actions.

You will have been successful before, using your strengths (e.g./ concentration, empathy, dedication, motivation) and values. Using these same strengths and values to perform the training and to think in the right way leads you to a better outcome. What are your strengths and values? The exercises, training and treatment are all straight-forward, but their effectiveness is impacted upon by the way you think about your pain and your life. There are many factors in your life that are affecting your pain: e.g. tiredness, stress, anxiety, people, places. Understanding these and your pain puts you in a position to make changes and groove healthy habits and in so doing take the focus away from pain and worrying about pain to the doing and enjoying and living. There is only so much you can attend to in a passing moment, so why not focus on the good stuff? And if you are in pain, you can learn how to create conditions for ‘pain-off’ over and over whilst you get healthier and fitter generally as well as specifically training to resume meaningful activities: common problems are typing, texting, carrying etc.

This is an insight into modern thinking about pain and how to overcome pain. We understand so much more and this knowledge is ever-expanding. Passing this knowledge to you with practical ways of using it to overcome pain is our role, and treating you with techniques that calm and ease symptoms whilst you get fitter and stronger. Together we can use your strengths to resume a meaningful life.

Call now to start your programme if you are suffering RSI or if you are a business wanting to reduce risks or develop a programme for your staff: 07518 445493

 

18Sep/15

Sports injuries that don’t go away

Jan-Joost Verhoef| https://flic.kr/p/6qqqCU

Jan-Joost Verhoef| https://flic.kr/p/6qqqCU

There are many cases of sports injuries that don’t go away. They linger on and on, becoming increasingly impacting as the sensitivity builds, often accompanied with varying patterns swelling and stiffness. Understanding what is happening is the key to deciding upon the right action to change course and recover. The way that your body and you respond is determined by the circumstances of the injury, prior experiences (injured the area before? previous injuries?), beliefs about pain and injury, genetics, the immediate thoughts and messages given by others and the action taken at that point, including pain relief. Here are some of the reasons:

  • The circumstances of the injury: how healthy you are, how you are feeling at the time, where you are, how the injury happened (your fault? Someone else’s fault? An accident? In fact, it is how you perceive it that is important, not the actual reality), your first automatic thoughts, the time of the game, the importance of the game — all of these factors come together, physical-emotional to create a memory of that moment, the pain intensity determined by the perceived level of threat, and not the extent of the tissue damage (consider the player who has a break but does not realise until later). The way you and your body respond to an injury will be very different if you are stressed vs relaxed for example.
  • Previous injuries leave their mark in terms of how you think about them and the associated pain. If you have injured the area before, then there is a greater likelihood that it will hurt because the body will protect more readily. If you have had a good or a bad experience before, this affects how your body systems that heal and protect will kick in.
  • Your beliefs about pain and injury that began to be sculpted in the early days of bumps and bruises and in particular how people around you reacted — too much mollycoddling by parents/teachers is perhaps not great for how we learn to deal effectively with injury; that’s both in the way we think but also how our biological systems work. What you are thinking will impact upon the pain (‘I must get up and play on in this cup final’ vs ‘it is the end of my career’ = very different biologies), and hence the early messages given by the clinicians and therapists must be accurate and calming.
  • It seems that we can have a genetic predisposition to over-responding to injury, with inflammation kicking in as it should but more vigorously. Some people are more inflammatory that others so it seems.
  • The early actions after an injury, including the messages as mentioned above, are really important to set up healing. It is normal for an injury to hurt, however in cases of severe pain, this needs to be addressed with the right analgesia. Early high levels of pain can affect the trajectory of the problem.

For these reasons and others, some injuries appear to persist or recur, which is highly frustrating for the individual, and for the therapists. Sometimes the factors mentioned above set into place a level of sensitivity and certain protective behaviours that mean protection is vigorous — this in terms of the way the person thinks, acts and their biology plays out. This needs to be identified as quickly as possible so that the right treatment can be administered alongside working with the player to developing his or her thinking. Whatever is playing out in their minds will be affecting their biological responses, in a positive or a negative way, so we must intervene or encourage depending on the predominant thought processes.

When an individual is experiencing an on-going issue there are a range of factors to consider and address, some relating to the points above. Hearing their complete story is a vital start point, including an understanding of their perception of the events to date, as well as prior experiences that will flavour what happened then and what is happening now.

Here are some examples of the common features:

  • Often the body continues to try and heal, squirting inflammatory chemicals into the area periodically or in response to movement. This is neurogenic inflammation and sensitises just like inflammation from a fresh injury and is part of the sensitised state, but co-ordinated by higher centres
  • Rarely does the person understand their pain, which creates worry and concern. Remember that chronic stress can make us more inflammatory — also consider other life stresses as these will impact; if the body/person is in survive mode (fright-flight), then resources for healing and recovery are limited.
  • Altered movement patterns, in part from fear/lack of confidence but also as part of protect mode. These must be re-trained from the right baseline (often people start too far down the line and fail)
  • A belief that there is a re-injury when in fact it is a flare up, or an increase in sensitivity, not an actual injury

In brief, we must ensure that the individual’s thinking is right — understand pain and injury, their pain and injury — and that they are taking the right actions towards recovery (a negative thought or over-training will not take you towards recovery); but they need to be able to think clearly about this themselves, because they are with themselves all the time whereas the therapist is with them periodically. They need to become their own coach, which is why I developed the Pain Coach Programme — not only are we coaching them, but also teaching them to become their own coach. When the understanding and thinking is in place, the training and exercises are all straightforward. I use no fancy tools or kit to coach and treat, except of course the most fancy piece of kit we all possess, our brains! But let’s not be all brain-centric; we are talking whole person. It is the person who is injured, not their leg or arm; it is the person who feels pain in the context of who they believe they are and in their life, not a leg or an arm. The person feels hungry, not their stomach. Remembering this when educating, coaching and treating creates the right thinking platform.

Pain Coach 1:1 Mentoring Programme for Clinicians — see here or call us 07518 445493