Category Archives: Pain Education

03Mar/15
Treatment of pain and injury

Joe’s pain story

Back pain, Chronic pain, Pain, Pain Education, Pain narratives, , ,

Up LogoJoe’s pain story told by his mum Jenny as part of the UP | Understanding Pain Campaign that launches this Saturday with 700+ singers performing at Heathrow – follow us on Twitter @upandsing to show your support

It was the morning of Tuesday 27th November 2012 and the usual school morning rush was well underway when my son, aged 11, lent forward and picked up his school bag. Straight away he complained of back pain, he was unable to fully stand up straight but by no means was in agony. I explained to my son that I felt his muscles were in spasm and the best thing for him to do was to keep moving. I work in a sports injuries clinic and said that I would book him in after school for a massage. I’d only been in work 10 minutes when the school called to say that Joe had ‘got stuck’ bending down at this locker and could I come and collect him. Joe shuffled out to the car in a manner that I had seen many patients at work walk and knew he must be in a fair amount of pain. On the subject of pain I would like to point out that Joe was no stranger to pain, he’s broken bones in his foot and not even muttered anything about it until I noticed the lovely purple bruise. He’s been a keen cyclist since the age of 5 and has had crashes resulting in loss of skin and friction burns; crashing at around 30 mph dressed in lycra is always going to hurt! Thinking back over Joe’s life he had never complained of pain and he was always one of those people who would rather get on with it.

Joe’s muscles where indeed in spasm and the physio treated Joe as much as he could but he recommended further investigations at our local hospital. The local hospital listened to what had happened and sent us home with paracetamol. That evening Joe’s pain became worse. He was only comfortable lying on his side and struggled to walk, I started rotating paracetamol and ibuprofen every two hours but nothing was touching the pain. We tried every distraction technique we could think of, hoping that once Joe slept he would feel better in the morning. Joe was literally screaming with pain by midnight, we had no way of moving him to the car so we called an ambulance.

To cut a very long story short this first hospital visit was the first of many. Joe would be screaming in pain day in day out. It was the most heartbreaking thing to witness as I had no way of controlling his pain. Our local hospital had no way of controlling Joe’s pain either, they had tried everything they could think of but where unable to pinpoint why Joe was in so much pain. Our experience at the hospital soon became very stressful, we became in a loop of ambulances and ward stays. One day they sent us home and within two hours of being at home Joe started screaming, ‘blacking out’ and screaming again, it was relentless and we had no option but to call for another ambulance. Thankfully by now they were used to seeing Joe so started the morphine and we thought it would just be a matter of time before the pain was under control. Three hours later Joe was still screaming non stop and my husband and myself were at breaking point. Consultant after consultant came in to see Joe, they all did the exactly the same leg lift test and left. No one except the A&E nurses seemed to care that Joe was still screaming and that nothing was helping him. Eventually one of the nurses said she had had enough. He had enough morphine to knock out a rugby player and she was moving Joe round to adult A&E as she said they couldn’t ignore him there. Within five minutes we were surrounded by consultants who decided that Joe needed to be put under so that they could perform a lumbar puncture. The relief when he fell asleep was overwhelming. I cannot begin to describe what it feels like to see your child in so much unbearable pain. Every time Joe ‘blacked out’ for a few seconds it was a relief only for him to wake again and continue screaming.

Joe was awake when we next saw him and surprisingly in no pain. The consultant said that maybe his brain had forgotten to turn his ‘pain switch’ off and going under had ‘reset him’. At the time I didn’t care why the pain had stopped I was just so glad it had! Joe was admitted and over the next day his pain started to return. His results had come back negative so the hospital decided to refer him to Great Ormond Street Hospital (GOSH). After spending a very surreal New Year’s Eve in hospital we were transferred on New Years Day. GOSH started him on a different mix of medication that started to work within a coupe of days. Their physio’s worked with Joe several times a day with his first goal being able to sit up for 10 seconds. They re-ran loads of tests on Joe but they were also unable to come up with a definite answer. They explained that unfortunately as it was 5 weeks since the Joe had injured himself, the injury could have already healed. They felt that the best course of action was to continue with the medication, pain killers and tens machine and to go to our local hospital to continue the physiotherapy.

We returned home after a week in GOSH with Joe’s pain under control with medication and plenty of telephone help from the Pain Team. After our experience with the local hospital I felt that attending physio with them would be a waste of time. I started searching on the internet for private physio’s and Richmond Stace came up again and again. I spoke with the GOSH Pain Team and they were happy for us to attend a private physio. I contacted Richmond and briefly explained our story and asked if he could help, ‘Of course’ was his reply. I remember putting the phone down half smiling and half in shock. Had I just heard right? He knew how he could help Joe. I was so shocked as apart from the staff on Koala ward at GOSH no one, I repeat no one had any idea what was going on with and how to deal with it.

Our first meeting with Richmond was such a positive experience, he listened and understood Joe’s pain. He explained that Joe was not the first person he had seen with that level of pain and it was something he could help us with. Joe started to improve over the weeks that we saw Richmond and we started to lower his medication. He was also managing more school that ever before and I could finally see a glimpse of the future and Joe being well. Richmond has this amazing ability to calm you, take the stress and worry out of the situation and just help you focus on the here and now. We learnt that our surroundings, state of mind, belief in what is wrong etc all have such a major impact on how we perceive pain and how we deal with it. For me, as Joe’s mum, I felt in control for the first time in months and I have no doubt that the feeling of being in control rubbed off on Joe. Listening to Richmond speak to Joe made me realise there was hope. I had truly started to question whether Joe would ever be pain free, how can no one know what caused the pain? How can they not know how to stop it? If we didn’t know what caused the pain could it happen again?

After everything that Joe had been through it had changed him. No longer was Joe my fearless boy, he was now cautious, carried himself differently and seemed different from his peers. In my opinion there is no doubt that pain changes you, makes you aware of your immortality and causes you to protect yourself when, most of the time that protection isn’t actually needed. Maybe our brains are too clever for their own good! Richmond helped Joe realise he was ok. In fact his was better than ok he was Joe again. Not Joe who screams in pain, not Joe who is fragile and unable to do much more than lie in bed but old Joe — Joe who loves school, riding his bike, playing football, going out with friends and playing his guitar. Richmond helped Joe see that and he helped him see that he can control his pain, giving Joe the belief in himself again, proving that he was not at the mercy of a painful back, destined to take painkillers and other medication for the rest of his life. The belief and the tools Richmond gave Joe changed his thought processes, enabling him to progress through his physio, lower and eventually stop his medication.

If anyone reading this is suffering with pain please, please see Richmond. Your life doesn’t have to be ruled by pain. Pain is exhausting and all consuming and it doesn’t have to be that way.

24Nov/14
Sturridge thigh injury

One injury, and then another…and another….

Chronic pain, Chronic pain in sport, Football injuries, Pain Education, Sports Injuries, Sports medicine, , ,
Sturridge thigh injury

Sturridge | more thigh troubles

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

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

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

 

18Nov/14
Caring for our carers

Caring for our carers

Carers, Chronic pain, Chronic pain treatment, Pain Education, Uncategorized,

help concept, special toned photo f/x, focus point selectiveMy simple message with this blog is that we need to care for the carers. Undoubtedly the individual with pain or ill-health is suffering, but so are the carers who may be partners, family members and friends. They may also be professional carers who are not immune to the stress of looking after someone.

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

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

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

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

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

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

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

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

15Nov/14
RSI specialist treatment

5 facts about repetitive strain injury | RSI

Chronic pain, Neck pain, Pain, Pain Education, Repetitive strain injury, Uncategorized, , ,

IMG_0149.JPG

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

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

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

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

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

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

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

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

09Nov/14
Pain specialist clinic in London

My top 5 pain myths

chronic back pain, Chronic low back pain, Chronic pain, Pain, Pain beliefs, Pain Education, ,

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

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

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

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

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

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

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

There are many others.

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

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

28Oct/14
Low back pain specialist London

Top 5 back pain myths

Back pain, chronic back pain, Chronic low back pain, Chronic pain, Chronic pelvic pain, Low back pain, Pain beliefs, Pain Education, , ,
Back pain myths

Back pain myths

Welcome to my top 5 back pain myths. What are these you may ask?

Around pain and in particular back pain, there are many phrases and explanations used to try to educate the patient. These have been handed down through the generations and can appear to be logical. Fortunately, the science has moved on and we know better.

Here are 5 common beliefs that have been challenged:

**I have not included the myths of core stability because this has been well documented previously. Pulling in your abs does not solve the complexity of back pain, especially chronic back pain.

1. Bending is dangerous

2. Discs slip

3. Nerves are trapped

4. Pain comes from facet joints, discs etc

5. Low back pain is in isolation to everything else in your life.

Comments below:-

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1. Bending is normal. Sure it can hurt when the back is being protected, and when we have back pain the muscles are guarding and this can reduce the amount of movement. In the acute phase, most positions and movements hurt, but this is protection and it is meant to be unpleasant in order to motivate action. Moving little and often, changing position and breathing all help to keep blood and oxygen flowing.

2. Discs are not actually discs and they do not go anywhere. Yes they can be injured like any other tissue. They can bulge and affect the local environment, and they can herniate, triggering a healing response — both can hurt because protection is initiated. The fact that there are so many nerve endings around the area mean that sensitivity can arise in a vigorous manner. Again, this is a normal if highly unpleasant experience. Remember that a 1/3 of the population have such changes in their spine but without any pain. The body as a whole must rate the situation as threatening for it to hurt.

3. Nerves do not get trapped. Local swelling and inflammation can sensitise the nerves meaning that they send danger signals. There is not too much room either, so if there is swelling or a bulge, this can affect blood flow to the nerve itself and cause sensitivity to movement and local chemical changes. Again, this can happen without pain as well, so it is down to the individual’s body systems and how they respond. Understanding, gradually moving and breathing can all help ease you through this phase.

4. Pain is whole person and involves many body systems that are protecting you. There is no pain system, pain centre or pain signalling. Pain is part of a protective response when the body deems itself to be under threat. We feel pain in the body but the underlying mechanisms are upstream of the body part that hurts. To successfully overcome pain we must go upstream as well as addressing the health of the body tissues.

5. Low back pain is embedded within your lifestyle. It is not separate to how you live — e.g. lack of exercise, postures, work, stress, emotional state, previous experiences, understanding of back pain, gender, genetics, just to name a few. This maybe more complex, but this provides many avenues for overcoming pain.

Suffering with persisting back pain? Have other seemingly different problems such as irritable bowel syndrome (IBS), headaches, migraines, other joint pains, muscular pains, pelvic pain, jaw pain, recurring bladder infections? Contact me today to learn how you can move forward and overcome your pain: 07518 445493

26Oct/14
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Pelvic pain in men

Chronic pain, Pain Education, Pelvic Pain, Uncategorized, ,
Pain is a whole person experience

Pain is a whole person experience

Many men experience chronic pelvic pain that significantly affects their lives. When we talk of pelvic pain, we often think about women and their suffering, however, this problem is one that besets both sexes and hence we must encourage all who endure such pain to seek help. As with any persisting pain state, pelvic pain impacts upon the way we think, the way we act and the decisions we make, thereby intruding on quality of life.

There are many reasons why men can suffer pelvic pain. To identify all the causes is not the purpose of this blog, but rather to highlight the problem and provide an insight into how the body becomes stuck in a protective mode. This is the experiential dimension, the story that is told and the narrative that provides all the clues. For the pelvic pain itself is downstream, and with chronic pain we must also go upstream to look at the context within which the pain is happening.

Most people who come to see me do not have pathology or ‘damage’ that justifies the pain response that they suffer. Some have nothing of note at all as shown by scans and other tests. Understanding that you can be in pain without an injury is an important step towards changing pain — for those new to this notion, consider phantom limb pain for a moment. Often there is a start point that involves inflammation, which shifts the body into protect mode. Protect mode involves many body systems, conscious and unconscious behaviours (the latter being habits and conditioned responses). When the body is protecting itself, the area needing attention and defending will hurt, but we also move differently and think differently — if you have a painful ankle, you may think twice about ‘popping’ out to the shop for a paper.

In many cases, these protective responses die down as healing progresses. However, this does not always happen, and with statistics suggesting that 20% of the population suffer chronic pain, many continue to experience protection despite the tissues healing — pain, tension, a different sense of the body (there are many other feelings and sensations described to me, and I encourage this narrative so that I can fully appreciate the story). My thinking about this on-going protection is that the body senses all is not as well as it should be. In other words, the individual is not fully fit, the tissues (muscles, joints etc) are not entirely healthy, behaviours are not orientated towards health, and lifestyle factors in which pain is embedded have not been addressed satisfactorily. This is a huge topic to address at another time, but suffice to say, as much as pain is multi-factoral, so is recovery, which is why a programme to change pain must address the biology of pain and all the influences upon this biology (they are also biology!).

Back to the pelvis, an area full of muscles, nerves, blood vessels, ligaments and other soft tissues. From the pelvis ‘hang’ the legs, and on top sits the trunk. And let’s not forget the genitals, and both their importance and necessary sensitivity. The deep tension and pain that one feels in this region is truly visceral, radiating out into the groin and abdomen, accompanied by an awful tension and pulling in the muscles and testicles. Once the pelvis is grabbing your attention, it can be hard to distract yourself without learning how to change body tension.

Tim Parks - Teach us to sit stillIn this very personal tale of pelvic pain, Tim Parks describes his own journey via the book he wrote, “Teach us to sit still”. It’s a wonderful read for so many reasons, and I frequently encourage patients to tuck in. For me though, the bottom line is that Tim has validated a problem that needs addressing in a comprehensive manner, because so often there is no serious pathology despite the significance of the suffering. Getting to grips with this is part of moving forward and should be embraced. We do not need pathology to hurt. There are other reasons, one of which includes, as Tim says, sitting on your pelvis for 20 years and being stressed — this is by far enough to cause nasty pelvic pain!

What do you do when you are stressed? Tense muscles. This has an energy cost and impacts on the way oxygen is delivered to those very muscles. Consider exercising a muscle over and over. It hurts. It is exactly the same in the pelvis that you may be parked (no pun intended Tim!) on for extended periods of time. “I don’t get stressed” you may say. First of all, I don’t believe you (sorry!), because we all stress out at times and secondly, most of the time we are unaware of what our body is doing in response to our thoughts, environment and what we are doing; that is until it is too late — ooh, my ____ hurts because I haven’t moved for ____ hours (fill in the gaps).

So, what can we do. What do we need to do. Here are a few things that I believe are fundamental to changing what your body is doing:

  • Understand your pain and condition — that’s your clinician’s job, to help you.
  • Create awareness of how your body is responding rather than being on autopilot and then fire-fighting when it gets too much.
  • Think about what the body needs — oxygen to the tissues, especially nerves that become very grumpy when the supply drops (numb bum from being sat too long) — and make sure you do enough to nourish the muscles: move and breathe!
  • Go upstream of the pelvic pain, and look long and hard at your lifestyle and environments — e.g. How are you doing things? Where are you doing things? What habits can you release and change?

Chronic pain is a huge and costly global problem. The main reason why this is true is because of misunderstandings and the low expectations of successfully overcoming the condition (patients and clinicians) because the focus is upon treating ‘structures’ deemed to cause pain. Pain is not a structure, hence why this approach fails. The science of pain has moved forward hugely over the past 10 years and continues to deliver a new understanding. This new understanding challenges existing thinking, and it needs to. Pioneers of pain are hard at work and are finding ways to reduce suffering, and we can. It starts with a change of thinking based on new knowledge. Your knowledge that is translated into effective action.

If you are suffering pelvic pain, get in touch and start your programme to overcome your pain — call us now 07518 445493 — Specialist clinic in London and Surrey for chronic pain & persisting pain

 

22Oct/14
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Girls, stress and pain

Chronic pain, Functional Pain Syndromes, Headache, Irritable Bowel Syndrome, Joint Hypermobility Syndrome, Migraine, Pain, Pain Education, Stress, , , , , ,

Stress and painI have seen a number of teenage girls over the past year who are affected by chronic pain. They are often referred because of recurring headaches or migraines but we discover that there is widespread sensitive at play. How does this happen? Why does it happen?

Headaches and migraines can be functional pains. When these pains are part of a picture of sensitivity, often accompanied by anxiety, there are often other problems such as irritable bowel syndrome, pelvic pain and jaw pain. Whilst these problems all appear to be different, they have a common biology. Typically I work with women aged between 30 and 55 who suffer these aches and pains, but increasingly this is an issue of the younger female. Having said that, when I explore the story of an adult, we often find reasons for sensitivity that begin in childhood. This priming sets the scene for later events.

As adults we face many challenges. We have body systems that are trigged by these challenges, especially if we think they are threatening to us. In particular the autonomic nervous system (ANS) is quite brilliant at preparing us to fight or run away, which is very useful…..if you are facing a wild animal. On a day to day basis, it is in fact useful for the ANS to kick in and create some feelings in the body that alert us to danger — the caveat being, nothing is dangerous until it is interpreted as so, and hence we need a construct of ‘danger’ and of the thing that is perceived to be dangerous. For example, a baby may not have the construct of a lion and hence sees this big, cuddly, moving….thingy…like my teddy (may not have a construct for any of these either!), and essentially detects no threat. As the baby detects no threat, he or she behaves in a way that may not threaten the lion and hence the lion may feel safe. Both feeling safe, they become friends. Perhaps — these things have happened apparently. Please do not try this at home, but hopefully you get the idea. Back to day to day….

London Fibromyalgia ClinicsIn the modern world we often feel anxious. This is the body warning us that something is threatening. In many cases that I see, there is a strong reaction to banal events and non-threatening cues. Or if the cue is worthy of attention, the response is well out of proportion — e.g. utter panic and defensive thinking-behaviours. To what do we respond most frequently? Definitely not lions. Muggers? Gunmen? Earthquakes? Tidal waves? These are all inherently dangerous situations, that we simply do not often face. Sadly some people do have such encounters but the majority of us do not. The answer is our own thinking. The thoughts that are evoked — seemingly appearing form nowhere at times — are not the actual problem but instead the interpretation of the thought (metacognotion; our thinking about our thinking). The meaning that we give to a thought, often automatically, will determine the body response as our thoughts are embodied. And just to complicate things further in relation to thinking, there’s a world of difference between the experiencing-self and the memory-self. The former refers to what is happening right now, the latter to what we remember, or think we remember. In terms of pain, if our memory of a painful event concludes with a high level of pain, this will flavour the memory-self and we will report as such. The story, which is a snapshot within our lives, and how it turns out has a huge impact upon the subsequent memory of what happened.

The adult within an environment that becomes threatening, the workplace for example, can become very responsive to different cues that once were innocuous. Now they pose a potential danger and each time that happens and we respond with protective thinking and behaviours, the relationship becomes stronger — conditioning. There is no reason any this cannot be the same for younger people who are consistently within an environment and context that begins to pose a threat; a demanding school environment with high expectations plus the child’s own expectations and perfectionist traits. Place this context within a changing period of life and minimal time for rest and there is the risk of burn out or development of problems that involve many body systems. We cannot, no matter what age we are, continue to work at a level that is all about survival.

I focus on girls and women because females outnumber the males coming to the clinic. Many are perfectionist, many are hypermobile, many are anxious, many are in pain and many are suffering. This is a situation that needs addressing worldwide, and starts with understanding what is happening, why it is happens and how it happens. Over the past 10 years this understanding has evolved enormously, providing tangible ways forward. This does not mean that we need to change perfectionism, but rather recognise it and use it wisely; this does not mean that anxiety is abnormal, but rather recognise it as a normal emotion that motivates learning and action; this does not mean that feeling pain is a problem to fear, but rather know it can change when we take the right action; and it does not mean that we will not suffer, but rather accept that part of living involves suffering that we can overcome and move on.

We have created an incredible, fast moving world. The body does not work at such a pace. It needs time to refresh and renew so that we can think with clarity and perform to a high level, achieve and be successful. We are humans. We are a whole-person with no division between body and mind; instead one thinking, feeling, sensing, creating, moving and living entity responding to the experience of the now and to memory of what we think happened. Gaining control over this with understanding and awareness provides a route forward to wellbeing, no matter where the start point.

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If you are suffering with persisting pains — body pain, joint pain, irritable bowel syndrome (IBS), headache, migraine, pelvic pain, jaw pain + feeling anxious, unwell, tired — call now and start moving forward 07518 445493 | Clinics in Harley Street, Chelsea and New Malden

20Oct/14
Hamstring injuries in football

Chelsea FC – ‘long, long’ injury list

Chronic pain, Chronic pain in sport, Medicine in football, Pain Education, Sports Injuries, Sports medicine, Uncategorized, , , ,
Hamstring injuries in football

Hamstring injuries in football

Part of the role of being a manager is to juggle the team according to injuries. The list of injured players in The Premiership at the moment is significant. Jose Mourhino described his list as ‘long, long’, hence the Chelsea manager is being forced to consider his options for the forthcoming games. With the ever-growing costs involved in football, questions about players’ availability are now a routine focus for interviews.

Diego Costa is struggling with a persisting hamstring injury. Leg injuries and pain are the scourge of footballer’s careers, but with a change in thinking, many of the on-going problems can be eradicated.

Certainly players work hard on their conditioning to make sure that their bodies are prepared for the rigour and vigour of the modern game. Time away from running and kicking allows for the body to adapt — muscles and the systems that control the muscles. Active rest is vital and should include a techniques that create calm in the body via the mind. We know only too well the potent influence of the mind upon the body and vice versa. Allowing a negative thought about pain or injury to take hold will affect movement and performance. But, there are effective ways of dealing with this and should be routine for both players and managers.

There is a difference between hamstring pain and a hamstring injury. The latter involves damaged tissue whereas the former does not. Everyone needs to understand this and know how to discriminate — by everyone, I mean players, medical staff and managers. With everyone knowing the facts about pain and injury, communication is open and free, meaning that any stress created by worry and concern is eliminated. One thing that is not good for pain is stress. Why? Because the body will be in protect mode, and this is not compatible with recovery.

Understanding pain and injury is the start point. From here, recovery can be planned and implemented, working with all the body systems involved with injury and pain — and that includes body awareness, sensorimotor function, immune function, autonomic function; all involved with protection. Protection is vital in the initial stage of an actual injury, but as healing takes hold, the biology of protection may need a helping hand to switch off.

Struggling to get back to football? Have a player who is struggling? Get in touch and we can work together to return him or her to play — 07518 445493

 

 

18Oct/14
Chronic pain and injury in football and sport

More Premiership injury woe

Chronic pain in sport, Football injuries, Pain Education, Sports Injuries, Sports medicine, Uncategorized, , ,

Chronic pain and injury in football and sportHeadlines today in The Guardian sport section report that Daniel Sturridge is suffering from a further strain, this time in his calf. I do not know if this is the same leg as the thigh strain from which he has recently recovered, but if so, I would not be surprised. In addition, we learn that Raheem Stirling told Roy Hodgson that his legs were sore. Anyone who plays sports will know that feeling.

A second injury or pain on the same side — why?

When we injure a muscle or ligament, inflammatory chemicals are released locally. Danger-sensing nerves (nociceptors) are activated by these chemicals when their threshold of firing is lowered. Danger signals are sent to the spinal cord, where modulation takes place with signals being sent down from the brain — these are in response to thoughts, emotions, context, perceived danger etc. The danger signals are then sent up to the brain via a second neuron, where an analysis of what is happening takes place. On concluding that there is danger, pain emerges from the body in the place where it is thought the problem lies. The body uses cortical (brain) maps to allocate the pain in the body. Put simply, the biology of pain does not reside in the injured tissues but instead involves the protective functioning of many body systems working together.

Once protection kicks in, pain draws our attention to the area, our movement changes as does our thinking amongst other things. This does not involve only the injured body region, but widespread responses of body systems that protect us from actual and potential threat. The original injury goes through a healing process — we have incredibly potent healing abilities — yet the sensitivity and protection can persist. If, for example, the thigh is strained, it is all the ‘wiring’ that involves the leg that will be on alert. Without full resolution, and this includes confidence in the body, the systems are primed and hence during this period it is easier to ‘pick up’ another injury. Sometimes there is an actual injury and damage, but often there is nothing discernible yet it hurts in the same way. Differentiating an actual injury from the sensation of an injury is important. Players and coaches understanding these mechanisms (of pain) is vital in my view, so that these problems can be tackled efficiently. It would be straight-forward to deliver a mandatory, FA backed education package — contact me for details of an education programme.

In summary, why do pains appear on the same side? Because the initial sensitivity has not fully resolved in the case when no actual injury can be found. If there is a strain or sprain detected, there is a good chance that motor control, body sense and awareness and or confidence are not complete. Of course, there is always the possibility of just plain old bad luck, however I would suggest that it is more likely that the body remains in a degree of protection mode.

Aching legs and recovery

Briefly, the body needs time to recover from the demands of exercise. This can be all out rest for a short period but also active rest that would be a lower intensity of movement and activity; a skills based session for example. There are ways of enhancing recovery that include focused movements and body awareness exercises as well as the practice of mindfulness. We have a great ability to adapt, and in fact our body systems are continually changing and adapting to our lifestyles. This is one of the reasons for chronic health problems in a society that is ‘wired’ and ‘immediate’. Put simply, our bodies are not designed in this way.

Educating players about pain, injury, recovery and health empowers them to make good decisions. With coaches and managers also understanding these principles, it creates a positive culture with clear communication about injury and pain. A player should always feel that he can talk openly about how he is feeling, physically and mentally — although I would argue that these are one and the same because we are whole person: genes, character, personality, experience, knowledge, beliefs, mind, body etc., with no single feature standing above the others.

Contact me for information about pain seminars and training at your club — 07518 445493