Category Archives: Pain Education

Pain Coach Programme

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.

r.nial bradshaw |

Repetitive strain injury (RSI)

r.nial bradshaw |

r.nial bradshaw |

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… 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


Jan-Joost Verhoef|

Sports injuries that don’t go away

Jan-Joost Verhoef|

Jan-Joost Verhoef|

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


I am in pain

We often say I am in pain but does this really describe what is happening. Knit-picking perhaps, but I think that what we say, the words we use and the way that we use them are fundamental to being human and who we are as individuals. The innumerable phrases that have been passed down the generations will have their origins in a time was very different. So how relevant are they now? And how useful?

Someone says to you, I am in pain and instinctvely you know what they mean. You cannot possibly know what they feel or how they are feeling it, but you know that they are feeling something unpleasant and want you to know about it. There is a point to telling others about your pain, perhaps to seek help or advice, to gain sympathy or to give reason for non-participation for example. These are all accepted reaons for sharing, and would typically be known as part of the social dimension of pain. 

However, we cannot really be ‘in’ pain. We can feel pain, pain can emerge from our very being (this includes our body) and pain can hurt, but you cannot be in pain. You can be in a house, a car or tent. Being in something suggests that you can get out. If you say that you are in pain, it suggests that you can get out of pain. Now, pain changes and is transformed (we are not in a constant state of anything, hence pain comes and goes like any other state–pain is part of a protective state), but you cannot get out of pain because you cannot be in pain. There is no entrance or doorway to pain that once you have entered requires you to find an exit. 

Should we change our terminology and what effect would that have? I don’t think it will really change anytime soon, however when clinicians are thinking about the pain being described by an individual, it is more accurate to  consider the whole person from where the pain emerges in a particular location, with the underpinning biology involving many systems upstream of the lived experience. A story book requires a reader, words on a page and the book to be bound together. The book is the body that is read yet the reader must take the words and create a meaning, a story that makes sense, lived in his or her whole person–a beautiful description is felt and lived through the whole person involving complex biology that is a blended mind-body; embodied cognition. Our body is a story book yet the story is our experience. Changing the terminology will occur with time and as the understanding of pain evolves. 

The growth of pain understanding is vital as a basis for informed choices and treatment choices–one of the biggest reasons for chronic pain being the number one global health burden is the lack of understanding, whereby the medical model continues to predominate treatment choices; i.e./ target treatment at the place where pain is felt in the body. This misses the point of pain as part of the way in which a whole person protects himself/herself, and indeed much of our common language contributes to an old belief system that our generation has been brought up upon. Evolution takes time and of course a new and more complex explanation to replace one that is simple, will be threatening. Nonetheless, this is where we will go as people experience failed treatments or do not reach the expected outcomes alongside developments in pain science that become increasingly known in the public domain. This knowledge will demand that things continue to change, and as a result so will our language. As is common though, this is a two way street and if we take opportunites to change our language, then we are using the social dimensions of pain to create learning opportunities that lay the foundation for perceptual shifts. And there’s one thing that changes pain, and that’s a perceptual shift.

Richmond with Georgie Standage co-founded UP | Understand Pain, a campaign to raise awareness of the problem of pain and what we can do to overcome pain — we are no longer managing pain, we are changing pain and coaching people back to a meaningful life. The next UP event is in October when more than 1000 singers will be performing; even more than last time! 

The Pain Coach Programme is a comprehensive strengths based approach to overcoming pain. Call us on 07518 445493 to start your programme.

vintage typewriter by philhearing |

Gillian’s story | back pain and mindfulness

vintage typewriter by philhearing |

vintage typewriter by philhearing |

Many thanks for Gillian’s story | back pain and mindfulness


I am always a busy person; I play short mat bowls several times a week and have represented my County and England, I run a Junior session for bowls, I love to swim and I am a member of Horsham Rock Choir. I use a computer as the main part of my job of Practice Manager for a charity.

My problems began in 2010 when I slipped on some ice and inadvertently tried to break my fall with my left arm. I had restricted movement and upper arm nerve pain but after some physio my situation improved.

In Dec 2012 I developed pain in both arms after lifting a heavy object at work. I was referred for physio in Jan 2013 when I was diagnosed with tennis elbow in my right arm and shoulder impingement/tennis elbow in the left. After some exercises my right arm improved but I had further physio in the following months for my left arm. During this time the worst aspect was the nerve pain from my elbow to my hand – no painkillers relieved it, and I was in constant pain with or without movement, even scratching my face or lifting a kettle were agony!

In September 2013 when I was still in a lot of pain and had a further condition added – ulnar nerve entrapment – I was given 2 steroid injections. There was an improvement but of course the underlying problems were still there and in January 2014 there was a return of my intense pain. A further course of steroids followed, but the actual injection was excruciatingly painful and I was left with numbness in my ring finger. I was pain free until Nov 2014 when I moved a pot in the garden and experienced a twinge in my elbow, the problem was exacerbated when I used a simple screwdriver in Dec at work and I ended up in the worst pain I had had for some time.

By Jan 2015 I was at the end of my tether and rather than go the NHS route saw a physio who I knew privately. She felt that my neck was also the cause of my problem plus bad posture. Her approach was more holistic and she gave me some acupressure to try and calm me down from my very distressed state. She even suggested counselling as she was concerned about my mental health as a direct result. I was at various times loaned a TENS machine, given ultrasound and massaged. She helped me address by posture and gave discussed calming techniques. She discussed with me how my mental state was affecting my pain but I was sceptical about this at the time and more or less dismissed it. There was a degree of improvement in my condition over the following month thanks to the new physiotherapist but I was still struggling day to day.

During all these periods in and out of pain I have had to stop playing bowls and going swimming, use my right hand more – particularly with the mouse at work, been unable to sleep on my left side, been restricted doing the dance moves at choir, and not been able to do many day to day things that I used to take for granted.

In March 2015 I attended Heathrow Airport with Horsham Rock Choir where Georgie Standage my choir leader and Richmond Stace were hosting an event for UP. I took one of the flyers and did my research via the UP website. I found the videos very interesting – in particular the one explaining how “all pain comes from the brain” (Lorimer Moseley). I took particular interest too in the mindfulness videos. But I also found the written information really useful too. Over the following weeks I used mindfulness apps and also ‘talked’ myself out of pain. When I felt pain I closed my eyes and tried to focus on other parts of my body; if I hit my weakened elbow (as I do frequently!) I told myself that it was fine, it would hurt for a while and then I’d be OK. I used Mindfulness to keep me calm and I found that my nerve pain lessened in the weeks that followed.

By May I was able to resume my bowls for short periods to use my mouse at work left handed, do my Rock Choir moves without pain and return to swimming. Significantly I can sleep for periods on my left side without pain – which I haven’t done for a long time!

It is now July 2015 and I have been pain free for just over 3 months–other than the odd elbow bash! I do get the occasional twinge, and very interestingly if I am stressed about anything I get a bit of nerve pain in my arm! Looking back some of the worst pain ties in with significant stressful times in my life. I am still wary and careful about exacerbating things, but importantly I feel that “yes I do have pain sometimes, but pain doesn’t have me”. I am indebted to UP for giving me my life back, and I continue to use the techniques I have learnt – in particular the Mindfulness Breathing – to keep me calm and in control.

Photomarathon - Alphabet by Eva Van Ostade |

My A to Z of pain

Photomarathon - Alphabet by Eva Van Ostade |

Photomarathon – Alphabet by Eva Van Ostade |

My A to Z of pain –

This is by no means exhaustive, but rather a brainstorm of some of the most salient features of the Pain Coach Programme to overcome chronic pain and injury.

I am sure that I will mould this and re-shape it in time, as you are also free to from this basic framework. At the heart of the thinking lies the person suffering persisting pain, whereby their sense of self and who they feel that they are has been compromised and affected by the pain. Pain often becomes all-encompassing, pervading into all corners of one’s existence. Except that this need not be the case as we understand our pain, develop our thinking to take the right action and focus, utterly focus upon the vision of how we want to be living. All too often the messages given and auto-suggested are negative and inaccurate and hence as soon as the thinking is right and based on what we really know about pain, the person will see the opportunity to move forward towards a meaningful life once more.

A to Z of pain:

Attitude to pain affects what you think and the action you take.

Behaviours are chosen based on your beliefs; work on your beliefs about pain by really understanding it.

Change happens in the wake of developing your thinking about pain.

Decide to focus on what you can do rather than what you can’t.

Energise yourself with movement, breathing, diet and engagement with people who nourish you and make you feel good.

Focus on your vision of who you want to be and what you want to be doing. Re-visit this focus often each day.

Galvanise your strengths and focus on them to develop and grow.

Habits of health created by you.

Intelligent emotionally to be aware of how you and others are feeling so that you can make positive changes by focusing on your strengths.

Jump for joy as often as you can; if not literally, then in your mind — imagine jumping!

Kick unhealthy habits by developing your strengths.

Laughter has great effects on health and you.

Meaning is key for engagement at work and in relationships, so create a meaning for all these situations.

Notice what is happening right now; be mindful and see how anxiety drops and you feel better. When you feel better, your pain feels better.

Observe your thoughts rather than being embroiled in them.

Persevere to achieve your vision.

Quiet time to re-charge.

Refresh often during the day with movement, breathing and creating calmness in your mind.

Success comes with perseverance, choosing to think positively, learning from mistakes and focusing upon your vision.

Tell yourself positive messages over and over and notive how you feel — also using your own body language: sit up, stand tall, be proud becasue you are worthy.

Understand your pain is undoubtedkly the fisrt step in overcoming pain.

Virtues and morals drive what we do because that’s what we believe. They should be in synch with those of our relationships and work.

Worthy of overcoming pain and living a meaningful life – you are!

X factor is something we all have. Use it to motivate yourself and change emotional gears.

Yes I can.

Zzzz’s are an absolute must for health. 8 hours.

* These thoughts derive from the Pain Coach Programme for overcoming chronic pain.

There is a programme for individuals suffering chronic pain and a mentoring programme for clinicians who work with people with chronic pain problems who want to develop their skills and strengths. Call us now: 07518 445493

By Tess Watson |

Pain and society

By Tess Watson |

By Tess Watson |

Pain and society — Pain is an issue in society, and for society. Why pain has become the number one global health burden is a question that we must consider and answer using on-going study of what pain really is, how it influences us, how we influence pain, how pain emerges from individuals who form society and how society views pain. No mean task, however we must envision where we want to be as a society and focus on getting there.

One of the biggest problems with pain is that it is misunderstood. The predominent thinking remains in the pathological and body structure camp as an explanation for pain. This thinking needs to develop across the whole of society, in fact begining in schools where I believe children should be taught about pain.

Fear is a huge factor in pain — what does this mean? Will it get better? Will this pain ever go away? Etc etc. Of course those who understand pain will know that these very thoughts are ample to fuel further protection and hence pain. We need people to understand that pain emerges in them as an individual, very much flavoured the situation in which the pain is noted, influenced by past experiences, beliefs about pain and immediate thoughts and emotions. There are reams of papers examining these factors. The early messages are vital when someone has injured themeselves or suffre an acute episode of pain. The right thinking from the outset creates a way forward with effective behaviours and actions to allow the body systems to co-ordinate healing and recovery. Unnecessary fear and worry simply divert resources away from these processes and hence affect the outcomes. We do not need to fear pain but rather, take action and deal with pain.

When someone has more persisting pain, and this is likely due to certain vulnerabilities that we are understanding more and more, again the mesages must be clear and accurate. The notions of management and coping are just not good enough. We can deliver much better care, advice, coaching and treatment than ‘management’ implies. This is beneficial for the individual, the funder and hence society as a whole. Society needs to be purporting the right messages about pain and therefore we need to develop thinking on a large scale.

When I studies the Pain MSc at Kings College London under Dr Mick Thacker, I used to wonder why it was called ‘Pain: science and society’. Whilst I do not know the exact reasons for KCL’s entitling of the course, now it is obvious to me that we have a huge societal problem that needs urgent attention. There is a responsibility for all of us to come together and develop so that change occurs in the wake of new thinking based on the huge amount of research into pain. We need the support of the policy makers, businesses and individuals. Why policy makers and business? Because we can change what is happening now including the vast cost of chronic pain — this huge pot of money could become available for many other areas of life. So let’s move forward together.

If you are a policy maker or a business recognising the effects of chronic pain on society or upon your business, contact me for information on shifting and devloping thinking to take big action. t 07518 445493

Pain and society by Richmond Stace


Sticks and stones

Sticks and stones by Coloured Pencil Magazine (2014)

The old saying goes, “sticks and stones will break my bones, but words can never harm me”, however this is not exactly true when it comes to messages that are used to explain pain. Of course you could argue that words only cause harm if we interpret them as harmful rather than what they are per se, just words. Easier said than done!

Earlier this week I saw the word ‘instability’ written in reference to low back pain. This is a word that has been used frequently as a means to justify the use of something to create ‘stability’ and hence solve back pain. It has not worked.

The reason it has not worked is because there is no instability, and more importantly because pain is not a structure. I emboldened those words.

Pain is a whole person, emerging in that whole person in respect of a perceived threat. That is not a structure or a pathology. It is the whole person’s response to that pathology or injury that manifests as pain (in a bodily location), involving a number of systems that have a role in protecting us: e.g./ the nervous system, autonomic nervous system, immune system, sensorimotor system.

An injury or a pathology is not the same as pain. We cannot equate them as they are poorly related. An injury is an injury, and pain is pain, the latter being one of a number of responses to the former.

Back to instability. What does it suggest to the recipient of the message, “You have instability, which is why you have back pain”? How will this affect their pain, bearing in mind this is a pretty threatening thought? How will it affect their movement?

If there is true instability from a serious injury or a pathology that has affected the vertebrae to a significant degree, this calls for urgent surgical care. We are not talking about this scenario though, rather the number one global health burden that is low back pain. This pain is not explained by instability. If anything, the use of this word creates dependence rather than a proactive approach to restoring normal, confident movement and living life with less or no pain.

Pain is the vehicle that brings most people to the clinic. We need to give meaning to the individual’s meaning about their pain that they have already created, bringing their thinking into alignment with what we really know about pain. We must convey the right messages from the start to reduce the risk of chronicity. I just want to add that we need to tackle pain in the broadest way from the beginning, incorporating all dimensions–physical, emotional and cognitive–but importantly, how these interact as the whole person with prior experience, beliefs, genetics, gender, co-morbidities etc. The step-wise approach of trying medication, then physio, then interventions, then psychology etc (not always in that order!) does not work. It does not work. The whole-person needs to be addressed from word go. The whole climate and culture of health-caring for pain must change. And this includes the words we use, in reference to my earlier point.

When we understand pain, the actions that we take change for the better. When it makes sense and we know that we are safe to move and live, it takes us in the right direction. Each person has their own lived experience of pain that has been cultivated through the development of all the protective systems that have been subject to prior demands, and learned how to react in certain situations. This makes some people more vulnerable to chronic pain. Let’s help these people by asking the right questions at the start so that we can change the course that they are heading on.

We can and must do better. The science is there to be used and the thinking is there to be used. With the blending of neuroscience and philosophical thought, we are now in a time of great optimism. We can make lasting change for our generation and the next as we change our thinking and take big action across society and the globe, together.


Richmond Stace: Specialist Pain Physiotherapist

My overarching aim is to change the way that society thinks about pain so that we can tackle what is the number one global health burden, chronic pain. One to one with individual sufferers, via writing and talking, and the UP | Understand Pain campaign, I hope to shift thinking so that we can reduce the suffering that people feel across the globe.

UP | Understanding Pain

Bec’s Story — overcoming chronic pain

In support of the @upandsing chronic pain awareness campaign by UP | Understand Pain, Bec has very kindly written her story of achievement. Bec illustrates how we can change our pain and overcome chronic pain by understanding her pain, and taking action based on this knowledge. Enjoy.

“I suffer from chronic pain. This is when pain persists beyond the normal expected healing time. In writing this story, I wanted to describe to you the affect that living in chronic pain had on me as a whole person, since understanding this is vital in order to improve our understanding of both ongoing pain and its treatment.

‘YOU CAN IF YOU THINK YOU CAN.’ Norman Vincent Peale

‘Life can only be understood backwards; but it must be lived forwards.’ Soren Kierkegaard

I didn’t crawl before I started to walk. I have never had a good sense of direction or spatial awareness – I get disorientated coming out of a shop, not knowing which direction I need to turn. I have hypermobility in my joints. I have perfectionist tendencies. I fractured a vertebra when I was eighteen. I have always placed a great deal of importance on exercise and struggle to be as happy without it. Doctors told me I would live in long-term persistent pain.

These are all facts about me. Facts that at first may seem to have no connection. But since nothing works in isolation, everything about us – our experiences, our personalities, the words we hear and stories are told, create a whole. And in order to overcome chronic pain we must learn to deeply understand it, not just from an external objective perspective, but also from a uniquely personal and internal one. Chronic pain comes from and affects the whole person and it therefore must be the whole person who is treated. Once this happens, it is possible not only to overcome chronic pain, but to redefine old stories, undo unhelpful thoughts, alter perspective of past experiences, develop healthier habits and ways of living, know that we can change. Not just our pain, but ourselves…in any way we wish to.

‘Movement anchors thought.’ Cara Hannaford.

I don’t believe that our minds and bodies are separate entities and I have always found a joyous energy in movement that I could not create in any other way. I am told that as a baby I was desperate to get moving and began walking at nine months. On my first trip to the swimming pool as a toddler, I jumped straight into the water the moment I saw it. Growing up, I spent hours outside, climbing trees, building dens, riding my bike. And I was always trying out new sports: dancing, gymnastics, trampolining, roller-skating. From the age of 10 to 18 I played competitive netball. But it was horse riding I really loved once my family moved to Norfolk when I was five. As I grew older, I recognised the deep sense of connection to the world I found when I was engaged in physical activities. It wasn’t the technical aspects of riding I enjoyed the most, but the sheer physicality of it – both whilst in the saddle and working on the yard.

In 2000, aged-18 (during my gap year before university), I had a seemingly uneventful fall during a riding lesson. But an awkward landing caused a compression or vertebral fracture to my spine. Looking back now, it was my first experience of the ambiguous nature of pain. In the first moments after the fall it was incredibly painful, but this quickly eased and I thought I had just winded myself. I got up, walked the horse back to the stables, untacked her and lay down for a rest. But in the following thirty minutes I experienced excruciating pain in my back. I was taken to A&E and x-rays and scans revealed the fracture – it was a clean break without any splintering. This was a fortunate discovery, not only because it meant an operation wasn’t necessary, but also because a splinter could have severed my spinal cord as I moved around after the fall. I remember the consultant berating me for this, which created an intense feeling of fear of how different my life could so easily have been, of the fragility of a life well known – a fear that never completely left me from that moment onwards.

I spent a week in hospital lying as still as possible until a back brace could be fitted. I can recollect the high level of pain only through memories of pleading for more morphine before it was allowed; and from attempts to writhe around to try to redistribute the pain to other parts of my body (although I was held still by the nurses). I spent the following four months in my back brace permanently, a rather unattractive bulky white contraction aimed at preventing kyphosis (curvature of the spine) while the fracture healed. For a further two months I used it only when I was out of the house for long periods. Occasionally, I used a wheelchair when a lot of walking would have been involved. But the pain subsided after just weeks of the accident.

Within six months I was back in the gym, running and horse riding again. I spent the two months I had left before starting university travelling around Europe: I ran the streets of waking cities; mountain biked in the Alps; paraglided off the coasts of Greek Islands; and went whitewater rafting in Austria. These are the parts of the trip I remember vividly due to feeling enormous gratitude that I was still able to do them. It was the type of gratitude created by a near miss, a lucky escape, the insight that life can change in a second. My accident made me realise the ability to move our bodies is a gift. It is a gift that not everyone is given, or gets to keep. Running became a prayer. The heightened awareness of the ground beneath me in those first few steps provides immediate comfort. And then as I settle into the rhythm, the motion becomes an energy, which is like life waking up inside me. Running gives me a connection to something bigger, something both within and beyond myself. I am mindful, totally present in the moment, immersed in the feeling of moving and, if outside, in my surroundings.

‘People will forget what you said. People will forget what you did. But people will never forget how you made them feel.’ Maya Angelou.

For the majority of the following twelve months my back gave me few problems, but towards the end of my first year at university I began getting bouts of terrible pain in it. A new MRI scan and x-ray revealed what I was told was Degenerative Disc Disease, and that the fluid from inside one of my discs had leaked, pressing on nerves – the cause of the pain. I received some physiotherapy and the pain subsided over the next couple of months.

I have since learnt that Degenerative Disc Disease is a very general term used to describe changes in the spine – a normal part of the ageing process. Aged 19, one of my discs had degenerated faster than was usual for someone my age, (but not an uncommon result of a spinal trauma), which it was why it was used to describe the cause of my pain at the time. However, what the label actually meant wasn’t explained to me, and the power of the word ‘degenerative’ (suggesting progressive deterioration) and ‘disease’ (implying impairment or abnormal function), remained long after the pain had disappeared. I became more cautious of activities that may threaten my back’s ‘safety’, especially falling, and concerned that in the future I may have further problems relating to a condition I now believed I irreversibly had. A more accurate description of the situation would have been to simply state that one of my discs had degenerated.

‘There is nothing either good or bad, but thinking makes it so.’ William Shakespeare, Hamlet.

Throughout my twenties I experienced pain in my back on a fairly regular basis, but nothing too debilitating or lasting much longer than a month or so. I remained very active: as I was now living in London, mostly running and going to the gym. However, from the age of 26 I also began getting a recurrent pain in the outer part of my left knee – not an uncommon for problem runners. Various physiotherapists informed me it was Iliotibial Band Syndrome (a tightness or inflammation of the ligament that runs down the outside of the thigh from the hip to the shin), and gave me exercises to treat it. But they never provided a long-term solution and I began to find it increasingly irritating as the pain reoccurred more often; for five years it prevented me from running more than a few miles, and sometimes appeared when I was just walking.

In March 2013, the knee pain began again and this time I set out to find an alternative treatment since traditional physiotherapy hadn’t worked. Whilst I did so, I stopped running altogether. The knee pain simmered down but in May 2013 I noticed soreness in the front of my hip – it felt like I’d pulled a muscle. Yet despite reducing exercise even further over the summer, it didn’t improve – in fact the soreness heightened and spread around the back of my hip (a burning-like pain), and for a few weeks acute tenderness in my calves and shins developed.

In September 2013 I began seeing Christian Poole, a Sport and Exercise Rehabilitation Coach (specialising in running) who uses an Applied Functional Science approach, which targets the cause rather than symptom of an injury, unlike previous physiotherapy I’d received. Since my focus was very much on the returning knee pain, which I saw in isolation, in my naivety, I didn’t mention the other more recent pains I had. Short-term injuries were common because I exercised a lot, so I still didn’t think much of the hip pain. I presumed I simply hadn’t rested it enough yet.

We began a running re-education and rehabilitation programme targeting the potential cause of my knee pain, which would change my running form and improve the overall movement of my body. However, within weeks we had to discontinue because the soreness around the back and front of my hip worsened significantly, spreading into my right gluteus muscle and lower back. I also got sharp shooting pains down my right leg and in the outer left knee (a different type of pain to what I’d experienced in this area before). My emotional response to this was stress and further frustration: I’d finally found what I believed would be a way to alleviate my returning knee pain, only to be faced with a new set of problems.

I will never know for certain, but it seems probable that the following factors: whatever injury originally caused my hip pain; the importance I placed on running (or not running); my emotional response to pain at this point; and the prolonged and incorrect belief there was a structural abnormality in my spine (‘Degenerative Disc Disease’) contributed to what happened next – a persistent, ongoing pain response. Scans in 2014 showed that there is now no degeneration to my discs that wouldn’t be expected for my age, yet for many years I had a misguided perception that this wasn’t the case. What I had always attributed as the cause of my reoccurring back pains didn’t exist. Therefore, it is possible that for a long time my central nervous system was becoming gradually sensitized, firing pain as protection, when no protection was actually necessary…Perhaps the injury to my hip was just the final trigger.

‘When you are courting a nice girl an hour seems like a second. When you sit on a red-hot cinder a second seems like an hour. That is relativity.’ Albert Einstein.

By December treatments were reduced to symptomatic relief as the pain spread further up my back and neck, more intense, ever present and distracting. Moving hurt. Not moving hurt. Walking and simple everyday activities (loading the washing machine, cooking, getting dressed) became challenges. My general level of energy dropped significantly: being in constant pain over a prolonged period is tiring.

Initial investigations didn’t reveal any obvious cause of my pain and I began to feel as though I was going insane: I would go to sleep with pain in one area only to wake with it somewhere else instead or in addition. The moving of the pain felt like a cruel game – like one of those tricks where someone hides the ball under a cup, moves it around, and no matter how carefully you watch, it’s never under the cup you think it’s going to be. I saw my pain as a separate entity, a small gremlin of a creature, which merrily jumped around my body parts, taunting and laughing at me as I tried to pin it down, unable to catch it and hold it still. My knowledge of pain at this point was that for pain to be present, there had to be a physical injury or illness. This idea – this myth – is embedded in most of us. If I’d had a better understanding of pain before this experience, then I would have felt less fearful. But I didn’t understand, and as a result I felt anxious and even more stressed.

Fortunately serendipity had been kind to me. It was lucky I’d decided to see Christian about my knee, because he did understand what the behaviour of my pain now suggested. He began educating me about the neurophysiology of chronic pain using the work of Professors Lorimer Moseley and David Butler. However, in order to rule out a physical cause for certain, I went for x-rays and MRI scans on my back and hip. Due to NHS waiting-times, it was further seven months from the referral in December before these were carried out and the NHS would offer me no treatment until we had the results.

Consequently, because the behaviour of my pain strongly indicated it, in the meantime Christian and I treated my pain as chronic – a result of an unstable central nervous system. Over the following months we used a variety of strategies to begin to overcome the pain: mobilisation and massage, trigger-point therapy, specific exercises, and graded exposure and pacing of physical activity. I educated myself as much as a could about chronic pain and neuroscience-based treatments. As a result, I understood that gradually increased activity was part of the treatment process and that movement, even if it hurt, wasn’t going to physically harm me (aerobic exercise at the correct level calms the central nervous system, and controlled movement prevents secondary pain from muscular deconditioning and joint stiffness). But moving parts of my body through pain was counterintuitive and the complexity of chronic pain scared me. My prior experience of pain, which stayed in one area, was familiar and felt concrete. There is damaged tissue or bone, which is treated in some way: the pain goes away. Now pain itself was the problem and this felt abstract and evasive. Despite this, in January I made some significant progress and even began introducing some very short run/walk exercises.

However, in that seven-month wait, in my mind there still remained a degree of uncertainty – and sometimes hope – as to the cause of my pain, that it still might be the result of an injury or structural issue. This option felt like it would be less complex to treat and more understood (by myself, doctors and those around me). The waiting for the MRI scans undoubtedly impacted negatively on my pain, mindset and therefore effectiveness of the treatment. It was a liminal space to live in for over half a year and to have been without the care of a private clinician at this stage (and as it turns out at any stage) would have made remaining at work and coping with my pain impossible, especially as my interactions with medical practitioners working for the NHS were largely a source of frustration and anxiety rather than supportive and constructive.

‘There is something about words. In expert hands, manipulated deftly, they take you prisoner.’ Diane Setterfield.

I saw numerous GPs over these seven months as they coordinated my care (providing medical notes when I needed to work reduced hours; sending me for and receiving the results of scans; and finally referring me to the pain management team). I also later saw a number of physiotherapists and a pain psychologist. With the exception of one physiotherapist I saw just once, but who I will forever remember for her positivity about my situation in a culture of different beliefs, all delivered a similar message: there is no cure for chronic pain. I would have to learn to live with it. They only ever talked of “pain management” as a long-term solution, usually with the help of painkillers. In the earlier months what my GPs said to me planted enormous doubt around my chances of getting better. These were medically trained doctors and I was no expert. Why would they say this to me if it wasn’t true? I couldn’t shake what they’d said: and what they said terrified me. I was very social, outgoing, active. These things were already becoming difficult to keep up in a constant pain-state.

I was desperate for reassurance from other sources that there was a way to overcome my pain. However, websites of the NHS and pain management clinics, along with those of pain charities, all delivered a similar message: it was possible to learn to manage chronic pain to gain a greater quality of life, but not to cure it. I was – and remain even more so now – confused as to why they all repeated this message when scientific, evidence-based research around the brain, pain and neuroplasticity has proved this no longer needs to be the case. Newer treatments have proved effective in overcoming chronic pain conditions. I am now evidence of this myself.

But back then I searched for blogs written by survivors of chronic pain who had made recoveries…I found none. Instead I found blogs and posts written by desperate people who had been living in pain for many years, possibly typed out sitting in the darkness at their computers, just like I was. I was left with two opposing messages. There is a Chinese proverb that says: ‘When faced with two points of view – better to choose to believe the more positive one.’ I made a conscious decision at this point to do just this and returned to what I knew to be the latest biopsychosocialist treatment approaches, adding the work of Dr. Adriaan Louw to my list of pain educators.

However, this was constantly tested as the GP who took on my case was frustrated by my determined attitude: he repeatedly told me I needed to accept that there was no cure for my pain and that private practitioners who said otherwise did so because they had a vested interest (i.e. my returning ‘business’). He was also annoyed I wouldn’t accept painkillers. I was adamant I didn’t want to begin a process of relying on them or want to mask the pain: I needed to feel it so I could work to overcome it, not a short-term fix. His response was to tell me I was in a state of denial, and that people who refused painkillers always came back in the end for them, often in a worst state. I felt criticised rather than cared for.

I believe that all the NHS practitioners I saw were well intentioned but either that their pain education is out of date and inadequate, or that the system doesn’t allow for necessary treatments to take place due to short-term cost demands. I have since spoken to a number of GPs, who informed me they know little of the latest neuroscience-based research around pain, yet they are the first contact for a chronic pain patient and what they say matters. I often wonder what would have happened if I hadn’t by chance been seeing Christian during this time: the only voices I’d have heard would have been of those who told me there was no way to fully recover…

The additional anxiety caused by negative medical prognosis and information on the Internet impacted on my pain – now living alongside it was fear. Fear that my pain would never go away. I tried to ignore it, but in the ever-presentness of the pain, the fear gnawed away at me in the background. And despite the progress made in January, by March the pain had spread to more parts of my body and significantly heightened. Some places, such as below my ribs became incredibly sore, I had stabbing pains continuously down the entire right side of my body, turning my right hip caused an intense shooting pain… And although my resolve to overcome my pain didn’t waver, Christian, and some practitioners whose research I’d read, were lone voices of hope in my world. I didn’t doubt the science, or the treatment approach, but I did often doubt myself. I knew it was necessary to manage my stress and fears to overcome my pain, but was struggling to do so. No one else I knew could offer me reassurance because most found it difficult to understand that there was no physical cause of my pain and were genuinely perplexed by what was happening to me.

‘My suffering left me sad and gloomy.’ Yann Martel, Life of Pi.

My pain, the gremlin, was winning. The constant state of discomfort had an ever-increasing affect on my life. Events that required I stay for a given length of time, (a birthday party, a wedding, a dinner out, a meeting at work), or imposed activities and environments (crowds, travel, sitting or standing for long periods) evoked a claustrophobic feeling.

My general health started to deteriorate. I couldn’t sleep, was fatigued and easily caught viruses. I felt guilty if I visited someone and then felt unwell. I often had to cancel plans to meet friends. My parents began travelling from Norfolk to clean my flat. Activities I could take part in were restricted. Walking and driving became problematic because my neck was too rigid and painful to turn – I had to rotate my whole body to cross the road or check at junctions. I have a physically and cognitively energetic job as a teacher and senior leader in a primary school, and although I remained at work for the majority of the time, my capacity and performance were affected.

And I deeply missed running and exercising. Not just because these had previously formed large parts of my identity and social life but because of what moving my body, and physically pushing myself means to me. Because of the clarity of thought and inner-calmness I find in them. Without them, I couldn’t see a way out: I saw myself standing, dressed in my running kit, alone in the middle of an empty road, enclosed by a thick fog. Being unable to run, felt like an ironic joke. What once had been a source of comfort, a means of escape, was an activity I associated with pain. And by March 2014 I was overwhelmed by how physically fragile I perceived myself to be. There was a total disconnect between my mind and my body, which scared and frustrated me in equal measure. By now just thinking about running made my pain worse. I was unable to truly imagine ever running again.

Pain infiltrated every movement, every thought, every plan, every conversation, every interaction. It was there in my body, in my facial expression, in my words, in the tone of my voice. It was there in my laughter. It was there in the reflection of light as I poured water into a glass. Others couldn’t see it, but I could feel it. It painted the world in muted colours. It was like watching each moment through a dirtied window, everything slightly marked and smudged, and always from a three-step distance from everyone else. My experience of the world now felt different because pain added an extra unpleasant sensation to every moment. My perceptions of space and pace altered: sometimes action around me became too fast, sometimes it became disorientatingly slow; busy, thriving, energetic places became threatening, oppressive. These things sometimes provoked a type of loneliness that was engulfing. A kind of detaching loneliness. A kind of loneliness at its most acute when I was surrounded by people. A kind of loneliness that made me want to be alone – because it was the least lonely place to be.

Courage does not always roar. Sometimes courage is the quiet voice at the end of the day saying, ‘I will try again tomorrow.’ Mary Anne Madmacher

However, there was progress and hope – days when my pain lessened, and although initially just for short periods, moments when I was completely pain free. In these I experienced a lightness of body akin to floating. The same feeling as that very first day of spring after winter – that feeling that lasts only a second in the very moment you step outside and suddenly notice the air is warmer. Shapes and colours returned with a more intense clarity and brightness.

And I was intent on not being completely reduced by my pain. The deterioration in the quality of my life and my passion for running only made me more resolute. I refused to be signed off work, and as my pain improved I began volunteering at running events to reconnect with the community I missed. I felt a deep sense of identification and belonging here and was reminded that runners believe that our bodies achieve what our minds believe. Reconnecting with this helped me enormously to get back up each time I was knocked down. I gained resilience from recognising progress, no matter how small. And for a reason I cannot explain, throughout the whole experience, a notion that good would eventually be born from it drove me on. Some very close friends supported me in remaining focused on this when I became fearful or doubtful. These people still saw me, as me – a person beyond my pain. This too was important.

From April to June 2014 more steady improvements in my condition were made. Finally, in June the scans and x-rays were completed and showed there were no structural causes of my pain. I was put on a waiting list to see a NHS pain management team. By now, my pain was consistently at a much lower level and had settled along my right side in a line from hip to neck. Changing my pain so that it remained only in this area was significant progress and a relief. My pain was no longer a gremlin that jumped around, but a crocodile that rested along the side of my spine. Yet each time I attempted to increase my activity – walk a little further, cycle for a few minutes, or just be more active in day-to-day tasks – my pain flared up. The crocodile dragged me under water again every time I moved too much or whose presence I couldn’t ignore if I stayed still for too long.

I was told it would be at least another three months before an assessment with a NHS pain management team. I also understood by this point that whatever they might offer me in terms of support, would be from a viewpoint of helping me ‘manage’, rather that ‘treat’, my pain. This wasn’t what I wanted. I had no interest in engaging in a process of this nature: I knew it would feed my fears, and fear knocked me off course. I knew that my pain could go, but not that it would, or when this would happen. This, and worrying I’d never be able to run or exercise again was a limiting issue, preventing me from moving forward again. As a result, Christian referred me to Richmond Stace, feeling that at this stage a new voice; his expertise in chronic pain conditions specifically; a change of clinic I didn’t already associate with pain (or running), could help me to overcome my pain further.

‘When you become aware that pain can change you’ve started on the right path, when you know that you can change your pain, then you’re really moving forwards. Don’t fear pain – change it.’ Richmond Stace.

During my first appointment with Richmond, I described my pain to him. But he listened to and heard me – the whole person. He saw the altered sense of self that it had created. This was the first step that really enabled me to know, rather than just be aware of, my pain experience as one within a whole. My pain was not in isolation from the rest of my self. One of the first things he did was to get me to refer to my pain as my pain, rather than the pain as I had been doing. My pain was coming from me, my brain, and therefore was part of me. I felt fully seen for who I was at that moment. But he also reassured me that this wasn’t who I had to remain, since someone who was continually living in pain, was someone I desperately didn’t want to be.

We began a programme that built on the treatment I had already received, continuing to incorporate specific exercises, manual therapy and mobilsation techniques. We also added in a graded motor imagery programme. This included: mirror feedback (performing very precise movements in front of a mirror in order to provide visual feedback to rewire the neuro network within the brain to create new maps); and an online imagery recognition programme to treat my altered nervous system by exercising the brain in measured steps. But as well as treating my pain neurologically, we also began to look at improving other aspects of my life: ways to treat my fatigue, insomnia, and weakened immune system; ways to tackle my fears; ways to manage the demands of life that had become challenges in pain. I had already begun mindfulness meditation as I had read about its benefits in managing living in chronic pain. Richmond coached me how to use and apply it to improve my quality of life as a whole, and explained how it changes pain given its calming affect on the central nervous system’s ‘fight or fight’ mode. We also set very specific targets of what I wanted to achieve in the long-term, such as running a marathon.

Over the following months we began working on this goal. But since just thinking about physical activity would make my pain worse, we started by using visualization techniques to prepare my brain for these in a way it would perceive as non-threatening. First there was an imagery recognition process using photographs of other runners, and then by watching other runners themselves and imagining myself in their position. I then applied specific visualization techniques, which used brain and body, to imagine myself running. Over the course of the following months I would practise these daily, often with the help of music, words and mantras, and gradually, imagining running and other physical activities no longer made my pain worse. Within a couple of months my pain levels had reduced further, and I was able to walk and move more without my pain worsening. I was also experiencing longer periods without pain and by August I felt confident enough to do some yoga. In June, this had seemed like an impossible idea. In October I started running again. In November I completed a 5km. In February 2015 10km. In March (almost two years since the pain had begun) a half-marathon. I still had regular pain during these periods, but bit by bit I learnt to disassociate it from movement, learnt to nudge into it, work around it, sometimes even use it to my advantage. It didn’t all suddenly become easy – at times the process felt relentless and exhausting. However, I was now in control of my pain, rather than my pain being in control of me.

Key to the process was individualisation. Not only did we work towards the goals I had set – things so important to me they would drive me forward – but we also incorporated strategies to challenge the affect that negative words had previously had on my progress, as well as aspects of my personality, mindset and beliefs about past experiences that may be causing the persistence of my pain. As a result, even in times when my pain flared up, I could increasingly remain feeling focused, positive, safe and reassured. These strategies were taken from a variety of fields – from writing, philosophy, sport, psychology, and science. It was finding what worked best for me. I deepened my understanding of chronic pain to understand my own particular pain so well that I could overcome it. I now perceive any flare-up as an opportunity to learn, rather than something to be feared – although these flare-ups are becoming fewer and further between each month now.

‘YOU CAN IF YOU THINK YOU CAN.’ Norman Vincent Peale

Overcoming my chronic pain was the most physically, mentally and emotionally challenging thing I have ever done. But in retraining my body how to move, my mind how to think, myself how to be, it has left me not only running further than I have in eight years (with no knee or back pain). It has also taught me to find the same joy and energy in stillness as I find in movement. It taught me to live my life with greater positivity, confidence, compassion, gratitude, and to be more fully in the present moment.

And to anyone living in persistent pain: it is possible to overcome chronic pain. You do not have to learn to live with it, or manage it. You can treat it and change it. No matter how out of reach this may seem, know that it is true. ‘You can if you think you can.’


50 strokes

Ajahn Brahm tells the story of a monk who thought he deserved punishment for breaking a monastic rule. He had knowingly done wrong and expected reprimand, yet this was not the way. The monk insisted, so Ajahn Brahm prescribed 50 strokes. The thought of this ancient punishment undoubtedly filled the monk with fear yet he knew this was his fate. However, no whip was produced but instead a cat, which the monk was ordered to stroke—50 times. After the 50 strokes of the cat there was peace and calm and the passing of a learning experience. Change was afoot. 

In physiotherapy we use our hands to treat and create calm in a body that is protecting itself, perceiving a range of cues to be threatening. It has been thought that moving joints, muscles and nerves bring about the desired changes (or not if unwisely applied) because of a change in the structures. Science has since taught us otherwise, and that in fact what we are really doing is changing the processing in the body systems and then the recipient has a different and better experience—pain eased and movement more natural and thoughtless. 

Touch is very human. Touch is a part of the way we develop in the early years, a lack of touch being detrimental to normal development. So potent when the meaning is aligned with a sense of creating wellbeing and soothing woes both physical and emotional, touch should be part of therapy for any pain condition. Interweaving hands-on treatments during sessions, teaching patients how to use touch themselves, teaching carers and partners how they can use touch, all create the conditions for healthy change. 

Touch send signals from the nerves in the skin and muscles to the spinal cord and then onwards to the brain. In this way, the body is an extension of the brain and the brain an extension of the body, demonstrating  how we are  a whole person with no system or structure being in isolation to any other. Using touch is literally sculpting the representation of the body that exists in the brain, like moulding clay into a humanly shape. And of course, a shape has a function and the two are not distinct. The more precise the shape, the better the function. The manifestation of this being a normal sense of self in how we think and feel and a move. Normalising, desensitising, to me are one and the same. 

– 50 strokes of the area of the body being protected, much like stroking the cat then, sculpts our ever changing brain and sense of physical body. The physical body exists and occupies space with the ever-potential of action, yet this does not exists without thought—it is my thought, the meaning that I give to my body that creates what it is in any given moment. When the strokes feel pleasant, or at least not painful, then this is your body and brain perceiving the action as being non-threatening and learning that the area is safe. The more of this the better. The same applies with movement: any action that is tolerable or feels good is the body (your whole self) saying ‘yes, that’s ok’. And that’s what we practice and practice. 

To overcome and change pain is to normalise and to alter one’s relationship with pain and overall perception. We have much more say in this than most people realise but once they understand their pain, what pain really is and what they can do, change occurs in the desired direction.