Category Archives: Pain

30Apr/18

Stuck in pain

 

Overcoming chronic pain

Stuck in pain and how to move on

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

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

are you stuck in pain?

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

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

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

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

we need a plan

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

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

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

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

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

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

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

Call us now to start your programme ~ Jo 07518 445493
30Mar/18
Persistent pain and injury in football and sport

Persisting football injuries

Persistent pain and injury in football and sport

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

Persistent pain and injury in sport

28Jan/18
Motion in e-motion

motion in e-motion

Motion in e-motion

motion(less) https://flic.kr/p/o4jG5d | C Frenzl

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

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

Your state is governed by what you focus upon

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

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

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

motion in e-motion

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

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

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

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

RS


Pain Coach Programme

Pain Coach Workshops

Pain Coach 1:1 Mentoring 

14Oct/17
Whole person to treat chronic pain

Pain is a very human experience

Pain is a very human experience

Pain is a very human experience

It is easy to take being human for granted. It is what and who we are but it is also why and how we ‘do’ life. We do it in a very human way, which is somewhat unique to each of us, yet there are patterns.

Part of being human is being conscious. Now, we don’t have to be conscious to be human, but we do have to be conscious to be having the experience of being human. We have many, many experiences, and one of the commonest is pain. There are a few exceptions, but on the whole most people will experience some pain each day. Many people will experience a lot of pain each day. This can be to the point that they feel it is continuous.

Despite pain being embodied, it is somewhat elusive. It is as complex as we are, because it is part of who we are and how we survive. To say that pain is embodied means that we experience it in our body, for where else could it happen? There has been a huge focus on the brain in recent years and this continues. However, pain is not ‘in my brain’ as some people believe and say, instead it is emergent in me, and I am a whole unique person (WUP).

What is the purpose of pain?

Despite the complexity of pain in terms of biology and experience that together are a lived experience known only to the individual, there are simple reasons why we feel it. There is also the way that we do pain. This is our style and it typically resembles the style with which I ‘do’ my life. My life-style is the approach I take to life. This incorporates the way I face challenges and address my needs.

We are aware of our needs implicitly by the way we feel and the sensations we experience. These are our need states and we must attend to them to maintain homeostasis. Failing to do so results in a shift into a protect state. Basic need states include hunger, thirst, the urge for toileting and pain. When our basic needs are taken care of we can focus on what we are doing.

Of course there is a prioritising system, so if I am thirsty but a pack of hounds are chasing me, it would not be wise to stop for a drink. Also, we don’t always get it right and so needs may not be apparent or we may feel a need but not actually require any more. An example of the latter would be food when you may have the feeling of hunger, yet you have actually eaten enough.

Similarly with pain as a human need state, when this becomes a more persistent state, we can argue that the emergent experience does not fully represent the need. I would suggest that when someone is suffering chronic pain, this is normal and what is an experience that compels thinking and action to address certain factors in one’s life. However, the frequency, intensity and intrusion is not representative of the threat. Instead, it is a summating nagging that can become extremely intense at times as the evidence continues to suggest that something dangerous could, or is happening. This is basic biology at play, maintaining our survival.

Continuously we appraise our circumstances, our brains predicting what could be the best explanation for the sensory signals. This is what we experience consciously as the world around us as well as ourselves in the midst of this most vivid film. We are the actor, the director and the pundit all together somehow. There can be a flitting from one to the next but never wholly one nor tother.

Perfection is what you are striving for, but perfection is an impossibility

As well, we can often be the most critical of each, seeking the perfect performance, which of course rarely of ever exists. As John Wooden said, arguably the most successful coach ever and a wholly decent and insightful man, “Perfection is what you are striving for, but perfection is an impossibility. However, striving for perfection is not an impossibility. Do the best you can under the conditions that exist. That is what counts”.

Pain and the way we experience it, what we do with it, how we acknowledge it as part of us like any other experience or anatomical part makes us the very human that we are. Love and how we ‘do’ it is another fine example of a conscious experience that is so very human. The repertoire of descriptions, responses, narratives, poems, paintings and expressions pays homage to something that we need not fear, only address. For that is the purpose of pain.

How we address pain, how we approach something that is not just a feeling but an action and cognition, is as part of the experience as the experience itself. There is no separation. When people try to distance themselves from ‘it’, or fight ‘it’ or resist ‘it’, they only try to do this to pain with themselves. We cannot successfully fight ourselves. Instead, accepting and understanding the need state before taking action that proves our own safety. We have to actively generate that prediction, or actively infer by new understanding and new actions within a world that we, as Anil Seth describes ‘predict into existence’.

Let us never forget that we have remarkable potential because we are human. We can choose our approach to life once we have become aware of our existing style. If it does not work, if it does not bring health and happiness, you can choose another. And like anything that is important, we have to practice and take steps and learn along the way. This is what we are doing each moment as it unfolds and we are re-sculpting ourselves to make sense of the world and ourselves, where the two are interconnected. So why not feel a sense of control and practice skills of being well, each day, every day. This you can choose to do.

24Jul/17

Improve staff fitness

Improve staff fitness

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

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

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

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

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

“The skills of wellbeing easily weave into the day”

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

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

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

“Staff fitness benefits business and society”

Staff fitness

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

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

What could we do at our place?

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

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

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


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

Individual coaching and workshops ~ t. 07518 445493
04Jun/17
Teens suffering chronic pain

Headache

Headache is a leading cause of suffering

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

 

Headaches

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

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

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

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

A brief look at pain ~ what is it?

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

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

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

What can we do about pain?

The short answer: a lot!

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

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

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

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

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

“what is your vision of success?

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

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

RS

 

 

 

 

05May/17

Exams, stress and pain tips

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

Exam exhaustion | Felix Neumann

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

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

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

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

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

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

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

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

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

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

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

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

Recharging and sleep

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

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

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

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

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

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

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

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

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

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

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

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

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

For appointments or enquires about Pain Coach Mentoring and speaking events, call Jo on 07518 445493
01May/17

High Performance Sport Knowledge Exchange 2017

High Performance Sport Knowledge Exchange 2017

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

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

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

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

~ Make each day a masterpiece ~ John Wooden

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

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

Language & the inner dialogue

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

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

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

Super-teams

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

The problem of pain & pain in sport

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

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

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

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

~ pain and injury are poorly related

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

#upandrun

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

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

Communicating

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

Some good questions for self:

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

Summary

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

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

Choose to feel excited.

RS

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

Facebook & Twitter @painphysio or frequent updates

27Mar/17

Charity quiz night

Charity Quiz Night

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

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

Chronic pain is the number one global health burden

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

UP | understand pain

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

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

CRPS UK

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

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

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

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

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

 

15Mar/17

Values mismatch

Listening to peoples’ stories for over 20 years, one picks up on the important themes that consistently arise. These are the areas that need addressing as part of a full programme to overcome chronic pain. One such theme is the values mismatch.

Values mismatch

Put simply, a values mismatch is when our deepest held beliefs about ourselves and the world are at odds with the value system in which you find yourself. Arguably the most common context for a values mismatch is when the individual’s values do not fit with those of the workplace. A further example can be when a person’s values evolve so that a difference exists between the new values and those held by the family or close network.

As an illustration, trust is the value at odds. With trust being of inherent importance to the person, when the work environment is driven by high levels of competitiveness, the so-called dog eat dog culture, underhand methods can be rife and accepted by the company. This fear based approach causes great suffering. Continuously looking over one’s shoulder is unhealthy and unsustainable. For the person who holds the value of trust to be dear, this can drive a more consistent state of protect. Further to this is the impact upon health and the sense of well-being.

Values mismatch and suffering

The mismatch can affect us deeply as we either try to fit in or somehow rebel against the culture. Both require effort. Add this to the energy cost of being in a sustained state of survival, and one can begin to see how health can be affected. How many people who suffer burnout would tell you that they hated their work? Scratch beneath the surface and you usually discover that it started well. With time they became ground down by the demands, the attitudes and behaviours. We are not separate from the environment, nor the other people who we are surrounded by, and hence the ‘toxic’ place affects our health. Even just thinking about the place or certain people there cause a feeling of discomfort or anxiety.

When we are in survive mode for sustained periods of time it potentially affects many body systems. The systems that protect us are looking out for danger and the feel of our body and self is just that. We feel on edge, uncomfortable, tense, anxious and this tells us that threats are about. They may or may not be, yet this is what we feel. Our body is saying there is danger when in fact there is no actual threat. The systems work on a just in case basis. With protect state ‘on’ consistently, everything appears to be dangerous. Now, every little prompt or cue stokes the fire: watching the news, reading social media, the look someone gives you etc. How you consciously interpret these things and how your body systems alert you has changed.

“Our body is saying that there is danger when there is no actual threat. This is a habit that can change

The common manifestations in terms of health include chronic pain, fibromyalgia, fatigue, poor sleep, irritable bowel syndrome, headaches, migraines, struggling to recover from an illness or injury, jaw pain, anxiety, depression, poor concentration and memory, feelings of isolation and despair, and a great deal of suffering.

This does not need to continue. You can change course by understanding why this has happened, addressing the reasons and creating a new way forward. We are designed to learn and change, and with a new moments continuously unfolding, we have enormous potential to succeed with the right thinking and right actions. Writing down our values helps to clarify what is important to us. From there we can see how any mismatch maybe affecting us. Then we can seek to understand how we can best go about achieving alignment with our values. This would form part of a programme of training, coaching and treatment so that you can achieve your best by focusing on your strengths.

++++

Pain Coach Programme to achieve your best | t. 07518 445493