Category Archives: Self-management


5 reasons why I use manual therapy for cases of persisting pain

Some will argue that manual therapy — joint and/or soft tissue techniques — has no role in chronic pain. I disagree. Why?

(In no particular order)

1. Touch is normal and it is something that we do when we care.
2. Hands on treatment is expected when you visit a physiotherapist or physical therapist.
3. Stimulation in the area of the body that hurts can feel good. If it causes little or no pain, the brain is happy and interpreting the stimulus (touch, pressure, movement) as being safe. More of that please! A great way to desensitise and for the experience of pleasure in the affected area.
4. Change the brain’s output by addressing the area with therapy that feels good — that’s the output feeling good, along with reflexive reduction in protection.
5. What do you do if you bang your elbow? Rub it. In chronic pain, you may need to think about how and when to rub it, but nonetheless, rubbing it needs. Combine rubbing with visual feedback and there you have a pain relieving strategy.


Top 5 tips I’ve given to patients this year

There are a number of key messages that I deliver to patients during their programme

I see this as ‘drip feeding’ vital information that changes the perception of threat and hence alters the way in which pain is experienced. We know that understanding pain has a very real benefit by changing the meaning of the pain, i.e. informational medicine. We also know that negative messages can have a detrimental effect upon pain and also the way in which behaviours are constructed subsequent to such messages, e.g. ‘You’re always going to have this pain’ or ‘you’ve slipped a disc’. Unfortunately if such language is used, it can be so potent as to change the way in which the listener perceives their problem and hence chooses to move. This, often at a subconscious level (most of our thinking that influences our behaviours).

Lets get accurate in our understanding and reconceptualise pain so that we can know that it is changeable.

Here are common pieces of information that I pass onto and re-emphasise during treatment & training programmes.

1. Pain is constructed by the brain and felt in the area of the body that is perceived to be in danger. Think of phantom limb pain.

2. Pain is not an accurate indicator of tissue damage. Think of the discomfort of a paper cut and battlefield tales of significant trauma that is painless at the time.

3. Regular and consistent movement & positional change throughout the day from the start to nourish the tissues and representation of the body in the brain.

4. Exercise doesn’t have to mean the gym or going running. There is always some form of activity that can be started with the right baseline & instruction to develop confidence and healthy notions of movement.

5. There are a range of influences upon the pain: stress, fatigue, emotional state, expectation, attention, physical activity changes (new activity or more intensity).