Getting the best of athletes
Yesterday I was excited to speak at the ACPSEM Symposium 2018 at The Imperial War Museum — an inspiring place to inspire our best selves! Having been asked to talk about sensorimotor training, mindfulness and using hands for treatment, I shifted the title slightly: getting the best of athletes. To prepare the participants, not passive listeners, I wrote a brief premise: problem pain in sport.
Starts with the best of you
Getting the best of athletes and patients necessitates you getting the best of you. For athletes to reach peak performance they need those around them to also be at their peak. For physiotherapy this means delivering the best care, which we can only be doing in our own way when we are top of our own game. How can we achieve this?
Self-coaching is something we do all the time, primarily featuring what we tell ourselves — our inner dialogue. Now of course just because it is your dialogue based on your thinking and beliefs, does it mean that it is right? The art of self-coaching requires us to be skilful with our mind from where our actions follow. It seems easy to convince ourselves of something through simple repetition together with cognitive dissonance. Becoming familiar with the way your (embodied) mind works is a most valuable skill, as it is in the athlete to focus on performance.
You have probably noticed how the skills of self-coaching are the same as those we can use to get the best of our athletes and patients. In that we are also practicing makes it authentic.
What do you want?
What is your picture of success? We need to know where we are going and what we want to achieve. To really embed this within our thinking and actions, we must take the time to picture and feel it. Otherwise it is a mere doff of the hat and off we go again in a vague direction leading wherever.
Take a moment to write down your picture of success — what does it look like? What are you doing? Where? Who with?
What are your strengths?
When you use your strengths you achieve results. Do you know your top 5 strengths? One way to clarify your strengths is to think of an example of when you were successful. What did you achieve? How did you achieve it? What part did you play?
Further useful questions to ask yourself could be, when am I in flow? When do I feel at my best? When do I quickly see the answers and a way forward?
Take a few moments to write a list of your strengths on a blank piece of paper. You can then establish your top 5
Like working a muscle, you can choose a strength each day to flex and practice.
Blending strengths based coaching with the latest understanding of pain is an approach to working with people suffering chronic pain, which I devised and continue to sculpt. This work will never be completed as we continue to develop our understanding on a route of mastery. To truly understand pain takes a working knowledge of neuroscience, biology, cognitive sciences, social sciences, consciousness, perception and more. This is not enough for then we need the wisdom to best use this knowledge.
Wisdom + knowledge = best actions
The essence of this approach is to focus on an individual’s strengths, whilst managing the consequences of their weaknesses. This is always about getting results by aiming to get the best out of the person and their circumstances. It is also about concentrating on what we can control and not what we cannot control.
What is pain?
We touched on this most vital of topics. Not in the detail of a full day Pain Coach Workshop, but to highlight the pinnacle of current thinking. I always emphasis the size of the global problem of pain as a backdrop. The understanding of pain must move forward in society where the problem is embedded in terms of personal suffering and the enormous cost.
There is no adequate brief explanation of pain. Pain is the greatest example of a conscious experience flavoured by individual stories, past experiences, expectations, emotions, context and meaning. Love is another. To understand a person’s pain to help them to understand their pain is to understand them and their style of life. How do they do life? How do they do pain?
The question to ask, having listened deeply and compassionately to the narrative, is why have they not got better? Why the hold up? What is limiting their progress? We are always moving onwards, it’s the direction that is key. Which direction is the person going in and why? Establishing this allows us to create a new way forward together.
Pain is part of the way we protect ourselves. It is a perception and like all perceptions, can be thought of as an inference. Or our brain’s best guess based on a need to protect us, often just in case. Like anything that gains momentum, this builds over time as the perceived threat builds and the range of cues, triggers, contexts widen. Some may assume we are assuming that because of this understanding we are saying it is somehow unreal. This is definitely not the case. Pain is always real. Pain is always embodied. Pain is always individual, and what the person says it is. Let us never confuse this again.
The examples I used to demonstrate the Pain Coaching approach were those I was asked to discuss: sensorimotor training, hands on and mindful practice. Now of course these are not exclusive to Pain Coaching, which is the arching way of getting results. Pain Coaching is not a technique in itself so to speak.
Here is a short summary of the important points. Each example is about changing the person’s state. We practiced bounding and breathing in the session as a way of experiencing and feeling state change. Such change is always happening, but we are often unaware. The body is ever-present, yet our minds are often elsewhere. We can never be truly ourselves or well without being whole and connected, which is one of the reasons for being mindful.
As clinicians we are state changers, encouraging and inspiring others to change in their desired direction, day-to-day, moment to moment. This is why self-coaching is so important. The person has to be able to encourage and enable themselves in their world to get results.
To be mindful is to be present in yourself, in this moment whilst being open to what is happening, whatever that may be. Mindfulness is accepting, non-judgemental and seeing things for what they are instead of being biased by the mind’s presuppositions. So often we worry about things that never happen that way.
How do you look after yourself? Each day?
Mindful practice enables us to become familiar with our mind, to face our suffering and transform it with compassion rather than try to avoid it or cover it up, which leads to more suffering. Change is what someone in pain wants, and to do so takes awareness, understanding and focus, all of which mindful practice nurtures. This can be through mindful breathing, mindful movements and body scans as examples.
Movement is fundamental for survival. In persistent pain, protect and survival states predominate, usually just in case as opposed to true need. This is one reason why being in touch with reality is so important. To be in touch with reality means you can perform a more accurate risk assessment, considering that we have no direct access to our biology, just inferred states (what I experience as my perception and reality).
Movement enables us to create our reality. The brain needs movement to actively gather sensory information from the world, thereby creating my perceptions. Anything that threatens my ability to move and act in the world is a threat and will maintain a state of protect. The perceived threat could be restriction, a thought (anticipating pain) or a lack of control due to altered body sense.
On moving we are fulfilling a prediction that has already been made. To re-train normal movement that features ease, action in perceiving (rather than thought about) and flow, is a necessary part of the programme. This starts with body sense training and re-establishing the clear boundary of me and the world, gradually building towards meaningful movements and activities, bringing in elements of control, strengths, endurance and flexibility.
I jokingly talk about hypnotic hands. But in essence we are talking about the use of meaningful touch to bring about a state change. We can see and feel the change in someone when we use touch skilfully. This is a most useful state change that creates a new and pleasurable experience in an area of the body only ever thought of negatively. We also see changes in engagement with the body, re-interpretation of experiences, reduction in threat, and parasympathetic states. All of these are important steps in the right direction. We explore this is detail, creating experiences for each other, in the workshops.
I like the talks I give to be interactive and experiential.This is one way to emphasise messages. Making it real. Being told something and experiencing something are completely different. Immerse yourself!
As physiotherapists we are pattern breakers, disruptors, state changers, perceptual sculptors. That is the reality and we must forge forward in the profession as we are in a great position to encourage and inspire people to achieve success and live their best lives.
On a route to mastery we seek to grow and develop ourselves as the knowledge tree ever-blooms. We must match this with wisdom, which is why I suggest kaizen and the beginner’s mind at the top of the session. We are each following our own MAP: mastery, autonomy and purpose.
‘Make each day your masterpiece’ John Wooden
If you are looking to develop your practices, to get the best of you and your patients and athletes, The Pain Coach Workshops give you the knowledge, skills and know how: