Tag Archives: back pain

26Jul/16
Back pain

Back pain

Back painIn today’s Daily Mail Good Health section an article boldly claims that an ingenious new approach to back pain could transform your life. This is indeed a big statement to make about one of the largest ‘public health’ issues — chronic pain and depression are the top 2 global health burdens.

The authors describe the biopsychosocial model for pain (BPS) that incorporates factors relating to the biology, psychology and sociology of pain. This is the model claimed for most modern pain services, although whether all are fully addressed in an integrated manner is a separate point. It is good for the BPS model to gain some air time as it is certainly a step forward in the right direction compared to the dominant biomedical model that would suggest we need to look for a structural or pathological reason for pain. For anyone with even a basic knowledge of pain, the biomedical model will be deemed outdated and lacks any use for understanding persistent pain. This is simply because pain cannot be explained by a structure or pathology.

For the first time, perhaps ever (in my memory), I was delighted to read about danger signals rather than pain signals in the public press. This is a vital piece of information as we do not have pain signals or pain centres, instead we have a biological system that detects salient events and orientates our attention — termed the salience network by Giandomenico Iannetti and colleagues. Conjoining this model with current models of consciousness, AI and brain (e.g. predictive processing) and you are getting somewhere near a very, very good way of thinking about pain. Of course we have some way to go yet and need to be careful about how we frame the current knowledge in terms of existing data.

There are many biological and behavioural changes that occur when we have back pain and other on-going pains. We change with every moment as every moment is unique. We feel that we are the authors of our own inner dialogue and this often means drifting into the past or future, becoming embroiled with what has been (as far as we can recall) and what may be, but of course neither actually exist despite the embodied sense we have in that moment. Keeping a close eye on what is in front of us, also known as being present, helps us to see what is really happening versus a story that we construct. By regularly thinking about a painful event in the past, we can easily ‘prime’ or sensitise this moment. Equally by anticipating pain or projecting ourselves forward by imagining that a movement will hurt, we change our way of moving and the sense of our body as anxiety and tension emerge. This is one of the reasons why awareness of one’s own breathing helps.

An important aside: It is important to clarify here that although we talk about the mind, thinking and emotions in relation to pain, the actual experience of pain emerges in the person and is felt in the body or the space in which the body should reside (for many biological reasons). The notion that pain is in the brain or in the head is nonsense. And, we are more than a brain.

Turning one’s attention to breathing means that you are being aware of this moment, now. There are other important ways of cultivating this skill, which allows you to think clearly about what action you can take to create a new experience, a better experience that takes you towards your desired outcome. Additionally, on the out-breath we naturally relax as the parasympathetic nervous system increases its activity. This is opposite to the sympathetic that is involved with protection in the face of perceived threat. And this is really what pain is all about.

In the face of a predicted perceived threat, we can feel pain as part of a whole person defence strategy. There is no pain system. Instead systems that have a role in protection: musculoskeletal system, sensorimotor system, immune system, endocrine system, autonomic system. Then consider how systems support each other as they are all integrated: the gastrointestinal system’s role in providing nutrients to energise the other systems — consider how many people with persisting back pain also have digestion issues as their resources are diverted away from digestion and towards protect. So, more threat to ‘me’ (the self — that’s a huge area to discuss alongside consciousness), more pain. Less threat to me, less pain. How often will a person report an increase in pain when they perceive to be in a threatening situation. The beauty of this is ‘perception’, because we can change it. So in changing our perception of threat we can change our pain. We are designed to change so we can use this biological advantage and with practice become good at it. Remember, pain and injury have a poor or absent relationship — consider phantom limb pain. There is no body part yet there is most certainly pain.

Our understanding of pain has moved on enormously over the past ten years. We are in a very exciting time now as we draw upon many areas of science and philosophy to advance this knowledge, asking new questions and gathering new data. The biomedical model is not sufficient and the BPS model has been a useful step forward but now we need to think about pain in terms of a public health issue. People need practical ways of overcoming their pain moment to moment, coaching themselves so that increasingly they generate their own better and better experiences driven by internal messages as they motivate themselves to a healthier life. This is the reason for my term ‘Pain Coach’ as the individual becomes their own coach using continuously updated thinking and actions to get better, overcome pain and resume a meaningful life.

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22May/16
New thinking in dystonia

Sports injuries brewing

Sports injuriesHaving seen a couple more cases of sports injuries brewing this week, it reminded me how common this issue is amongst the active population. It goes something like this…..

A minor tweak that improves somewhat, but not entirely, hanging around and occasionally reminding you that there’s something going on. Often dismissed as a pain that will get better in time if I forget about it and think about something else. It goes away for now.

Then another body part or region chimes in, sometimes replacing the first tweak, sometimes in concert. You tell someone who will listen that the pain has moved from A to B, as B now demands some attention now and again. Except now and again becomes more frequent, being more now than again, subtly creeping up on you as a more consistent pain. You may notice that your running style has changed, or that you are not concentrating so much on the activity but instead wondering if it will hurt or why it is hurting. Performance suffers.

I have described a two step story when in fact in most cases the person tells me about their pain and as we look back, there are multiple aches and pains. It is not unusual for there to be a slight change in general health, and most definitely lifestyle patterns influence the problem. This is simply because none of the issues are separate or in isolation. It is the person who lives the experience and hence they are the perceivers of their body and environment (unified) as well as the producers of that perception and the action taken.

What is happening?

Some refer to kindling, like a fire building up over time. There is an injury or inflammatory response during a time of vulnerability (e.g. perceived stress, tiredness, illness), or the person is vulnerable to experiencing an amplified protective response due to prior learning — how their protective systems have learned to interpret the possible causes of sensory input. So each time there is a protective response, the effects grow, the impact increases and all quite gradually in many cases.

How did this happen? This is frequently asked as the gradual nature means we forget about the priming or kindling events on the way to what is happening now.

This is why it is important to fully recover from injuries and illnesses so as not to carry over the effects. To do this, one must restore the normal healthy mode, re-train body sense and movement, develop confidence and technique; in essence feel yourself again, which is to say that the focus is on the performance.

Pain Coach Programme to comprehensively overcome persisting pain and sports injuries | t. 07518 445493

** Common persisting pains from sports injuries include back pain, tendon pain, knee pain, ankle pain, shoulder pain, tennis elbow, wrist pain.

23Mar/16
Women in pain

Women in pain

Women in painI see more women in pain than men in pain. Naturally, it depends upon the individual as to whether they seek help or not, yet as a general observation it appears that women in pain are more likely to take some action.

The most common presentation is a female aged between 30 and 55 years, who has suffered pain for some time, months or even years, which is now impacting upon her life in a number of ways. Typically the pain is affecting homelife, particulalrly looking after young children,  and worklife, or both in some cases as the pain pervades out into every nook and cranny. Sometimes this happens over a few months but often it is a slow-burner that is suddenly realised. When we have a conversation about the pain, cafe style*, it becomes apparent that there have been painful incidents punctuating a consistent level of sensitivity, building or kindling. The pains emerging in the person include back pain, neck pain, wrist pain, knee pain, foot pain — any joint pain — muscular pain; and can be accompanied by a range of pains known as functional pain syndromes: pelvic pain (dysmennorhoea, period pain, endometriosis, vulvodynia), irritable bowel syndrome, migraine, headache, fibromyalgia, jaw pain. The person, whilst unique and has a unique story to tell, is often hard on themselves by nature, a perfectionist, anxious and a worrier.

There are many, many women suffering a number of these problems that appear to be unrelated, but this is not usually the case. Upstream changes, or biological adaptations, play a role in the symptoms emerging, yet of course the way a condition manifests is dependent upon the individual themselves, with the uniqueness of each person, their tale, beliefs and life experiences.

Nothing happens in isolation. In other words, there is a point in time when we experience a sensation that we label and communicate, but this is not in isolation to what has been before. The story that the person tells me is vital because it reveals both the unfolding of how the individual comes to be sat in the room and allows me to begin giving some meaning to the experience; i.e. helping the person understand their pain and how it sits within their lifestyle and their reality. I say within because pain should not define who we are, yet it often appears to and hence needs to be put into perspective; the first step to overcoming the problem.

So, there are priming events that often begin much earlier in life than the pain that eventually brings the person along to the clinic. These priming events are biological responses to injuries, infections and other situations that are also learning situations. Learning how to respond at time point A then ‘primes’ for time point B as a response kicks in based on how our brains predict the best hypothesis for what ‘this all means’–what we are experiencing now is the brain’s best guess about what all the sensory information means based upon what has happened before, probability playing a role. One of the reasons for a good conversation is to identify the pattern of pain over the years, how it has gradually become more intrusive as the episodes intensify and become more frequent. The pattern can then be explained, given meaning and then provide a platform to create a way forward.

We are designed to change and each moment is unique. This gives us unending opportunities to steer ourselves towards a healthier existence and leading a meaningful life. To get there though, we must have a belief that we ‘can’ and be able to hold that vision. This vision of the healthy me is one that allows us to ask ourselves the question ‘am I heading towards the healthy me with these thoughts and actions, or not?’. If we are not heading in that direction, then we are being distracted and need to resume the healthy course, actively choosing to do so. How are you choosing to feel today? This is an interesting question to ask oneself.

We still have a certain amount of energy each day and a need for sleep and recuperation. Exceeding our capacity means that we are not meeting our basic needs — security, nutrition, hydration, rest. There is only a certain amount of time that we can keep drawing on our energy before we must refresh. Failing to attend to the basic needs leeds to on-going stress responses that are meant only for short bursts. Prolonged activation begins to play havoc in our body systems as we are in survive mode, not thrive mode. In particular, systems that slow down include the digestive system and the reproductive system. Many, many of the women I see have issues with both — e.g./ poor digestion, bloating, sensitivity, intolerances, fertility problems. The biology that underpins behaviours of protection (fright or flight) are preparing you to fight or run away. Having a meal or trying to conceive are low on the biological agenda when you are surviving.

Too much to do, too little time. Modern day living urges us to be busy being busy. Demands flying in from all quarters, yet it is the way we perceive a situation, the way we think about it that triggers the way we respond, not the situation itself. This gives us a very handy buffer. By gaining insight into the way we automatically think and perceive, this being learned over years (i.e. habits), we can become increasingly skilled at choosing different ways of thinking, letting thoughts go, and focusing on what enables us to grow. This very quickly changes our reality, our body, our environment and the sum of all, which is the lived experience.

With on-going pain we develop habits of thought and action, including the way we move that is integral to the way we sense our bodies. Our body sense and sense of self changes in pain, as does our perception of the environment (things can look further away when we have chronic pain or steeper when we are tired), all of which add up to provide evidence that we are under threat. More threat = more pain because the amount of pain we suffer is down to the level of perception of threat and not the amount of tissue damage. We have known this for years, yet mainstream healthcare and thinking remains steadfastly into structures and pathology. It is no mystery then, as to why chronic pain is one of the main global health burdens when the thinking is wrong! So what can we do?

If you are a woman suffering widespread aches and pains, tiredness and frequent bouts of anxiety, there is good news! As I said earlier, we are designed to change, and change is happening all the time. We need to decide which way we wish to change and then follow a plan, or programme, that takes you towards your vision of the healthy you. Pain is a lived experience and hence the programme must fit your life and unique needs as the techniques, strategies of thought and action interweave your life, moment to moment, taking every opportunity to create the right conditions. The blend of movements, gradually building exercises, mindful practice, sensorimotor training, recuperation, resilience, focus, motivation and more, together form a healthy bunch of habits that are all about you getting healthy again, which is the best way to get rid of this pain. No threat, no pain.

* the cafe style conversation is my chosen way of unfolding the person’s story. How do we chat in a cafe? It is relaxed and open, allowing for the full flow of conversation.

  • Pain Coach Programme t. 07518 445493
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21Sep/15
karlnorling
| https://flic.kr/p/d5cPyA

Andy Murray wins despite back pain

karlnorling | https://flic.kr/p/d5cPyA

karlnorling
| https://flic.kr/p/d5cPyA

Andy Murray wins despite back pain, a classic example of how the meaning and situation flavours the lived experience. Simon Briggs of The Telegraph said: “Not many players are capable of winning three points in a Davis Cup semi-final, as Andy Murray did to put Great Britain into the trophy match against Belgium in late November. But to do so with a bad back – an issue that Murray revealed only once the combat had finished – was a different story again: a quite exceptional feat of courage and stamina”. Pain is not well related to the state of the body tissues (joints, discs etc) but instead the perception of threat detected by body systems that protect us: nervous system, immune system, autonomic nervous system, endocrine system, sensorimotor system — one only has to consider phantom limb pain to realise this fact. One of the biggest reasons why persisting pain is feared is the belief that the severity equates to more damage or something more serious. You may also consider that some cancers remain painless and this is certainly serious. Pain is a protective device that motivates thinking and action to reduce the threat and restore normal physiological activity (homeostasis); it is a need state lived by the whole person — with ‘back pain’, it is the person who is in pain, not their back.

In Murray’s case, he was quite capable of focusing on the game, his body allowing this due to the context and the significance. There are many stories of sportsmen and women sustaining injuries and only knowing when the game is finished. We also had the scenario a few years ago when Messi collided with the keeper and experienced such pain that he thought his career was over. It was a bruise and he played the next weekend. The pain was still severe at the time though, reflecting the situation and the need as deemed by his body systems that protect. It works both ways.

Between games Murray may well have felt some stiffness, but he was able to re-focus. A few simple movements to nudge fluids around, ease off the muscular tension that is initiated and executed by the brain sending signals down via the spinal cord, perhaps a few reflexive messages contributing alongside the immune and autonomic activity. Context remained king though, as it was wholly more important to put all his attention on what was required to win than to start worrying about his back. That could be dealt with later, and indeed this is what happened as Murray did what he knew he needed to do to be victorious. All those top down signals, cultivated and delivered from a neuroimmune system, which countered those danger signals coming from his back (not pain signals — there are no pain signals or pain centres) — top down signals generated from his beliefs, expectations, mastery of focus and attention, as he hit flow, that state of being utterly in the moment. That’s a wonderful place to be and not a room where pain can enter.

Now that the game has finished, familiar aches and pains will flood Murray’s consciousness. There maybe additional and new feelings that evoke new thoughts and a need for re-assessment for the next best steps. These steps will need to include consideration of how Murray’s neuroimmune system and other systems that protect have learned to react (priming or kindling), the possibility of sub-conscious and environmental cues, expectations and of course an assessment of tissue health and function. From thereon in, a comprehensive treatment, training and coachng programme can address movement, body sense, neuroimmune-sympathetic-sensorimotor interactions to name but a few. It is worth pointing out here that such a programme is not unique to elite sports people, but a modern approach to pain and injury that should be accessible to all.

Richmond is the co-founder of a pain awareness campaign called UP | Understand Pain. Together with Georgie, they are using music and song to deliver the right messages about pain, particularly chronic and persisting pain; which are:

  • Pain can and does change
  • You can overcome pain and lead a meaningful life when you really understand it and know what you can do

** Pain Coach Programme for chronic pain, complex pain, persistent pain — t. 07518 445493

 

20Jul/15
vintage typewriter by philhearing | https://flic.kr/p/9pRzps

Gillian’s story | back pain and mindfulness

vintage typewriter by philhearing | https://flic.kr/p/9pRzps

vintage typewriter by philhearing | https://flic.kr/p/9pRzps

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

MY PAIN STORY – GILLIAN WESTON

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.

11Jun/15

Stiff low back. Why?

Have you got a stiff low back? Stiffness is often part of the picture of low back pain. Why is this?

Stiffness is a conscious experience–a feeling that we sense, interpret and then label as ‘stiff’, usually describing difficulty moving a body part. And just like any other conscious experience, there are the embodied dimensions as well as cognitive and emotional elements: how does it feel? What does it mean for me? Hence to think about stiffness is to think about the body-body systems that create the feeling and meaning.

Stiff low back: there are three common types of stiffness that are addressed in different ways.

  1. Stiffness from actual shortening of the muscles and their compounding tissues
  2. Stiffness from muscles being told to be ‘on’
  3. Stiffness from changes at the joint

Stiffness from actual shortening occurs due to sustained positions or repeated positions being held so that the tissues change in their length. In so doing, there is less freedom of movement at the joints. This tends to gradually worsen as time progresses, with less and less movement at the joint causing further shortening. Regular movement, nudging into the limitation is key in overcoming this aspect of stiffness along with manual treatment that gives you the experience of movement into that part of the range. The manual treatment must sit alongside your understanding of what is happening and why this therapy is being applied, otherwise ‘top-down’ influences can interfere with success (see next section).

Stiffness from muscles instructed to be ‘on’ by the brain is part of the way that the body protects. Otherwise called guarding, the body-brain’s continual planning, expectation, anticipation and desire are embodied, responding to the environment and the context of the situation at that moment. Within our consciousness, different experiences seemingly appear and then fade away as others emerge. Stiffness and pain are no different in this respect, however they may emerge repeatedly in response to normal situations that pose no actual threat. But, due to the sensitive state and vigilance to the environment, non- or low threat stimuli are now interpreted as potentially dangerous and therefore the body responds. The first we know about this is the pain or tightening — the stiff low back. The pain and stiffness are motivators for us to take action, both in thought and behaviour. These thoughts and behaviours seek to reduce the threat and therefore reduce the pain (pain emerges in the person as a result of a perceived threat) and how the body is responding with it’s natural armour, the muscular system. As the need for defence diminishes, so the muscle tension eases and movement improves.

What reduces the threat and muscle tension?

  • Relaxation–this is a skill to learn
  • Mindfulness
  • Understanding pain and knowing that you are ‘safe’
  • Motor imagery

Changes at the joints can, but not always, affect the quality of movement. It is not a given that if your joints show arthritic change, movement will be problematic. Many people have arthritis but suffer no pain or stiffness. Whether you feel pain and stiffness or not is determined by many inter-related factors: e.g./ genetics, gender, past experience, beliefs, expectations, the environment; also known as pain vulnerabilities that all have an underpinning neurobiology that is becoming increasingly understood.

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09Jun/15

Do you have persisting low back pain?

Persisting low back pain is common. It is the number one global health burden (Vos et al. 2012) and hence is the cause of much suffering,  and personal and societal cost. We need a re-think, because the misunderstanding of pain is at the root of this vast problem, especially when it comes to chronic low back pain: persisting or recurring.

I see people every day with chronic low back pain. It is one of the main vehicles that brings patients to my clinic. In many cases, chronic low back pain is part of the presentation with other complaints and problems including widespread pain, anxiety, irritable bowel syndrome, headaches, migraines, pelvic pain, disturbed sleep, poor concentration and performance at work, relationship disharmony and fertility issues. Is there a connection between these seemingly disparate issues? Yes. And by focusing on the whole-person, as suggested by the latest thinking in pain neuroscience, neuroscience and philosophy, we can create a tangible way forward.

So what can we think about? Here are some ideas with examples:

1. What is pain all about in this person?

  • Protection

2. How is the persisting back pain emerging in the individual?

  • Where in the body is the protection emerging?
  • Which (protective) body systems are interacting?
  • What is the context for the pain?
  • What features of the individual’s narrative suggest a vulnerability to persisting pain?
  • What habits of thought and action (the two being utterly entwined) exist?

3. What are the person’s beliefs about pain?

  • Pain = damage?

4. Why is the pain persisting?

  • Vulnerabilities to chronic pain
  • Is there a good reason for the pain to persist? Is it useful somehow, indicating a need for more action?

5. What needs to be done?

  • Understanding — the right thinking, pain can change
  • Create the opportunity for change
  • What action is required on a moment to moment basis?
  • Development of motivational skills and resilience
  • Persistence, courage, focus, determination

This is merely an insight, and conveniently broken into sections. There is no prescription, just facts about pain that we must work with and employ within a whole-person centred approach to overcoming persisting low back pain and other persisting pain problems.

For further information about treatment and coaching programmes to overcome pain, call now: 07518 445493

* Specialist Pain Physio Clinics: Harley Street | Chelsea | New Malden

 

11May/15
Pain Coach Programme

The language of back pain

The language we use when we talk about back pain is revealing and worthy of noting. This is both the language of the back pain sufferer and the clinician or therapist. Why? Because it highlights the beliefs held about back pain. Why is this important? Because the beliefs underpin the thoughts and action taken in response to the back pain.

Common descriptions that patients use when I ask them to narrate include the ‘slipped disc’, ‘wear and tear’, ‘disc bulge’, ‘worn out joints’, ‘weak spine’, ‘weak muscles’, ‘weak core’, ‘worn out spine’ and let’s not forget the range of expletives that can be attached the the above as well, ‘my ****** spine’, ‘it’s ********’, ‘when he looked at my x-ray, he told me I was ******’ — and I am not joking when I state these are just a few of the things I hear. Do bear in mind that I spend my days listening to people’s stories, making sense of their experience so that we can create a way to move forward.

And where do people obtain such language? They have been told that this is the case, they have read it on the net or heard from well-meaning significant and not so significant others. Sadly, these terms are not useful in any shape or form and in most cases create the wrong image, construct the wrong beliefs, leading to the wrong action and on-going threat and hence protection and pain (pain is about protection as regular readers appreciate).

Clinicians need to watch their language as they are in a position to deliver the right messages at key moments. This creates understanding, which emerges as behaviours and actions that are healthy and groove a way forward to overcome pain. The clinician will have a set of beliefs about pain, and perhaps suffers chronic pain himself/herself. Sticking to the facts about pain, being honest about what we don’t know, avoiding extrapolating a research finding to the populous when it has only been validated in a small number of people and focusing on the ‘cans’ rather than the limitations are just a few notable strategies. I am not going to tell you how to treat or deal with back pain here, merely highlight some observations that I have made over the years.

Back pain is a huge problem the world over and we need to think about it in a different way; a whole-person way, just like any other pain. Considering what we say, how we say it and when we say it is vital. The potency of language and communication should not be underestimated. The words we use will form an internal dialogue in the back pain sufferer’s mind, flavouring their pain perception. Let’s get it right.

Pain Coach ProgrammePain Coach Programmes for chronic and persisting low back pain — coaching you to overcome pain.

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16Apr/15

George Clooney’s back pain

George Clooney’s back pain — Back pain can affect anyone, and does affect most at some point in a lifetime. In fact, it is probably more unusual not to suffer back pain!

George Clooney has been suffering persisting back pain since 2005 when he sustained an injury whilst filming. Reports described a torn dura that can result in severe pain, and certainly did for Clooney. With so many nerve endings, an injury will trigger excitement locally. Danger signals are transmitted from the area to the spinal cord and then to the brain–note that there are no pain signals, but rather danger signals.

It is the normal inflammatory response (the release of inflammatory chemicals) that causes increasing excitement (sensitivity) in nociceptors, reducing their threshold for firing. This means that it becomes easier to stimulate the nerves to fire the danger signals. The bombardment of danger signals causes (plastic) changes in the spinal cord that in effect operates as a volume switch.

So if all these responses are normal, how does pain persist and become chronic? This is the BIG question. The answers are complex as is a pain response, but I would argue that within this complexity lie opportunities to change pain and overcome the problems.

Pain is not a structure, it is a response to a perceived threat — very different! Pain is a response that is influenced by context, environment, beliefs, prior experiences, the state of protective systems at the time of injury, gender, intentions to move, fatigue, emotional state and more. Pain is not a disc or a joint or a dura. Pain does not come from a disc, a joint or a dura. Yes, that is where you may feel it, in that part of your body, but those structures do not have the properties of pain. Your nose does not have the properties of a common cold, yet it will stream. There is an upstream biology that involves many body systems that are designed to protect. This biology is a complex blend of all the influences I have mentioned, interpreting a situation as being threatening and hence protecting: pain, altered movement, altered thinking, altered emotions–if you suffer on-going pain, how rational are you when in pain? Can you think clearly? We lose precision.

We lose precision of movement, sense of the body, where a stimulus is being presented to the body, where we feel pain (does yours move or grow?), as well as precision of thought and emotion. Our discrete ability to plan and execute thoughts and actions is marred, ‘smudged’, blurry.

So, to the way we can overcome pain and in particular chronic pain. It has to start with thinking differently, and changing our relationship with pain. On doing so, the way that pain is experienced changes. This, alongside strategies and training the develop precision of thought, movement and sense all reduce the perceived threat. Reduce the perception of threat, reduce the pain — you are answering the demands of your body. The caveat of course is that we are not separate in body and mind. There is no separateness to pain as it is part of you, part of every cell. To overcome pain then, you must become aware of what you are currently thinking and doing (habits) and then consciously change until it becomes unconscious and normal.

Pain Coach ProgrammeThis is an insight into the Pain Coach Programme that addresses the whole person as we must to overcome chronic pain. We are constantly changing and those who suffer chronic pain have been changing towards more and more protection in response to normal activities–how many normal activities now hurt? They shouldn’t!

It is time to take the science of pain and translate it into action to change your pain. Call us to start your programme for chronic back pain or chronic pain. 07518 445493

28Oct/14

Top 5 back pain myths

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

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

Here are 5 common beliefs that have been challenged:

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

1. Bending is dangerous

2. Discs slip

3. Nerves are trapped

4. Pain comes from facet joints, discs etc

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

Comments below:-

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

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

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

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

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

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