Tag Archives: mindfulness

Pain Coach Programme

Art of living

Pain Coach ProgrammeWe like to be good at things. Sport, work, parenting, music are all common examples. We practice, note what goes well and what does not, making changes, and essentially practicing to get better.

But what is common to all of these and everything else in our lives? What overarches all of these? Living. Living itself. There’s an art to living a life of content—and this does not mean that there is no pain or suffering. A life well lived is one of moment to moment skill, and this includes what we tell ourselves and what we do. The moment to moment experiences. These determine overall how content we are rather than the ‘biggies': new car, new iPad, and the so-called life events. Now, these are all significant (if they are significant to you) yet they make up fleeting moments much like anything else. They are passing through, like other moments. It really depends on how you are framing it; what do you think about it? That’s what makes it what it is, for you in this moment.

So, there is an art to living well that depends on what you are telling yourself over and over. A situation is just a situation until you rate the situation and then feel it and live it. Until that point, it is nothing. We create our reality in any given moment and this is an art form. And art forms need good quality practice just like sports, music, how we communicate etc. The great thing about this is that we have every moment to practice and get good at it. You don’t need to go anywhere or any kit to get good at the art of living. So what do you need? Nothing.

Whilst you are seeking to be somewhere else, you are missing what is happening now. And that is all that is happening. Have plans, have aspirations but see them for what they are—plans and aspirations. Work out how to get there, but see that for what it is—a plan for how to get there. Be excited, be nervous, be anxious, but see these feelings for what they are—feelings, emotions that will pass as everything else does. Impermanence.

Here’s a simple tip of how to enact this: cultivate the habit of standing or sitting talk, taking a normal breath in and paying attention to this breath. Do this every time you feel tense, anxious, happy, excited, angry, sad…… Try it and see what happens.

puppy love by Porsche Brosseau https://flic.kr/p/cu9h5h

Pain and compassion

puppy love by Porsche Brosseau https://flic.kr/p/cu9h5h

puppy love by Porsche Brosseau https://flic.kr/p/cu9h5h

Pain and compassion are being explored at a forthcoming British Pain Society Conference, so I thought that I would comment on a couple of important aspects.

Firstly, as clinicians compassion plays a role in our desire to guide and treat others in pain and most likely coloured our choice to become a health-carer in the first instance. Secondly, I find that the vast majority, if not all those I see are compassionate people to everyone (or most!) except themselves. Here are some brief thoughts.

Compassion is defined as ‘inclining one to help or be merciful’ (Oxford Dictionary). The Dalai Lama describes compassion from a Buddhist viewpoint: ‘Compassion is said to be the empathetic wish that aspires to see the object of compassion, the sentient being, free from suffering’. There must be an object of compassion that is another individual or of course the one that is often forgotten, oneself.

The feeling of compassion is often described as a warmth across the chest; the type of feeling associated with seeing a small, defenceless animal, or perhaps a newborn child. This feeling enhances our empathy, which drives actions of kindness towards that being. As a clinician there are clear benefits of cultivating a compassionate approach towards patients who suffer the consequences of pain, particularly on-going pain. Certainly compassionate listening and actions are skills to be nurtured as they envelope the therapeutic encounter with essential authenticity. Compassion also creates an environment and a context for effective and skilful communication; an openness that encourages the patient to express themselves as themselves, revealing the challenges that can be surmounted with a joint therapeutic effort. The importance of the clinician being kind to himself or herself is akin to that of the patient. Looking at ways to grow and flourish, to be a better clinician requires acknowledgement of the current standing, acceptance and a desire to improve, yet without self-criticism.

Frequently patients will illustrate their harshness towards themselves. This punishment and criticism fosters angst, frustration, anger and other negative emotions that are draining, damaging and ultimately wasteful as energies are put into everything but clear thought and action towards improvement. At any given time, one does his or her best based on their knowledge and skills — everyone makes mistakes, which the wise learn from and see the opportunity in errors, the opportunity to develop. Learning to be kind to oneself, often breaking a habit of some years (many people I see are perfectionists; but in some arenas this trait is very useful and a strength that enables high performance resulting in success; so let us learn how and when to utilise it), is a vital part of learning how to overcome pain, especially persisting pain.

Here are several videos that are useful to that end:

Learning about compassion towards oneself and others is part of the Pain Coach Programme for overcoming and transforming persisting and chronic pain. Call us to book your appointment: 07518 445493 | Clinics in London | Sessions available on Skype on request

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


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.

Kitty Terwolbeck
| https://flic.kr/p/nJ3oH4

Zen and the art of human maintenance

Kitty Terwolbeck | https://flic.kr/p/nJ3oH4

Kitty Terwolbeck
| https://flic.kr/p/nJ3oH4

Zen and the art of human maintenance is not a spiritual blog but rather a practical one that considers a way of approaching hands on treatment–this is whether you are a massage therapist, a physiotherapist, an osteopath or any other clinician who uses their hands for examination and treatment. Equally it could apply to a person comforting a loved one.

How you bring yourself to the act has a huge impact upon the act itself. Setting the scene both in terms of the environment and the focus of your intention will play out through the treatment in subtle ways that effect the overall experience. A moment’s preparation in that vain allows the therapist to focus and be present meaning that the full experience is had, allowing for a sensitivity (via the therapist’s hands yet experienced through their whole person) that enables gentle responsiveness to adapt the treatment to the recipient’s needs. A classic example is being aware of how the muscles react to different levels of touch. Being aware means that you can detect even gentle guarding that indicates protection and need for both nourishment (improved blood flow and oxygen delivery to over-working muscles that are being told to tighten in an attempt to protect–yet this comes at a cost, both of energy and a build up of acids) and a sense of safety so that the systems that are protecting the body can ease up.

Take a moment: before you begin the treatment, 3 easy breaths to become aware of what is happening now, how you are feeling, what you are thinking; continue to maintain awareness of the present moment, letting go of distracting thoughts that interfere with your focus.

Zen is a sense of oneness with the present experience, what is happening right now, free from distractions and letting life flow. There are many situations when this state of simply being is very useful–before exams, interviews, when negotiating, discussions with your employer, before performing etc. However, cultivating this skill on a moment to moment basis is hugely beneficial as it allows you to see and think clearly, even when thinking about the past or future, which can cloud what is really happening now. These are all just thoughts, but when we become embroiled, the body reacts and responds because we are our body as much as we are our mind, and all that this means. So, just thinking about being in an argument or giving a speech creates similar responses in the body as if you are there; but you are not.

In giving treatment to another person, being fully present means that you fully experience the moment. You will be completely engaged in all that is happening ‘now’, creating a potency that cannot be otherwise reached with a wandering mind that has no connection with the treatment. This is undoubtedly a practical skill that can be developed, some calling it ‘focused attention training’ and others ‘mindfulness’. Everyone has the ability to focus, even for short periods, and to enhance the skill with practice. There would be some benefit of simply taking a few breaths as described above, yet there is even greater advantages to be had from further practice with 5-10 minutes of mindful breathing each day; more if you are so inclined.

Not only does being present whilst treating enhance the treatment through a more responsive selection of pressures and movements, the clinician also benefits from the calm created, and the clarity of thoguht offered by being present and aware. In effect, the whole experiecne means that while you are treating, you are being treated. A good way to measure this is by noting how you feel at the end of the day. A mindful day will end with energy, and non-mindful day with fatigue. I know which I prefer.

* These are skills to be learned and developed in the Pain Coach Mentoring Programme for clinicians | call 07518 445493 for details

By LordEfan | https://flic.kr/p/kUfKKZ

Pain and the perfectionist

By LordEfan | https://flic.kr/p/kUfKKZ

By LordEfan | https://flic.kr/p/kUfKKZ

Pain and the perfectionist could be a title of a book in which the character suffers on-going pain, seeking to conquer himself using his perfectionist traits. I know of no such book, but I do know that a significant number of people who I see with chronic pain are perfectionists.

Like most things though, it is how you look at it that makes the difference. Most traits that we exhibit have a benefit and a purpose in our lives in one quarter but can be problematic in other arenas. Perfectionism is no different.

Whilst being a perfectionist would be highly adaptable when studying the detail of a document, arranging a bouquet or organising an event, when this spills over into being hard upon oneself, it can push the individual too far. Compassion must start with the self — being kind to yourself. It is all too common that people are self-critical, either overtly or more frequently via the inner dialogue. Continually telling yourself that you are not good enough or that you will never achieve is the exact opposite of believing in yourself. If there is one characteristic that is vital in overcoming pain, it is the belief that you can do it.

The sense of never being quite good enough is a safety mechanism of sorts. On the flip side it may drive the individual to practice or work harder, and this is acceptable if it does not cause angst and on-going stress that is incongruent with health and a feeling of wellness. Chronic stress is a significant issue in the modern world, having a huge role in many of the common problems that we see today — e.g. functional pain syndromes such as IBS, headache, migraine, functional abdominal complaints. Chronic stress causes the body to set itself in an inflammatory state, and there is a constant preparedness for action to fight or run away from a wild animal. Except there is no wild animal, just our thoughts and interpretations. These we can learn to observe rather than become embroiled within with techniques such as mindfulness.

Perfectionism is a strength that we can foster as part of the programme of overcoming pain. I base my treatment and training programmes upon your strengths as these are what we use in life to succeed, and succeed you will by nurturing these within an action plan that takes you back to a meaningful life. It is easy to say don’t be too hard on yourself, yet difficult to master. But it is possible to harness the strength of perfectionism and use it to overcome your pain.

For information about the Pain Coach Programme to overcome chronic pain, call 07518 445493. The Pain Coach Programme is also a learning programme for clinicians who want to develop their skills, either 1:1 mentoring or in small groups. Call us for details or email [email protected]


Mindfulness is a great skill

Mindfulness is a great skill

Mindfulness is a great skillMindfulness is a great skill to learn at any age. To be mindful simply means to be aware of what is happening right now and without judgement–notice how you judge your thoughts and how that makes you feel.

Everything that we are aware of is our own, unique interpretation that emerges from our belief system. We appraise our thoughts, our actions, others, and the environment around us. This appraisal evokes an emotional and bodily response in many cases, even if it is just a shrug of the shoulders. It is important to clarify that emotions, body responses, thoughts and actions are all part of one and the same; i.e. the whole person. Sadly, much of the thinking, particularly in health, remains Cartesian and separates mind and body. This is despite reams of research papers and common sense telling us otherwise. What does your tummy do when you think about giving the presentation tomorrow? Your body reacts in response to the thought, and that reaction involves the nervous system, the motor system, the brain, the immune system etc etc….WHOLE PERSON.

So, if the appraisal or our perception guides how we respond, then we have a buffer between any give situation or thought and what happens next. We have a choice — ‘the greatest weapon against stress is our ability to choose one thought over another’ said the great philosopher William James. Shakespeare had insight: ‘there is nothing either good or bad, but thinking makes it so’.

Mindfulness is the skill that allows you to observe thoughts and interpretations rather than become embroiled, living out thinking that is felt in the body as emotions and tensions. You notice with quiet curiosity how your body is responding, lifting the veil of suffering.  We have that choice, but most don’t realise, operating on automatic overdrive leading to repeated stress physiology that affects every body system.

A stress response is designed to protect us from the dangers of wild animals. The same responses kick in to a threatening thought–the most dangerous things we face are our own thoughts and interpretations: a shadow after watching a horror film is threatening because of the way you think about it and create a story of a murderer lurking behind the tree. Actually, it’s a cat but that story does not feature. What stories do you tell yourself to create fear? How useful is fear? Not very.

Fear triggers further negative thinking, and that gets us nowhere. Respect and understanding create opportunities to learn and grow. Much better.

How are you mindful? If you look on the bookshelves, tome after tome sits there awaiting your mind. It seems that everyone has something to say on the matter. The reality is that mindful practice is simple. Practice is a habit that needs to be grooved. You must fail and fail and fail again. That is how we learn. And when you think you are good, fail again to get better. Learn to love failing because then you are getting better!

Start being mindful by noticing what is happening now. Where are you? What are you thinking? How are you feeling? Take a breath and observe it. The rise and fall of your chest and tummy. It’s a wonderful feeling to sit still. Especially in this crazy, high speed world with demands pouring in digitally and otherwise. Simply recall that whatever comes your way, it is your perception that counts. You are in charge of that perception. Make a choice. Create calm so that your body systems can do their job and slip out of protect mode and into health mode. On-going stress accounts for and contributes to most of the modern day ills–chronic pain, infertility, headaches, chronic inflammation, IBS etc etc. To think effectively about stress we need to look at it as a societal, cultural, physiological, personal phenomena.

So, I thought I would write a book about it as well. A very short one. Coming soon.

Mindfulness practice is part of the Pain Coach programme; a complete strategy to overcome chronic pain | t. 07518 445493

Healthy revision tips

My tips for healthy revision

Easter holidays are here! Bunnies, chocolate eggs, Easter bonnets, spring and…..revision. Chatting to my younger patients, they all tell me that this holiday will be dominated by revision. So it is not so much a holiday but instead, 2-3 weeks of homework. Perhaps Easter Sunday will be a day off.

This appears to be the way of school life in the modern world. The demands increase, the pressures increase, the stress and anxiety increase, and the pains increase. Is this right? 1:5 children reporting chronic pain. Chronic pain is the number one global health burden and depression is at number two — and frequently they come as a pair.

Body systems are on alert. They are working hard for survival instead of orchestrating the biology of health. In adults we used to call the effects ‘burn out’. These systems that protect us can only function at that level for a finite period of time.

Of course there is nothing wrong with hard, conscientious work. But, we need to regularly put the heavy bags down and take a break.

If you or your kids are entering the revision season, here are some handy tips for them to reduce the risk of ill-health, persisting stress responses, and flare-ups of existing aches and pains. We not only need to be physically fit, we also need to be emotionally fit. The two are not exclusive but instead come together to form the whole person. The whole person is not in isolation to their environment, beliefs or what has been before. Dwelling on negative events in the past and anticipating an unpleasant future both create suffering, until you realise that both are in our minds. The problem is that we play these out in our body, e.g. tension, pain, anxiety. It is not the situation that is important, but rather how we respond.

There is nothing either good or bad, but thinking makes it so. Shakespeare (Hamlet)

My Tips for Healthy Revision

  1. Make a timetable that incorporates your best time of day for learning, chunks of 40 minutes, exercise, movement.
  2. Motion is lotion: change your posture every 15-20 minutes; stand up and move around every 40 minutes
  3. Take 3 breaths every 20-30 minutes (when you breathe out, muscle tension naturally relaxes, which you will notice if you pay attention). The breaths can be slightly deeper than normal. Of course you can do this for longer and more often if you wish. Focusing on breathing anchors you to the present moment which means that you are putting down the heavy bags of ‘past’ and ‘future’. The bonus is clarity of thought and hence performance, memory and learning can improve as you become more efficient.
  4. Exercise before you start working; e.g. a walk, a jog. And a little more later as well; 20-30 minutes is good.
  5. Test yourself on the material you are learning — many people tell me that they copy their notes out again and again. You will have a nice pile of notes, but how much do you know?

** BONUS tip 1: set up the right environment – your desk space, the lighting, odours (don’t under-estimate the effects of smell; e.g./ use an infuser for a fresh ambience).

** BONUS tip 2: dress for work and sit for work – this will put you in the right mindset. We respond to our body language as much as our body language communicates how we are feeling. Keep moving (motion is lotion) but concentrate and engage more by sitting up.

** BONUS tip 3: make sure you have enough sleep — minimum 8 hours, and if you are tired, have a power nap between 1pm and 3pm for 20-30 minutes. You need to refresh and renew and you need sleep to learn.

Pain CoachFor more information about Pain Coach programmes and wellbeing programmes for health and performance, call us today 07518 445493

Mindfulness for pain, health and performance

Want to feel happier, suffer less pain & anxiety, think more clearly?

Mindfulness for pain, health and performance

Mindfulness for pain, health and performance

Mindfulness programme

The brief practice of mindfulness for just 10 minutes each day has a positive affect upon physical and psychological health.

Mindful practice forms part of our treatment and proactive training programmes for chronic pain and health problems. However, learning the practice is beneficial for anyone who wishes to reduce feelings of tension, anxiety and stress; improve sleep, concentration and clarity of thought; and overall have a healthier and happier experience of life.

Mindfulness itself is very simple and practical. Much like we train our body in the gym to be fitter and stronger, mindfulness trains our ability to be aware of what is happening in the present moment, and without judgement.

How much time do you spend on autopilot? How much time do you spend noticing what is going on right now as opposed to dwelling on the past or constructing a future in your mind? Does the past or future make you feel bad or anxious? Do you relive scenarios that make you feel unhappy? The problem is that the brain does not distinguish between what is happening in reality and what is happening in our mind. The body still responds, often by protecting itself using different systems in the body such as the nervous system, the immune system and autonomic nervous system (‘fright or flight’). Gaining insight into the mechanisms and becoming skilled at being present not only creates time, but also disarms the effects of drifting into the past or the future.

Enhancing the potency of mindfulness

Alongside the practice of mindfulness, a simple exercise habit that includes strategies at work will create the conditions for the body systems to cultivate health. A rounded programme of physical and mental training that interlaces with normal living improves performance, sleep, clarity of thought, sense of self, social interactions and immune responses. These factors are related and positively affect each other once healthy habits are learned.

Call us now to book your first mindfulness session: 07932 689081

The Specialist Pain Physio Clinics in London – expert treatment and training to tackle the problem of chronic pain and injury.


Bear traps and how to avoid them

My old headmaster would warn us not to fall into bear traps. By this he meant pay attention to what you are doing so that you do not make a simple mistake. He would set a few bear traps and see if we were concentrating or if we were on autopilot. It was also a way to note tomfoolery.

As clinicians we can also fall into bear traps by not attending to or challenging our own thinking and beliefs. This is especially true with pain, where we can so easily rely on our own beliefs about pain and what we should do in response to pain. We know for example, that GPs can give advice about back pain according to what they would do if they suffered back pain — rest or remain active.

Cultivating awareness of our understanding, beliefs and noticing the messages that we give to patients is a simple habit. It takes practice but allows us to ensure that we are giving the best possible advice and information, perhaps in the form of a metaphor. This includes the mode of delivery: body language, tone of voice, timing of the message and the environment in which the message is given.

Here are a few simple tips:

1. Before each patient, gently notice your breathing — in, and sense the chest rise and expand; out, and feel the body tension ease. This helps to create an awareness of what is happening now, including preconceptions and thoughts that could flavour the coming session.

2. Listen deeply — by continuing to breath, remaining present and listening to every word and noticing the patient’s body language, we can learn all that we need to intervene in the right way. The most potent way for that moment.

3. Speak with compassion — our brains are wired to thrive on kindness. We can create an effective session by both listening and communicating in a mindful way without the clarity being lost by intrusive thoughts that obstruct effective messages being passed.

The Specialist Pain Physio Clinics in London provide treatment and training programmes for pain and dystonia based upon the latest neuroscience of pain, brain and mind. The approach is comprehensive, addressing the problems and influences in a compassionate and encompassing way. If you are suffering with chronic pain, call us now to book your first appointment: 07932 689081

Mindfulness for pain, health and performance

5 reasons why mindfulness is part of our treatment programmes

1. Mindfulness reduces suffering: pain, anxiety, tension.

2. Mindfulness promotes clarity of thought.

3. Mindfulness develops a sense of calm.

4. Mindfulness creates an ability to focus ones attention where you want to, and not in response to the wandering mind.

5. Mindfulness changes physiology, triggering restorative processes: e.g./ healing, digestion, sleep, anti-inflammatory action.

For pain, stress, anxiety, performance, concentration, call us to make an appointment: 07932 689081