Tag Archives: pain

06Jun/18

Space and fuel

Diet, Energy, Environment, Nutrition, Pain Coach, , , , , ,

Environment and food

Space and fuel

There are many factors that influence how and what you feel. Space and fuel you use are two that are instantaneously transformable. Of course what I mean by space and fuel is the environment you are in and the food that you eat.

A key part of managing and building energy is choosing the right fuel. To engage with life and to pursue a purpose, we need energy. And to have energy there are certain practices that are musts, not shoulds. These include a healthy sleep pattern, movement, exercise, a focused mind and the fuel we take on board. The question to ask yourself is:

What must I eat each day to have the energy that I need to feel great and be successful?

You will know the foods and snacks that give you fuel and those that meet a short-term need. The quick fix may make you feel better for a few minutes, but quickly you realise that it is no solution to the energy problem if you are often tired and yawning. Here are some more questions:

  1. Are you tired and grouchy in the morning?
  2. Mid-morning are you struggling and telling yourself how tired you are?
  3. What about mid-afternoon, how is your energy?
  4. Are you enthusiastic about your daily endeavours, or is it often a drag?
The kids and space and fuel

As adults, we shape the patterns of the youngsters by setting the standards. So if we stock the cupboards with sugary things, that is what the kids will consume. We must normalise the good stuff. It is pretty clear now that the gut and brain hugely interact, meaning that the stuff we put inside us affects our emotions and our thinking. At this vital time in life when there is so much learning and development, we often excuse grumpiness and lethargy as being a ‘teen’. Yet when you look at diet and the space that they live in, if it is sugary and cluttered, guess what?

Observing youngsters in their environment you can see how they react. They will of course model behaviours of the adults nearby, so together with the space and how it is organised you can see the patterns emerge. Again it is about setting the standard of what works for health and wellness and what does not. We are both part of and creating the environment in which we reside. There is no separation, and hence to look after ourselves with compassion, we must care for the environment. Kids can understand this at an early age and develop patterns that nourish, nurture and support healthy development.

Tidy space = tidy thinking

Contrary to the common belief, tidying and cleaning are both useful practices. They create the opportunity to build a routine of movement and focus, appreciation and caring. These are all vital for health and wellness. Kids and teens understanding that health and wellness underpin their enjoyment in life are more likely to engage. This is also a chance to share time together and demonstrate the importance of giving, which is one of our human needs. Here is a great little monk’s guide ~ click here.

We are all shaped in our early years, but this does not mean we must continue in that way. Realising limiting beliefs, we can disrupt them and use empowering beliefs to feel great. When we do this as adults, we can then help to mould the youngsters in ways that mean they work to their strengths, building energy, confidence, self-belief, self-compassion, gratitude and generosity. These are all great states and those that drive health, wellness and success.

KIds and space and fuel
A fuel exercise

What foods give you great fuel? Make a list if you like, and then plan how you will use these each day. You know that much like cleaning your teeth this is a daily practice, not a one off! Writing things down helps us to commit.

My great fuels are:

1.

2.

3.

To get momentum behind what you are doing, you decide upon a standard that you set in your life. How do you want your life to be? Sustained joy or just meeting short-term needs? If it is the former, then we set that standard and live by it each day, enacted by the moment to moment decisions. Having a standard and a vision of success means that you have a reference point for these decisions: am I heading towards my vision or not?

Here is an experiment you can try (if you are following a medical diet or you are under medical instruction, please check with your provider) => for 2 weeks cut out sugar, red meat and bread and see what happens.

Your space

Environment and food

How do you organise and manage your space?

The environment has a clear impact upon the way we feel, the way we work and our health. On a simple level, being able to move with freedom, locating things with ease and seeing the space around us help to keep clarity. Thinking (cognition) emerges from the embodied person meaning that how your body feels (your physiology and your interpretation of your physiology) impacts upon the way you think and reason. Being cluttered, unable to move and hunting through to find something all result in frustration and suffering states.

Here are some simple questions:

  • Do you put things away when you have finished with them?
  • Do you wash the dishes before you go to bed? Or wake up with them to do?
  • Can you walk round your house without having to navigate bags, shoes and other clutter?
  • Have you got drawers full of stuff that you never look at?
  • Have you got clothes in your cupboard that you have not worn for a year or more?

We change when we are desperate enough. Or we are inspired. Whichever it is, we must associate either enough pleasure with our current approach or too much pain and suffering with a change. This must switch so that there is pleasure associated with new actions: tidying, clearing, cleaning etc. The long-term joy arises from the clarity that emerges, the ease of living, the pleasure of seeing a clean kitchen. What is going to happen if you do not change? What is the cost of that now, and in the future?

Space and fuel are important parts of living a great life. If you have set a new standard, and you have a clear picture of how you want your life to be, getting results and being successful, this becomes a simple way of being.

30Apr/18

Stuck in pain

Chronic pain, Pain, Pain Coach, , ,

 

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

Chronic pain, Pain, Pain Coach, Sports 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

22Jan/18
loneliness is embedded in society

Politics of loneliness

Chronic pain, Depression, Happiness, understand pain, , ,
loneliness is embedded in society

loneliness by Alice Popkorn (https://flic.kr/p/a6RWak)

We have a new ministerial post in Britain: the minister of loneliness. Tracey Crouch was recently appointed to continue the work of Jo Cox and following the recommendations of a cross-party report. This is a positive move to address a problem that is embedded within a society that has championed individualism at others’ cost, a rat-race, and a ‘me-first’ model of economics (The Guardian editorial, 20th Jan, 2018). Happiness does not emerge from such a context, instead isolation for many, with very real effects upon health.

Of course this approach is not just evident in the marketplace and the workplace. It has been encouraged in schools where grades are the measure of success, and being better than everybody else is a driver. The reality is that no-one is better than anyone else, and on continually feeling that they must look a certain way, be on a certain social media channel, have certain material things and strive to be better than the others, the pressure builds. This is one of the main reasons for the ever-growing issue of childhood and teen ill-health. Loneliness is almost certainly in the mix. How lonely must it be to always be thinking about oneself?

“You are no better than anyone else and no one is better than you

~ John Wooden

Yet this is a society of our making. We must all wake up to this and build structures that promote collectivism and connection in line with our design to co-operate. It will not be enough to try and minimise suffering downstream by picking up the pieces. We need top down change in attitudes and beliefs, because what we are doing at the moment is not working. The next generation needs this desperately. They need to be prepared for the modern world: creativity, critical thinking, communication and collaboration — the 4Cs.

Suffering is part of life. How we address our suffering and support others who suffer determine what it is actually like. Suffering affords opportunities to learn and transform experiences. To try and wrap people up in cotton wool will not work. Giving them practical tools to roll with life’s ups and downs together with know-how, creating opportunities to pursue a purpose, to master chosen skills and feel a sense of autonomy are all part of a healthy, evolving society.

Those who are familiar with the scientific literature on loneliness know about the biological effects. There are several key points to consider. Firstly, it is the perception of loneliness that is the governing factor. Secondly, in the case of perceived loneliness, we switch at a gene level to being inflammatory. This makes sense because being isolated means that if we are bitten by the sabre-tooth tiger, our healing responses are ready to go. That’s basic biology at play. If we perceive ourselves to be part of a community and connected, we are pro-viral because we are more likely to pass viruses to on another. Great system, but being pro-inflammatory for a prolonged period has health consequences: e.g./ chronic pain, depression–the two largest global health burdens.

Tracey Crouch has a job of huge importance. This is not just about people who live alone. This is about how society functions to enable people to connect with purpose, to support and trust each other and to share a planet. Now that’s a job worth doing well!

A brief note on loneliness and pain

Chronic pain is often described to me as being a cause of loneliness for several reasons. Firstly because of the limits that the pain can seem to impose until the person learns skills and has tools to change his or her experience, and secondly because no-one else can actually feel that pain.

Pain is a shared experience however. Each person will suffer their own pain of course, and for different reasons, yet it is a conscious phenomena that most will feel. Being that it is unavoidable, it becomes essential that people understand pain so that they can address their needs with effect.

One of many actions that can be chosen and committed to, is that of making connections and ensuring meaningful interactions as often as possible. These practices and others can easily be interwoven into life as a means to address the effects of loneliness.

22Jan/18
Living well

Get back to living by living

Chronic pain, Pain Coach, Pain Education, , , ,

Living well

It’s raining today (Monday 15th Jan). Not unusual for January but how does it make you feel when you look out of the window? Do you see possibility or problem? A wet day or a chance to jump in puddles? Most kids love jumping in puddles to see what happens and because that exploration is fun. As an adult, life is much more ‘serious’. To spend time splashing about many not even occur to you.

Having fun is a fundamental part of living a healthy and fulfilling life. Carefree movements and silliness in all their shapes and forms makes us feel free and easy, together with laughter, smiles and joy emerging from such acts dotted through each day. There is time for serious stuff, but this can be addressed with more focus, clarity and resilience when we are well. We learn, we bond, and we foster wellbeing through fun. However, this can all seem to be lost when our health and sense of self is threatened, so how can we get back to living when suffering chronic pain? Do we wait to feel better? Or do we actively do something to feel better? I would strongly argue the latter, but we need a way; the ‘know-how’.

Do we wait to feel better? Or do we actively do something to feel better?

Many people suffering chronic pain and other complex health problems are merely surviving or getting by. There is no sense of living. Instead, they are struggling through each day, perhaps with the occasional pleasure. There do not appear to be many choices because of the seeming limitations imposed by the pain, and even if there is some sunlight breaking through the clouds, it is short lived through the expectation that pain will soon return.

As with many of chronic pain’s associated consequences, to understand it informs new thinking, new decisions, new behaviours and hence new experiences. When the fears and worries diminish, opportunity arises. The fears naturally ease when pain is understood. Here are a few simple examples of what is known about pain:

  • pain and injury are not the same
  • pain and injury (damage to tissues) are poorly related
  • pain is part of the way we protect ourselves together with changes in thinking, feeling, movement and perception; all in the name of defence just in case the perceived, or predicted danger really exists (based on what we know, or ‘priors’).
  • pain is much better an indicator of the person’s state — i.e. in a state of protect; this is why tiredness, anxiety and perceived loneliness increase the likelihood of being in pain as all of these are potentially threatening
  • pain is embedded in our society
  • pain changes — when you monitor your pain, you realise the ebbs and flows; the notion of impermanence is useful here, as life would not be possible without our ability to transform and learn. All experiences come and go.

There is much more that we know about pain, and we are learning rapidly alongside the ever-deepening understanding of consciousness.

There is no way to happiness. Happiness is the way ~ Thich Nhat Hanh

With insight into the way we think, the way our mind works and being in touch with reality by being present and aware, one can begin to craft a way forward, step by step. This is the practice of being mindful, which is a way of living life, and really being here and now. These are not just words or concepts, but a reality. The past has gone and the future never comes; there is only this moment to live. Indeed this moment may be filled with suffering as this is unavoidable in life — this is the truth. But it may also be filled with joy and pleasure — this is also the truth. Rolling with the natural ups and downs of life then, becomes a skill that we can develop together with the practice of the skills of being well so that we build wellness and resilience.

In this sense, we need to go out into the world to ‘sample’ the sensory opportunities. In doing so we ‘update’ our perceptions and experiences. This is work in progress, so we take steps to build the effect as we become more skilful, just like learning a musical instrument. This is living by living.

There are likely to be parameters to work to if you are suffering chronic pain. One of the modern tenets for managing and overcoming chronic pain is that of creating a sense of safety (pain is about perception of threat, hugely involving the person’s interpretation of the situation, consciously and subconsciously). Understanding pain forms the basis of feeling safe to move and ‘act’, which then become the next prior experience(s) or reference point(s) (consciously and subconsciously); i.e. a building effect.

Along the way we associate with the success of the little wins, rewarding oneself at each step; rewarding the fact that you took action as you may not ‘see’ much change day to day. Think about dental health. You know that you must clean your teeth twice a day for 2 minutes. Not just once, but every day if you want to maintain a healthy mouth. Consider getting fit. Going to the gym once will do little. Going 3 times a week will build health and fitness, although you may not see much change for a few months.

Living by living

The start point with the principle of ‘living by living’ is to think about what you can do, even for a short time. This maybe walking, meeting friends (social interaction to counter perceived loneliness), simple movements or stretches to nourish the body tissues, reading, going to an event. Immediately you may think of the reasons why you CAN’T, but remember that these are the thoughts informing your decisions that you can change by associating with pleasure rather than ‘pain’. When you update your beliefs by truly understanding pain, you realise that you CAN do certain things, which you can build up, just like getting fit.

As you gradually fill your time with chosen and meaningful activities, the pain rents less space in your thinking and experience of life. The wheels start turning in the right direction, and you begin to associate more and more pleasure with your successes, even if you feel your pain at times. Pain is an action, a perception, a feeling, an emotion, a thought, all together as a means to make oneself safe. Whilst more complex that the (wrong) belief that pain resides in the tissues, this understanding means that we have a huge number of ways to transform the experience. Pain is embodied; we feel it in our body. But ‘I’ feel it, the person feels it, not the body part where I feel it — back pain: it is not my back that is in pain; I am in pain, feeling it in my back. Pain is ‘whole person’ and hence needs this approach.

*Action: think about something you CAN do, especially if it is fun. Picture it, visualise doing it and notice how you feel. Then try it, perhaps just a little to begin with so that you have a good experience that becomes a past experience to draw upon. We create these past experiences by living, hence getting back to living by living. Write down what you have done and how you feel that sense of success and achievement. Then build.

The Pain Coach Programme is a comprehensive approach to managing and overcoming chronic pain and easing the suffering of chronic health conditions. Contact us to book your initial conversation to learn about reaching your potential to live well. We look forward to hearing from you. t. 07518 445493

* You should always discuss new approaches with your healthcare provider.

14Oct/17
Whole person to treat chronic pain

Pain is a very human experience

Chronic pain, Pain, Pain Education, understand pain, , ,

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.

04Jun/17
Teens suffering chronic pain

Headache

Chronic pain, Headache, Neck pain, Pain, Pain Coach, understand pain, , ,

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

Anxiety, Chronic pain, Pain, Pain Coach, Uncategorized, , ,
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 here: John 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

Pain, Pain Coach, Sports medicine, Uncategorized, , , , ,

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

05Apr/17

5 ways a partner can help you

Chronic pain, Communication, Pain Coach, , ,

Chronic pain can be the source of huge strain upon a relationship. Partners and other people close to the suffering individual can be at a loss as to what they can do to help. Sometimes their assistance is welcomed and other times not. It can be confusing and stressful. There are many ways that a partner can help and some will be individual to those involved. Here are 5 ways a partner can help you:

Be an extra pair of ears and eyes

During consultations with specialists or therapists, it can be useful for a partner to come along. Beforehand you can decide upon their role. The possibilities include:

  • listening and note taking
  • offering observations about what has been happening
  • watching and learning exercises so that they can provide feedback at home
  • just being there for moral support

Sometimes having someone else in the room, even a loved one, can be distracting depending upon what is being practiced. So do discuss this with your clinician for the best outcome.

Understand pain

When your partner understands pain they will be able to further empathise and act through compassion rather than fear and worry. We do respond and are influenced by the people we are close to, meaning that if they have a working knowledge of pain they will better provide support and encouragement.

Pain can and does vary as each pain experience is as unique as each unfolding moment. Knowing that pain is related to perception of threat rather than tissue damage or injury, along with some of the main influences (e.g. emotional state, context, tiredness) helps to navigate a way forward. To overcome pain the person learns to coach themselves, making best choices in line with their picture of success. Sometimes we need help or someone to listen to us whilst making these choices.

A hug

Touch is healthy, especially from a loved one. Someone recently told me about how a hug from her children relieved her pain. Why? The release of oxytocin for a starter. The feelings of compassion and love can cut through all other emotions and feelings, which is why the development of self-compassion is one of the key skills of well-being.

Sometimes a hug can be painful of course, depending on where you feel your pain. If this is the case, then simple touch somewhere else is enough. Seek to notice the good feelings that emerge in you: what do they feel like? Where do you feel them? Concentrate on them. And if you are not with that person, just imagine a hug or a loving touch. This triggers similar activity, just like when you think about that beautiful scene in nature, your body systems respond as if you are there ~ our thinking is embodied.

Practice the skills of well-being together

A good example is metta or loving kindness meditation that cultivates self-compassion. It is best to gain instruction 1:1 to start with and then use a recording as a prompt until you are familiar with the practice. Group practice is also good when the collective or community creates a soothing atmosphere in which to practice.

At home, practice metta with your partner. Doing it together, you form a bond as you spend meaningful time together. You can also practice the exercises together. These are nourishing and healthy movements with the purpose of restoring confidence as well as layering in good experiences of activity to overcome pain.

Spend time together doing something meaningful

We are designed to connect. The chemicals we release and experience as that feel-good factor, do so when we have meaningful interactions. Pain all too often appears to limit choice and our tolerance for activity. However, on thinking about what we CAN do rather than what we cannot, we begin to build and broaden the effects of choosing positive action.

Positive action is all about focusing on what we can do: e.g./ I can go for a coffee with a friend for half an hour to gain the benefits of connecting, moving, a change of scene etc. and I will concentrate on these benefits. Make some plans, working within your current tolerance level, knowing that you are safe to do so, and follow them through by keeping yourself pointed towards the picture of success*. You can then gradually build your tolerance by pushing a little with increasing confidence.

There are many other ways that a partner can be involved. The key is to communicate openly and make plans together ~ here is a great insight into communication by Thich Nhat Hanh.

* Clarifying your picture of success gives you a direction and the opportunity to check in and ask yourself: am I heading in that direction or am I being distracted?

Please note: Whilst the practices above can appear to be straightforward, you should always discuss your approaches with your healthcare professional