Tag Archives: Pain Coach

29Nov/17

Getting the best of Christmas ~ top tips if you’re suffering pain

Top tips to enjoy Christmas

Christmas top tips to thrive rather than survive!

Getting the best of Christmas ~ here are some top tips if you’re suffering pain so that you can maximise your enjoyment and create some great memories!

“get the best of you

Christmas is not an easy time for everyone. There are numerous challenges that include preparing a lunch, buying and wrapping gifts and seeing relatives. Add a layer of persistent pain, and these and other challenges are somewhat amplified. Having a plan helps you to organise your part in the festive season, allowing you to enjoy the time in the best possible way.

How are you framing the Christmas period?

The inner dialogue or script we are running has an enormous impact on how we have that very experience. If I keep telling myself that it will be tough, or tiring, or painful, then it usually is and more so. In essence we are feeding the prediction plus our choice of behaviour will enact those thoughts. So, write a positive script that is rich with all that you want. This does not necessarily mean that it turns out exactly this way, but it will be much better than if we anticipate the worst. What we focus upon we get more of!

My Christmas will be ______________. Fill in the blank and keep focusing on this picture and how you can go about doing your best to achieve it. This is the basic model of success used by anyone who has achieved results, including you! Clarify the picture of what you want and then decide upon the principles to follow to do your best to get there.

Make a plan

For each day of the festive period make a plan. You will need to prioritise your activities and create space for ‘refresh and renew’ time. To prioritise you can make a list of all the things you want to do. Then categorise them A-C (A the most important), before numbering 1, 2, 3, 4 etc (1 the most important).

Your plan is flexible, meaning that if it does not turn out exactly as you wished, you can accept the changes. It is useful to have a set of principles to follow, which allow for flexibility within the plan. Here are some examples;

  1. Knowing that wherever you are, you can create calm by using breathing or imagery, either because you are aware of a more intense emotional state or just because you wish to plug in and recharge.
  2. Motion is lotion is a way of nourishing yourself with simple movements that you know are safe, despite how they may feel at the time. Pain and stiffness are both need states that we perceive in order to choose an action that will satisfy the need. This is much like hunger and thirst.
  3. Refresh and renew time is when you deeply relax, engage in something pleasurable, have a conversation, listen to music, look at a scene with awe, practice gratitude.

Write your plan out so that you are much more likely to commit. You may like to share your plan with someone as a further way of cementing your intended actions.

Motion is lotion

Movement is fundamental for our health as it is the way we nourish our body and our brain (the two are not separate–we are whole). Movement is part of the way we are and the way we represent ourselves to the world. Consider how you can recognise a friend from far away by the way that they walk.

Motion is lotion is the consistent practice of moving, little and often through the day. Stiffness is a common bedfellow of pain due to the guarding (overactive) muscles that become tense and tight. The feeling of stiffness is inferred as a way to make us move, much like pain is an inferred (whole person) state to make us protect ourselves and meet the impending need.

Repeated simple movements that are tolerable or feel good will build the evidence that we are actually safe. This momentum creates a new back story that informs the next moment in such a way as to drive easier and easier movements. This is a practice and must be used through the day, every day. As a guide, when sedentary, change position every 15 minutes, and stand up every 30 minutes. Part of your planning (see above) will be how you can integrate movement into your day.

Be aware of what is happening right now

Being ‘in the moment’ is not just a phrase. There is no rehearsal for life; this is it. ‘Life is long if you know how to use it’ is Seneca’s classic title. Using our time wisely maximises the opportunities we have presented to us each day, together with an openness to experience. The beginner’s mind illustrates this well, whereby we maintain a wonder about our perception of the world that unfolds each moment, much like a small child walking into a grotto, experiencing the impact of the lights and aromas of Christmas.

Mindful practice is about being present, aware and open to all experiences without judgement. Noticing emotions, feelings, thoughts and sensations as they come and as they go is at the heart of the practice, however they appear. Quickly we can become familiar with the impermanent nature of things, so no matter what you are feeling right now, it will pass. We can easily integrate mindfulness into our day with a simple ‘formal’ practice of 10-15 minutes together with moment to moment awareness through the day. The latter is achieved by paying attention to a few breaths, which bring you to the present moment rather than dwelling and embodying the past or an anticipated future.

A further practice is to notice positive feelings and emotions through the day as they arise. ‘What we focus on, we get more of’, is a phrase I repeat to clients, as they train themselves to build awareness of all perceptions, in particular those that feel good. The broaden and build effect of noticing positive emotions has been well studied by Barbara Fredrickson, and it only takes a short period of practice for the impact to grow. Good feelings can often be subtle and pass by quickly, whereas negative emotions often hit us hard and linger for long periods. Paying attention to each moment as often as you can, permits the awareness of the positive in its many forms, building your wellness and ability to notice more. There will be plenty of good feelings to notice if you choose to create a positive approach to Christmas, pay attention and address your ever changing needs (see below).

Meeting your needs

We can strongly argue that feelings arising in the body are the conscious emergence of need states. I feel thirsty, I feel hungry, I have an itch, are all common examples. Pain and stiffness are also need states that motivate us to take action to meet the need, perhaps more urgently that some of the others.

When we feel thirst, this is a user-friendly representation of complex biology (sub-personal), which we only need consider as a percept to address by drinking. Pain can be considered in the same light to a degree. The variance comes from the desire to know why we are in pain. Is it something really dangerous? Clinicians must do their best to answer this question for the person.

Much of the suffering comes not from the pain itself, but the way in which the person interprets and thinks about the pain. This is why understanding pain is so important, and why many people feel immediate relief on knowing the answer. If you consider that pain is based upon the perception of threat, understanding pain is a way to reduce this threat together with knowing what can be done.

On feeling thirsty, we drink until the feeling appears to pass. On feeling pain, we must keep using our practices to create the conditions of ‘safety’ until we start to sense an easing, which will come. This may be repetition for a good period of time along with consistent practices we are using to get better overall. We must also address the reasons why, if we know, the state may have arisen. For example, a situation that is perceive as stressful, tiredness, anxiety, different or new movements, or a change of environment to name but a few. Pain is embodied and embedded in the context of your life, hence all factors need attention and new approaches engaged where existing ones fail.

An example to illustrate: I have neck pain sitting at my desk. I must move and stretch to nourish, and keep doing so until there is a sense of relief (this may need to be consistent through the day). I must also address the reasons why it could be painful. For example, I have sat here for a long time repeating the same posture and movement, I am feeling anxious about this piece of work or a forthcoming meeting, my mind is wandering, I am tired. Without considering all influences as well as the actual perception, there is not adequate reason for your body systems that protect you to shift gears. We actively shift gears with new thinking and new actions.

Summary

Here I have outlined some simple practices and approaches that you can decide to adopt for not only the Christmas period, but in a way to overcome your pain. The Pain Coach Programme is a practical approach to living life and building wellness as a buffer to the challenges that arise for each person. We can choose our style of ‘doing life’, and this has a significant impact upon whether we reach our potential or not. The Programme is about getting the best of you, or peak performance in different areas of your life. Each day presents a range of opportunities. Which will you engage with?

Here’s an equation:

(My current physical ability – my tolerance) + my approach = what I achieve

“How can I be the best me, and enjoy the process? 

** Please note that these practices should not replace your existing treatment or therapy programme. You should always check with your healthcare professional if unsure.


To start your Pain Coach Programme, to organise a Pain Coach Workshop or for clinician 1:1 mentoring, contact Jo 07518 445493

24May/17
Are you ready for clinic?

How do you get ready for clinic?

Prepare for a successful performance

Are you ready for clinic?

 

Remember the excitement of those first clinics? The anticipation of that first patient, the challenge of working out their story and coming up with a solution. The opportunity to practice those skills. The fascination with the narrative blending with the body language and phraseology used by the patient. The feeling of pride wearing the uniform. And so on. All great feelings!

How do you feel now? Are you aware of how you feel now before clinic? Do you make time to notice or do you walk in on autopilot and crack on without any awareness?

When we fall in love, we will do anything for that other person. Take the bins out — yes please! Clear the dishwasher — anything for you!! Six years later…. take the bins out — you gotta be kidding! I’m not your servant! Wash up — no chance, why can’t you do it….. How about acting like the first few months, always? How about acting like those first years of clinic, always?

“have you warmed up?

You go to watch your favourite team. The excitement builds, the crowd are singing, you can’t wait for the whistle to start the game. Then you see the players wandering in aimlessly, not paying attention, just moments before the kick off. Have they prepared before the game? Have they warmed up? Got their thinking in the right space? Attuned to the situation? Players prepare. Musicians prepare. Actors prepare. Should we prepare? Of course!

Let’s create a routine of warming up for our performance today. Let’s get our thinking aligned with our values; what’s important right now? Let’s get focused. Let’s be the best we can be and notice when we are distracted and come back to the focus. In clinic, we are performing. This is our centre court, our pitch, our stage where we work with a person to present them with the opportunity to commit to change to improve their life.

“what’s your kindset?

What were the reasons you went into this job? Why did you choose this career? What is your ‘WHY’? Think about this each day to refresh and renew and drive yourself to be the best you can be. It’s a choice. Feel motivated, feel great about it!

It’s a mindset that you choose. It’s a ‘kindset’ for the people coming to see you — what a privilege that people come to see you. That is an opportunity to practice gratitude as well. What is a kindset? It’s a mindset driven by kindness!

RS

1:1 Pain Coach Mentoring for Healthcare Practitioners and Clinicians: practice the very skills that you present to patients to improve your life, improve your relationships, improve your performance. Feel inspired because you CAN! See more here
01May/17

High Performance Sport Knowledge Exchange 2017

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

15Mar/17

Values mismatch

Listening to peoples’ stories for over 20 years, one picks up on the important themes that consistently arise. These are the areas that need addressing as part of a full programme to overcome chronic pain. One such theme is the values mismatch.

Values mismatch

Put simply, a values mismatch is when our deepest held beliefs about ourselves and the world are at odds with the value system in which you find yourself. Arguably the most common context for a values mismatch is when the individual’s values do not fit with those of the workplace. A further example can be when a person’s values evolve so that a difference exists between the new values and those held by the family or close network.

As an illustration, trust is the value at odds. With trust being of inherent importance to the person, when the work environment is driven by high levels of competitiveness, the so-called dog eat dog culture, underhand methods can be rife and accepted by the company. This fear based approach causes great suffering. Continuously looking over one’s shoulder is unhealthy and unsustainable. For the person who holds the value of trust to be dear, this can drive a more consistent state of protect. Further to this is the impact upon health and the sense of well-being.

Values mismatch and suffering

The mismatch can affect us deeply as we either try to fit in or somehow rebel against the culture. Both require effort. Add this to the energy cost of being in a sustained state of survival, and one can begin to see how health can be affected. How many people who suffer burnout would tell you that they hated their work? Scratch beneath the surface and you usually discover that it started well. With time they became ground down by the demands, the attitudes and behaviours. We are not separate from the environment, nor the other people who we are surrounded by, and hence the ‘toxic’ place affects our health. Even just thinking about the place or certain people there cause a feeling of discomfort or anxiety.

When we are in survive mode for sustained periods of time it potentially affects many body systems. The systems that protect us are looking out for danger and the feel of our body and self is just that. We feel on edge, uncomfortable, tense, anxious and this tells us that threats are about. They may or may not be, yet this is what we feel. Our body is saying there is danger when in fact there is no actual threat. The systems work on a just in case basis. With protect state ‘on’ consistently, everything appears to be dangerous. Now, every little prompt or cue stokes the fire: watching the news, reading social media, the look someone gives you etc. How you consciously interpret these things and how your body systems alert you has changed.

“Our body is saying that there is danger when there is no actual threat. This is a habit that can change

The common manifestations in terms of health include chronic pain, fibromyalgia, fatigue, poor sleep, irritable bowel syndrome, headaches, migraines, struggling to recover from an illness or injury, jaw pain, anxiety, depression, poor concentration and memory, feelings of isolation and despair, and a great deal of suffering.

This does not need to continue. You can change course by understanding why this has happened, addressing the reasons and creating a new way forward. We are designed to learn and change, and with a new moments continuously unfolding, we have enormous potential to succeed with the right thinking and right actions. Writing down our values helps to clarify what is important to us. From there we can see how any mismatch maybe affecting us. Then we can seek to understand how we can best go about achieving alignment with our values. This would form part of a programme of training, coaching and treatment so that you can achieve your best by focusing on your strengths.

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Pain Coach Programme to achieve your best | t. 07518 445493

 

 

 

20Feb/17

Pain is whole person

Pain is whole person

There is only one way to approach the problem of chronic pain as it emerges in the individual, and that is by addressing the whole person. This way demonstrates a true understanding of pain: the lack of any pain system, pain signals or pain centres and that the vast majority of the biology of pain is not where we actually feel it in the body or body space in the case of phantom limb pain. Much like when you watch a film in the cinema, most of what you need is not on the screen.

With pain being absolutely individual, coloured by the context, the environment in which it is being phenomenologically experienced, prior experience and beliefs (about pain, health, danger, ‘me’, the world etc.), the action we are motivated and compelled to take, existing health and level of threat perception to name but a few. In short, this includes activity in the brain and central nervous system, immune system, endocrine system, sensorimotor system, visual system, and the autonomic nervous system. Most of this is not where the pain is felt.

Pain and injury are notorious for being poorly related. There are countless stories of people suffering great trauma (tissue damage) and reporting minimal or no pain, some sustaining minor injuries and describing agonising pain and a huge variation in between. Considering the factors in the previous paragraph, one can start to understand why. In essence it is due to pain being a better indicator of the level of perception of threat; i.e./ more threat, or existence of threat = pain.

Bearing this in mind, and this is the current understanding of pain, you can see why the whole person approach is necessary. It is as much about the person as the condition, as Oliver Sacks wrote and practiced, and indeed this is a vital principle to work to. Understand the person and their circumstances and you go some way to seeing a way forward. Listening deeply in the first instance creates the opportunity to gain insight into the reasons for the person’s suffering — the reasons for pain and what is influencing that experience. From this foundation, one develops a rapport, not just as a clinician or therapist but as a trusted advisor, giving the person the knowledge and skills to overcome their pain and live a meaningful life.

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Pain Coach Programme to overcome chronic pain ~ t. 07518 445493 or email: [email protected]

 

18Feb/17

Pain and choice

Pain and choice

There is one thing that pain does and that is narrow down our choices. A sense of choice has a major role in the sense of ‘me’ and who I am. Losing choice impacts upon us significantly as we feel less and less like ourselves and who we are meant to be. This is a very common description of the impact factor that I hear when listening to people enduring states of chronic pain.

Talking to people with pain as we seek to gain insight into the causes of their suffering. This provides a way to offer support, guidance and a way forward. Of course we can only move forward, but sometimes it does not feel like that! Groundhog day.

Enabling one to see their choices then, becomes a valuable and important exercise. We have many, but sometimes we just need a little help to realise and then actualise. I believe that the greatest steps are taken when this happens as the person feels empowered to steer their ship once more.

We need to know where we are going of course, a direction created by clarifying what we want as opposed to what we do not want ~ “I don’t want pain” versus “I want to live well”. Focusing upon living well motivates actions and behaviours in line with this whereas thinking about getting rid of pain keeps our attention on pain. We will only be successful, and we can be, if we have the right approach, mindset and attitude that we may have to cultivate and practice. Most I see do need to work upon these skills of attention, resilience, self-belief and determination. That is the first choice.

We can choose our approach. We can choose to engage in healthy activities. We can choose to take every opportunity to live well. We can choose to create the conditions to feel better. We can choose to have meaningful interactions. We can choose to leave some thoughts alone if they make us feel bad. We can choose to move and gradually move more as we adapt. We can choose to learn about our pain and our responses to pain, and then change them if need be. There are many choices we can make.

Of course it sounds easy when written and the doing is different. It is an experience. However, it is perfectly do-able. We are designed to change and do so every moment that passes. We can harness our potential and opportunities with simple measures, practices and skills based on new knowledge. Achieving success is with everybody’s reach although sometimes we need some help and guidance. But we can do it. This is the ethos of UP. Let us make choices to live well, create joy and face challenges with a sense of ‘I can’.

Choose ‘I can’.

01Feb/17

The inner dialogue

The inner dialogue ~ what do you listen to and what do you tell yourself?
You are beautiful by La Melodie https://flic.kr/p/99ACEa

You are beautiful by La Melodie https://flic.kr/p/99ACEa

One of the things that makes us human is the inner dialogue or inner voice that is fairly continuously ‘speaking’ to us. Of course the voice is part of each and everyone of us and is not an outside agent. To some people it can appear to be coming from somewhere or someone else as in the case of psychiatric disorders. That must be frightening.

The inner dialogue is part of the workings of our mind. Our minds play a significant role in our actions and perceptions but it is not a one way street. The physicality of our existence can impact upon the way in which we think. The branch of philosophy named embodied cognition has much to say on this matter, addressing the notion that our thinking is embodied. A simple example is when thinking about hunger and food, we would typically feel that in our body, interpreting the sensations as being in need of food. A further example is the way we gesture with our hands to demonstrate a point, freeing up resources for further thinking. Consider how you feel when you think of a loved one or a difficult situation in the past — where do you experience it? Certainly not ‘in the head’.

There is a skill in choosing whether to listen to and act upon our inner dialogue or our thinking. It is true that we do not choose the workings of our mind, however we can learn about how it works, our habits of thought and realise how we embody these thoughts. In so doing, we have the opportunity and responsibility to become increasingly skilful in deciding whether to pay attention or to let go of thoughts and the inner dialogue. Being mindful is just that. We are aware of the thoughts, noticing their impermanence, recurrent nature, the way they create feelings in the body, but we are not engaging or becoming embroiled. There is a monumental difference between being in the film and watching the film. You are still experiencing the full richness of the feelings and emotions but with curiosity, with compassion and with an intent to only act with kindness, towards self and others.

Learning to be observant of the inner dialogue allows you to make choices. We have choices and often need to realise them. How am I choosing to feel or think about a particular situation? Even asking yourself that question gives you space to decide what you can do. Shifting the thinking to take another perspective can give a very different feel to the experience. Knowing that you can do this is very empowering, as you know that you can face challenges with skill and insight.

The story we tell ourselves can be so impacting upon our reality, lived experiences and ultimately our health and sense of well-being. If you persistently tell yourself that you are not good enough, have not tried hard enough or blame yourself for all sorts of things that may not actually be your fault, this will create a range of unpleasant feelings in the body as well as paint a bleak picture of life. Being hard on oneself causes our protect systems to switch into action. A range of common ailments manifest if these systems are ‘on’ too much without adequate refresh and renew time. Such problems include chronic aches and pains, sleep disturbance, gut issues, mood variance and exhaustion; very common presentations in my clinic. This need not be the case by learning some simple skills of well-being and day to day practices that stoke up our healthy systems. This is the bulk of the work we do to overcome pain and health problems — see here.

The inner dialogue and pain

Pain and the inner dialogueThe inner dialogue can tell us our story; the story of me. The self that I experience moment to moment, which is continually updating. Our implicit ability to change creates great hope as we can transform our suffering by gaining knowledge and insight into our existing habits. From this awareness we can choose to create new habits that are based upon our value system (what is important to you in life) and are by design all about sustainably living a meaningful life.

Many people with chronic pain have received messages that suggest pain must be managed or that they must just cope. This lowers expectations and hence our story and the inner dialogue is based on this belief. We can and must do better. Changing our story, and this is applicable to any story we tell ourselves, creates a new way onward. This begins with understanding pain. Countless people have told me how much better they feel on starting to understand their pain when we discuss their experiences at the first meeting. There is no magic here. We feel better when we have understanding of a problem and insight into how we can address the issues — feelings of agency, choice and empowerment feed and motivate us to take action; the right action. The Pain Coach Programme is all about the right action based on the right thinking. Understand your pain, write and see a new story and then live it. This is the story of your success, whether it be overcoming pain, setting up a business, writing an essay, doing an exam or playing a game of football. Use the story wisely, make it count and use every moment in a way that encourages and motivates more and more great action.

The Pain Coach Programme is a blend of strengths based coaching and pain sciences for your to achieve your success | t. 07518 445493

 

26Jan/17

Pain Coach Tips

Pain Coach Tips

Pain Coach ProgrammeThe Pain Coach Programme is the complete approach to chronic pain and painful conditions. The programme addresses the specific changes and adaptations that occur in on-going pain, together with skills to sustainably create the conditions for health and happiness. Here are a selection of tips that you can use straight away.

Before getting into the tips, it is important to understand that our knowledge about pain has moved on significantly over the past 10 years. Pain is not something that is only referenced by where we feel it, and it is certainly not observable on an investigation such as a scan or x-ray. Pain is subjective, unique and emerges in the person when there is a perceived threat to that person. The focus here is upon simple Pain Coach tips, so if you are needing to understand pain further, keep checking back for future blogs or read through the library here.

Pain Coach Tip 1

Clarify your picture of success ~ what does it look like? What are you doing? How are you feeling? This gives you a direction, a steer, and orientation. Write it down and share it with someone, making a commitment. We need meaningful direction, something to aim for.

Pain Coach Tip 2

Frame your thinking in positive terms. Set out your intentions: what do you actually want? For example, instead of thinking about how to get rid of pain, think about how you can feel good. When we focus on feeling good and well, we will orientate our subsequent thinking and actions towards that end.

Pain Coach Tip 3

Think about a success you have had in your life. How did you achieve this success? What strengths did you use? Consider how you can use these strengths each day, building them as you would a muscle. Then think about how you can use these strengths to develop your wellbeing, health and happiness. Make the choice to adopt this approach.

Richmond Stace | Pain Coach & Specialist PhysiotherapistThere are many strategies and techniques to work to your potential to overcome pain. Setting the scene by understanding your pain, what influences your pain, knowing what you can do and how you can do it gives you the confidence and belief to focus on what you CAN do.

The Pain Coach Programme | t. 07518 445493

28Aug/16

Simple skills

simple skillsThere are a number of simple skills that can be practiced to become a better clinician. In essence, when we are fully present and engaged, we are communicating this to the patient thereby creating a nourishing environment. This environment sets the scene for new understanding and new habits, beginning the transformation of the suffering person.

We are not separate from the environment in which we reside and hence we, the clinicians, have a role in how the environment supports the person getting better. Arranging the treatment space is important then, enabling the patient to feel welcome, heard, comfortable and free to express themselves. This expression is the story to which the clinician must listen deeply as all the information is contained within the narrative. Allowing the person to speak in their own language with occasional prompts and guidance is the basis of the onward journey towards their vision of a desired outcome.

For the clinician to practice mindfulness is a simple way of maintaining presence and engagement with the patient. This simply means that you are listening deeply and using insight to see the causes of suffering that are revealed as the person speaks freely. Add to this compassionate speech and the communication facilitates the way forward. Communication is part of the treatment as the clinician helps the patient understand their pain and suffering — what has happened so far, what is happening now, what is influencing their pain, what they can do, what the clinician will do and how they will go about it.

Practicing mindfulness is a simple skill. As a starter, the clinician can take 4-5 breaths between patients, paying attention to the rise and fall of their chest. On the out-breath you can consciously let go of unhelpful and distracting thoughts. As soon as your mind drifts into the past or future, you are no longer present and your engagement dissolves. During the session, recognising this happening and bringing your attention back to your breath is a way of re-engaging once more.

Taking a break midway through the day to move, breath and nourish is an important refresh and renew point. A period of deep relaxation for 10-20 minutes gives us energy to be present once more and focus on the patient: their words, their gestures, their messages. We must develop our abilities to gain insight into the causes of the patient’s suffering so that we can guide and treat, enabling them to get better and ease their pain and suffering. In fact, by gaining insight ourselves, we can then help the patient to develop their insight into the causes of their own suffering and create new healthy habits around their thinking, choices and actions to actively infer new experiences.

Practical point: start by taking 4-5 breaths between patients, and at the start of the day express gratitude for the opportunity to help people get better.

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Pain Coach 1:1 Mentoring Programme — develop yourself and your insights to coach people overcome their pain | t. 07518 445493

18Aug/16

Trauma

TraumaAll injuries have a degree of trauma, but some more than others. The moment of injury is just that, a moment. Part of the experience is an urge to do something in a way of protecting the self both in thought (what shall I do here?) and action taken. The thoughts and actions, unified into a lived experience of action-perception, are based on prior knowledge and situations as we try to make some sense of what is happening now. As humans, we have a tendency to flavour the present moment with thoughts of the past or future, neither existing beyond the thought itself. The problem lies in the fact that the thought is embodied, resulting to a greater or lesser degree from the current body state, which we then fully experience with sensations in the body, feelings and emotions; embodied. For example, purposefully thinking about a prior happy occasion usually fills you with the same feelings of joy and pleasure as if you were there again. The same is true for thoughts of an unhappy situation in the past. However, this body state is continually updating and hence we are in a position to steer our change in a desired direction by thinking-acting in a way that aligns with our values and vision of how we want to be. We purposely put ourselves into situations to get better.

Understanding the state of the individual before the trauma and at the time of the trauma provides important insight into the subsequent unfolding of events. A person experiencing persistent pain continues to suffer despite the tissues (body) healing, which they do to the best of the body’s ability, because the systems designed to protect us continue to be vigilant to potential dangers. These potential dangers soon become normal day to day situations, now regarded as posing a threat to the individual’s survival, hence the pain to motivate defensive thoughts and behaviours. The longer these habits persist, the more suffering. But, this is not set in stone and indeed the practice of new, healthy habits steers a new course. We are designed to change and we can decide on the direction, using new habits to get there. Not always a smooth route, it is the one that takes you towards a meaningful life as you overcome the challenges with new understanding of pain and the best course of action. Maintaining this course also relies upon recognising distractions (unhelpful thoughts that affect mood and motivation — old habits) and re-orientating to the desired route.

Healing is not simply about the muscles, bones and other tissues repairing. It is about the person resuming their sense of self — ‘I feel like me’. This is a process of understanding, adapting, gaining insight into the causes of suffering, the practice of new habits and gradually engaging once more in normal activities including socialising. I think about this as getting back to living, by getting back to living instead of waiting for pain to subside before re-engaging. The re-engaging itself has a role in getting better and pain easing. This comprehensive approach, or whole-person approach, is key to success.

A pure focus on tissues means that the person living the experience is neither acknowledge nor addressed. There is the pain, the injury (the two are not well related) and the person’s appraisal of both, which if not validated and considered, means that a huge source of suffering is neglected. This does not mean in-depth psychological assessment, instead recognising that there is an individual with a story that needs guidance towards getting better. We are more than an injured leg or back. Insightful and compassionate clinicians will work in an egoless way as they focus on the person getting better by helping them to understand how they create the conditions for their health — environment, surrounding and influential people, their programme. We often use the phrase ‘I want to go back to how I was’, but of course this is impossible as we cannot go back in time. What we can do is adapt and focus on getting fit and healthy, and in so doing the body, the self, predicts less and less need to protect and hence the pain changes as we get better.

On first seeing a person who has experienced a trauma and on-going suffering from their persistent pain, we must consider prior health, pain experiences and beliefs about how we overcome problems. It is common to have had or to have other sensitivities, sometimes for many years, which exemplify a pre-existing state (or pain vulnerability) that has been primed by painful episodes over the years. This means that a new injury or situation deemed in need of protection will arouse a more vigorous and potentially prolonged set of protective responses, vigilant and fear-based behaviours. Knowing this from the outset means that the new issue can be addressed fully. Examples of common prior conditions include irritable bowel syndrome, migraines, jaw problems, persistent aches and pains (e.g. back pain), pelvic pain or period pain. These sensitivities can have arisen as part of an overall protect state following early traumas in life that have triggered the protect state, which has continued to emerge in many circumstances including normal ones. We learn to avoid and look out for trouble and can see it in the face of day to day activities, resulting in persisting pain and anxiety. However, with change occurring every new moment, we are able to transform this suffering by seeing things for what they are as opposed to being lost in thoughts about the past or future that arouse unpleasant sensations and emotions (in the body — we are embodied).

In discussing emotions and thoughts, this does not mean that we only focus on these dimensions. As stated earlier, we must focus on the person and their unified experience that is constructed by their brain, mind, person, body etc. On shifting a thought purposefully, inferring something different, we immediately feel differently about that situation. ‘How are you choosing to think about this?’, you could ask yourself. ‘Is there another way I can look at this?’. Recall the experience of where you feel emotions. It can only be in the body as thoughts are embodied. They are not ‘out there somewhere’, they are here, in me. My body state determines my thinking as much as my thinking determines my body state. Sit up for a while and notice how your thinking and feeling changes. You can gain insight into how someone is feeling by observing their posturing and manner. Imagine going into a business meeting to find the person you are about to discuss a deal with, sprawled across his chair with his feet up on the table. He has not said anything yet you gain insight into his approach, character and manner. Will you do business with him? Further, force a smile by gripping a pencil longways between your teeth, look in the mirror and notice how your feelings and emotional state change.

We are complex, predicting what needs to be experienced in any given context based on what we know. There are a huge number of variables that we cannot account for as we are only aware of a very thin slice of what is going on in any given moment — what we are conscious of, making many assumptions from prior learning. In terms of persistent pain, the intensity, the impacting nature of the experience usually far outweighs any signs of ‘damage’ or injury. Often there is evidence of natural degeneration that slowly evolves, quietly informing body systems which predict the meaning of the information, eventually reaching a point of conscious protection when it hurts. This is a slow burner with a point in time when pain is noted. 

In trauma, there is an obvious incident, which is embossed upon the person at that moment in time. The reverberating effects from there on depend upon that person: what they have experienced before, how their body systems predict the causes of the sensory barrage, urges manifesting as behaviours and actions taken, thoughts about the situation (meaning, attribution of causes etc.), emotions that emerge and the onward unfolding of these experiences unified as the story. Naturally the time frames vary according to the conscious awareness of the person, wherein a head injury would impact on memory of the event. In an emergency situation, clearly there are priorities for the medical team to protect the person and maximise the chances of survival and sets the scene for recovery and healing.

From the earliest possible time point, the right messages about what has happened and what needs to be addressed should be purported. The person needs to understand their pain and problems so that they can focus on the right action to get better. This is day to day, moment to moment as the advice and education are taken, internalised and become second nature as new healthy habits are practiced. The notion of the Pain Coach emerged from this thinking, blended with a strengths-based approach. Strengths-based coaching focuses upon developing a person’s existing strengths and managing their weaknesses. On the basis that we are seeking to focus and perform to the best of our ability, the strengths coaching method offers an effective modus operandi stretching across recovery from injury to sports and business performance. Strengths are many, and can include perseverance, attention to detail and compassion. People often realise that they use these strengths in other areas of their life but not in relation to getting well again.

Experiencing trauma in life presents the person with a challenge in many different ways. It also presents a challenge to those around them including family and friends as we are not in isolation to others or the environment in which we reside. There may be a region of the body that has been injured or affected, however, it is always the person who has to deal with the situation and recover. This is a key point that can often be missed, particularly when the injury is complex and multiple parties are involved in the treatment planning. Whilst we discuss the incident, the injuries, the symptoms and the impact upon that person’s life, they are living that life and only they know what that experience is like. This is the reason why deep listening is so important from the outset. It is the person who heals and recovers. It is the person who gets better, and hence it is the person we must know and treat as much, if not more, than the condition because each of us will experience our life events in our own unique way.

The Pain Coach Programme to overcome persistent and complex pain | t. 07518 445493