Self-management strategies

Self-management strategies are very important in the treatment process as you have the time when you are in the clinic and the majority of your time away from the clinic. This period needs to be optimised in terms of when and how you do your exercises and also how you manage your other activities such as work, leisure time, housework and sports.

As part of your programme you will be given a number of strategies. Below you will find the details.

Pacing

This is how you can break up activities that are provocative and still be able to do them. Firstly you calculate a baseline from where you will be starting. This is usually taken at 60% of the time it takes for the pain to reach such a level that you have to stop. It is all about making a change before you reach the ‘threshold’ when your protective systems kick in, including pain.

  • e.g./ sitting for 30 minutes causes you to have to move due to pain; at 20 minutes you would change position, stand up or do something in a different position

Graded Exposure

This is about gradually doing the activities that you find painful, avoid or are limited in achieving due to pain. Coming from dealing with fears, it allows the nervous system to adapt to the perceived threat and move on. Gradually the response (pain, stiffness etc) becomes less as you habituate and become used to the challenge. It is similar to when you start a new exercise and the muscles feel painful the next day, gradually becoming less painful as you repeat the exercise on the subsequent occasions.

Typically we will select some activities that you are having difficulty with or avoiding and develop strategies

Specific Exercises

You will be given certain exercises that aim to restore normal movement and control of movement, both often affected when we have pain and injury. This is in essence a training programme and must be practiced as prescribed to optimise the outcome. Being consistent is important and often at the beginning of the programme ‘little and often’ is advisable.

General Exercise

There are huge benefits of exercise including aerobic and resistance work. These include tissue health and strength, cardiovascular health, disease reduction and significant effects upon brain function such as improved learning, memory, concentration and stress busting. If you are not familiar with regular exercising we will give you the advice and education that you need to be active safely. It is now recommended that we perform at least 150 minutes of moderately intense aerobic exercise per week.

Posture & work

Changing position, standing up and moving around is very important for tissue health. Often we become stiff and sore when sustaining any position for some time, commonly in the neck, shoulders and low back. Repetitive strain injury is also a problem in these scenarios. Movement pumps blood and oxygen through the tissues, washing away the products of muscular use (acids).

Relaxation, mindfulness & meditation

All these skills can be excellent ways of calming a sensitive nervous system, also providing many health benefits. Neuroscience has demonstrated clearly that thoughts affect our physiology. It is well known and accepted now that mind, body and brain are connected with a branch of science being dedicated to this understanding, psychoneuroimmunology. Simple examples include thinking about food and salivating or thinking about something embarrassing and turning red in the face. Looking at these relationships and how they affect your pain and body responses is an important part of gaining control.

Goal setting

It is good to have goals and achieve them with the right approach. These are usually personal goals and relate to activities that you have avoided or been limited.

Flare-up management

Understanding your condition and pain is very important to successful coping and management. A flare-up is when the symptoms worsen and this can be because you do something new, take part in an activity that you have avoided for some time, you are under the weather (the immune system releases chemicals that make you feel unwell; flu-like symptoms), you are under stress (pain is a stressor itself), you are tired or sometimes there does not appear to be any reason.

During a flare-up it is important to remain as active as possible within tolerable limits. If you are feeling unwell you should behave as you would if you had the flu as this is exactly what you body is doing. Taking it easy for a day or two can help but movement is still important (little & often) to reduce the stiffness and to keep the blood flowing.

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