May has come and almost gone in a flash. In that time, the lockdown has eased slightly meaning that we can get out for more exercise. In turn, this opened different opportunities for upandrun 15. In the end I chose the 3 Parks, not the 3 Peaks! The latter is on my radar as soon as it is acceptable to travel further.
I am fortunate to live near plenty of green despite being on the edge of London. The 3 Parks are Bushy Park, Richmond Park and Wimbledon Common. A bimble around the edge of these and back home takes in around 50k — a nice distance for an afternoon in the sun.
The last upandrun was dedicated to raising money for my local hospital. I ran around my block for 100k and managed to reach over £3000 in donations — thanks to all those generous people!
Now I am back on the case for chronic pain, one of the largest and most costly of health burdens across the globe. This is in tandem with the end of the Pain Coaching project as I tot up the outcomes and study both the data and the key features of the coaching conversations. Just as a brief insight, the average satisfaction score given by participants in the programme was 9.4/10. They also all agreed that they would recommend pain coaching to another person suffering chronic pain as a way to understand their pain and learn how to improve their life.
There is something special about getting into nature; running along the trail. Out there for hours, you can appreciate the changing colours, shadows, light, terrain, thoughts and feelings. It is a privilege. Nature offers itself to us. When we respect it, nature provides us with all we need including a listening ear. The past year of ultrarunning has brought that home to me. We are all wounded at times in our lives, yet we can heal. Nature offers that healing. Experiencing this so strongly, I have started Trail Life.
Trail Life is about immersing yourself in nature, on the trails or even carving your own trails on your way to wellness: moving, breathing, feeling, running, walking, talking, silence, feeling, seeing, listening, being present, being aware and more.
We started the tour in Johannesburg, then on to Durban and finally to Cape Town. It was a whirlwind. Each event drew local physiotherapists, kinesiologists and other healthcare professionals together for a burst of education, socialising and presentation of the product range.
The organisers and sales teams created a positive vibe, which made the delivery of the pain talks a pleasure. I also had the opportunity to gain an insight into the pain problems that exist in South Africa by talking to the therapists.
We can be optimistic. Our knowledge of pain is expanding at a fast rate directly via pain science but largely from related fields. This was a message I tried to get across.
Therapists can choose to see people’s potential and strengths. Through this lens, the possibilities open up and we can help and encourage patients to shape their own positive futures.
The three days of talks in three cities was energising. It did not prepare me for a mountain though. Or the heat.
For the first 10k I was guided up to Lion’s Head by Nicola from Energy in Abundance. We set off on the trail chatting about life, running and philosophy. The photos tell the story.
Nicola hooked me up with South African ultrarunner Linda Doke for the Table Mountain part of the adventure. Incidentally, Nicola made all the arrangements by email beforehand so I just had to turn up. I would recommend this if you are a runner wanting to explore the area. You’ll be taken safely on the best routes and experience the awesome views.
We set off along the bottom of the mountain to reach the point of ascent. Apparently the weather was to be the best of the season today. It was. The flip side was the heat, which I was not prepared for having come from the English winter. This together with the steep climb took some effort. The reward was the magnificent view and a tin of coke. I love coke on long hot runs. And coffee.
Leaving the cable station and heading off along the stony trail, we also left contact with humanity except for a few lone souls we met. Three in total over the coming hours. It was a rugged and jagged terrain, yet covered with green resilient flora. We stopped to look at some of the plants that thrive on the mountain top.
There was little shelter from the sun. We knew the temperature would be rising so I had plenty of water on board. Of course this warmed up against my body.
When Linda mentioned stopping at the dam for a dip, I couldn’t wait to get my feet in and refresh. What a moment it was, to step into the reddish water, tanned by the fynbos plants beneath the surface.
The five dams are entwined in the history of Cape Town. They feel remote, sitting above in stillness like a meditating hermit. Some say that they have been forgotten (read here). A small dedicated museum at northern end of the Hely-Hutchinson Reservoir houses the original steam train. It was closed and did not look like it would open any time soon.
Recharged, dripping and grateful for the simplicity of fresh, cold water, on we went. To the right appeared the sea. As the reservoir had, it looked so tempting. There was the feeling that I could dive off the mountain into the blue. Later and warming up, I thought of icy drinks on the beach that I could see. The sounds from the people on the sand wafted up on the wind, yet we were a long way from any form of significant rest. Linda kept me going. Plodding along. The initial climb had taken a lot out of me.
We made a descent down a gorge towards Hout Bay and Llandudno. We chatted about the latter and how it bears no resemblance to the North Wales version. Both have their charms.
This was a bit of a scramble over loose scree before reaching a more defined path around the peak we were navigating. I had to navigate a few tricky points, expertly advised and encouraged by Linda. To many they would be easily traversed, but with a fear of heights I had some extra sweat to manage.
I realised that I had taken something from the Snowden experience in September. Looking back now, I know that these experiences have pushed the balance towards a greater confidence.
There is much to love about mountains: their strength, enormity, resilience, their danger and unpredictable bedfellow in the weather to name a few. I continue to be attracted to the challenge of ultra trails in mountainous regions. The mystery they offer and the contrast to my local running spots draw me in.
The final push up a long jeep track to us to the edge of the park. Across from the parking lot was a smart looking restaurant and bar. Linda assured me they would serve a smelly, dusty runner, and they did. I sat outside amongst the casually dressed Cape Town diners, mostly families, and enjoyed a pint of icy coca-cola reflecting on a tremendous day of trails.
Big thanks to Nicola for organising the tour and to Linda for guiding me and running at the slowest pace that she has had to endure for a long time!
Contact Nicola here for information about guided runs around Cape Town
Read about Linda’s running here. She also coaches runners.
I was very pleased to be asked to speak at the Adcock Ingram Sports Science & Rehabilitation division launch roadshow — a whistle-stop tour of South Africa.
Innovative TensCare CEO Neil Wright asked me whether I would give a series of talks in South Africa (Johannesburg, Durban and Cape Town). He had heard that I bring an ‘edge’ to the topic of pain. I like to think so, but only in terms of challenging out-dated thinking that holds us back. What a great opportunity, I thought. A chance to spread important messages via Understand Pain (UP) and to learn about how chronic and complex pain is addressed in South Africa.
The new Adcock Ingram division was being launched to local physiotherapists, chiropractors and biokineticists, and the theme of the events was pain. How could I resist? Adcock Ingram are engaging with therapists and clinicians in a new way that is generating a great deal of excitement. This is based on creating great relationships and distributing high quality products that compliment rehabilitation, including the range of devices from TensCare.
Both the team putting on the roadshow and the attendees were buzzing! The feedback from the people in the audience was very positive. There was a thirst for quality pain education, and it would be great to follow up with full Pain Coach workshops.
In my experience, TENS is under-used for chronic pain. Whilst TENS will not solve the problem, it can offer relief that helps the journey forwards. As an inexpensive and simple form of self-treatment, it is a good option. The key is that the user understands how it works and how to best use the unit. This can take some time and practice, but with instruction, discovering the right parameters can be found more swiftly.
I shared the stage with Nick Martichenko from Canada. Nick spoke about the use of tape and the understood mechanisms, whilst I focused on pain and pain coaching. I entitled the session ‘The Challenge of Pain’ as a doff of the hat to Pat Wall, the founder of modern pain biology, who wrote a book of that name. It was Wall’s work that resulted in the development of the TENS machine.
Three days, three events
On the road…
The roadshow put on by Adcock Ingram was very high quality from start to finish. They really wanted to make sure that every detail was covered. This was appreciated by the attendees who were most enthusiastic about the event. There was a new precedent being set, and the beginning of a new engagement between Adcock Ingram and therapists/clinicians.
I was particularly impressed by the way that the sales team approached their work. Selected and led by Juan Schaerer and Sheila Keshav, this group has come together in a short period of time. There was a great deal of positivity within the team, supporting each other, and getting jobs done from start to finish. I was privileged to be able to hear some the individual stories about how they came to join the team.
From a pain education perspective the roadshow was a great opportunity to talk about ways in which we can help people understand their pain and move on to improve their lives. That’s the purpose of UP. I hope that everyone else enjoyed their time as much I did. This was a super start and I will be very interested to learn how this story unfolds.
The Programme is now open to anyone suffering persistent or complex pain.
Face to face or Skype ~ reaching across the globe with Pain Coaching to improve lives
As the project has proceeded, I have been making changes to better suit the needs of the participants. Now I am delighted to be able to offer the programme to a wider audience — chronic pain is one of the biggest global health burdens.
Participants will receive 6 free Pain Coaching sessions: an initial conversation to understand the person’s narrative, clarify what is important to them, what they want to achieve and outline the steps forward. The next four sessions focus on practical tools: e.g./ practices, exercises, strategies, habits of peak performance. The final session is a summary and an opportunity to look at ways to keep momentum.
The schedule is pretty packed with talks and meetings, yet there is always time to run. Running gives energy for all else.
Starting in Johannesburg where we arrive tomorrow morning, the Klipriviersberg Nature Reserve looks like a great place to get into nature. The second leg sees us in Durban where we have the beachfront as a backdrop. I went there in 2003 on an England Women’s Rugby tour when I was a team physio. The beach was a place to move our bodies, enjoy the sun and the waves, to recover and relax.
Finally, Cape Town where I have not been before. Many people have told me how great this city is to visit. I can’t wait!
#upandrun 12 route from Gloucester to Bath, taking in the Cotswold Way
I started running along the road towards Birdlip to pick up the Cotswold Way. It was just after 530am, the streets were quiet and I was on my way. The streetlights came to an end as I reached the edge of town and began to climb.
In the darkness with my head-torch illuminated, I could see on-coming cars in the distance and I hoped they could see me. Running along close to the narrow grassy verge, I continually created an escape plan in case I needed to take evasive action. That plan, which fortunately I did not have to use, was simply to dive into the bush. I thought it through what seemed to be every few seconds.
The sun was just starting to rise as Cotswold Way signs appeared, the trail bisecting the road. I turned right onto the path that immediately started winding its way down into the woods. It was soft underfoot, with occasional muddy patches, but perfectly passable and even supporting a steady running pace.
Running a trail is the perfect time to be present. The ever-changing pink sky delivered a backdrop for the unfolding scenery as I trotted along. Noticing the changes in light is something unique to being in the countryside, almost moment by moment. It is easy to miss, especially in a town or city.
It felt like it was going to be a good day. I had a plan for fuelling, learning from previous ultras that it is important for me to keep it regular, so a snack every 10k. I was loaded with bars, Kendall mint cake and other snacks, plus I was confident that I would come across a cosy cafe serving great coffee and offering respite. That didn’t appear for quite some hours though…
Mud, bogs, rain, wind
The trail was starting to become muddy, slippery and skiddy. My Speedgoats were helping me stay upright, although I had to slow my pace to navigate these patches. Over the day, I only fell once, imprinting a sizeable brown mark on my left buttock.
Losing the trail in a small Cotswold village, an elderly couple pointed me in the right direction, warning that the field I was about to cross was steep and very wet. It was. That was the end of having dry feet for some hours.
Rain was forecast, so I was not surprised when I noticed a few drops on my face. Playing it safe, I donned my waterproof. That, was a wise decision. Within moments the rain was coming at me sideways. On off went the showers for the rest of the day, mainly on from what I recall. The wind whipped around me, especially on the exposed hills, resulting in a crouching style of running that probably did nothing except make my thighs work harder. Note to self.
It was not the water from the sky that was slowing me down though. It was underfoot. I was fortunate not to lose a shoe as I squelched my way through and round fields that were utterly waterlogged. The animals I passed looked at me and wondered what I was doing. This was the sense of their expressions anyway.
How grateful I was when a farmer gave me directions along a lane rather than over his field, which did not look like a field. It was more like the top of a moist chocolate cake.
On I went.
The Cotswolds Way is far steeper than I had anticipated. Mind you, I do like climbing a hill. There is great satisfaction on reaching the summit and looking back to see where you have stepped and taking in the scenery. King of the hill.
There are moments along the way when you ask yourself why? Pain, cold, wet, miserable weather are all reasons to stop. They are also reasons to go on exploring and discovering. That’s the beauty of ultra. Rolling with the ups and downs, the successes and challenges, one foot after the next. There is no stopping the stream of conscious experience that continually delivers the plethora of unplanned feelings, thoughts, sensations, sounds and other appearances. Noticing this is being mindful.
And so, after about 13 hours, Bath arrived out of the darkness in the distance. The last kilometers followed alongside the A46. The sun had long gone, replaced by a blackness pierced by red and white car lights. Back into urbanity, running along the city streets towards the pizza and beer that had so clearly formed in my mind.
The day ended at 90k. I am looking at when I can move this on to a 100-miler, the next natural step. My feeling is that a supported run would be best, but we will see. The next #upandrun will be in South Africa where I am heading in a week’s time to give a series of pain talks — read here. The plan is to take in Table Mountain within an ultra of around 50k.
In a week’s time I head off to South Africa to deliver a series of Understand Pain talks. This is a great opportunity to connect with clinicians, therapists and others who work with people suffering pain. Invited by TensCare, we will be working together on this tour to educate, enable and empower people to provide best care for pain.
TensCare: We provide drug-free pain relief for the long-term treatment of chronic pain conditions and the relief of the acute pain during childbirth
One of the main issues and reasons why pain is such an enormous global health burden is the misunderstanding of what it is and how it arises. The predominant approach remains biomedical despite the fact that this model does not deliver solutions. Society needs us to build on our knowledge about pain and offer person-first care: it is the person who feels pain, not the body part.
In brief, I will be talking about the purpose of pain, why it persists and what we can do to help and encourage people to move on and live fulfilling lives in their own unique way. This is using strengths based coaching together with the latest pain and related sciences, focusing on meeting the person’s needs. This is the essence of Pain Coaching, which is a skillset and way of delivering care that sees a person first, not a patient or a list of problems. Instead, we see someone with strengths and the potential to improve their life. We guide and facilitate this growth in a positive way.
My hope and aim as ever, is to bring the latest understanding and thinking about pain to society in a practical way.
Towards the end of the trip I plan to run #upandrun 13 in and around Cape Town, taking in Table Mountain. This is the awareness raising part of the Understand Pain social enterprise work, as I continue with monthly ultramarathons.
“I can see the world”, were the words of a person who learned to be upright. Early reflections on the UP OA Pain Coaching Project
I love hearing people’s realisations, uttered as they experience something new, with wonder, curiosity and excitement. This was someone participating in the UP OA Pain Coaching Project, who learned to be more upright and hence had a new view of the world.
It sounds so simple to be upright, yet it takes practice. We can train ourselves to use our body in a more efficient way seeking thoughtless, effortless movement, yet with awareness of having a body. Disconnection with the body for reasons of persistent pain or trauma are common. Reconnection with the body then, is an important part of moving forward, together with whatever is most important to us in our life.
The focus of osteoarthritis treatment is usually upon the area that hurts. This frame of reference needs widening as it is the person who feels pain (and other symptoms), not the body part. Further, the biology of the experience of pain and stiffness, and any other perception, exists far beyond the location of the actual feeling. To feel pain, we need a sense of the body area, a nervous system, an autonomic nervous system, a sensorimotor system, an immune system and more. What we don’t actually need is the body part. Confused?
Consider phantom limb pain. The limb is lost yet the person feels pain in that space. The simple fact is that pain and injury, or pain and pathology, are poorly related. This is why purely addressing the bit that hurts is not adequate.
You may think that in an acute injury this will be enough. I sprain my ankle so I treat and look after the ankle. Many do this. But the body (person) keeps not only the score of the injury and response, it will craft adaptations that can only be addressed by considering the whole person. Failing to do this means that protective responses and habits, formed at the outset, can persist and create further problems or on-going sensitivity. The idea of a quick fix is largely to blame. There is no quick fix. There is only complete treatment and rehabilitation of the person if you want the best outcome.
UP OA Pain Coaching Project
We are a month in, some nearing the end of their course of sessions. It’s been fascinating to look deeply at people’s experiences and beliefs. This project is an opportunity to reflect upon and study Pain Coaching, identifying key moments in conversations and themes that arise.
The purpose of UP is to improve the lives of those suffering chronic pain. Beyond building insights into the coaching process for pain, the UP OA project is a great way of reaching into the community and helping people understand their experience and learn new ways of moving forward.
I will be posting reflections each week.
If you suffer osteoarthritis pain or know someone who you think will benefit, please contact us here, putting OA in the subject bar. We have opened more free places.
UP moves into the 3rd week of the OA Pain Coaching Project. There are more places available if you suffer pain from osteoarthritis…
We started the UP Pain Coaching Project for osteoarthritis pain three weeks ago, and so far it has exceeded expectations. Motivation has been high amongst the participants, keen to learn different ways to improve their lives. Most have signed up for face-to-face sessions at the New Malden Diagnostics Centre, but we can also use Zoom/Skype if you live afar.
“I realised by the time I’ve got here this week my joints already feel better.” (A participant at their second session)
The free programme consists of 3 interrelated steps
Clarify your picture(s) of success
The types of questions you explore:
What are the real results you want to achieve? (This is your direction)
What is the ideal self you want to work towards?
What is really important to you in your life?
How committed are you to the programme?
How and why is it important to you to make some changes to improve your life?
Understand your pain
What you will understand…
What is pain?
Why does pain persist?
What causes and influences my pain?
What positive action can I take when I am in pain to feel better?
Positive action: exercises, strategies, practices and tools
On clarifying what you are working towards, we design a programme for you. The content will depend upon your picture(s) of success. There is a huge range to draw upon, some of which are daily proactive practices, and others that expand your choices for dealing with challenging moments. All are in line with the results you want to achieve.
Your toolbox can include: movement, mobilisation, sensorimotor training, breathing, relaxation, sleep strategies, periodising your activities, exercise, increasing activity levels, connecting with what is important to you (people, places, purpose), self-coaching and motivation, imagery, how to form better habits, prioritising, mindfulness practice and more.