back pain

Jen’s story

January 15, 2020Richmond Stace | The Pain CoachLeave a comment

Holding a yoga pose — Jen holding a yoga pose

In Jen’s own words…

When asked to write a ‘brief’ insight into my story, I questioned whether I could do this. I thought to myself ‘my story is far too complex to be able to sum it up in a short few paragraphs’. But then I realised how throughout my journey so far, when I have been faced with a challenge I step up to the mark, and I make it happen. So, here is my story:

Growing up I was a happy and healthy child who lived and breathed sport. And I was very successful with both my academic and sporting achievements. From the age of twelve I was playing cricket for Kent, representing Kent for Cross Country Running and Athletics as well as participating in any other sport where I could find the time. Life was good as a child, and I loved every moment.

However, in my teen years I developed anorexia nervosa which lead to a hospitalisation in my early twenties. I was in a critical state when admitted to hospital and there was little hope I would recover. However somehow, someway I managed to find some inner strength, determination and drive to want to recover from this illness. And so I began a long journey to restore my physical and mental health. I had a vision of leaving the hospital and being able to return to my sport, and continue working towards my goals of representing Great Britain at either cricket or running (I hadn’t quite decided at that point).

Someway into my recovery I began to experience pain in my back. To begin with this pain was leaving me in tears on any movements. And it soon began to spread, I started feeling pain in my feet, knees and hips. For me this was not only an immense source of suffering, but it was puzzling as previously I had only ever experienced pain through injury during sport. So, like most people we began to get tests, scans and multiple visits to countless health care professionals including physios, psychotherapists, doctors, hypnotherapists, movement specialists, nutritionists, the list was endless. I was in desperate search to see if anyone could shed some light on this unexplained pain. This went on for a good couple of years, all the while my hope gradually fading before my eyes as I struggle to walk for five minutes without breaking down or sit through a coffee date with a friend before becoming in terrible discomfort. This led to a desperate google search, which became a moment I will never forget. I vividly remember laying on my bed one evening, crying and typing in to google ‘success stories of overcoming chronic pain’. And this search led me to Richmond Stace. I instantly knew at that moment I wanted to work with Richmond, to try something different. And what an incredible decision that way.

My first appointment with Richmond was similar to many, myself walking in depressed and clearly rapidly loosing hope. Yet upon leaving my energy had changed completely, and my mind was fixed, pain can and will change, I can do this. Over the coming weeks Richmond taught me what pain was and I began to understand that I can influence this pain simply by choosing my thoughts, feelings and actions wisely, always keeping them inline with my vision, to be happy and healthy. Richmond provided me with tools such as mindfulness, visualisation, motor and sensory skills, the power of gentle touch and lastly he empowered me to know that I can and will live a fulfilling life.

We worked slowly, acknowledging that i had also been diagnosed with osteoporosis from my eating disorder so we were mindful of this when putting plans and programmes together for me. And the changes in my pain and happiness were incredible. Within a few weeks I was doing things I had longed to do for so long, I was back out walking pain free, I was in the gym, going to yoga, I could swim. Running and cricket were being held back for the time being until my bone density improved but they remain goals in sight. Richmond’s approach was one that was so different to any other practitioner I had seen before, but one that truly changed my outlook on pain.

Four years later, I now have a 1^st Class honours degree in Sport and Exercise for Health, I have a distinction from my Masters degree in Clinical Nutrition and Eating Disorders, and I am now pursuing a PhD at Griffith university in Australia exploring the effects of low energy availability on injury risk and sporting performance in athletes. I now enjoy going to the gym most days of the week, I am a qualified yoga teacher who practices most days and I love nothing more than a long walk in nature. There is a famous quote that says ‘don’t look back you’re not going that way’, but I don’t like this quote because for me sometimes looking back is truly remarkable, as it allows me to really see how far I have come. From a place of suffering, from a place where all hope was lost, from a dark depression, to now being in a place where I moved on significantly, I am living a fulfilling life, living an adventure. I would be lying to say I am free from my issues with pain, I still get some periods where I experience pain like I previously did, and occasionally I find myself slipping back into old habits. However, I soon realise this does not benefit me in the slightest, so I turn back to all the tools in the toolbox I now have to overcome difficult times. If I experience an increased period of pain, my instant reaction used to be ‘this is a disaster’ and I would seek out physios, doctors, pills and potions to try to find a quick solution. But through my increased knowledge and understanding of pain I no longer react in such a way, instead I now view these experiences like this ‘ok, I feel you. What is the next best decision I can make that is going to help the situation (whether that be rest, movement, sleep, mindfulness, 3 deep breaths, laughter, food/ drink, meeting a friend) that is in line with my underlying vision of health and happiness’. Ultimately my next decisions always try to reduce the threat level, to reassure my body and mind that I am ok, I am safe. I have leant to observe my thoughts, feelings and actions and change them if they are not serving me well or if they contribute to suffering in any way.

I will never be able to thank Richmond enough for his ongoing help, support, guidance and encouragement during this stage of my life. Not only has he provided me with so many tools to overcome chronic pain, but also I have learnt so much about myself, who I am, what I want, my visions, goals and not to mention to wonderful books I have been guided too along the way. Richmond you are truly incredible and I thank you from the bottom of my heart.

So, for anyone out there who may be in that dark place right now, please trust me when I say, pain can and does change, when given the right environment to do so. Our experience of pain is influenced by our emotional state, fatigue, prior experience, our beliefs, our environment, our anticipation and expectation about pain. This can seem overwhelming however it is also truly empowering because having so many factors that influence pain means there is so much opportunity to change pain, because after all we are always changing. So, in this moment don’t be afraid to leave the shoreline, dive in and explore, along the way you will learn there is real depths to explore. There may be some darker patches, and inevitable challenges, and every now and again you may feel like the waves crash down on you. But trust me there is a shimmering horizon that calls you, and this is a journey that will ultimately take you towards that horizon. So, reach far, reach wide, take those meaningful steps, even if you need to tip toe forward to start, begin now and know there is a meaningful life out there for you too.

—

August 6, 2016Richmond Stace | The Pain CoachLeave a comment

In a recent Daily Mail Good Health, an article boldly claims that an ingenious new approach to back pain could transform your life. This is indeed a big statement to make about one of the largest ‘public health’ issues — chronic pain and depression are the top 2 global health burdens.

The authors describe the biopsychosocial model for pain (BPS) that incorporates factors relating to the biology, psychology and sociology of pain. This is the model claimed for most modern pain services, although whether all are fully addressed in an integrated manner is a separate point. It is good for the BPS model to gain some air time as it is certainly a step forward in the right direction compared to the dominant biomedical model that would suggest we need to look for a structural or pathological reason for pain. For anyone with even a basic knowledge of pain, the biomedical model will be deemed outdated and lacks any use for understanding persistent pain. This is simply because pain cannot be explained by a structure or pathology.

For the first time, perhaps ever (in my memory), I was delighted to read about danger signals rather than pain signals in the public press. This is a vital piece of information as we do not have pain signals or pain centres, instead we have a biological system that detects salient events and orientates our attention — termed the salience network by Giandomenico Iannetti and colleagues. Conjoining this model with current models of consciousness, AI and brain (e.g. predictive processing) and you are getting somewhere near a very, very good way of thinking about pain. Of course we have some way to go yet and need to be careful about how we frame the current knowledge in terms of existing data.

There are many biological and behavioural changes that occur when we have back pain and other on-going pains. We change with every moment as every moment is unique. We feel that we are the authors of our own inner dialogue and this often means drifting into the past or future, becoming embroiled with what has been (as far as we can recall) and what may be, but of course neither actually exist despite the embodied sense we have in that moment. Keeping a close eye on what is in front of us, also known as being present, helps us to see what is really happening versus a story that we construct. By regularly thinking about a painful event in the past, we can easily ‘prime’ or sensitise this moment. Equally by anticipating pain or projecting ourselves forward by imagining that a movement will hurt, we change our way of moving and the sense of our body as anxiety and tension emerge. This is one of the reasons why awareness of one’s own breathing helps.

An important aside: It is important to clarify here that although we talk about the mind, thinking and emotions in relation to pain, the actual experience of pain emerges in the person and is felt in the body or the space in which the body should reside (for many biological reasons). The notion that pain is in the brain or in the head is nonsense. And, we are more than a brain.

Turning one’s attention to breathing means that you are being aware of this moment, now. There are other important ways of cultivating this skill, which allows you to think clearly about what action you can take to create a new experience, a better experience that takes you towards your desired outcome. Additionally, on the out-breath we naturally relax as the parasympathetic nervous system increases its activity. This is opposite to the sympathetic that is involved with protection in the face of perceived threat. And this is really what pain is all about.

In the face of a predicted perceived threat, we can feel pain as part of a whole person defence strategy. There is no pain system. Instead systems that have a role in protection: musculoskeletal system, sensorimotor system, immune system, endocrine system, autonomic system. Then consider how systems support each other as they are all integrated: the gastrointestinal system’s role in providing nutrients to energise the other systems — consider how many people with persisting back pain also have digestion issues as their resources are diverted away from digestion and towards protect. So, more threat to ‘me’ (the self — that’s a huge area to discuss alongside consciousness), more pain. Less threat to me, less pain. How often will a person report an increase in pain when they perceive to be in a threatening situation. The beauty of this is ‘perception’, because we can change it. So in changing our perception of threat we can change our pain. We are designed to change so we can use this biological advantage and with practice become good at it. Remember, pain and injury have a poor or absent relationship — consider phantom limb pain. There is no body part yet there is most certainly pain.

Our understanding of pain has moved on enormously over the past ten years. We are in a very exciting time now as we draw upon many areas of science and philosophy to advance this knowledge, asking new questions and gathering new data. The biomedical model is not sufficient and the BPS model has been a useful step forward but now we need to think about pain in terms of a public health issue. People need practical ways of overcoming their pain moment to moment, coaching themselves so that increasingly they generate their own better and better experiences driven by internal messages as they motivate themselves to a healthier life. This is the reason for my term ‘Pain Coach’ as the individual becomes their own coach using continuously updated thinking and actions to get better, overcome pain and resume a meaningful life.

Functional Pain Syndromes — e.g./ IBS, headache, migraine, fibromyalgia

September 22, 2015Richmond Stace | The Pain CoachLeave a comment

Functional pain syndromes (FPS) are not uncommon and there are likely to be people living their lives putting up with a range of aches, pains and symptoms without knowing.

More common in women than men, though this maybe in part due to more women seeking help, functional pain syndromes account for a great deal of suffering.

Functional pain syndromes include:

Irritable bowel syndrome
Headaches/migraines
Chronic back pain
Chronic neck pain
Pelvic pain
Fibromyalgia
Chronic widespread pain
TMJ dysfunction
Bladder dysfunction (interstitial cystitis)

These are often accompanied by anxiety, depression (or low in mood but not actually depressed), hypermobility, perfectionist traits, early life stressors and complex lifestyles with demands or stress and difficulties that reverberate through the body as painful conditions.

In this recently published article, Richmond looks at functional pain syndromes, which can be overcome with the right understanding and action.

Article here

Andy Murray wins despite back pain

September 21, 2015Richmond Stace | The Pain CoachLeave a comment

Andy Murray wins despite back pain, a classic example of how the meaning and situation flavours the lived experience. Simon Briggs of The Telegraphsaid: “Not many players are capable of winning three points in a Davis Cup semi-final, as Andy Murray did to put Great Britain into the trophy match against Belgium in late November. But to do so with a bad back – an issue that Murray revealed only once the combat had finished – was a different story again: a quite exceptional feat of courage and stamina”. Pain is not well related to the state of the body tissues (joints, discs etc) but instead the perception of threat detected by body systems that protect us: nervous system, immune system, autonomic nervous system, endocrine system, sensorimotor system — one only has to consider phantom limb pain to realise this fact. One of the biggest reasons why persisting pain is feared is the belief that the severity equates to more damage or something more serious. You may also consider that some cancers remain painless and this is certainly serious. Pain is a protective device that motivates thinking and action to reduce the threat and restore normal physiological activity (homeostasis); it is a need state lived by the whole person — with ‘back pain’, it is the person who is in pain, not their back.

In Murray’s case, he was quite capable of focusing on the game, his body allowing this due to the context and the significance. There are many stories of sportsmen and women sustaining injuries and only knowing when the game is finished. We also had the scenario a few years ago when Messi collided with the keeper and experienced such pain that he thought his career was over. It was a bruise and he played the next weekend. The pain was still severe at the time though, reflecting the situation and the need as deemed by his body systems that protect. It works both ways.

Between games Murray may well have felt some stiffness, but he was able to re-focus. A few simple movements to nudge fluids around, ease off the muscular tension that is initiated and executed by the brain sending signals down via the spinal cord, perhaps a few reflexive messages contributing alongside the immune and autonomic activity. Context remained king though, as it was wholly more important to put all his attention on what was required to win than to start worrying about his back. That could be dealt with later, and indeed this is what happened as Murray did what he knew he needed to do to be victorious. All those top down signals, cultivated and delivered from a neuroimmune system, which countered those danger signals coming from his back (not pain signals — there are no pain signals or pain centres) — top down signals generated from his beliefs, expectations, mastery of focus and attention, as he hit flow, that state of being utterly in the moment. That’s a wonderful place to be and not a room where pain can enter.

Now that the game has finished, familiar aches and pains will flood Murray’s consciousness. There maybe additional and new feelings that evoke new thoughts and a need for re-assessment for the next best steps. These steps will need to include consideration of how Murray’s neuroimmune system and other systems that protect have learned to react (priming or kindling), the possibility of sub-conscious and environmental cues, expectations and of course an assessment of tissue health and function. From thereon in, a comprehensive treatment, training and coachng programme can address movement, body sense, neuroimmune-sympathetic-sensorimotor interactions to name but a few. It is worth pointing out here that such a programme is not unique to elite sports people, but a modern approach to pain and injury that should be accessible to all.

Richmond Stace

Richmond is the co-founder of a pain awareness campaign called UP | Understand Pain. Together with Georgie, they are using music and song to deliver the right messages about pain, particularly chronic and persisting pain; which are: