chronic pain – understand pain

Pain the week before a marathon and during: what can you do?

September 26, 2022Richmond Stace | The Pain CoachLeave a comment

Pain before and during – what can I do?

With the famous London marathon coming up this Sunday, there are a few nerves in the air. That’s completely normal and part of the journey. As is excitement!

What’s the objective this week?

To get to the start line!

You may have heard of maranoia. All those thoughts, feelings and bodily sensations that can pop up the week before: am I ill? Have I injured myself? I’m so emotional etc etc. Again, all normal part of the journey.

You have put in the best training that you could over the past months. The day is the icing on the cake. The fun bit!

It is an amazing day. For me, because of the people—your fellow runners and the crowd. Each has a story.

Advice: immerse yourself in it! Take moments to look around and be present with what you are doing and what is happening.

Pain before

Some people will have pain that they are now worrying about. Especially if it has cropped up recently.

So here are a few insights that may help you. Then some ways to deal with pain during your run.

Have you actually injured yourself? If so, you can seek help and advice that may help you get through the day. Remember that you just want to get to the start line. As long as the injury is not serious, you may just get through it. Amazing what you can do by focusing on your purpose and why the marathon matters to you.

If the injury is significant in terms of tissue damage, it’s unlikely you will be able to take part. This is hard to deal with when you have put in all the effort. But remember, you have put in all the effort! The process offers invaluable learning about yourself and what you are capable of achieving. To choose not to run can be a wise yet tough decision. You can now focus on recovery and using your new knowledge and training history to shape a positive future in a different way.

Sometimes there is no significant injury but there is pain. That’s because pain and injury are poorly related and are completely different entities.

Maybe it is a minor tweak or simply a manifestation of a length training period. Whatever, it’s a message or information for you to act upon. Seeking advice to understand your pain is key.

Worry, concern and fear can all effect your pain. The pressure you put on yourself, the stories you are now telling yourself can create stress that amplifies the pain experience.

What happens if you use calming practices such as breathing, mindfulness and easy nourishing movements?

In many cases, the aches and pains are part of the maranoia experience. I typically feel achy and fluey, and notice various pains in the week or so before an event. It’s just what my body systems do.

In response, what can you do?

1. Keep moving, all within your window of tolerance (some aches and pains but essentially good experiences of movements): tapering runs, mobility, yoga etc.

2. Breathing, mindfulness, relaxation

3. Good fuel and hydration

4. Prioritise sleep

5. Minimise stress where possible—focus on what you can control and not what you can’t

6. Keep focused on your picture of success and the step you can take right now

7. You are creating the conditions now, in this moment, to maximise your chances of getting to the start line.

If you unsure, do seek help. Make sure who you speak to knows their stuff; ie/ expert in pain and running.

Pain during

Inevitable for most people, if not all.

Perhaps you have learned some strategies that you have practiced during your training.

There are many ways to handle pain during a marathon. Having a range of tools is important because at different times you’ll need different strategies. You can scroll through until you find the one that works in that moment.

Here are 10 examples.

1. Have a snack

2. Have a drink

3. Remember your purpose and the people you are running for

4. Create a mantra you can use, or several. You can write it on your hand.

5. Zoom out: reassure yourself that you are ok, then look ahead.

6. Zoom in: some people find that focusing on the pain brings an initial increase but then ease. Why? Because being open to the experience allows it to pass through.

7. Chat to a fellow runner

8. Listen to the crowd

9. As you are running along, imagine running smoothly and confidently

10. Focus on a part of your body that feels good

Bonus…. From Eliud Kipchoge….

11. Smile 🙂

Good luck from me! Onwards!

Stuck?

October 5, 2021October 5, 2021Richmond Stace | The Pain CoachLeave a comment

Client not progressing as you hoped due to persistent pain?

You are trying your hardest to help them, but whatever you try does not seem to work.

We have all been there.

It’s so frustrating.

And we often start blaming ourselves. Or them.

But…..

There’s a way forward

When you understand pain and the reasons why it can persist you will see a way forward.

You become unstuck.

Join my webinar on Tuesday October 19th at 7pm to find out how.

Reserve your place here.

Richmond Stace
The Pain Coach | Pain Specialist | Chartered Physio | Hon Clinical Lecturer

Takeaways

What is persistent pain?
Why does it persist?
What can we do to help people move forward and get results?

Q&A

Bring your questions.

What do you want to know?

What is one question that would make a difference to you?

You can email me before if you like: richmond@stace.com

2 giveaways: where am I going?

I will randomly pick 2 people from those who ask questions (whether answered or not).

They will be invited to a free Pain Coach Mentoring session that will help you take the first step towards your ideal career.

See you there!

Here is the link again just in case: click here to get unstuck

Dealing with disappointment

September 27, 2021September 27, 2021Richmond Stace | The Pain CoachLeave a comment

Twice I have pulled out of events this year. It does not feel good.

A deep disappointment and regular waves of regret. There seem to be reminders everywhere.

In May I stopped halfway into a 100k race. I also took a wrong turn that meant I had to run 12k back to the start — 62k total. Should have just kept going, part of me said.

This month I pulled out at 90k along the South Downs Way. Should have slept for a bit and then kept going, bit by bit, part of me said.

That part of me always chimes in.

How to deal with the disappointment?

Three ideas to share with you.

1. Take a perspective

Zooming out, I quickly realised that whilst it matters, there are other considerations.

When you look at the bigger picture of your life and those around you, how does that feel?

2. In that moment, you made the best decision

There are always circumstances. Some things we cannot control and some we can.

What were the circumstances surrounding that decision and action?

What could you control?

3. The art of setting one’s expectations

I spend a lot of time working with people on the skill and art and practice of setting expectations.

When we set them too high and what actually happens comes in low, we feel bad.

Or we push on when we should stop.

Neither works.

What is realistic? You can certainly be positive in as much as you focus on what you can do, but tied with what is possible.

Positive realism.

If you think it might be possible, break the task into chunks and take it steps by step – achievable steps.

Your ideas

There are many other ways to deal with disappointment.

Of course, it is inevitable in life. So having skills to deal with it is better than being surprised.

What do you do to deal with your disappointment?

Do share your thoughts so others can benefit.

Tapering

August 30, 2021August 30, 2021Richmond Stace | The Pain CoachLeave a comment

I used to think tapering meant feet up, hardly any running and lots of eating for a week or so before the event.

Wrong!

For pro advice, you can read about tapering with coach David Roche here. For anecdotal experience, read on.

How I used to taper

I looked forward to the tapering week, sometimes two. Take it easy, occasionally run a few k’s. By a few I mean 3-4. So very little.

It meant a week or so of eating whatever I wanted. Awesome!

Days of sitting around, usually reading. That’s not so bad. There’s always something to learn.

But there was something that quite right. Reaching race day as I did in May this year, I felt heavy. Heavy legged.

My overall programme, which could be named hit and miss at best, was ending with a slothful period.

What was I thinking?

To put on a positive spin, it was a learning experience that has led to something much better.

How I am tapering now

Good training is sustainable training
David Roche

Tapering is part of the programme. With a measured, gradual approach to building fitness, speed, resilience, quality movement, stability and more, I have no need to spend a week or two resting to recover.

Been there…..

The week before SDW 100 miler, my training now looks like this:

Saturday: 20k easy on trails, hilly not steep. Run down hills with brakes off (building courage and skill)
Sunday: 10k easy + 4 x 30 sec hills (fast & smooth)
Monday: rest day, stretching/mobility, breathing
Tuesday: 10k easy, core/stability training
Wednesday: 8k easy
Thursday: 5k easy
Friday: 5k easy
Saturday: SDW

Feeling rested, ready, and relishing the opportunity to hit the trail next Saturday.

Now that is tapering.

Daily practices

Several times a day I stretch with micro practices dotted through the day – balance, stretch, mobilise, massage gun, roll, yoga pose, mindful breathing.

Most days I will sit and meditate. Other days are micro meditations of a few minutes. I am lucky because I get to practice with people most days as well in the clinic when we look at different ways to change state, create calm and clarity to help overcome persistent pain.

Walking. I walk everywhere.

Standing. At home I stand to work. In the clinic, I get up and move around often as a matter of course.

Our mind’s are embodied. Thinking emerges from the body state and the body state can depend upon what we are thinking. There really is no separation. We have just the one experience.

Hence, movement is a fundamental part of being at our best.

Upandrun.

Onwards.

RS.

PS/ If you would like to support the work of St Wilfrid’s Hospice, please donate here. We are over half way to the target, so your help is much appreciated.

The team looked after my dad and us so well in his final days. To help them continue this vital end of life care is so important to our society.

Thanks

upandrun 21

October 26, 2020October 26, 2020Richmond Stace | The Pain CoachLeave a comment

Back on the trail tomorrow for upandrun 21

Tomorrow is my birthday. My present to myself is to run from home to where I was born for upandrun 21.

21 is not my age.

The idea came from the Pegasus Ultrarunning guys. They have created an Ultra Marathon Birthday Hall of Fame.

Of course, the primary purpose is to raise awareness of the problem of chronic pain that besieges so many people across the globe.

It is also to share hope as our knowledge and understanding of pain advances at a rapid rate. As a result we can help people shape positive futures.

Further, ultrarunning is a way to experience one’s own pain and learn — blog here.

The route

It is a mixed bag. A good amount of the trail will be along the South Downs Way as I head from Ditchling Beacon to Eastbourne.

From there I will find my way along the coast to Hastings, where it all began. I don’t remember that day, but I know it happened.

The distance will end up around 80k I would suspect. Time? No idea. I always get that wrong.

One of the beauties of heading off on a long bimble is the loss of a sense of time. I often have no idea of the hour. There is only this moment. Truly present.

As ever, pics will be on social media.

Instagram | Twitter | Facebook

ultrarunning to understand pain and share hope

October 10, 2020Richmond Stace | The Pain CoachLeave a comment

Heading off to the Menai Bridge for September upandrun

There is a purpose for my ultrarunning, and it is mainly to share hope.

You may have seen the tagline I was using for the September upandrun: ‘ultrarunning to understand pain and share hope’. Here is why.

Ultrarunning to understand pain

Running for long distances means being on your feet for hours, moving along. On the journey, you discover much about yourself — you find out what is under the hood.

Under normal circumstances, we use our resources to deal with challenges as they arise. Life is full of uncertainty (more than certainty), twists and turns. That is the way.

What we can do is to focus on controlling the controllables. What can we control? Our approach and attitude.

Suffering comes from the way that we think about any given situation. Prior to this, it is merely a situation. This has long been realised by philosophers and others.

Life is a journey — cliche yet true. How do you approach the journey? How do you deal with things when they don’t go your way? The style that you use will determine whether you see it as an opportunity (to learn) or an obstacle?

Ultrarunning is the same. You set out on a journey that will be full of unknowns. When you are trotting along and feel great, it is wonderful. What about when you are in pain, feel sick, are hit with fatigue and hunger and thirst and more? How do you respond? How do you keep going?

The concept of the pain cave describes the place you can go. It is dark.

But, there is ultimate learning about oneself in the pain cave to the point that many embrace the experience.

Pain is inevitable on an ultra.

You become your own experiment (n=1) as you examine your perceptions and thoughts shaped by the very actions you are making. When you change the way you move, your thinking changes — embodied cognition at work. Thoughts are very much grounded in the state of our body, and the state of our body is determined by the focus of our attention. Expectations also play a significant role — we see the world that we expect to see.

As inevitable pain emerges, the opportunity arises to closely examine the sensations and how they change. Different perspectives and different language all shape the experience. Noticing a shift in running pattern, perhaps leaning forward or the head dropping, one can lift and be taller to notice the change in perspective.

What is the story I am telling myself in these moments? If I alter the words, what happens? I notice how attached I am to that particular narrative and how easy or hard it is to let it go. Bringing my purpose to mind, or a loved one and there can be a sudden transformation of state.

Heavy moments are normal. Body, legs, head suddenly feel like sacks of wet sand — have you ever tried to move one? But you know that this will pass, like all perceptions. Nothing is permanent. This insight alone pulls me back from the mire of thoughts.

Our perceptions and bodily sensations are dynamic — always changing. Life is not static, instead fluid and moving onwards. It is the story that stays the same. The one we have been conditioned to believe is true.

Then you realise that there are infinite stories and possibilities. Freedom.

Ultrarunning teaches you about freedom.

I can examine my own experiences under duress and elucidate my resources my journey continues. The finish line is of course the beginning of the next.

Sharing hope

My message is one of hope.

Both the knowledge of pain and what we can do to guide, support and encourage people to live fulfilling lives has grown enormously.

We have much better answers to the questions (start here):

what is pain?
why do we feel pain?
what is the purpose of pain?
what can we do to improve our lives?

Many of the strategies, practices and techniques to transform and overcome pain are taken from the skills of being well, peak performance and strengths based coaching. Over the past 10 years or so, I have called this Pain Coaching.

There is a simple principle. The more you focus on the pain and try to treat it, the worse the outcome. The more you focus on the person and how they want to shape their life, the better the outcome.

Focus on what you want, not what you don’t want. As soon as you are saying, ‘I don’t want this pain’, we focus right back on the pain.

Instead, re-focus on your picture(s) of success and the steps you can take right now in that direction. This is an approach and an attitude. You will need some help, it will be up and down, but

There is great hope for many. This is my message.

September upandrun

September 20, 2020Richmond Stace | The Pain CoachLeave a comment

Richmond's route for September 2020

September upandrun ~ Bangor to Chester

This month sees the return of the 100k + distance as I trot along from Bangor to Chester.

For some time I have been chatting with Jeff, an UP ambassador, about running together. So, I am delighted and excited to say that Jeff is joining me for the last leg — I will be on my last legs, that’s for sure!

Jeff is a great encourager. He is a coach, a facilitator, a writer and much more. Jeff has a book coming out soon, which I know will be superb. I am going to ask him to write a blog about it.

I also have crew for this one. Jo, my wife, has agreed to drive along the route and keep me supplied. She will be ably assisted by Chico.

Chico will be part of the support crew — Chico

Here’s the plan:

Drive up to Anglesey on Sunday. Set off around midnight, wrapped up and be-torched.

Make my way along the coast line through the night. Meet Jo and Chico at dawn with fresh supplies.

Keep going.

Find Jeff.

Keep going.

Have a beer and a pizza.

Lie on the back seat and be driven home.

Why?

To raise awareness: pain is one of the largest global health burdens affecting millions and costing billions.

There is much we can do as a society.

It starts with understanding pain. From there, people can feel educated, empowered and enabled to move on and shape a positive future.

This is the purpose of Pain Coaching, an approach I began pioneering around 10 years ago.

Thanks to…

Recently I started using Wholy Me organic products: the drops and the balm.

The drops I use each day, morning and evening. The balm I apply, using self-massage, as needed. This is quite often as I usually have some aches and pains from training and running.

I have no other me to compare, however, my own experience is certainly one of overall calming and soothing on a day to day basis. The balm relieves my local soreness. It is a great combo.

Recently, I had a chat with Celine from Wholy Me on Instagram Live. I shared my thoughts and experiences. The Wholy Me Instagram page is here.

Here’s the blog that Wholy Me wrote about our conversation.

I will certainly be taking my drops and balm with me!

Please share so that we can give hope!

Over the past 5 years there has been a significant increase in the understanding of pain as a perception. This enables us to offer a wide range of practices, exercises and ways to help, guide and support people along their journey to improve their lives.

See the Resources tab on the site for articles and talks, and more on the Specialist Pain Physio site; podcasts and blog (Richmond’s clinic site)

You can see the photos from September upandrun on Instagram and Facebook and Twitter.

upandrun 13 Table Mountain

May 7, 2020Richmond Stace | The Pain CoachLeave a comment

At the end of the Adcock Ingram roadshow in South Africa, I tackled Table Mountain for upandrun 13. It was awesome, but much tougher than I expected.

In another time, when we were able to travel, I was in South Africa. It was March 2020.

I had been invited to give a series of talks on the Adcock Ingram roadshow to launch their Sports Science and Rehabilitation division. My host was TensCare CEO Neil Wright.

Thanks to TensCare for sponsoring upandrun 13

visit TensCare Pain Relief and Therapies for a range of devices for pain, maternity care, continence issues, pelvic floor and muscle stimulation

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.

Richmond and Nick the speakers — Richmond and Nick selfie

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.

Sunrise

View from Lion's Head

Lion's Head

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.

Flora on Table Mountain

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.

The sea

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.

UP on the road in South Africa

March 18, 2020Richmond Stace | The Pain CoachLeave a comment

The end of a successful roadshow: Neil Wright (TensCare), Juan Schaerer (Adcock Ingram), me, Nick

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.

Richmond giving Pain Coach talk — Johannesburg audience

TensCare and TENS

TensCare is an employee owned company, distributing TENS and electrotherapy machines all over the world. One of the main reasons to use TENS is for pain relief, in both acute and chronic pain. It is probably best known and most used in maternity care.

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.

Richmond Stace The Pain Coach in South Africa — Cape Town 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.

Pain Coaching Project UPDATE

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

Pain Coaching Project UPDATE

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.