I have long thought that there should be a self-care module within physiotherapy training. Here is why.
Physiotherapy is arguably the best job in the world. Once qualified there are so many choices and ways that you can take ownership and forge a way forward.
I believe that there is a universal desire to contribute within the profession: to help people improve their lives and make it a better world. This in itself is healthy and helps build wellness. The latter is where we can make a real difference as we encourage, empower and enable individuals to shape positive futures — because they can.
There’s a but.
All this focus on helping others requires a strong sense of self and an absolute need for self-caring.
If you want to care for others, you must start by caring for yourself
There is a good chance that a number of therapists will be great empathisers. They will can can feel similar emotions and even pains described by others. There is a reverberation through their own embodied minds, which in time can cause stress responses and anxiety if not recognised — empathetic distress.
In one sense empathy is a gift that allows connection and understanding. Uncontrolled, this can lead to burnout. The answer to this appears to be cultivating compassion, which is boundless. There is an outlet in compassion that is a desire to help — taking action. When we take action there is a kind of release as we feel a sense of control and destiny with our chosen way of helping the person. (Whether they want our help and the kind of help we offer is another question! This is one of the skills of being a therapist).
A common way to practice compassion is with metta, or the loving kindness meditation. We develop our understanding and acceptance of ourselves, accepting that to take care of ourselves is the first step in caring for others.
This sits well with the person-first approach: person before patient. Certainly when it comes to pain, it is the person that feels pain, not the body part. We guide and encourage a person, not a body system or a limb. Zoom out.
The more the focus is on the place that hurts, the worse the outcome for a number of reasons: e.g./ attention and expectation play significant roles in pain perception. The more the focus is upon the person and what they want to achieve in their life, the better the outcome.
Each person has resources, knowledge, strengths and the potential to improve their lives. This is the start point, not a list of problems to solve.
It is the same for the therapist of course. A person with all the above.
How do you build yours each day?
To care for others we need to be well. Daily skills and practices that manage and lift our energy, help us to pay attention, maintain a positive outlook will keep us on a healthy path.
These are habits. Many are the same ones that we encourage the people we work with to create.
When I used to run Pain Coaching sessions for clinicians and therapists, we always start with you: ‘know thyself’. There is nowhere else to start. You have to gain insight into who you are, how you think and what you offer. From there you can build and be the architect of a fantastic career.
There are many ways to build wellness. The more obvious include exercise, moving your body, eating and sleeping well. There are more.
Connecting with people who encourage you, getting out into nature, knowing your purpose, breathing and being present more often.
As a start, I have created an infographic that you can use in your own way (download above).
My hope is that we see universities and colleges increasingly include self-care in the syllabus. Some methods and techniques are now outdated and should move aside, making room for the important practices. In my view, there is none more important that making sure therapists feel supported and that they are developing a strong sense of who they are as healthcare professionals.
Training is a huge investment, both personally and for the state. Surely then, we must ensure that the people undertaking this enormous commitment come first and are cared for by teaching them how they can care for themselves.
University lecturers and leaders, I am here to chat.
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.
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.
Have a beer and a pizza.
Lie on the back seat and be driven home.
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.
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)
My first year, what have I learned from ultra running?
I started ultrarunning at the start of 2019 as I prepared for a run around the Isle of Wight in May. My decision to take up ultra-distance came before.
In July 2018 whilst waiting for a mate, Chris, to finish Race to the Stones, I had a strong urge to give it a go. The vibe at the finish line was exciting and infectious. I loved the unconditional support for each runner as he or she finished. At the same time, I was wondering how it would be possible to run all day over that distance; 100k.
Soon enough, Race to the Stones was in my diary for 2019. How do I prepare, I wondered? That was when I came up with the idea of the Isle of Wight 106km challenge in two halves. This was to be my first experience of running an ultramarathon, trotting round the island. It was awesome and I was hooked.
In fact, I was so hooked that I quickly booked another race. This time it was a full-on 100k in one day from London to Brighton. And on it went.
At some point I decided that it should be monthly. Partly because I had a cause, #upandrun, and partly because the way to get over the last run is to organise another.
For some time I resisted calling myself a runner. I think that I now qualify. Plus Adharanand Finn told me so.
This is on the basis that I am out at least 5 days a week, covering 70-100k, and our habits form our self-identity. I also have a good collection of running books, often watch running films on YouTube, have a box of running shoes, a selection of hydration vests and running belts, headphones, and a pile of running clothes.
Also, I often find myself talking about running. Typically to myself or on #ukrunchat.
First up, a sense that I can and will complete the task at hand. I start here and end there. By whatever human means, I will make it to the other side. That is not to say that a DNF (did not finish) is not possible, as part of the adventure is the stretch, the push and the risk. Anything is possible en route.
The unknown beckons. Uncertainty is fuel as each moment unfolds, step by step along the changing terrain: trails, roads, fields and more. Each footfall is new and feels different.
Ending up somewhere that started as a mere pin drop on a map beholds a deep sense of connection with one’s own resources. These are available to us each day of course, no matter what we are doing.
Running an ultra is decidedly uncomfortable, which is putting it mildly.
The perceived bodily pain in the form of muscle and joint noise, stomach pains, the blisters, the chaffing, the rubbing from the straps and more.
You plan what you will do in the tough moments. Visualisations, mantras, music and plain old ignoring, all have their time. What can I focus upon? Some prefer a more mindful approach.
To be mindful is to be completely aware and present. There is no judgement: good or bad? Who knows? This is the practice. Noticing all sensations, thoughts and feelings as they arise and pass on. Nothing is permanent.
What do I learn from this deep discomfort? I understand my mind under pressure: what do I think? What are my leanings? How much am I prepared to endure to reach the other end? In essence, I learn what is under the hood. We all have much more than we might think.
Day to day, it means we can deal with the inevitable ups and downs of life with a clearer perspective. This allows us to make better choices.
Out in nature for hour upon hour, you cannot help but connect. Or reconnect. You see the planet as you pass through: the changing shades, shapes, sounds and smells.
Nature bathing or forest bathing enriches our wellness. At least two hours a week is beneficial. As a trail runner, you may be out for five to ten hours or more a week, sucking it all in.
Touching nature lets you into its secret world. Paradoxically, it is protective and nourishing, yet also a source of extreme danger if you stop paying attention. Rocks, cliffs, rivers, tree roots all create a wonderful landscape. But, lose touch with your body for too long and you may come a cropper.
Wrapped up with the immersion in nature, you realise the interconnectedness of things. As well as creating the perception of nature, ‘I’ am also within and part of that very nature.
During a race I am interconnected with other runners. It is a wonderful state of interbeing. We are all in this together, sharing the experience through our own unique lenses.
Both this and a sense of loyalty towards nature means that the world takes on a new importance as our collective home. Artificial boundaries dissolve.
One of the experiences I love most is reaching the top of a hill or mountain and absorbing the view. The feeling of awe is potent.
Our significance pales. Self-importance fades if it was there in the first place. How small I really am in this world.
It would not be a blog from me without mentioning the P word. This is not the same as discomfort. I somewhat blended these above.
Western culture promotes the idea that we should be comfortable; perhaps even deserving it because …… . This is on the basis that more comfort results in more happiness. It’s an idea. It’s wrong. There has not been an increase in happiness (a fleeting emotion like all the rest) by having more comfort.
It is through discomfort and challenge that we have the opportunity to grow and learn.
Pain is different. Pain is complex. Pain is human. And, pain is far too fascinating to nail in a few words here. That is for another time.
On perceiving pain, we try to elucidate the meaning. What is my need? It can often run deep. Pain is poorly related to tissue state or injury; although slightly better perhaps in an acute scenario. Pain is about the person, their life, the context, their past experiences, their expectations, their outlook and more.
Pain is poorly understood. This is the reason why persistent pain continues to be one of the largest global health burdens.
And what of ultrarunning and pain? Yes, they come together. We have to expect it, and welcome it rather than resist. The latter only causes more suffering.
On the run, there are a number of ways to deal with pain. Again a big topic. Suffice for now and this blog to acknowledge the normalcy of pain, an experience that many of the well-known runners describe.
I have been making study of pain for some years now, both the science and the experience. Ultrarunning gives me insights that I did not have before. All of this will be explored at a later date.
There are of course plenty of other lessons learned. You will have your own to ponder upon and share.
On we go. Step by step: the run I am on, and in life.
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.
After a few months of planning, the Pain Coaching Project started today. This is a really exciting time for Understand Pain (UP) and we are thrilled to be able to offer free sessions to people suffering the symptoms and pain of osteoarthritis (OA).
Pain Coaching focuses on the person, their strengths and their potential to improve their life. This comes in many forms as each person will have their own picture(s) of success. For some it will be an increase in walking, whilst for others it maybe to be able to socialise and feel more connected. We all have our ‘thing’. The aim of the programme is to give you knowledge, tools and practices to improve your life.
Starting with a conversation about you, your life and what you want to achieve, we then move into the practical sessions. There are many practices and tools to use, so we choose those most relevant to you. For example, we look at ways to mobilise your body and improve your quality of movement, breathing, planning your days, organising activities, relaxing deeply, building fitness, mindfulness, improving strength and confidence to be active.
If you would like to take advantage of the Pain Coaching Project and see how you can improve your life, book your place now by emailing here, and putting OA in the subject line.
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 1st 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.
I wholeheartedly believe in people’s ability to change their pain. Why? Because I have seen it so often and heard how individuals have improved their lives. We also see the effects of changing people’s perceptions in the research settings.
Many scientific studies have shown how we can alter experiences in many different ways. My role as a clinician is to translate this into something practical for people to use day to day to get better. This is why I spend time with scientists, researchers and philosophers on a regular basis, but also draw upon many fields to create programmes for people to get the best of themselves.
Here is a story about a person’s experience of changing their pain. In this case, chronic headache. I act as an encourager, a supporter and a coach, but it is always the person who must do the work to get better.
I suffered from Chronic Daily Headaches for twelve years, before I was eventually referred to Richmond by my neurologist, Dr Marie-Helene Marion, to whom I am eternally grateful for doing so.
Before visiting Richmond, the only option I had to relieve my headaches was medication and, when the drugs stopped working, I would feel completely hopeless in their wake. But, in just a few short sessions, Richmond completely reconfigured my relationship with my headaches – giving me tools to manage the pain and, more importantly, feel in control.
Very soon the hopeless despair was gone because now, when I was faced with a headache, I had options. Whether it was as simple as a full body meditation, going for a run, or turning to my daily journal, there were things I could do that had a direct impact on the pain and therefore my state of mind. I no longer felt crushed by the onset of a headache because I could take action. If the drugs didn’t work, it wasn’t the end of the road, there was something I could do to better the situation.
As a result of my treatment, I am slowly coming off my medication (something I would never have imagined possible, having been on them for so long) and feel better than ever about my headaches. It has honestly changed my life.
And there’s one other thing – until I saw Dr. Marion and Richmond about my headaches, no one had ever told me that I would ‘get better’. It was always about managing the symptoms with medication. It’s a simple thing to say , that you might ‘get better’ but, for the first time, I had been given permission to believe that I didn’t have to live with my headaches forever – from the outset this was a huge psychological boost. And, I am pleased to say, they were right. I am getting better.
For the 7th ultra I am hitting the hills, or rather mounting the mountains….
Most of the races so far have included some steep hills. Over the South Downs near Ditchling Beacon on my way to Brighton from London, traversing the Seven Sisters from Eastbourne towards Brighton and along The Ridgeway on Race to the Stones, have all challenged my thighs. Running and walking uphill is one thing, coming down is another. There’s an art to the latter. A balance between controlling one’s descent so you don’t fall and saving your quads! The Maverick inov-8 ultra has an elevation of 3020 over 60-odd k.
Traditionally I am not great with heights. So this ultra presents an additional element and feature for me to cope with whilst climbing, descending, walking trotting, hopping, shuffling and running. Don’t look down! Having said that, I have been on mountains plenty of times before and usually enjoyed the views, fresh air and freedom.
Recently I was thinking that #upandrun would continue for 12 months, #12in12. But then I thought about afterwards and what I would do. I can’t see that I will stop, so this will continue indefinitely with a blend of races and solos that accompany the monthly UP workshops (next one on 18th Sept >> tickets here).
You can support Understand Pain here, helping us to run the workshops each month so that they are free for those most in need, to increase the number of workshops and the reach. Meanwhile, I’ll keep running to raise awareness and bring the tools to people so that they can improve their lives.