#upandrun 9 and #thewayoftherunner

#upandrun 9 in November

#upandrun No9 took place this week. I chose two trails on the South Downs that totalled thirty miles; a form of staging. Both were circular.

This was off the back of a weekend away on #thewayoftherunner running and writing retreat with Adharanand Finn and Richard Askwith. They are both runners and writers, responsible for a number of excellent books on the former. Finn penned the recent and popular Rise of the Ultrarunners, and Askwith the fell running classic, Feet in the Clouds.

Adharanand & Richmond

Richard & Richmond near Heytor, Dartmoor

We gathered near Totnes in Devon at a holiday house on the Sharpham Estate, with dual hot tubs outside on the deck. The taxi driver who dropped me was most surprised to see a full, steaming circular bath full of people as we pulled up. He quickly reversed, and I don’t think he believed me when I said that it was a running and writing retreat.

It was a super weekend. The group gelled as we shared our stories, reasons for signing up and our dreams. Adharanand and Richard set a tone of openness, humility and clarity that enabled authenticity. Naturally I cannot speak for the others, but this is how it felt. Through this we were treated to passionate, amusing, hilarious, ridiculous, descriptive writing, some in the form of a game and some in prose. People we had left at home may have thought we were on a jolly, but this was hard work. It just so happens that both the running and writing are passions.

On running

We wound our way up and down trails, through woods, along paths, hopping from rock to rock, through gates, over stiles, under the sun, through the rain, in the shadows, in wide open spaces, along the river, skipping through streams, sliding down narrow muddy routes, sploshing and squelching, flying and skipping, trudging and striding we went. Most of all though, we were together, sharing our own experiences as one.

The running was fun. However, it was the writing workshops that created the opportunity for openness and vulnerability. That’s when you get to know someone at a deeper level. Each person brought themselves, cultivating a unique blend of thoughts feelings, emotions, insights; all embodied.

Down! On Dartmoor

The next UP Workshop is on November 20th at The Groves Medical Centre; free tickets here.

If you would like to hots an UP workshop for clinicians who want an introduction to Pain Coaching or for people suffering persistent pain to learn how they can improve their life, please contact me: richmond@specialistpainphysio.com

Look out for #upandrun 10 in December — it could be in your area!

Getting the best of Christmas

5 top tips if you suffer chronic pain

If you are suffering chronic pain, here are 5 tips to maximise your festive spirits and joy. You can decide upon your approach and give it your best by following some simple principles.

1. Make a plan

What is your picture of success? How do you want Christmas to be? What can you focus on that would make it memorable for the right reasons?

The questions we ask ourselves, we will always answer. So, make sure you come up with ones that self-encourage, helping you to focus on what you want, rather than what you do not want.

Think and act like the person you want to be

Make a plan each day, prioritising the key moments, punctuating them with rest and recovery time. You can share your plan with those you’ll be sharing the day with so that everyone is on board. Of course, the best plans do not always turn out the way we want, so we need to be flexible. However, if we try to stick to it in the best way that we can, often made easier by writing it down, then we are doing all that we can to be successful.

2. Motion is lotion

This is a way of nourishing your body (tissues — muscles, joints, tendons etc.). The key is to be consistent through the day. In essence, the movement is ‘pumping’ blood and hence oxygen into the tissues as well as removing the build up of toxins (that cause sensitivity).

The brain is embodied, and needs movement to survive — the brain needs a body. Pretty much everything that we do requires movement. Anything that gets in the way of the movements necessary to meet our needs will raise the perceived threat value. As many readers will know, pain is well-related to perception of threat and the state of the person, and poorly related to the tissue state.

Move to groove >>> any movement is a good movement!

A simple way of using ‘motion is lotion’ is to move and change position every 15-20 minutes, and then stand up and move around every 40-60 minutes. These are ball-park figures and it is important to work out your own need for movement. Further, you may like to use prompts and reminders until this becomes a habit.

3. 3 breaths

As often as you can remember (use reminders for this as well), stop and pay attention to three full breaths. Notice the moment when you first breathe in, the sensations in your body, and as you breathe out, the sense of letting go.

Attention is one of the skills of being well. A famous study was entitled, ‘the wandering mind is an unhappy mind’; in other words, the more we can pay attention to what is really happening, the happier we feel. Paying attention to your breath is a simple way to develop this skill.

Notice how you relax and muscles ‘let go’ as you breathe out. This is because on the out-breath, the parasympathetic nervous system is more active. This branch of the autonomic nervous system is responsible for all the important healthy functions behind the scenes: digestion, sleep, energy, anti-inflammatory activity and more.

5/5 breathing >>> count slowly to 5 as you breathe in, and count slowly to 5 as you breathe out. Continue for a minute or two, or longer

We have no direct access to our biology. It is in the dark, so to speak. However, there are one or two things we can choose to take control over to an extent. Breathing is one, with all the benefits that come with the innumerable practices that have been ‘breathed’ over the centuries.

A further use of the 3 breaths is when you feel tense, pain, frustrated, angry, upset or any other emotional state. Notice how when you pay attention to the breath, those feelings ease. This is because you have stopped fuelling them with the thoughts.

4. Meaningful connections

We need each other. We are design to connect and share and be generous. Have you noticed how your feelings change when you do something for someone else, no matter how small or insignificant that it may be? In fact, it is the little things, consistently, that make the difference, especially in a relationship.

How great does it feel to be with people who care about you, and you care about? Notice how that feeling builds when you pay attention to it (re-read the bit on attention above if necessary). Become aware of those great feelings and sensations in your body when you merely think about a special person.

Even when you don’t know the person you are encountering, can you make the connection meaningful by passing the time of day, and smiling? Of course you can! This can become the way you do it; your style.

Watch other people interact, share and be kind to each other. You will change state and feel it. Pay extension.

One way of connecting is by touch. Again, by design we have a system dedicated to light touch that is a direct way of soothing another, showing care and concern and evoking a healthy biological response. This is also a simple way for a partner to share a moment with you.

The key to feeling the effects, is to be present. This is the only moment, right now…it’s gone, and here is another…gone, and so on. Being present means that you can pay attention to what is actually happening, rather than being embroiled in the mind’s wanderings. To be present is also a skill to practice.

5. Smile. Just because you can

Notice what happens when you bring on a gentle smile. A soft upturn of the corners of your mouth. You can choose to tie this in with the now well-known practice of gratitude. The (biological) state of gratitude is one of the healthiest and an ‘antidote’ to suffering states.

Before the practice, it is important to acknowledge that all states are normal and part of the spectrum of feeling states. We need all of these states of course, as they communicate a need.

What are my needs right now? This is a great thinking tool, as you step back from being caught up in it all, and realise what it is that you need to do in this moment: move, breathe, eat, re-frame a thought etc.

What are my needs right now?

To practice gratitude is to become aware of something in your life that you are grateful for. There are many things that we can chose. Of course, whether they become apparent depends on your mood. A handy mantra here is: for a good mood be grateful, in a bad mood be graceful.

Practice: think of a moment in your life when you felt truly grateful for something. Focus your full attention on this memory, re-living it using all your senses, noticing which senses amplify the feelings. Is it the sights, the sounds, the feel? As you continue to focus on the feelings as they arise in your body, notice how they build.

Moment to moment noticing of things to be grateful for and those that bring you joy is a practice; a skill. For instance, you can decide to approach the day by looking out for things that make you laugh or smile. Then you practice.

The fact of the matter is simple in principle. The challenge is to keep focused and pay attention to what is really happening in the face of the many distractions. It is to realise that we live out a story that can appear to have been written for us. There’s some truth here in as much as we are fed beliefs from a young age, many of which are wrong, yet can limit us as we grow. Realising that you do not have to continue with the same story if it is full of suffering, is the first step to moving onward. Many don’t realise their potential, feeling that somehow, this is it. Not true. Is it time for a new story for you?

What will be your story from now?

And so, what will be your approach? How are you going to do Christmas? How are you going to do life? What is your picture of success? What principles must you follow each day to get those little wins on the way forward? Make a plan, get the right support and encouragement around you, and go for it. Each person is a miracle when you think about how we came into existence and how we are designed to grow and serve a purpose.

Merry Christmas.

UBER-M to overcome persistent pain

understand painPersisting pain pervades all aspects of life, thinking, feeling and doing. Pain affects decision making, with tendencies to avoid or sometimes overdo and lead to a flare up. This is very individual, and each person will have their stories to tell about fears, worries, beliefs and what they did.

The Pain Coach Programme gives the person knowledge about their pain and skills to make moment to moment decisions about what is best to think and do at any given moment. In effect, the Pain Coach is coaching the person to become their own coach! The person is with themselves at all times, and therefore needs the knowledge in order to make the best choice. And this choice is all about taking an action that takes you towards your vision of where you wish to be. Where you wish to be is in the answer to the question ‘why do I want to get better?’

One of the strategies I coach people with persistent pain is called UBER-M. Cheesy perhaps, but easily remembered. One of the first things we do in the Pain Coach Programme is to help the person understand their pain, this to reduce fear and increase engagement with what needs to be done to overcome pain. You cannot solve a problem unless you understand it. But it is not just telling the person about their pain, it must be a working knowledge that can be applied: what do I know, what can I do now that is wise and healthy? This is the ‘U’. And below are the others:

U – understand your pain

B – breathe (mindfulness, relaxation)

E – exercises (general exercise, specific exercises & training)

R – recharge (we need to have enough energy to engage with the programme, with others, at work etc)

M – movement is congruent with health, but you need to develop confidence to move

For more information Pain Coach | Specialist Pain Physio Clinics London | Richmond Stace

Repetitive Strain Injury (RSI)

r..nial bradshaw https://flic.kr/p/fBm85W

Repetitive strain injury (RSI) is one of the office blights so it may seem. Of course you do not have to work in an office to suffer on-going arm or hand pain, or as some call it: WRULD (the rather clunky ‘work related upper limb disorder). You may have tennis elbow or golfer’s elbow, of course without playing either sport — then it should be lateral or medial epicondylalgia! Words aside, this is a big and costly problem for individuals who bear the brunt of the pain, symptoms and their consequential limitations, and for businesses that have employees on light duties or off sick. So how does typing cause an injury?

Well it may not. We are not really designed to be sat, hunched over a desk (as I am now I have just realised), poking away at small buttons, getting quicker and quicker so that we don’t even have to think about where our fingers are going in order to produce a document. The ‘noise’ created by all these small, precise movements of the fingers (signals flying up from the joints and muscles about movement, pressure, touch etc) can be difficult for the brain to gather into a tangible meaning. We start to develop different sensations, perhaps a change in temperature, some tingling, numbness or a sense of size difference (my hands are now warm and a bit tingly). If you interpret this as strange or mildly worrying because you have heard of RSI and you don’t want it because your job involves typing all day…..you can perhaps see how the worry and concern and vigilance and responses begin to amplify and amplify; this without any notable injury. However, the tension that builds, the stress responses that affect tissue health, the change in blood flow and nerve function when anxious, all impact and can create a threat value that is perceived as dangerous and hence the body systems that protect kick in — this may well mean some pain. And pain is useful and normal, even without a significant injury, because pain is a need state, motivating action: maybe I should take breaks? Perhaps I should type less at the moment? Maybe I need to work at changing my thinking about a situation that is making me stressed? Maybe I should start exercising regularly? Maybe I should seek some help and advice?

On-going use without adequate recovery can lead to an imbalance between tissue breakdown and rebuild, the natural state of change that is constantly occuring to all of us. The inflammation that results can of course add to the level of sensitivity or activate it, leading to aches and pains that can begin in specific locations but with time expand up and down the limb and even be noted in the neck and shoulder. This is not the spread of a ‘disease’, but rather the volume switch being turned up, meaning that increasingly normal stimuli (touch and movement, thought of movement, particular environments) can result in pain. Associations build with stimuli, and we get better and better at certain habits of thought and action that can perpetuate the problem — e.g./ avoidance, expectation, changes in movement, extra muscle tension unbeknownst to us.

There comes a point when the symptoms can begin so quickly that it becomes difficult to type, text, hold light objects and even gesticulate. This makes work life and socialising very challenging as well as frequently occupying much of our thinking, planning and our mental resources from the emotional impact. A comprehensive approach is needed to change direction and begin recovering, from wherever your start point. Certainly if you are feeling a few aches and pains that are becoming more frequent, you would be wise to seek advice. Or if you are struggling, then the right treatment and training programme can help you to resume meaningful activities.

Due to the biology of RSI, like all persisting pains, being upstream in the main, i.e. away from where the pain is felt, any programme must address this as much as improving the health of the tissues locally with movement and use (gradually). Once you undertand your pain, you realise that pain is not an accurate indicator of tissue damage, and that there are many things you can do to take you towards a better life. Asking yourself why you want to get better gives you the answer as to where you want to be going; your direction. We need direction and then the know-how to get there, dealing with distractions on the way, so that we remain focused on the right thinking and actions.

You will have been successful before, using your strengths (e.g./ concentration, empathy, dedication, motivation) and values. Using these same strengths and values to perform the training and to think in the right way leads you to a better outcome. What are your strengths and values? The exercises, training and treatment are all straight-forward, but their effectiveness is impacted upon by the way you think about your pain and your life. There are many factors in your life that are affecting your pain: e.g. tiredness, stress, anxiety, people, places. Understanding these and your pain puts you in a position to make changes and groove healthy habits and in so doing take the focus away from pain and worrying about pain to the doing and enjoying and living. There is only so much you can attend to in a passing moment, so why not focus on the good stuff? And if you are in pain, you can learn how to create conditions for ‘pain-off’ over and over whilst you get healthier and fitter generally as well as specifically training to resume meaningful activities: common problems are typing, texting, carrying etc.

This is an insight into modern thinking about pain and how to overcome pain. We understand so much more and this knowledge is ever-expanding. Passing this knowledge to you with practical ways of using it to overcome pain is our role, and treating you with techniques that calm and ease symptoms whilst you get fitter and stronger.

UP in the news

UPYesterday The Basingstoke Gazette published an article about the UP event tomorrow at Heathrow (Sat 24th October 2015). We are very excited about this second huge sing-song as the members of Rock Choir get ready to belt out the tunes all day at T5, London Heathrow. We will be filing the event and sharing the footage after the event, so you won’t miss out on the fun.

Read the article here

A brief guide to pain – what is it?

Welcome to my brief guide to pain. Pain is an enormous topic, drawing upon many disciplines and fields, similar to the study of consciousness. Whilst putting together my thoughts to answer the question ‘what is pain?’ I soon realised that it was going to be a lengthy piece, and only for those who had the time and inclination to bear with me. Regular readers of my blog at Specialist Pain Physio will be familiar with the importance of understanding pain (hence UP!! and @upandsing) as the start of changing and overcoming pain, particularly persistent pain. Now it is obvious why we called our campaign UP | understand pain — because when you do, you’ll realise that it can change when you take action, and that is what Pain Coach is all about.

So here’s my brief guide to pain in bullet points:

What is pain?

Here are some facts but not all (we will always discover new facts, and I will update accordingly):

  • This is my recent thinking on pain: “Pain is the conscious experience of a need state, others being hunger and thirst, felt by a person in a particular area of the body in respect of a perceived threat (that may be conscious or subconscious, or both), not separate from the context of the moment, the environment, prior experience, predicted experience, the social circumstance, current biological state, health, thoughts, feelings & emotions”.
  • Pain is a vital survival device, without it we do not live as long or as healthily.
  • Pain is part of the way we protect ourselves alongside changes in movement, body sense, thinking, emotions, perceptions of the environment, planning, anticipation, attention.
  • Pain is how we protect ourselves in the face of a perceived threat. When our body systems detect danger, actual or potential, there is a need to protect and this includes pain in the area that is perceived to need such protection — consider that the sum of sampling our body tissues, organs, systems (they sample themselves as well), plus the sum of the environment, plus the results of sampling the brain (what do I know, where am I, what are my beliefs, what have I done here before, what has worked, how am I feeling etc) leads to what we experience in any given moment; and if the sum of all of these inseparable characteristics of being alive represents some kind of threat, then we will change our behaviours and experience pain. For the mathematicians:
    • (what is happening in my body + what is happening in the environment + what I know + what I do not know I know) right now = (my reality in this moment) that is always passing
  • It is poorly related to the extent of the injury or tissue damage.
  • It hurts and ‘I’ feel it in my body (or where my body used to be or should have been, in the case of phantom limb pain).
  • It is ‘I’ who feels pain, not my body; I hurt, much like I am thirsty and not my mouth
  • When I feel better, my pain feels better (because I feel pain).
  • Pain involves many body systems — always the nervous system, often the immune system, plus the autonomic nervous system, the endocrine system and the sensorimotor system.
  • There is no pain system, there are no pain signals. There are systems that detect changes and presume threat that requires attention and action; pain compels us to do something to make it go away, both in how we think and what we do.
  • Pain is influenced by how we are feeling, how we think about it, where we are, who we are with, what we have been doing, what we are doing, what we may do, how tired we are, how much attention we put on the pain and our expectations to name but a few.
  • We can only feel pain now, in the present moment. Our memory of the pain experience is unreliable, and whilst we may recall that we were in pain several days or weeks ago, we cannot remember that actual feel of the pain with any accuracy. Like any experience, pain happens in the moment but is hugely flavoured by the way we think about it. For example, if we are anticipating that something will hurt, such as getting up from a chair, then it usually does and more due to the expectation priming our systems that protect. If we have pain under certain circumstances, an association can develop so that the next time the context arises, protection kicks in, including pain.

Next time….what sorts of things can we do to overcome pain?

Richmond Stace | Pain Coach & Specialist Pain Physiotherapist