The Pain Coach – 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.

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

The 3 Parks

May 27, 2020Richmond Stace | The Pain CoachLeave a comment

The 3 Parks tomorrow for upandrun 15

May has come and almost gone in a flash. In that time, the lockdown has eased slightly meaning that we can get out for more exercise. In turn, this opened different opportunities for upandrun 15. In the end I chose the 3 Parks, not the 3 Peaks! The latter is on my radar as soon as it is acceptable to travel further.

I am fortunate to live near plenty of green despite being on the edge of London. The 3 Parks are Bushy Park, Richmond Park and Wimbledon Common. A bimble around the edge of these and back home takes in around 50k — a nice distance for an afternoon in the sun.

The last upandrun was dedicated to raising money for my local hospital. I ran around my block for 100k and managed to reach over £3000 in donations — thanks to all those generous people!

Now I am back on the case for chronic pain, one of the largest and most costly of health burdens across the globe. This is in tandem with the end of the Pain Coaching project as I tot up the outcomes and study both the data and the key features of the coaching conversations. Just as a brief insight, the average satisfaction score given by participants in the programme was 9.4/10. They also all agreed that they would recommend pain coaching to another person suffering chronic pain as a way to understand their pain and learn how to improve their life.

There is something special about getting into nature; running along the trail. Out there for hours, you can appreciate the changing colours, shadows, light, terrain, thoughts and feelings. It is a privilege. Nature offers itself to us. When we respect it, nature provides us with all we need including a listening ear. The past year of ultrarunning has brought that home to me. We are all wounded at times in our lives, yet we can heal. Nature offers that healing. Experiencing this so strongly, I have started Trail Life.

Trail Life is about immersing yourself in nature, on the trails or even carving your own trails on your way to wellness: moving, breathing, feeling, running, walking, talking, silence, feeling, seeing, listening, being present, being aware and more.

Look out for the pictures tomorrow on Insta @paincoach and Twitter @painphysio

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.

upandrun in South Africa

February 29, 2020Richmond Stace | The Pain CoachLeave a comment

I head off to South Africa tonight on a Pain Talking tour, invited by TensCare and Adcock Ingram. More on the pain side later, but for now, where can I run?

In a week’s time, I will be on the trails near Cape Town, guided by Nicola from Cape Running Tours and ultrarunner Linda Doke. This will be upandrun 13, and I am really excited by this one!

The schedule is pretty packed with talks and meetings, yet there is always time to run. Running gives energy for all else.

Starting in Johannesburg where we arrive tomorrow morning, the Klipriviersberg Nature Reserve looks like a great place to get into nature. The second leg sees us in Durban where we have the beachfront as a backdrop. I went there in 2003 on an England Women’s Rugby tour when I was a team physio. The beach was a place to move our bodies, enjoy the sun and the waves, to recover and relax.

Finally, Cape Town where I have not been before. Many people have told me how great this city is to visit. I can’t wait!

Look out for the pics and blogs: links below.

@paincoach on Insta | @painphysio on Twitter | Facebook

#upandrun 12: Gloucester to Bath review

February 23, 2020February 23, 2020Richmond Stace | The Pain CoachLeave a comment

#upandrun 12 route from Gloucester to Bath, taking in the Cotswold Way

I started running along the road towards Birdlip to pick up the Cotswold Way. It was just after 530am, the streets were quiet and I was on my way. The streetlights came to an end as I reached the edge of town and began to climb.

In the darkness with my head-torch illuminated, I could see on-coming cars in the distance and I hoped they could see me. Running along close to the narrow grassy verge, I continually created an escape plan in case I needed to take evasive action. That plan, which fortunately I did not have to use, was simply to dive into the bush. I thought it through what seemed to be every few seconds.

The sun was just starting to rise as Cotswold Way signs appeared, the trail bisecting the road. I turned right onto the path that immediately started winding its way down into the woods. It was soft underfoot, with occasional muddy patches, but perfectly passable and even supporting a steady running pace.

Running a trail is the perfect time to be present. The ever-changing pink sky delivered a backdrop for the unfolding scenery as I trotted along. Noticing the changes in light is something unique to being in the countryside, almost moment by moment. It is easy to miss, especially in a town or city.

It felt like it was going to be a good day. I had a plan for fuelling, learning from previous ultras that it is important for me to keep it regular, so a snack every 10k. I was loaded with bars, Kendall mint cake and other snacks, plus I was confident that I would come across a cosy cafe serving great coffee and offering respite. That didn’t appear for quite some hours though…

Mud, bogs, rain, wind

The trail was starting to become muddy, slippery and skiddy. My Speedgoats were helping me stay upright, although I had to slow my pace to navigate these patches. Over the day, I only fell once, imprinting a sizeable brown mark on my left buttock.

Losing the trail in a small Cotswold village, an elderly couple pointed me in the right direction, warning that the field I was about to cross was steep and very wet. It was. That was the end of having dry feet for some hours.

Rain was forecast, so I was not surprised when I noticed a few drops on my face. Playing it safe, I donned my waterproof. That, was a wise decision. Within moments the rain was coming at me sideways. On off went the showers for the rest of the day, mainly on from what I recall. The wind whipped around me, especially on the exposed hills, resulting in a crouching style of running that probably did nothing except make my thighs work harder. Note to self.

It was not the water from the sky that was slowing me down though. It was underfoot. I was fortunate not to lose a shoe as I squelched my way through and round fields that were utterly waterlogged. The animals I passed looked at me and wondered what I was doing. This was the sense of their expressions anyway.

How grateful I was when a farmer gave me directions along a lane rather than over his field, which did not look like a field. It was more like the top of a moist chocolate cake.

On I went.

From http://www.cotswoldrunning.co.uk/cotswold-way-century

The Cotswolds Way is far steeper than I had anticipated. Mind you, I do like climbing a hill. There is great satisfaction on reaching the summit and looking back to see where you have stepped and taking in the scenery. King of the hill.

There are moments along the way when you ask yourself why? Pain, cold, wet, miserable weather are all reasons to stop. They are also reasons to go on exploring and discovering. That’s the beauty of ultra. Rolling with the ups and downs, the successes and challenges, one foot after the next. There is no stopping the stream of conscious experience that continually delivers the plethora of unplanned feelings, thoughts, sensations, sounds and other appearances. Noticing this is being mindful.

And so, after about 13 hours, Bath arrived out of the darkness in the distance. The last kilometers followed alongside the A46. The sun had long gone, replaced by a blackness pierced by red and white car lights. Back into urbanity, running along the city streets towards the pizza and beer that had so clearly formed in my mind.

The day ended at 90k. I am looking at when I can move this on to a 100-miler, the next natural step. My feeling is that a supported run would be best, but we will see. The next #upandrun will be in South Africa where I am heading in a week’s time to give a series of pain talks — read here. The plan is to take in Table Mountain within an ultra of around 50k.

On we go.