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
#thepaincoach
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.
Person-first. Always
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.
Building wellness
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.
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.
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?
Sunrise from the Little Orme
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
Preparing for an ultra requires planning. It is also a time to take it easy and eat.
Update on the route
I am now planning to start at the Menai Bridge.
Having looked at the path along the North Wales Coast, it became apparent that an acknowledged leg runs from the Bridge to Chester. Or vice versa, which is the way that I am travelling — East to West.
This extends the route a little to 131k.
In the meantime…
I am looking at the maps to build in my sense of the journey and to arrange the rest stops. Here I will meet Jo and Chico for fuel, fluids and any other bits and bobs that help me to keep going. Perhaps a change of socks.
Jeff is joining me for the last 30-40k.
Ffynnongroyw or Mostyn.
Meet Jeff
This week is an easy week: a few relaxed runs help to keep moving, plenty of sleep and nourishing food.
I’ll gradually be pulling my kit together. It maybe chilly running through the night. Perhaps it will rain. Must be prepared.
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
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)
upandrun 14 is a special one. 100k round the block to raise money for the #NHSHeroes at Kingston Hospital. This shall be the Kingston Hospital Self-Transcendence Race*, my much shorter version of the 3100!
Each month I run an ultramarathon. That is a distance beyond a marathon, typically 45 kilometers plus. This will be the 14th since I started ultras last May.
There are several purposes of upandrun. One is to raise the awareness of the problem of pain that affects millions and costs billions. Another is to help people understand how they can improve their lives. But, upandrun 14 (April) is different.
This month upandrun will be dedicated to raising money for NHS staff at Kingston Hospital, my local one. I am pleased to link up with the Kingston Hospital Charity to steer donations to the people who are caring for the sick and vulnerable. It is vital that the NHS Heroes remain well, and our support will help them and their families.
upandrun 14 for the NHS ~ Kingston Hospital: donate here
With upandrun 14 due, it made me wonder how I could use my legs to make a contribution to the NHS. I thought, why not run around the block?. I stay local, the streets are quiet (easy to keep distance from others) and I could clock up a decent mileage. Initially I decided on 50k but then it seemed like a better idea to round it up to 100. A 5k route times 20. Round and round I will go, grabbing refreshments from my crew (mainly my wife, but she does not know yet).
The Kingston Hospital Self-Transcendence Race is a tongue in cheek version of the Sri Chinmoy self-trancendence race. This is a 3100 race around one block in New York totalling, yep, you’ve got it, thirty one hundred miles. If you fancy that, read here. I’ll be doing a mere 60 odd miles.
The course set, the day chosen (Monday 20th April) and the charity on board, it’s all go. I have a JustGiving page set up and on the first afternoon had donations over over £1000 — great start! To get to £3000 would be fantastic, and maybe more…..
Now to take it easy for a few days.
You will be able to follow progress on Instagram (@paincoach) and Twitter (@painphysio) where I will post pics and vids. Please take part, send messages, share and donate what you can!
* The idea for the name of the run came from my old mate Chris, who actually got me into ultrarunning. Ta!
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.
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.
Nick & Richmond selfie in Durban
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.
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.
Richmond Stace | co-founder of UP and pioneer of Pain Coaching
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.
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!
understand pain 