‘Life isn’t about waiting for the storm to pass it’s Learning to Dance in the Rain.’
I am a fully qualified Chartered Physiotherapist who has specialised in working with people who have persistent pain as well as those with neurological conditions. I am also a qualified life coach, Neuro-linguistic Programming Practitioner and meditation teacher. I also integrate yoga, Acceptance & Commitment Therapy and Compassion Focused Therapy into physiotherapy and health & wellbeing coaching.
Over many years of working with people in pain, living with it myself and following evidenced based practice I have developed a programme for people living with persistent pain called Dancing through Life Despite Pain, Living Well. This programme also encompasses many aspects of my book called Dancing through life: Living Well which is pending publication. The programme has been designed for anyone living with persistent pain where pain is limiting life, or you feel it is difficult to manage. It aims to empower you to make the changes that are important to you, do what you love, move with more ease, create daily self-care practices (if more are needed in addition to any you use now) and live well.
Persistent pain, also known as chronic pain, is pain that persists for 3 months or more. Persistent pain is part of living with many conditions including: fibromyalgia, chronic fatigue/myalgic encephalomyelitis, chronic regional pain syndrome, peripheral neuropathy, migraines and headaches, arthritis, and back pain.
The programme has been based on a variety of aspects from clinical and personal experience as well as the current evidence. The programme will empower you to live well despite pain being present, whilst pain changes in the background. Persistent pain involves many things, especially the body, brain, immune system, previous experiences and beliefs. This is why an approach that is encompassing all aspects of being human is needed to help.
Physiotherapy and coaching knowledge are blended together to provide a programme of care for the whole person, encompassing the different aspects that make us all human. We are not the sum of our parts, the body and mind need focusing on together. The programme is tailored to help you make the changes that are important to you. As well as being a group programme the living well pain programme is also integrated into 1:1 appointments.
Is it time for you to see how pain can be moved out of the driver seat into the back seat or even the boot? Would you like to learn how to do the things that are important to you and live well despite the pain being present? If so this programme can help you.
What is covered in the programme?
The PACE’s & SIM’s, listed below, are woven throughout the pain programme, and there is a workshop taught by a nutritionist.
The programme will: encourage compassionate exploration of how things are now and the potential contributors to your pain; empower you to move back into the driving seat; explore helpful strategies; and see what changes you can make to be able to what’s important to you despite pain. This doesn’t mean ignoring the pain and pushing on regardless, this tends to create pain flares and fatigue. You will build a deeper awareness of body and mind as we explore things, awareness and understanding are part of making changes. We will also look at some of the pain science, what the evidence tells us about pain and relate this to you in your world.
The PACE’s and SIM’s below are acronyms I developed and use in clinic. They are also woven throughout my book, pending publication.
- 6 P’s– purpose, patience, persistence, pacing, practice and play
- 3 A’s– acceptance, awareness, action
- 6 C’s– compassion, curiosity, connection, change, communication, courage
- 3 E’s– explore, energy, exercise
- 3 S’s– sleep, stress management, self-talk
- 1 I– intention
- 3 M’s– mindfulness/meditation, movement, meaningful activities.
Nutrition (an important partner with the PACE’s & SIM’s).
There is a little more information on the PACE’s & SIM’s below, continue reading if further detail would be of interest right now.
If you choose to stop reading and want to learn more or would like to reserve a space on the programme get in touch.
These are in no particular order (where we start is dependent on you and what’s most helpful). We explore these things together in a way that’s relevant to you.
Patience: Changing pain takes a lot of time and commitment to regular practices that are part of your normal lifestyle. Self-criticism tends to be common in people living with persistent pain, nurturing patience and self-compassion helps support you.
(Flexible) Persistence: Persistent pain takes a long time to change. Evidence has shown that systems adapt becoming sensitive when pain persists and that this can change again with regular practice and a lot of patience. We need to be persistent when pain persists. This needs to be with flexibility rather than pushing on through things, doing the same thing and hitting the same brick wall. There are no straight lines in making changes, there are lots of ups and downs, with flexible persistence we can learn to navigate the bumps, twists and turns.
Pacing: is important for us all, especially when living with persistent pain. This term gets overused or used in a not so helpful way. Pacing is not the same every day and needs flexibility. We explore what’s too much, what’s not enough, what’s a helpful balance, and what’s helpful when the scales tip into too much (this happens, life is not predictable!). Thinks Goldilocks and the three bears here!
Play: Play is an important part of many of the aspects covered in this pain programme including in movement and exercise. Think about how children learn best, adults learn through play too. Play means exploring without a particular goal so you can be focused what you are doing rather than the end point. Play encourages us to be fully present and fully absorbed in what we are doing and having fun.
Practice: Have you heard the saying we get what we practice? This is because we are experiential beings and learn through doing and repetition, this is how we develop habits, both helpful and unhelpful ones. We look at daily practices that help support you and make changes so you can create a self-care plan. We often learn best through creativity and play, this is why exploring is important.
Purpose: The evidence shows us when we are connected to what brings us purpose and meaning it decreases stress levels. One reason for this is that it releases helpful hormones both of which modulate pain. Living with purpose often gets lost when living with persistent pain, sometimes it was hidden before, we can explore and reconnect with what’s meaningful.
Acceptance: Acceptance is a term that people often feel is passive, meaning not doing anything and putting up with, this not what is means. It doesn’t have an end point, it’s ongoing as things are always changing, so it is more about accepting things as they are right now, in this moment. Part of acceptance is understanding why things are as they are and allowing things to be there, rather than fighting them or pushing them away, so that the focus can then be on doing what’s most helpful for you.
Awareness: This is a foundation of change. Building awareness of mind and body helps you navigate life’s journey and pace activities and make choices that are most helpful for you. Everything we do is learning and part of building more awareness to empower you to make changes that you feel are helpful for you.
As Ekhart Tolle said: ‘Awareness is the greatest agent for change.’
Action: The action we take works best when its aligned with our values and what’s important to us. We explore your values, what’s most important, and set goals aligned with your values. Evidence shows us that values based goals are meaningful and effective.
Compassion: Commonly when pain persists people are frustrated, angry and self-critical. Does this sound familiar? It’s normal and part of being human. These things are part of the stress response, which is part of keeping the pain volume dial turned up. Compassion focused therapy/compassionate mind training has been shown to be helpful, especially with self-criticism. I use a compassion focused therapy based approach to help you explore what’s helpful. Being compassionate is not a soft skill it takes a lot of courage, it means gradually turning towards what’s difficult and exploring it, rather than turning away from it.
Curiosity and Courage: We need courage to explore with curiosity and turn towards what’s difficult. Often having the intention to build awareness, remember awareness is a foundation of change is helpful when exploring.
Connection: Connection to ourselves is important for building awareness and making changes, we can’t understand things and make changes when we are disconnected and don’t understand where we are. Connection, along with awareness, is part of maintaining our energy levels. Connection to others is important too, socialising and being with others has been shown to be helpful for our wellbeing. This includes decreasing pain, one reason for this is helpful hormones are released that modulate pain. Commonly people with pain have stopped seeing friends and family as much, and limited socialising, We work together to explore how we can change this.
Communication: Evidence shows us communication is powerful in lots of ways. Our self-talk is part of our reality, what we tell ourselves about our pain and how we say it affects our physiology. This is where my coaching and NLP training is really valuable in helping you understand communication more especially what you are telling yourself.
Meaningful activities: Meaningful activities are connected to our values, doing what’s important. Meaningful activities change pain over time and bring connection, joy, purpose and much more.
Energy: Fatigue is commonly an issue when living with persistent pain. It is a protection mechanism and a sign of system sensitivity. Understanding what helps maintain your energy levels, what you can do about the things that deplete your energy, and how you can keep some balance is helpful, which we will explore. This will help as part of being able to do what’s important to you, gradually improving exercise tolerance, and understand what can be done when the scale has been tipped into ‘too much’ to regain some balance again.
From exploring and finding the things that help maintain your energy levels you can create daily practices which will become part of your normal lifestyle.
Exercise: Exercise is important for our mind and body, yet when living with pain we react differently to exercise which means it can be challenging to balance doing enough to build tolerance & strength and not end up with constant pain flare-ups. The great news is things can be changed with time, understanding where your baseline is and that this isn’t a constant level, and regular practice.
Based on recent evidence there is no one form of exercise that is better than another. For example for chronic low back pain an article in the Lancet Journal in 2018 showed pilates to be no better than any other exercise for people with low back pain. It’s important that the exercise we do is varied and we enjoy it, so you don’t have to join a gym if that’s not for you! It is also important you are motivated to do it too.
You may find reading my blog on exercising with persistent pain helpful https://www.unityphysio.co.uk/exercising-with-persistent-pain/ We work together to explore the variables that can be altered and help you learn to move with more ease again.
Explore: This is what we do throughout the pain programme. We compassionately explore to build awareness and understanding to give more choices and help you make changes.
Stress: There is a lot of research relating to stress and health & wellbeing. Some stress is needed, it’s part of helping us to adapt and it keeps us alive. Too little and we don’t adapt and struggle with function, too much and systems are overloaded and we have problems with things like fatigue. With awareness we can learn when the scale tips too far to one side for too long and make changes.
Stress causes increased pain and pain can cause increased stress, it is a vicious cycle until you learn how to change it. We look at different aspects that contribute to stress and the impact on our physiology and what is helpful for you in managing and changing stress.
Sleep: There is a lot of research around the importance of sleep for our health and wellbeing. Lack of sleep makes our systems more sensitive to stimuli, affects our memory and concentration, increases fatigue, and decreases our ability to manage pain. It turns up the pain volume dial and increase the perception of pain.
Self-talk: We form habits in the language and tone we use in our self-talk which in turn affects our physiology. A lot of our self-talk happens automatically and unconsciously, we can become aware of what we are telling ourselves with conscious focus and change it with practice.
Intentions: When our intentions, values and behaviour mismatch we often have more stress or feel stuck. When our values are clear we can focus on bringing these to life each day, with an intention to do so, and make changes in-line with what’s important to us. It can also be helpful to set an intention when you wake up in the morning, a point of focus for the day. Commonly, unconsciously, pain becomes the focus, setting daily intentions can help change this and calm systems down.
Movement: We are meant to be active and regularly moving yet this can become difficult when pain persists. If you have’t already have a read of my exercise blog, linked above. There are some other helpful booklets and guides relating to exercise and movement with persistent pain in the resources section of the website.
Movement is part of exercise, not all movement and physical activity formally classes as exercise, however it may do and it is still essential for our health & wellbeing. Part of the Living Well Programme is helping you learn to move with more ease. A helpful saying to remember about movement is ‘motion is lotion.’
Mindfulness/meditation: Mindfulness and meditation are practices where the intention is to be fully present, to engage all your senses, without judgement. Both meditation and mindfulness are concentration/attention practices, meditation is a formal mindfulness practice. With regular practice meditation and mindfulness train attention/concentration, build awareness, improve memory and other cognitive factors, calm the nervous system and can help decrease pain.
Although trained to teach meditation I am not a mindfulness teacher, I have done an 8 week certification course so integrate the principles into treatment. Mindfulness is integrated throughout the workshops, there is a mindfulness workshop taught by a mindfulness teacher.
Nutrition: Nutrition is important in maintaining our energy levels. I am not trained in nutrition so can signpost you to some evidence based links and you may choose to see a nutritionist if it is helpful for you. The group programme has a nutrition workshop run by a qualified nutritionist.
All of these aspects together & individually create changes.
If you would like to learn more about how the ‘Dancing Through Life Despite Pain, Living Well Programme’ can help you, or to reserve your space, get in touch.