When people want help with a problem (like pain) they most
often want to know
How to fix it
How long it will take
My last few Instagram posts were shoulder movements that you
might have found helpful. So, if you came to me asking for help in regards to
shoulder or perhaps neck pain, would I choose to have you do them as thething for you?
Maybe. Maybe not. It
You see, the thing for you is likely not to be the thing that helped me or someone else for that matter.
Which is why looking to find the thing or the fix for chronic pain often leads to frustration. Or further
along the line, a sense of hopelessness.
There are variables between you and I not only in our
physical structure, but also other areas that affect what we might feel or
experience in any moment, on any given day. Particularly when it comes to pain.
And most often, it’s usually not just one thing.
Over the last couple of months, I offered up some movements specific to feet, hips and shoulders that you might have found useful. Whether you’re seeking greater mobility, ease, gaining more awareness or perhaps you’re trying to overcome some issues with regards to chronic or persistent pain that you experience. It can take some time to make progress, or it can actually be rather quick in learning what does, or does not provide relief for you or at least the ability to move with more ease.
I find it most hopeful to know there many things we can try along the way.
And no, it’s not just cherry-picking, or somehow blindly choosing, either. What’s been learned over the years in regards to pain is quite different from our understanding of the past in terms of causation and most important, what might be effective treatments.
It’s now understood that long-term pain is poorly correlated to tissue health and science shows us that it is both complex and often has a multitude of factors. We do feel pain IN our body. However, it is often a nervous system issue… which often increases our sensitivity to pain. We can affect our nervous system. We can affect change. We can affect our physiology. Which is what makes this a hopeful message.
For the most part, any movement you add into your day and into your life will be of benefit. What’s key while moving is for you to build awareness of what works and what doesn’t for you. What feels right and what doesn’t, for you.
If you learn to pay attention to even the most subtle of sensations, you’ll begin to notice and learn all kinds of things about your body and your self which will lead to the other things, that often play a part in your unique experience of pain.
So it’s not just one thing. Or the thing. Or your thing. Or my thing.
What are the other things, that might be contributing to your experience of pain? More to come…
My hope is perhaps you’ll come to see for yourself there are promising directions for those disabled and suffering from low back pain.
Most of the widely promoted interventions to prevent low back pain do NOT have a firm evidence base.
A surprising statement, isn’t it? These include what you have likely been told over and over again to do, yet evidence of their success is not there. Strategies about workplace education, no-lift policies, ergonomic furniture, mattresses, back belts, lifting devices. How often have you heard about most or many of these in terms of how we might prevent low back pain?
What then, seems to work?
First, is the recommended use of a biopsychosocial model.
I suggest most of the general public has never heard of this term or model of care. I surely didn’t just a couple years ago when I was first started to dig into the overarching problem of chronic or persistent pain that affects so many people.
What is this? Well, as often defined it encompasses “a dynamic interaction among and within the biological, psychological, and social factors unique to each individual.” My emphasis on the ‘unique to each individual’, as that’s turning out to be an important piece of the complexity of pain.
Second, greater emphasis is needed on
Physical and psychological therapies
Some forms of complementary medicine,
Along with less emphasis on
Pharmacological and surgical treatments.
What’s actually being utilized in our clinics?
Surprisingly, the treatments with less emphasis and effectiveness = pharmacological and surgical treatments.
Countries such as Denmark, the USA, and the UK do have guidelines around this. They are supposed to utilize exercise and a range of other nonpharmacological therapies such as massage, acupuncture, spinal manipulation, Tai Chi, and yoga.
Clinicians are meant to provide people with
Advice and education about the nature of their pain;
Reassurance that they do NOT have a serious disease and their symptoms will improve over time;
Encouragement to stay active and continue with usual activities.
I understand even the notion of engaging in movement and exercise is difficult for people who are experiencing pain. How do you keep active when you are in pain? How much does advice, education, reassurance really help? People typically go to their health care providers and want something to ‘fix’ the problem. Not more advice. However, evidence shows this does help. And, evidence shows that the pharmaceuticals and surgeries we’ve come to rely on, don’t. In the long-term, particularly. If they worked, we wouldn’t find ourselves in this predicament. Understanding that you have a part to play, in getting better, is critical.
Movement or Exercise Therapy
Going back to the problem of trying to move, when you’re in pain. Something that people may or may not be familiar with is the term graded exposure. Basically, it means you start where you can, and gradually, over time, work to increase your overall capacity.
I tell my clients it will help to do even the smallest of movements. Use your imagination and even just visualize movement if you must, but you CAN start somewhere. Move your feet, or hands, or arms an inch, if that’s what you can do today. Just begin.
It has been shown to be useful if you can tie in your exercise or movement with something you want or need to do, rather than just some kind of exercise that is not motivational for you.
It’s not really so much WHAT you do, but that you DO something.
“Since evidence showing that one form of exercise is better than another is NOT available, guidelines recommend programmes that take individual needs, references, and capabilities into account in deciding about the type of exercise.
I use tools that yoga offers and work to help keep clients joints moving in all the many ranges of motion they might need in their life. This does not mean they need to have a life-long love or commitment to yoga.
Yet, yoga does offer an important first step of building awareness and subsequently using gentle movement, breath awareness, and tools to ‘ease into a movement’ that may have be feared in the past. People can learn to calm their nervous system, work in a safe pain-free range of motion (or not increase pain). From there we work to build stability strength and power in whatever it is they want to do … be that swimming, walking, biking, skiing, playing with kids, sitting at a desk all day. Whatever it is they want to do in their life.
It should be noted that some guidelines DO NOT recommend passive therapies, such as manipulation or mobilization (think chiropractor, massage, acupuncture). Some guidelines consider these short-term options, optional. The same goes for other passive treatments received in a physical therapists office like ultrasound, nerve stimulation, etc.
Though these passive types of therapy may help to temporarily feel better, they often have many returning again and again, becoming dependent on them for relief. Much of the current research shows the need to get a person ‘involved’ in the treatment. Get their brain and nervous system participating in movements or other practices, so passively ‘being worked on’ might not be a long-term solution.
Guidelines also recommend Cognitive Behavioral Therapy (CBT), progressive relaxation and mindfulness-based stress reduction (MBSR).
This again is where yoga can play a part in terms of relaxation. I’ll often incorporate strategies from MBSR when working with clients.
Guidelines now recommend pharmacological treatment ONLY following an inadequate response to (the above mentioned) first line non-pharmacological interventions.
Paracetamol was once the recommended first-line medicine for low back pain; however evidence of absence of effectiveness in acute low back pain and potential for harm has led to recommendations against its use.
Health professionals are guided to consider oral non-steroidal anti-inflammatory drugs (NSAIDS), taking into account risks … and if using, to prescribe the lowest effective dose for the shortest possible time.
Routine use of opioids is NOT recommended, since benefits are small and substantial risks exists…
The role of gabaergic drugs, such as pregabaline, is now being reconsidered after a 2017 trial showed it to be ineffective for radicular pain … guidelines generally suggest consideration of muscle relaxants for short-term use, although further research is recommended.
The role of interventional therapies and surgery is LIMITED and recommendations in clinical guidelines vary.
Recent guidelines DO NOT recommend spinal epidural injections or facet joint injections for low back pain… they DO NOT seem to provide long-term benefits or reduce the long-term risk of surgery and have been associated with serious adverse events.
Benefits of spinal fusion surgery … are similar to those of intensive multidisciplinary rehabilitation and only modestly greater than non-surgical management.
UK guidelines recommend that patients are not offered disc replacement or spinal fusion surgery for low back pain.
For spinal stenosis … patients tend to improve with or without surgery and therefore non-surgical management is an appropriate option for patients who wish to defer or avoid surgery.
So why the GAP between evidence and practice?
Stay tuned and we’ll look to see how this is played out and why it’s imperative that we change it.
People often sit at their desk, laptop, TV, or plugged into a smartphone with their earphones in. Listening to music, podcasts, videos on YouTube, working, or whatever.
As an experiment, the next time you put your earphones on, don’t ‘listen’ to anything except your breath.
It may not be as noticeable if you’re on the bus, driving, in an airport or a similar noisy environment. But, still, I think you’ll find it to be … telling.
How are you breathing?
Are you breathing fluidly?
Is there equanimity on the inhale and exhale. Or is one shorter or longer than the other?
A pause in between may be good. But do you find that you’ve actually stopped breathing? As in not breathing altogether of course, but that your breathing is not fluid. Easy. Continuous. That there is a long pause, perhaps, between the two. That you fail to begin the inhale, until long after the exhale.
Why might that be?
How do your neck muscles feel, while you’re noticing ‘this’ breath?
How does your torso or trunk feel?
How does your abdomen/belly feel?
Do you notice or feel anything at all?
Do you sense anything?
What might this noticing, this awareness tell you?
In the meantime, try this.
Inhale, and exhale, along with the shape below. Expansion, contraction.
I’m curious to hearof your experience.
I can say for sure, I noticed a few things about my own breathing patterns.
When there is quiet, what do I hear?
(Though we’re in the midst of a cold winter, I find I can ‘listen’ more clearly to my breath when swimming or floating in water, similar to listening with earphones in as above. Or if I submerge myself in bathwater. So choose what’s best for you, whatever might be your season.)
I’m going to challenge you to change things up this week. Whatever you think you should be doing, (in a movement, in your posture) whatever you’ve been told to do… do the opposite.
As an example, while you’re sitting during the day:
If you have a tendency to hold yourself rigid, perhaps with your shoulders pulled back, chest puffed out front, sitting up nice and tall, as some would say ‘good posture’, allow yourself something different. Perhaps slump a little, let the upper back round a little, feel as if you can soften the area between your collar bones, let your belly be soft and full when you breathe. RelaxI’m not saying this is what you need or you should sit this way all day. But try it for a few minutes and notice what you feel.
If you tend to be someone who is generally in a slumped position when sitting, try the opposite. Feel your sitting bones on the bottom of your chair, perhaps even pushing them into your chair slightly. Think about sitting tall, imagining your head feeling light above your shoulders, it lifting towards the ceiling. Collarbones wide, shoulder blades down your back. Notice what you feel.
Though this is only one example. You might try this way of being, or doing, in a multitude of ways.
In yoga, do you always exhale when forward bending and inhale on the reverse? Try changing it up and see what you feel. What do you notice?
Experiment with doing the opposite of what you think is right for you, what you’ve been told is right for you and see how it goes. If you like, comment below so we can take the conversation further.
The bumper sticker on our last Yoga Tool was to recognize that just as we take a drink when we are thirsty, eat when we are hungry, we need rest when we are weary. All of which requires first, awareness of a particular sensation in our body.
There are signs and signals speaking to us all the time, but are we really listening?
Are you like me in that you eat regularly on a schedule or do you listen to the signal telling you when you’re hungry? Do you sleep only at certain times of the day or are you paying attention to the signs that you need to rest? These are two indicators built into the survival mechanism of our body. Similarly, if you enter a room with a smell so strong it seems toxic you know to immediately step out again. If you are suddenly ill bringing up something you ate, again a signal. Your brain’s number one job is to keep you safe and protected.
Below is a quick and easy Tool to begin learning to sense information your body or your brain, is providing. I often use it in the beginning of a yoga class, to bring some awareness to what we’re about to do.
Lie with your back on the floor. Bend your knees and place your feet hips-width apart. Let your knees gently fall towards each other, resting easy and comfortable.
To sense what you feel in terms of your body’s contact with the floor. What parts of your body are in contact with the floor? Is the surface of the floor hard, soft? Are you comfortable? Do you feel the support of the ground below? Lean in. Feel grounded. Feel supported.
To feel your breath moving through your body. Where do you first notice your breath? In your chest, your lungs? Your nostrils? In your belly perhaps? Does the air feel smooth flowing in, and out? Does it feel forced, soft, cool, warm? Can you sense movement, in tune with your breath, elsewhere in your body?
To notice the tone of your muscles. Are your muscles at rest, tense, or sore? Where in particular do you notice any tension? Where might you find softness? Can you soften the areas around your eyes? Let your jaw, feel relaxed. Your tongue loose and soft in your mouth. Can you contract a muscle somewhere and then for contrast, let it go?
To pay attention to your heartbeat. Can you sense it? Can you feel it? Where do you feel it?
Going even deeper, can you feel or sense the blood flowing through your body?
If you can’t feel a particular sensation, just notice that. Without judgement. Just let it be.
Body / Breath / Musculature / Heartbeat / Bloodflow
*Note: If you’re typically a doer, go-getter, Type-A, cannot sit still type of person, consider doing this AFTER a workout, brisk walk, end of your day, when you’re more likely to be at ease with the sense of quiet and stillness this exercise asks of you.
Life is not easy. For any of us. There is more than enough to do, day in and day out. Stressors at work, at home or elsewhere.
So cut yourself some slack. Give yourself permission to rest.
Start with just 5 minutes. Do this at least once a day. Do it twice if you like. But do it consistently.
You might want to set a particular time for this. Perhaps at mid-day, or early evening. It’s not often you need to rest first thing in the day and this 5 minutes isn’t meant for sleeping, so not too close to bedtime either.
Either lie down or sit in a comfortable position (*see below for specifics). It’s preferable to lay on the floor but if you’re unable to do so, a bed or sofa is fine.
Set a timer for 5 minutes.
Close your eyes or soften your gaze.
Begin to breathe in and out through your nose (close your mouth).
Be here for 5 minutes, just breathing naturally. Don’t try to change anything about your breath.
Notice where you feel your breath. It might be most noticeable in your nostrils, maybe in your chest or perhaps your abdomen.
Notice how your breath is moving. If there’s any particular quality to it such as smooth, interrupted, easy, strained.
Then just breathe. And just notice.
If your mind wanders, as it’s likely to do, just bring your attention back to your breath. Feel where it’s moving through your body, where you notice it. Try not to judge the wandering of your mind as anything either good or bad.
And just breathe. And just notice.
When the timer goes off, slowly open your eyes. Roll over and stand up.
Notice what you feel. Mentally or physically make a note of what you experienced or noticed.
Keep practising for a week.
Check in with me next Tuesday and we’ll expand on this practise.
If… you can’t find 5 minutes in your day? You might want to look at that.
If you have any questions or comments, post them below.
* Positioning if seated
Sit forward on a chair so your back is not touching the back upright portion of the chair.
See if you can feel your ‘sitting’ bones (ischial tuberosities) and let your weight be supported there.
Have your feet planted on the floor, hip-width apart.
Hands comfortably on your lap.
* Positioning if lying down
Lie on the ground, perhaps on a carpet or mat if available. If you have back pain, you may want to use a rolled up towel, yoga mat, etc. to slip under your bent knees for support.
Hands can be by your side or placed on your belly.
Notice the parts of your body supported by the hard surface of the floor (heels, hips, shoulder area, head).
I’ve also learned it seems we may have been ‘wrong about stretching‘ insofar as we’re not really stretching or lengthening muscles. At least not as much as we once believed. Rather, we’re changing our response to a stimulus via the nervous system.
Our brain is naturally going to respond in a protective manner to anything it perceives as dangerous. If we are trying to re-train flexibility or just movement in the body and do so with strong, forceful pressure or stimulus … the brain/body will react by saying … stop! No! Don’t go there. It will send a (pain) signal to safeguard our movement.
However, if we move in small incremental ways within a safe and pain-free range of motion, the nervous system will react by saying … this feels okay. Safe. I’m happy to explore this.
This is a somewhat simplified way to explain all that’s going on, but it’s a starting point we can work from. We can even begin by just imagining movement and still create changes in the brain and our nervous system. So we can, really, start anywhere.
By learning to pay attention, moving in a way that allows your nervous system to adapt and create new patterns while it feels safe, you will make progress.
Why is it you sometimes need to visit a doctor, chiro, physical therapist, massage therapist, etc. time and time again for the same problem? They adjust you, work with you in a manner that seems to provide relief but within a few weeks or months, you’re back in their office again. I have been to them all and credit is due in helping with immediate pain or to fix something.
Sometimes it works long term.
Sometimes, only temporarily.
I want to speak to the temporary fix.
Until you figure out what’s creating the problem, it will likely return.
For example, if you are overweight you understand that eating too much, moving too little or a combination of both is likely creating the problem. You can go on different types of diets, you might do a fast, you might work out for the first two months in the New Year but if you don’t change those first two factors, over the long term your body’s weight remains the same.
You’re experiencing pain. Not able to move well. Feeling restricted perhaps in what you’re trying to do or you may be the type to just power through, get an ‘adjustment’, chow down on ibuprofen for months on end … but until you learn what’s creatingthe problem you won’t find long-term change or well-being.
If you suffer from an addiction, you may quit ‘the addiction’ but it will probably show up again and again unless you figure out what lies beneath.
The weight, the pain, the addiction … and so it goes …
The problem is(and we all know this) if you keep doing the same thing you end up with the same result.
However, if you can first, pay attention you will actually learn to sense, see and feel signals your body provides that can guide you to what’s below your current level of awareness or understanding. Those signals are signposts that can lead to healing and wellness.
It’s not easy to do but with practice, information and support, we can most often, figure it out.