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Gaining Perspective

Have you ever had that overwhelming feeling and you just don’t know why you feel that way? It may be that you feel really anxious or depressed, or you feel run down and not yourself. I’ve had this feeling before and it can feel very daunting, particularly when you can’t work out what it is that’s making you feel that way. It could be down to any number of things going on in your life, but you just can’t put your finger on what it is. On some occasions, you may think you know what the trigger is, but can’t work out why it is making you feel like that. It feels like your brain is fogged up and it can seriously stress you out!

 

It may be the situation that you are in is stopping you from working things out. It may be that you are too busy to find time to figure things out, or it may be that you are ruminating on one thing, which is stopping you from having enough headspace.

 

At times like this, it may be that you need to change what you are doing to allow you to gain perspective. So what could you do to help give you time to think? Can you take some time off work? This may worry you because you lose a day at work, but in the long term you will probably feel better for it. If work is feeling particularly stressful, it can be good to give yourself a break and get yourself away from the usual routine.

 

More simply, take time out of your day to go for a walk and get yourself out of the office, or get out for a long walk in nature at the weekend; this can help to clear your head. The outlook can look much better from the top of a hill, walking along the coast or taking a walk in the woods. If it’s possible take a holiday, the amount of people who get better from a painful condition after a holiday is remarkable.

 

Talking to friends or family can also help give you a better perspective on things, often they know you better than you know yourself. If you feel like you can’t do this then maybe seeking professional help might help to make things clearer. If you don’t feel like talking to someone then try writing down your worries or problems, once they are on paper they may not feel so big.

 

However bad you feel, if you keep doing the same thing over and over it won’t help. Try to break away from your normal routine or try to get help from someone you trust, it can make all the difference to helping you feel less stressed.


November 10, 2016
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The joy and pain of watching Leicester City!

I’m a Leicester City fan and for those of you that follow football, you will know that they are having an incredible season and are currently top of the premier league! Before the season they were relegation favourites and in my wildest dreams I couldn’t have predicted this happening. So it is all very exciting!

 

This weekend I watched them play against Watford and they won 1-0. It was a great result and it meant they went five points clear at the top of the league. Although it was a great result, until the final whistle was blown I couldn’t relax, I was a bundle of nerves, jumping out my seat and biting my lip. At times I felt like I was physically shaking. Even after the match had finished it took me a while to calm down. I text some of my friends and joked that I wasn’t sure I could watch for the rest of the season as I might have a heart attack!

 

The next day I read a report on the BBC website explaining how positive events create stress and place strain on the heart that can cause a condition called ‘acute stress cardiomyopathy’. A bit depressing really! It explained how exciting and happy life events, such as getting married, someone having a baby…or your favourite team being top of the league, although positive, create stress and put extra pressure on your heart. In summary positive life events can be as stressful as negative ones can. You can read the article here: BBC article

 

Luckily I already knew this so didn’t feel too down. It is something that I’m often explaining to people, but find they have difficulty accepting. When I am working with people in pain I try to help them understand the link between their stress and pain. If I explain that the promotion at work or finding out your wife is pregnant is a cause of stress, people often question it by saying ‘But it was a really positive time for me?’ and they’re right, it is a positive time, but it can also increase stress levels. It creates extra physiological load, increases heart rate, blood pressure and may not allow you to sleep properly. If this carries on the unconscious part of your brain may activate a protective mechanism to try and make you slow down. Pain is often that mechanism, as it makes you stop, slow down or makes you rest.

 

This all may seem very depressing, but it’s not if you can recognise it. If you recognise it you can do things to balance and counteract the level of stress. You can make sure you do things that help you to relax, like exercise, walks in the countryside, meditation, offloading by talking to friends or writing things down.

 

So, even though I know it’s stressful, am I going to stop watching Leicester City this season? No chance! This is the most exciting season I’ve seen as a Leicester City fan! Even 20160309_112401if you don’t follow them you have to be impressed by what they’ve done. I’ll just make sure that the level of stress it creates between now and the end of the season is counterbalanced with time spent switching off!

 

Come on the foxes!!!


March 9, 2016
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Your pain threshold will vary depending on how you feel!

People often find it interesting to know that their pain threshold changes, it is often presumed that it’s set at a constant setting. Pain thresholds are subjective and everyone will have a different threshold, but your threshold will also vary on a day by day and even hourly by hourly basis and there are various factors that can cause it to shift. You can tolerate more or less pain depending on your mood or situation. Things that will cause your threshold to drop are stress, low mood and generally feeling tired or run down. The pain threshold decreases here as a protective mechanism, if you’re tired or stressed you will generally feel more aches as a consequence of the nervous system perceiving there to be more threat or feeling it does not have the resources to deal with the threat and so being more protective.

 

Studies have shown that your pain threshold can drop quite quickly in certain situations. One study found that if they made people feel more depressed then they could tolerate less of a heat stimulus before it became painful. In another study they found that putting people in stressful situations reduced the ability for them to tolerate a heat stimulus before it became painful. This happened in a relatively short period of time in both studies.

 

If you are interested in these studies the links can be found here:

http://www.sv.uio.no/psi/english/people/aca/sirigra/berna_biol_psych_2010.pdf

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0069460

 

Changes in motivation can cause an increase in the pain threshold. When people are playing sport their pain threshold will increase in order for them to achieve their goal of winning the match. When you are more relaxed the pain threshold increases, if you meditate, which helps to relax the nervous system and the muscular system, you can tolerate a higher level of pain. This can also happen fairly quickly. This study found that after four days of practicing meditation, people’s tolerance of heat increased before it became painful, compared to their pre-meditation levels. Follow the link for this study:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3090218/pdf/nihms286473.pdf

 

This might be why this meditating monk can smash a brick over his head:

 

monk[1]

 

So, how does the brain change the threshold? Well the brain has a mechanism where it can send a message to the central nervous system, specifically certain cells in the spinal cord, to tell them to change the messages that come in from peripheral parts of the body.  So, previously non-painful stimulation like a gentle touch on the skin can feel painful, even though it is not causing any harm to your body, because the signal that comes in is now an amplified signal. The brain uses this mechanism to protect you from perceived threat and this threat can be physical or psychological. If someone is relaxed then there is less perceived threat and the threshold increases.

 

If you have had a recent acute episode of pain, have a think about what was happening and how you were feeling at the time, as it may not have been any tissue damage to cause the pain, it may have been the nervous system trying to protect you from a perceived threat.

 

 

 

 

 

 

 


February 10, 2016
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Look after yourself this Christmas!

Every year around Christmas time I have a number of people come in to see me with lowerfather-christmas-7 back and neck spasms. When I ask these people how their pain came on, they reply that ‘they can’t really think of a reason, it just went into spasm’. This is a pattern I have observed for a number of years now and in my early years as a physiotherapist I was left scratching my head as to why these people had high levels of pain and intense spasms, without a clear mechanical reason for it.

 

Since I have transitioned to using a neuro-physiological approach and now use the SIRPA approach it is now obvious why I see this pattern. Christmas is one of the most busy and stressful times of the year! On top of your usual amount of stress, there are presents to buy and the stress of finding the right present for people. There is the food to buy in and the added pressure of making sure everything goes well on the day. There are more social events to attend and if you’re more of an introvert that may not be something you looking forward to. There is the prospect of spending time with your family and if you don’t get along with your family this can be difficult. You may also have work that needs to be finished before the holiday, so you are front loading to get that finished. All this is on top the stress that you already have in your life!

 

In previous blogs I have already explained how changes in lifestyle can cause stress. I have also explained how stress can make the central nervous system more sensitive and it makes muscles more hyperactive. If you’re not getting enough downtime, which can often happen in the lead up to Christmas, the pain and muscle spasm can come on to make you slow down.

 

During this period, try to take care of yourself and make sure you still have time for yourself. If you can, try and take ten minutes out of every day when you sit and do nothing at all. This will allow your nervous system to switch off. There is also lots of other good advice on the clinic’s facebook page: BPRC Facebook page

 

Look after yourself and have a Great Christmas!


December 23, 2015
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Breaking the Pain Habit

It was previously thought that the brain doesn’t change much after childhood and because of this certain habits or behaviours we developed in this period cannot be changed. It was believed that this could cause us to get stuck in later life continually acting out certain behaviours we have learnt during this period. Likewise there are also people who believe that once pain has lasted for longer than 3 months (the medical definition for chronic pain) then it is unlikely it will resolve and will become permanent. We now understand that this is wrong on both counts.

 
What I have found when working with people who have chronic pain is that there are certainly behaviour and thought patterns that can have a negative effect and even cause pain. Often these patterns are learnt in childhood, but they are not permanent and can be changed. Yes the brain can get stuck repeating the same thought pattern, which causes you to act in a certain way, but you can retrain it to think differently. Likewise the adaptive changes that occur in the brain and central nervous system that cause the majority of chronic pain are also not permanent. So by changing the negative thought and behaviour patterns you can in turn stop them from driving the pain cycle.

 
Here is a great video that explains neuroplasticity (Patterns of activity in the brain and nervous system). It shows how the brain like the nervous system is adaptable and constantly changing. Because of this it is possible to rewire your brain to a new way of thinking:

 

 

Negative self-talk that may have started when we were young can continue in later life and become a habit. Often when people with a low self-esteem can reinforce this with negative self-talk. This also prevents people from doing things that are good for them because they don’t feel they are worthy. It may mean you stop socialising with friends, stop exercising due to a negative image of yourself or don’t take time out to do things you enjoy. If you don’t do things that are good for you and you are regularly feeding negative information into the system, it will have a negative impact and is likely to cause pain.

 
As the video explains you can change your thought patterns, which in turn can help change your behaviours, which in turn can make you do activities that are positive for your pain. By doing this it helps to switch of the pathways in the brain that are causing the pain and helps to create new pathways that switch the pain off.

 
Now just because you can do this it doesn’t mean it is easy. It requires will power and perseverance to break the negative habits. Imagine you are golfer who has swung his club in a particular way for years. You go to see a coach who tells you that they could improve your game by changing your swing pattern. To begin with the new swing will feel very strange and you may not play as well for a few weeks as you adjust to the different way of playing. After a while though when you have repeated the new swing enough it will start to feel natural. You get used to it and actually find that your game improves and you are a better player than before.

 
Breaking habits can work in the same way but with perseverance and repetition you can create more positive habits instead! This switches off the old habits and pathways that were leading to the pain.

 
For some great advice on creating new positive habits have a read of this blog written by Georgie Oldfield on the SIRPA website:

http://www.sirpauk.com/blog/using-willpower-to-break-the-pain-cycle/


October 6, 2015
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