Tuesday, 11 May 2021

How are you right now?

Take a moment; how are you right now? Look around you, what can you see, hear, feel, smell; what do you notice? How are you feeling?

A recurrent theme in a lot of the professional reading I am coming across is our mental and emotional state and how it affects our experiences and perception. Tom Goom of The Running Physio explored a recent study looking at the effects of catastrophising (worrying about the worst possible outcomes) and how mindfulness may help with managing knee pain in runners: https://www.running-physio.com/mindful-knee/. Research into pain has noticed that we can train our brain: if we focus on and worry about the pain our perception of it becomes magnified as the brain is on high alert; if we can divert our attention onto other things or engage calmly with the sensation (for instance by understanding what is happening and so dampening anxiety) the brain tones down the pain message. Pain is a sensation; it can be a response to our emotional situation as well as to physical injury - the brain does not distinguish between the two - and how we respond to pain influences our sensation.

https://www.arthritis.org/health-wellness/healthy-living/managing-pain/understanding-pain/pain-brain-connection

How we communicate with people experiencing pain is important. People may worry that if their pain sensation is reduced then their other symptoms will not be taken seriously; this may cause them to focus on and nurture their pain. The fact that pain is controlled by the brain may cause people to worry that they will be told 'that it's all in their head' and not be taken seriously. Pain is our brain warning us about something; once the warning signal has been acknowledged we can ask it to turn down the signal whilst we explore what caused the alarm. However whilst pain can be triggered by physical damage, it does not always mean that there is injury; sometimes pain sensation is triggered by the brain recognising a scenario that it associates with danger and injury. 

Our past history can have a major effect (see my previous blog post linking to Lorimer Moseley's research, http://hedgerowremedies.blogspot.com/2021/01/retraining-brain-around-persistent-pain.html). Back in 2018 I began to experience debilitating, increasingly intense sciatic pain; it became so intense that I began to experience panic sensations. I didn't understand what was happening and the pain episodes became more frequent. I eventually realised that the cause was the effect my knee injury was having on my back; once I understood that I felt the return of some control and the pain became less intense and eventually after treatment went altogether. Recently some of the early signs began to reoccur and I noticed that my nervous system was going on high alert; I was experiencing fear in anticipation of the pain returning. What could I do? First, I acknowledged it; this calms the amygdala down in favour of the cerebral cortex. Next I put it into context; because I experienced pain in the past does not automatically mean that I will again and this time I understand it better. I then encouraged my body to relax - it had tensed in fear - whilst reminding myself that relaxing will encourage better movement and help my back and knee. I then initiated helpful exercises and self-treatment and looked for improvement in how I was feeling rather than focusing on negatives. The feeling of panic retreated and two weeks on the underlying issue is still there but I am feeling ok. I am mindful that fear can cause me to avoid certain movements and that this is not always necessary or helpful; it is beneficial for me to explore movement in a context where I feel safe so that I can expand my boundaries rather than be increasingly constricted.

So, why ask how you are feeling right now? I began with a link to Tom Goom's post on a mindfulness trial that sought to address the tendency when injured to dwell on the injury and worst case scenarios and to be overly protective. Mindfulness aims to take us away from worrying about the past or the future - what has happened, what may happen - and instead notice our immediate surroundings and how we are right now. It places us in the present and allows us to relax as we take in what we can see, feel, hear, taste and smell. From there we can check in on how and what we are feeling and see if we can influence this. Mindfulness encourages us to reflect on some positives; think of three positive things that have happened today. They don't have to be major things; it is restorative to take pleasure in small things. Examples could be a bird or plant you noticed, or enjoying a cup of tea or a book, or looking at the clouds in the sky, wearing a favourite item of clothing or someone saying thank you or smiling at you. Katie Sheen in her course on mindfulness (free at present) describes how she played a game with herself of creating stories around what she could see on her windowsill from her hospital bed to help her cope with her cancer treatment https://www.soulnutrition.org/mindfulness-for-anxiety-udemy-course/We can retrain the brain to look for positives rather than negatives and this can help us with our pain perception. 

Another way of managing pain is to take time to allow the brain to process what is happening. Often when we feel pain we very naturally flinch away and avoid repeating the movement or action we associate with triggering it - this is very helpful in learning to avoid burning ourselves, for instance. However sometimes, if we take a moment, the brain can process more information and maybe realise that in certain situations we don't always need such a strong pain response, or any at all. An example would be when we stumble; if this happened whilst we were recovering from an injury and there was inflammation this would initiate a pain response as part of protecting the injury. This may continue to happen even after the inflammation has gone - the brain has learnt to give a pain warning whenever it senses a stumble; pain can be initiated by the brain's perception of threat rather than actual damage. By taking a moment to process the situation and be curious about how we are feeling the brain can learn that it no longer needs to give the protective pain signal when we stumble. In some cases a conditioned pain response may be having a profound impact on how we move and hold ourselves; taking time to explore this in a safe environment can be transformative as the brain is reassured and lets go of perceived threats. 

Pain is real, it should be acknowledged; we can also engage with and understand it. Recovering from injury is not just a physical process, we need to check in with the mental and emotional side too.



 

Tuesday, 6 April 2021

Surviving and thriving by supporting others.


As many of my clients know I am a keen knitter. A very keen knitter, totally obsessed with wool. I like to know the provenance of my yarn, that it has been produced sustainably from animals that are well treated; much of my wool comes from small organic farms or sheep used for conservation grazing. I also seek out yarn with low mileage, produced from sheep to mill in the UK - sometimes entirely in Yorkshire. It is often difficult to find this information and I often buy directly from the small farm or croft that raised the sheep. Another place I can find it is from small independent yarn shops that share my ethics. Already vulnerable to high street pressures, all of these yarn shops had to close their doors during the lockdowns and due to their small size remain closed or use an appointment only system when lockdowns were lifted. Online sales continued but what else could they do during such a stressful time? Seven of them got together to form a group where they could share ideas and expertise, organise online events for the knitting community and generally support each other, iKnit7. Their different strengths enabled them to come up with a new website and raise their profile on social media, and they have run week long events featuring interesting interviews with designers and producers as well as promotional offers and competitions. As well as supporting each other and sharing their customer base, they have engaged and supported the knitting community by lifting our spirits. 

When I left BresMed my lovely colleagues gave me a generous gift in the form of vouchers for one of the iKnit7 yarn shops that I like to visit when I am in London so that I can indulge myself in my favourite yarns and other wool related purchases. My first purchase (online due to the pandemic restrictions) was some skeins of Dile from Uist Wool, a very special yarn I had been longing to knit a jumper with but was out of my price range until I received my vouchers. Uist Wool is a community project that takes in wool from local crofts and spins beautiful yarns using antique machinery that they salvaged and restored. I used it to knit the pattern Sian written by an independent designer who was inspired by her visit to Uist. I love my jumper; not only is it a beautiful pattern that evokes a landscape I love, making it has supported three other small businesses: the yarn shop, the designer and the wool mill - not to mention indirectly supporting the crofters the mill buys the fleeces from. Now my jumper is finished I have the fun of deciding what to buy next with my vouchers!

Together we thrive!

Sunday, 28 March 2021

Waiting for a green light...

Spring flowers: lesser celandine and wood anemones

 *UPDATE: Following on from the announcement on 5th April, I will be reopening from the 12th April. I am very much looking forward to resuming appointments!*

I hope everyone reading this is well and that your family and friends are too. 

I have been receiving enquiries about when I am allowed to return to work. I am waiting for the 5th April when we will be told if massage therapists are to be given the green light to return to work from the 12th. I am keeping a waiting list so if you would like to be on it do contact me by text, email or phone call and I will be in touch once I have a date to reopen. I have been reluctant to book people in on a provisional basis in case I have to postpone appointments once again. 

Meanwhile, I am here if you need someone to listen or if you would like some advice on aches and pains. My website also has links to the exercise videos I have made to help keep you moving well. A year in I know many more of us are beginning to struggle with the challenges this time has brought. Do consider contacting charities such as Mind,  citizensadvice.org.uk and Turn2Us if you are struggling with your mental health or financial and housing situation; they are there to help and support.

Take care, I hope to see you soon.



Saturday, 13 February 2021

Why I am staying at home....

I thought I would write this post as there has been much confusion in my line of work caused by the mention of 'other medical or health services' in the following government guidance:


 You Must Stay At Home, except where noted below

Exception 4: medical need
(7) Exception 4 is that it is reasonably necessary for Persons to leave or be outside Their home—
(a) to seek medical assistance, including to take any medical tests, be vaccinated or access any of the services referred to in paragraph 17 of the Schedule;

Paragraph 17: dental services, opticians, audiology services, chiropody, chiropractors, osteopaths and other medical or health services, including services which incorporate personal care services and treatments required by those with disabilities and services relating to mental health


However, although important for mental and physical health and rehabilitation, massage therapy is not counted as one of the health services and is not defined as medical. It is not included in the list of allied health professions considered as essential. More to the point the guidance explicitly lists massage therapists as one of the close contact services that must close (see below). My association therefore decided that the 'other medical and health services' is not applicable to us. A treatment from me involves being close to each other for over fifteen minutes and I feel the associated risk cannot be justified whilst infection rates are so high. I so want to work, but I agree with the statement below from my Professional Association and will stay at home until given the green light to return to my treatment room. 

Meanwhile I am still available if anyone wants advice over aches and pains, or just a listening ear. Do take care of yourself, I look forward to when we can meet again.

 Dear ISRM Members,

We are aware that this evening certain Professional Associations and the CNHC have changed their advice regarding level 4 & 5 therapists working during this national lockdown.
The ISRM’s position is that nothing has changed since we delivered our latest guidance on 4th January, and as such our members should not provide face to face appointments at this time.
As a Professional Association we exist to represent the best interests of our members for their studies and their businesses. We also have a public duty to take account of the health of our members, their clients and the community at large. We take this duty extremely seriously.
In order to provide our members with as much background to our decision as possible, we will share the below, which shows how legislation and Government guidance interact;
Legislation (Remaining the same as November)
You Must Stay At Home, except where noted below
Exception 4: medical need
(7) Exception 4 is that it is reasonably necessary for Persons to leave or be outside Their home—
(a) to seek medical assistance, including to take any medical tests, be vaccinated or access any of the services referred to in paragraph 17 of the Schedule;
Paragraph 17: dental services, opticians, audiology services, chiropody, chiropractors, osteopaths and other medical or health services, including services which incorporate personal care services and treatments required by those with disabilities and services relating to mental health,
Guidance (updated 6th January)
Close Contact Service Must Close
This includes hairdressers, barbers, beauticians, tattooists, sports and massage therapists, dress fitters, tailors and fashion designers
Relationship between Legislation & Guidance (Directly quoted from the Government)
To find out exactly what the rules are during the coronavirus pandemic, you need to look at both legislation and government guidance. Legislation sets out legal obligations and restrictions that are enforceable by law. If you do not abide by the legislation you are breaking the law. Guidance and advice is likely to be based on legislation (in which case it will be legally binding) and it might offer the best or most appropriate way to adhere to the law.
The law is what you must do; the guidance might be a mixture of what you must do and what you should do.
Some Figures For Consideration
When we restarted work in July, the incidence of covid in the UK was less than 1 in 1000
The November lockdown came in because infection rates were in the region of 1 in 100
As of January 6th, in England the incidence is 1 in 50 with hot spots of 1 in 30
In addition we know that the latest strain is 50% - 70% more infectious, which was not the case in November. Our hospitals have more covid patients than at any time during the entire pandemic (30,000 as of 6th Jan). Life saving treatments are being stopped. We are at Covid-19 Alert Level 5, indicating that the NHS may be overrun within the next 21 days without significant changes. We were at Covid Alert Level 3 when we restarted in July.
We are in Lockdown and the very clear message is;
STAY HOME, PROTECT THE NHS, SAVE LIVES
During normal times, we hope that you select the Professional Association that you want to represent you because you agree with the ethos of the association, what it stands for and how it works to progress the industry. Now in these extraordinary times, tough decisions must be made, our ethos, our duties to our members and what we stand for in the future of Soft Tissue Therapy means we are very confident to make these tough decisions and stand by them.
Thank you once again for your support, we will get through this together
The ISRM Team

Thursday, 4 February 2021

How is your First Aid?

 

Image by Claudia Schwarz @purlzlbaum

I will be updating my Emergency First Aid at Work certificate in a couple of weeks time with the St John's Ambulance. I have to renew my certificate every three years by doing a course in person but in between I sometimes do online courses to keep my awareness of basic first aid topped up. These don't take long to do and could help you to make a real difference to someone in need of help. Here is a link you may like to use to one that is available for free during the pandemic:

https://www.strongrootstraining.com/first-aid-awareness-at-home?fbclid=IwAR2lsOm4p9jqNOWhPtls5nFK0KQpLjIpRS3v_8HBVyI3eST7Dz2cPuWHnWI

The Red Cross also have online information:

https://www.redcross.org.uk/first-aid##

Earlier in the pandemic I did another one with SJA  which presented me with scenarios and I had to select the appropriate actions (suspected heart attack; heavy bleeding; unconscious person; choking). It was excellent and did identify some areas where I needed to brush up my knowledge.

https://www.sja.org.uk/course-information/free-refresher-course/?utm_source=Communigator&utm_medium=email&utm_campaign=COVID110221&utm_content=

Even though I have been doing first aid courses for over twenty years now (usually emergency first aid but I have done the three day more thorough course as well) as with everything if you don't use it regularly it is difficult to remember everything. I am very glad that I have not often been in situations that require me to use my first aid skills but this lack of practice makes it even more important that I keep refreshing my knowledge.

Do also keep an eye out for where you can access a defibrillator near your work or home, you can look them up on this site: https://www.heartsafe.org.uk/aed-locations

Monday, 18 January 2021

Walking not slipping...

 


It's been pretty slippy out there recently; when it hasn't been icy, it's been muddy, and sometimes it's been slushy mud over ice. All a bit of a challenge to our balance! At this time it's very important to look after yourself and not end up injured so you may be using studs or other footwear to improve your grip, but there are also movement strategies to remember:

  • Relax! Let your body stay relaxed so it can monitor what is happening underfoot and make minute adjustments to help you adapt and balance. Your nervous system will be working with your musculoskeletal system far faster than you can consciously control!
  • Remember to breathe; as well as being generally a good idea this will help you keep relaxed.
  • if you slip but recover your balance before you fall that is amazing - your body is looking after you!
  • Look at my blog post on vertical hip release; this movement strategy will help your body absorb and respond to the challenges posed by slippy conditions.
  • Look at my blog post 'Hunting in the Forest' which is about keeping your centre of gravity over your feet as you walk; again this will help with keeping your balance and feeling secure as you move forward.
You can find the two blog posts on the 'exercises' page of my website, scroll down to the bullet points where you can find the links to the posts.

I sometimes find myself nervous about going out in icy or frosty conditions as we live on a steep hill, but if I use these strategies plus maybe some grips that I can pull over my trainers then I find I cope just fine - and feel so much better for getting outside! Obviously I am not you so do use your own judgement to keep safe out there - especially when there is black ice.


Friday, 8 January 2021

Retraining the brain around persistent pain.

There has been a great deal of research into pain in recent years; it is now much better understood that perception of pain, as in how much pain we feel, is mediated by the brain rather than the tissues. Many of you will have seen a short talk on pain, 'Why Things Hurt' by Professor Lorimer Moseley made back in 2011. Here is a recording of a more recent lecture by him that as well as explaining what is going on when we feel pain also explores (from 48 minutes in) how we can manage our pain and retrain our pain response.  


One of the things that I really like about how he talks about pain is that he emphasises that many of his patients with chronic, persistent pain are some of the bravest people you could meet. He understands that persistent pain can get us down, that we can begin to worry that people don't believe us or that they think we are 'weak', or we may begin to be frightened of what is happening with our body to create all this pain. This is why he is so keen to educate about pain and as well as watching the video I recommend having a look at the two websites linked to below. 

In summary:
Pain is there to protect us, but it can become oversensitised and turn from a useful tool to something that is controlling and restricting us.
It is influenced by context and meaning - past history/associations; our mood, fears, thoughts and health; our beliefs, knowledge, culture, social circle and so on (listed in the video).
Inflammation elevates the pain response.
Perception of pain can be dampened down by:
- understanding what is happening, and being shown understanding.
- having patience and persistence as retraining something that has developed to protect us will take time.
- having someone to support and coach you through the process.

He also emphasises that movement and activity is good especially once a safe baseline has been established to build from; not moving (where chronic pain often takes us) is not good. We need to retrain the brain that movement is safe - something that many movement therapies such as JEMS embrace.
My own journey with chronic pain turned a corner when I discovered two different yoga teachers, teaching very different types of yoga, who provided a safe context for me to explore - gently, over many weeks so that my brain could listen to my body and recalibrate - movement that I had learnt to avoid, and to learn that movement was not only safe but felt helpful and liberating.

Useful links and resources:
- These two sites are mentioned by Lorimer Moseley and have been created to provide help for people experiencing chronic pain:

- This is a link to a pamphlet on persistent pain, produced by the Tasmanian health system. It is very simply but thoroughly explained.