Persistent Pain Recovery Part One — Movement and Trust

My second walk/run on April 28th 2024, Gibsons Beach coastal trail with both dogs and Olly. Our whole pack! I was sooooo joyful! So joyful I enthusiastically abandoned all plans of Graded Exposure and paid for it the next day with a stonker of a flare up. Lesson learnt!

I’m 10 days in to my recovery journey from persistent pain. Writing is part of it, so here I go, even though I had planned to clean the bathroom! April was a breakthrough month for me. Who knows what came ever me — maybe it was fighting off a pack of nine wolves with my bare hands back in February (but that’s another story!) — but there’s been a change in me, so when I saw Greg Lehman, Clinical Educator and Physiotherapist was doing online coaching I immediately went for it! Wahooo! I’ve been following his work for years so very timely.

I developed persistent (chronic) neck pain and the accompanying deep fear of movement in Whistler 10 years ago, following a running accident shortly after my beloved Dad Pops T had died. Maybe the recent 10 year milestone also triggered in me taking a good, hard luck at my situation and how to start recovery. A truly daunting prospect after living with pain that has frequently been debilitating on some days. It’s not that I’ve ever given up. Far from it. Although some of my friends maybe think so. My conversation with Greg revealed that on the contrary, the relentless quest for answers has been a huge contributor to my system’s vigilance and over-protection. Hell, I even changed my line of work so my life revolves around improving things!

You see, persistent pain is all about protection. “Pain, first and foremost and without exception, exists to protect and preserve you.” (from The Explain Pain Handbook Protectometer p. 11). Persistent (chronic) pain is defined as pain that continues for more than three months. Unlike acute pain, persistent pain serves no biological function and continues long after the tissue has healed from injury. Importantly, persistent and acute pain are entirely different clinical entities. Acute pain is provoked by a specific injury or disease; it serves a useful biological purpose (protection) and often disappears before an injury is healed, whereas persistent pain is currently considered a disease state. It is pain that outlasts the normal time of healing. Essentially, the brain ‘learns’ pain, it becomes habit, causing unimaginable suffering for a fifth of Earth’s population. It’s like a car alarm going off for no reason; there’s no danger but the system is stuck on. It is an invisible condition that is widely misunderstood, and greatly stigmatized. It is neuroplasticity (or bioplasticity as Noigroup would say) gone awry. Many things affect our experience of pain

Example 1: Noigroup’s Lorimer Moseley is a clinical scientist that investigates pain. He tells a story of a man being admitted to ER with a nail through his boot, in excruciating pain. The removal of his boot revealed that the nail had missed his foot but gone between his toes! The excruciating pain vanished. Proof that what we see and hear provide information relevant to threat and subsequently have a strong power to affect pain.

Example 2: An identical finger injury will cause more pain in a violinist than in a dancer because finger damage poses more of a threat to a violinist (Explain Pain p. 18). What we believe and where we are affect pain.

Example 3: If a cold metal rod is placed on your hand, seeing a red light at the same time will make it hurt more than seeing a blue light at the same time. What’s more seeing the red light will make the rod feel hot (Explain Pain p. 18.). What we think affects pain, as do our emotions and things we smell, taste and touch.

Essentially, our movements, sensations, thoughts, emotions and memories all have an effect on pain. My pain levels are rising now just because I’m sat typing at my computer. My system thinks it’s dangerous to sit as I had so much fear around sitting, especially at the computer, starting in 2015. My nervous system is watching out for me, keeping me safe. Pain is the unfortunate output.

So. Pain is complex, and I will write more about it’s mechanisms in further posts, but for now, believe me when I say that living with persistent pain sucks the life out of you. It’s real and it’s exhausting. It’s invisible. Look how healthy I look in the photo! No wonder no-one gets it. We look completely OK so why aren’t we? “Have you tried…?” is such a common refrain we hear, but here’s the thing: we don’t need fixing. “Do you believe you need fixing? There’s nothing to fix,” Greg said. This can be subconscious. I knew I didn’t need fixing from all I’d learnt and had read (books, courses, workshops…) but did I believe that at a bone deep level?

On to our Zoom meeting. I’m calling it Recovery Day One. Just having someone to finally work with was such a relief, after all this time. Someone to listen to my pain story, and get it. Someone knowledgeable yet humble, non-judgmental, down-to-Earth and fun. I trust Greg.Turns out I lost trust in my body — in myself — a decade ago. Now it’s time to start slowly building that trust back. “You’ll get better when you trust yourself as much as I do,” Greg said. Greg KNOWS I can recover. He’s seen it happen many times!

Greg was able to confirm I have nociceptive and nociplastic pain, although I don’t fit lots of the criteria for nociplastic pain. Google them if you’re curious. I found this helpful to know, as that’s what I’d suspected. Essentially, part of my homework is that there are no off- limit movements for me. I have permission to move and can do whatever I want!! Liberating. It feels strange typing this, and shame is creeping in. I’m a movement teacher that’s afraid of movement? It’s true! More on that in another post too, but crucially we discussed that in my case, too much interception is getting in the way of my recovery. I’m a teacher of Hanna Somatic Education, in which we sense ourselves moving as we move. I’m still getting my head around it, but it makes sense. Could it really be a contributor to my system to be on high-alert, causing an already vigilant system to be even more vigilant with such close internal scrutiny? Stress, worry and fear are all enormous contributors to my pain. My beliefs too. There’s a lot to discover!

The day after our meeting, I woke up, and in bed lay there and flexed my neck right back a few times, trusting, not sensing it (a terrifying movement for me). I got up and felt fine!! Then, with Jhana, I went for my first run/walk in 10 years!! I realised I hadn’t run since I fell training for the Sun Run in February 2014. Wow. As planned, I went out for about 20 minutes, and every two minutes, burst into a 10 second run. It was fun!! And no flare up. Three days later (in the photo) I got into a HUGE flare up, not that day but the next, interestingly. It was, of course, horrendous. The accompanying anxiety too. Extremely awful, but not the end of the world. It’s all part of the process. Yesterday I stuck to the walk/run plan, and felt great. I’m already hiking with less pain too. Because I’m starting to trust myself again and trust that I WILL recover. I feel empowered and less afraid. My system will learn by doing. Moving without hard rigid rules, for me, will ultimately convince that deep part of myself that has no faith that I am in fact robust and safe!

By the way, Greg’s a big fan of any exploratory movement without rules. Somatics included. More on that later. No movement is off the table! I’m free! :) That’s worth celebrating. And Greg has offered to do a guest post on this blog, worth celebrating too! There’s light at the end of the tunnel! There’s HOPE :) I can learn to trust in my amazing, adaptable and strong system.

The many different ways our protective systems can look after us when we’re facing trouble. From the Explain Pain Protectometer p. 25.

Why I practice

 “Habits are when we decide how to act before we are aware that we have a choice.” — Moshe Feldenkrais

Why do I practice? What is it about somatic movement that has me committed daily (well, most days anyway — I am human!)

My practice gets me to stop. To pause. To listen. It gets me to lie down and feel myself. To honestly and kindly meet myself where I am, then gently take myself to a softer place. And that’s just for starters…

Somatics is my work and my life. But, you may ask, haven’t I ‘learned’ all the movements after many years of practice? Well, yes in a way I’ve ‘learned’ the movements. But do we ever ‘learn’ self-reflection, meditation, or journaling? Of course not — each day I am a different person, my nervous system responds differently to different internal and external input, and each time I practice is an opportunity to learn something new about myself and make subtle changes.

In deeply sensing myself in the moment I learn how to sense my immediate, present lived experience. Nothing matters but today. Each movement exploration is an opportunity to ask myself how I feel in any given moment. What a rarity, what a gift this is these days.

My practice gives me permission to engage in a process of self-inquiry again and again. It is a brave and courageous thing to do, I feel, and a kind and compassionate action of self-care. How am I today, really? I explore how it feels to move with kindness, softness and tenderness. Expansion as opposed to contraction. Allowing movement to happen rather than forcing movement to happen, so change can happen (healing happens in the present).

Stressors are, of course, are a part of being human. But when our nervous systems’ ongoing involuntary reactions (reflexes) to stress get ‘stuck on’ is when those seemingly innocuous niggles can gradually turn into persistent (chronic) pain, illness, anxiety or burnout/exhaustion. 

So, my practice prevents me from getting stuck. Stuck in any of Hanna’s classic three stress reflex patterns and their relatives. I’d be lost without it. I’ve learnt to know myself at last, through feeling. I’m unfurling. I am a process.

Finding my Feet

As someone with a background in English language teaching and journalism, I find language endlessly fascinating. How many idioms can you think of that involve feet, for example? Here are a few: Finding my feet, Get your feet wet, Take a load off your feet, Dead on my feet, Cold feet, Itchy feet, Stand on your own two feet, Sweep someone off their feet, Thinking on your feet… you get the gist!

I’ve always loved movement. In my 20 years in Whistler I snowboarded 100+ days per winter season, coached high-level snowboarding to groups of teenagers, cross-country skied, mountain biked, hiked, practised yoga 4x a week and on… my feet of course necessary for all of this! Upon moving to the Sunshine Coast I trained as a Somatic Movement (and mindfulness) teacher in 2019 and I can happily say I’m still finding my feet teaching and guiding somas. One of my intentions when I teach is to never behave like an expert, as that takes away from the soma on the mat’s experience. I have no desire to take away any person’s power and autonomy by ‘experting’ (yes, this word doesn’t actually exist as a verb, but it does now!) — as one of my teachers Theresa Evans said “The truth is more meaningful when you discover it for yourself.” My role is to guide my fellow somas, they are in charge of their own discovery process. Our nervous systems self-organize when given the chance; we are an adaptable organism. Can I be confident and competent but let the soma keep their power and autonomy? Or maybe even help them find it again if they have lost it somewhere along the way. That is my aim.

This does not mean I do not have any knowledge to help — of course I do, but can I allow the soma to have their own somatic process, one of curiosity, courage, compassion and above all ownership and self-efficacy? I will be forever finding my feet teaching Somatics as there’s always something new to discover! Both somatically and intellectually. Somatic knowledge is inherent in all of us, but mostly very much neglected as in our modern world we allow our prefrontal cortex to prevail (thinking, analyzing, coming, striving and on…). We can all find easier, more efficient ways to move and be in this world if we simply change the channel. So next time you’re feeling uncertain, anxious, angry or disconnected, try this: Take off your shoes and socks. Stand up. Feel your feet. Notice the temperature. The texture of the surface you’re standing on. Is it smooth, spiky, uneven, soft? Is it pleasant or unpleasant? Do you trust the ground that’s supporting you? What information do you receive through your amazing feet about the surface you’re supported by?

Our feet have enormous sensory capacity. They have a huge amount of space in our body maps in the brain, the sensory-motor homunculus. The face and hands have even more. That’s a lot of untapped information we’re often not tuned in to when we allow our cognitive minds to dominate our daily experience. We are s much more than our intellectual minds. Feeling our feet on the floor beneath us is a simple way to connect to ourselves on a different level. It takes us out of the thinking mind and allows us to feel what it’s like to be human, a giant sensory-organism whose home is Planet Earth.

And by the way, Birkenstocks and socks truly feels THE best! ;) As does bare feet in the warm Salish Sea being caressed by sea grass.

Believing in Bioplasticity — Persistent Pain Recovery Part Two

Whenever I break out into a run the dogs do too! Even 14 year-old Indie. Wheeee!

“It must be fully realized from the start that the learning process is irregular and consists of steps, and that there will be downs as well as ups. We must not become discouraged therefore, if we find we have slipped back to the original condition at any time; these regressions will become rarer and return to the improved condition easier as the learning process continues.” — Moshe Feldenkrais, from the preface to Awareness Through Movement.

I’m one month, and eight walk/runs into my adventure with more movement. Recovery from persistent pain (which is essentially a sensitized neuroimmune system) is not a linear process and MANY things can influence pain. There are always many contributors to anyone’s pain. “You will have pain when your brain concludes that there is more credible evidence of danger (threat) related to your body than there is credible evidence of safety related to your body.” — Noigroup’s Explain Pain Handbook Protectometer. Pain is entirely about protection of the organism (me!). Out of the seven times I’ve run I’ve only had two major, horribly intense flare ups of pain so far, and those are part of recovery. Challenging my system to running slowly, using Graded Exposure, my system is getting the message that it’s safe! Our systems are built to adapt! We are bioplastic! One of THE most certain things about all living organisms is that we adapt. Plants adapt. Animals adapt. We ALL adapt, and it’s our whole system. This is what pain scientists refer to as bioplasticity (plastic brain and plastic body). By slow exposure to movement, my system will adjust — my system will learn by doing. It is possible to retrain my sensitized system and recover :)

Problem is, us humans can accidentally get in the way of the body, the system, figuring it out. This ‘getting in the way’ can happen in many ways, and these dangers or threats are what Lorimer Moseley (Noigroup) calls DIMs (DIM stands for Danger in Me). DIMs are anything that is dangerous to my body tissues, life, lifestyle, job, happiness, my day to day function — a threat to who I am as a whole person (the whole Soma in Hanna Somatics terms). The seven DIMs are: Things I hear, see, smell, taste and touch, things I say, places I go, things happening in my body, things I do, things I think and believe and people in my life (this is the biopsychosocial model— MANY factors influence pain). To find my DIMs, I need to ask myself, “What are the things in life that are worrying or threatening?” There are SIMs too (Safety in Me) – seeking ways to feel safe is a huge part of this too (another post to come on those!)

Self-reflection is an enormous part of the healing process, which is partly why I’m writing this blog. Note that in the above DIMs categories, some things I am able to control/influence, but some are more difficult, as humans have sub-cortical reflexive patterns of protection and (strong habits too!) However, a huge epiphany came a few weeks ago in a Somatics class that I was participating in, not teaching. Greg and I had discussed that it would be good for me to JUST MOVE, without paying close attention to internal sensations (as we do in Somatics). Hmmm! As my teacher started cueing the movements, before I even moved, I realized my nervous system was already on high alert, hyper-vigilantly looking out for possible threats that could cause damage or that were sub-optimal. As we’ve discussed in class before, it’s ‘What happens before we move.’ I realized my system was taking cues such as “Is the back of the neck long?” and “Is the lower back arching?” as THREATS or DIMs — my system was so on edge it had interpreted these suggestions as things that could be harmful (an arched neck or low back). Even though in Somatics we’re not trying to get it right (there is no ‘right’ way to move, we’re just looking for better choices in how to move) my system had immediately become on edge, sensing possible danger. Eyeopening!!

So, I opened my eyes, remembered my intention of moving with fun, play and frivolity, an “I don’t care, I’m safe!” attitude and this totally changed my experience! Opening my eyes made things feel safe, less intense, and I explored the whole class with a new spirit of adventure, just moving! I trusted my system to self-organize. Way less caution and scrutiny and a lot more pleasure. It felt really liberating to have discovered this. I explored huge movements in the Side Sweep (rotation) movement, just for fun! Wheee! I’ve identified the DIMs in this case as things I heard, things (potentially) happening in my body, and things I thought and believed (my system anticipated the movement to be harmful and dangerous, even before I moved).

I felt great after that class! It was incredible to understand the subtlety of what was happening. Ironically, my system was, beneath my level of consciousness, holding me captive, frightened to move, should I (GASP!) have my back or neck too arched (LIFE THREATENING!) Full of FEAR. It’s so paradoxical. In the very classes that we are exploring how to move beyond our movement habits and expand our choices in how we move, my system was holding me back out of fear and protection. Thank you beautiful nervous system, but I choose to move beyond THAT habit!

Greg and I had discussed how stress, worry and fear are biggies that get in the way of recovery. Discovering the intricacies of these is the key. It’s all part of the process. As Greg says: “The body is self-organizing. We just need to put it in an environment where it can figure things out on its own.” That is, I can learn to get out of my own way! Movement is medicine. ALL movements are on the table! I don’t have to be perfect to be pain free! To quote Feldenkrais again “Striving for a goal reduces the incentive to learn.” My task is to remove all the things I’m trying to do to subconsciously ‘fix’ myself and believe in my system’s amazing capacity for bioplasticity.

This is just one example of my system’s deep-rooted, mostly subconscious, fear of movement, however. Losing my deep, primeval fear of movement will be a long process, but I’m in for the ride. The best thing I can do is move — that’w what humans are designed to do! Understanding pain and retraining my system works. There will be many, many unhelpful habits to uncover along the way and fun new ways to move! The more I move, the more my system will adapt and the more I’ll believe that I CAN DO IT. One last thing — the irony that I am a movement teacher is not lost on me! It will only make me a better teacher :)

Growing my running resiliency on Chesterman Beach, Tofino, May 15th 2024.

“The aim (of the Feldenkrais method) is a person that is organized to move with minimum effort and maximum efficiency, not through muscular strength, but through increased consciousness of how movement works.” — Moshe Feldenkrais. This book was recommended to me by a friend and it’s helping me work with my body to discover my best running form, rather than imposing someone else’s theories about ‘proper’ form onto myself. Running and Somatics is a great combo!

Some of my Persistent Pain Neuroscience books from left to right: Greg Lehman ‘Recovery Strategies’, Lorimer Moseley and David Butler ‘Explain Pain’ and ‘The Explain Pain Handbook Protectometer’, Benjamin S. Boyd ‘Bodily Relearning’ (in April 2024 I attended ‘Bodily Relearning’ as a two-day workshop in Vancouver). “Learning (about pain) is an invisible force. We are bioplastic!” Lorimer Moseley

“For proper functioning, all nervous structure needs full activity followed by full rest.” — Moshe Feldenkrais

Jhana demonstrating her amazing ability to rest — yes even Border Collie nervous systems need lots!

We live in an incredibly competitive society in which doing equals success. I was in Home Depot garden centre recently and when I looked on our receipt I noticed their slogan: “Where doers get stuff done!” Doing, being busy, is a status symbol in our society — ever increasing modern demands entice us to do more, achieve more, own more and we feel like the odd one out if we don’t live up to the cultural demands What is the result? Pressure and stress. Striving to be good enough, in whatever realm, be it being educated and smart and fit and fashionable and interesting and successful and sexy, to paraphrase Kristin Neff, Self-Compassion Researcher.

According to 2021 Gallup survey data from adults in 122 countries, 41% of adults worldwide report experiencing a lot of stress. From a Somatic perspective, stress can play havoc with our our nervous systems — remember the brain doesn’t differentiate between an internal or external stressor — our own thoughts and feelings impact our Soma too (unkind self-talk, anyone?) With our never ending social media feeds, news cycles, endless phone alerts (email, text, Whats App, Signal…), deadlines and responsibilities — the constant pressure to be ON is it any wonder we’ve forgotten even how to rest? All this pressure from our environment and ourselves just ramps up our Green Light (the drive of the back of our body) until some of us reach a point of burnout/allostatic overload. Evidence shows that chronic stimulation of the sympathetic nervous system can lead to long-term physiological disregulation, resulting in problems such as increased blood pressure, cardiac arrythmias, digestive problems (often due to inflammatory processes), chronic headaches, backaches, neck pain, anxiety/depression pain and sleep issues. This level of damage to our systems is referred to as Allostatic Overload. In Somatics terms, there is a functional beakdown, our systems are no longer well-organized. Ironically, having any of these problems just creates even more stress.

So why are we so addicted to busyness? Here’s one insight from Jon KabatZinn: “ Filling up your time with busyness is another self-destructive avoidance behaviour. Instead of facing up to your problems, you ca run arund like crazy doing good things until your life is overflowing with commitments and obligations and you can’t possibly make time for yourself. Despite all the running around, you may not really know what you are doing. This kind of hyperactivity sometimes functions as an attempt to hold on to a feeling of control or deeper meaning in your life when it seems to be slipping away. But it may just do the opposite by obliterating our opportunies for rest and reflection, for non-doing.”

We may not have reached the point of Alloststic Overload when we come to Somatics. We come to this practice, this way of living for a variety of reasons. But many of us have. For some of us, we’ve had enough, we’re desperate and we finally decide that thaere has to be a better way to live and handle our stressors. Our over-wrought systems need soothing, softening and re-organising, via intentional, thoughtful Somatic Movement. We are already inherently good, it is our birthright, according to Buddhist tradition. We all have ‘Buddha Nature.’

You do not have to be good.
You do not have to walk on your knees
for a hundred miles through the desert, repenting.
You only have to let the soft animal of your body
love what it loves.
Tell me about despair, yours, and I will tell you mine.
Meanwhile the world goes on.
Meanwhile the sun and the clear pebbles of the rain
are moving across the landscapes,
over the prairies and the deep trees,
the mountains and the rivers.
Meanwhile the wild geese, high in the clean blue air,
are heading home again.
Whoever you are, no matter how lonely,
the world offers itself to your imagination,
calls to you like the wild geese, harsh and exciting–
over and over announcing your place
in the family of things.

— Mary Oliver

With clear seeing, we can feel the truth of Mary’s words. We do not have to be good. Or perfect. Or better. Or best. Our Somatic Movement practice is a place to drop the effort, unwind and reorganise our frazzled Soma and build heathier patterns. We do not have to be good. In my classes there are no perfect people allowed, our focus is on ease rather than effort and our focus is one of non-achievement. Compassion rather than judgement. Curiosity and playfulness rathr than that of striving todo it right. Sound good? Get in touch, or try the practice suggestions below with the intention of reducing the ‘Green Light’ drive of the back of our Soma (see the Hanna Somatics section for more information on Green Light Reflex and the other patterns):

SIM Seeking

SIM seeking in Tofino, May 13th 2024. SIM stands for Safety in Me. This was a day full of Super SIMs!

Metta Sutta (The Buddha’s words on Lovingkindness)

Sunset Practice Summer 2024