chronic pain

For over a decade I have been working with people who are living with pain.

I guess it kind of happened by chance and I definitely believe that it happened for a reason.

First of all, I found Pilates serendipitously when I was searching for ways to live with my own pain. So when people who were in pain started to trickle in to my studio I felt deep empathy for them and I also knew from my own experience that there was hope for them.

For the first few years of teaching I really didn’t understand how Pilates was helping these people overcome pain – heck, I didn’t even know how it had helped me – but it did and I kept seeing this play out over and over and over again which sent me on a path to understanding the magic of Pilates and how movement can indeed play a positive role in not only learning to live with pain but overcome the constraints that we are bound by.

Pain sucks in many ways – it sucks because the pain someone is feeling so often can not seen by others so it can be difficult for other people to empathise with the sufferer, let alone believe them. Unless your leg is hanging off or you have a deformity,  people around you can assume that the issue is what some insignificant or over played which makes the sufferer feel invisible and can prevent people from seeking help because let’s face it, no-one wants to be labelled a whinger – well not in my country anyways.

According to statistics from 2018, 3.24 million Australians are living with chronic pain – thats over 12% of our population which is costing us a bucket load. Here is a break down of those costs according to painaustralia.org:

Financial Costs

• The total financial cost of chronic pain in Australia in 2018 was estimated to be $139.3 billion, comprising:
• $12.2 billion in health system costs;
• $48.3 billion in productivity losses;
• $66.1 billion in reduction of quality of life costs and
• $12.7 billion in other financial costs, such as informal care, aids and modifications and deadweight losses.
• Health system costs make up 16.7% of financial costs, accounting for $12.2 billion. Of this expenditure, $2.7 billion was paid by Australians in out-of-pocket costs to manage their chronic pain. Governments paid for 66.7% of total health expenditure, while individuals and other funding sources respectively contributed 22.1% and 11.2% to the total. Hospitalisations accounted for $3.7 billion of total health expenditure, followed by out-of-hospital expenses ($1.3 billion), and pharmaceuticals ($1.1 billion).
• In 2018 Australian dollars, cost of pain was estimated to be $22,790 per person.
• Australians living with chronic pain paid $2.7 billion, or 22.1% (out-of-pocket) to manage their chronic pain, while Australian governments paid $7.9 billion, or 66.7%.

In my opinion these statistics are the very foundation of our failing social and medical system. What do I mean by this?

We are not born with chronic pain. It is something that develops in people over time when they do not know how to listen to their body nor have the resources available to manage their experience. The issue is – we are not taught nor encouraged to listen to our own body. We are taught from a very early age to push forwards – to aim high – to succeed at any cost – no pain, no gain – only the strong will survive. Nobody ever says stop – listen – nurture; well not until pain has nailed us to the floor; and for some of us the payoff is way higher than we realise.

Managing a problem should not be about taking medication or spending time in hospital or becoming a burden on society, yet this is ‘normal’ and completely accepted by most. This current plan is an absolute failed system that is not only costing millions of dollars but is disempowering our society to become reliant on the very system that is the demise of our own health. Anyone seeking an ‘alternative’ or traditional ways is labelled a hippy or a freak; it seems that knowing ourselves and tapping into our intuition is frowned upon and seeking self help is taboo. Looking something up on Google is now labelled as the ‘Dr Google’ syndrome, yet going to a GP and dosing up on medication to band-aid the symptoms of pain without considering the cause nor the long term effects on the rest of the body is completely okay.

How on earth did humanity end up in a position where we do not even know how to listen to our body’s most basic needs? How on earth has pain become so normal that you can walk into any shop and purchase a packet of pain medication, pop a couple of pills and go about your day as if nothing is happening? How on earth has it become the norm to have panadol or voltaren in your handbag so that you can share them with your friends at the drop of a hat? Why in the World are we shutting off our own body’s ability to tell us exactly what we need when we need it and instead are taught to suppress and ignore? To what end? In 2015 it was estimated that 40% of Australians had a long term, painful condition – that’s every second person you see on the street – that’s every other person you know.

Although the World is full of suffering; it is also full of the overcoming it

– Helen Keller

I see every day people who have been stripped of their dignity; psychologically damaged and absolutely exhausted by pain. The medication might be just getting them by – but there’s a pay off and eventually those cracks start to show. Not many people walk through our doors as a first option. They’ve tried everything, been to everyone, popped every pill there is before they arrive at Pilates.

So, the road is often steep and we start at the bottom; a broken body, a distraught mind and a sad sad soul. Driven to us by the very pain that kept them away in the first place, if only they had been directed to this ‘alternative’ at the beginning – imagine that.

The good news is, our brain is pliable – elastic and expandable; and our body is forever changing. As we learn more about our brain, new studies are heading towards the idea that our brain actually stays elastic into our older years – so the saying ‘you can teach a dog new tricks’ might apply to us as well.

Why is this important when it comes to pain? Well, acute (pain that is less than 3 months old) and chronic (pain that is longer for 3 months or recurring) has a strong relationship to our brain. Some might even say that pain is ‘all in our head’. Talk to anyone who is experiencing pain and that is not the case; it’s not as clear cut as that and there is strong evidence to suggest that there is a relationship between tissue damage and pain – thank goodness, otherwise we may well have people walking around looking like zombies with arms ripped off and not even realise it. So, while our body will tell our brain that we are severely injured so that we stop and take care of ourselves, our brain can also ‘hold onto’ the pain and we can experience it even without tissue damage – or vice versa – we can still have a disc bulge and not feel the pain. In fact, I have 3 disc bulges and 8 severely degenerated discs that are asymptomatic which means they do no cause me pain most of the time. Every now and again they become symptomatic (cause me pain) but the discs themselves are the same on an MRI when I am in pain and when I am not.

Confusing? Maybe. Promising? Definitely. The thing is when it comes to pain is we are still learning so much. And there is so much to be learnt. The good news is, we know more now than ever and our thirst for understanding and the availability of education is helping both therapists and sufferers in wonderful ways.

So, if pain can be both our body’s response to tissue injury but also a brain response to perceived danger, how can we as movement educators work with people in pain and potentially help them overcome this debilitating experience?

Breath work

One of the first things I teach as a movement educator when I am working with people in pain is to simply take pause. Take pause to sit or lay quietly and breathe. It seems simple right – and it is. Simple and powerful. Taking time out is something that some people rarely ever give themselves. Sitting or standing or laying (whatever is the most comfortable) and focussing on breath can actually be the first step to healing.

Language

People who are in pain often associate their pain with words like restricted or stuck. These very words (say them out loud) prevent us from breathing fully. So how about using breathing whilst thinking words like free, soft, relaxed? Does it change anything? Changing the language we use in the studio and exploring language with our clients can help free them of their own perceptions around their body. So whilst it is important for me to know how they feel, it is also important to move forwards – if I ask someone how their body is and they say I feel ‘tight’ – I might get them to do something and say does that feel ‘freer’ or ‘looser’ or ‘softer’ instead of saying ‘does that still feel tight’? Change the word to a positive image wherever you can.

Imagery

This is a powerful tool. Did you know that people with pain can experience pain or feel relief in their body by imagining they are moving without actually moving. In the same way that professional athletes train their mind to perform, so can we. I once listened to a podcast interview with Kelly Slater; only the best surfer to ever walk this Earth and he said that he spent time imagining himself riding a wave and winning the competition and that without this tool he doesn’t believe that he would be such a good surfer. If it works for Kelly it can work for you. I like to give this to my clients as a meditative homework. Lay down in a comfortable place – you can do this when you go to bed, close your eyes and practice moving with ease in your mind. If pain is in our brain – which is associated with our mind, changing the way we see ourselves in our minds eye may well have a positive impact on our actual ability to move. People who experience chronic pain in their body can also experience pain when they imagine moving. Studies show that this is mindful association. The key here is to move in your mind in a way that does not cause pain and go from there. 

Get creative

Know that one thing does not work for everybody; and no day is ever the same. It’s okay to change things up. Don’t get stuck on a ‘program’ – in fact ditch the damn program and be present with your client. What worked last week might not work this week. Be open to explore. Be open to learn and get creative. Sometimes if I ask a client to do something a certain way and they perform the movement differently, rather than saying ‘no, not like that’ I might ask ‘does that feel good’? If the answer is yes, then maybe, just maybe their way is better for them today. Maybe it’s not how I want it to look, maybe the alignment is out a bit, but they have found what works for them and that is a positive. Play with that. Let them explore and then gently work together to improve that movement over days, weeks or months and maybe their movement will start to look like what you thought it should – or may be not – after all.. what’s the goal? For them to do what you want them to do or for them to be in less pain, empowered and in control? That’s not to say I want people doing exercise that is all out of whack. Of course, good movement looks good. What I am inviting you to do is let your client lead – listen to them and work with them to find better ways to do things for their own body.

Make mistakes

Working with pain is not linear. It changes, it can be random and it can pop up when you least expect. And that’s okay. For many people living with pain, it can seem completely ad hock to them when the pain appears. And joining the dots can be a slow process. So, it’s okay if you take a few steps back every now and then. Pain can be cycleicle and that cycle itself can be changeable because the body is always changing, the things we do each day vary. We are not linear. We are expansive, multi directional, many faceted, complicated and irregular. We are individual in every way possible so when mistakes are made, when pain comes back, when there is a flare up or a regression or a set back – be the safe space. Listen; go back to breath; revisit the foundations; explore some more and be gentle. Change will come again and again and again.

Be the student

The fact is, we don’t know enough about pain; what we know today may be challenged tomorrow – this is the curiosity of learning. So, when working with someone with pain – be the student. Learn from their story. Listen to their story and know that the more we can absorb from each person we work with, the more we can contribute to the next.

I have worked with people who are in pain for over a decade and I am still learning. I don’t have all the answers. But I do have a safe space for people to come and explore movement. And we know from working with these people that movement is joy and by feeling joy, the pain becomes less, or maybe just less noticeable, or maybe more bearable and that in itself is sometimes enough.

Pain is complicated – it is complex and misunderstood. There is a lot of research being done on pain and there are some wonderful resources for us to understand pain more. If you are curious about pain I encourage you to learn more about the brain as part of your learning as science continues to unravel the mysteries of the unseen. We are born with a perfect system – a system that knows exactly how to operate with no interference from external forces; yet we are interfered with from the day we are born.

Pilates is a wonderful, gentle approach to movement that brings us back to our body; brings us into our mind and encourages the connection between our knowing self and our physical self. Maybe, just maybe Pilates already knows what science is yet to prove and all we need to do is come back to what we were born to do – movement heals the body, heart and soul and movement alone is a life lived well.

Want to know more about how Pilates can help with pain? I have a live workshop in Darwin on Saturday August 8. You can join here (spaces are limited). Not in Darwin? Don’t worry – we will be offering this course online in August too. Click here to register your interest. The course is suitable for everyone whether you are someone living with pain or if you are a Pilates Teacher who wants to understand pain better so that you can better serve your clients.