A goal in life is not to get rid of stress, but to get the right type of stress | Sapolsky talks | #stress

Stress is all about the individual’s perception of a situation. When something is perceived to be threatening, it kickstarts a range of biological and behavioural responses. The problem with the way we have evolved is that we can evoke these responses to our own thinking, and in doing so, affect every system in the body. Common problems associated with persisting stress include chronic musculoskeletal pain, irritable bowel syndrome, migraine, pelvic pain, fertility issues to name but a few. Cognitively, stress can negatively affect our ability to focus, recall and learn, thereby impacting upon performance at school or work.

The World renowned expert on stress, Robert Sapolsky talks:

Sleep and pain | Some tips on getting the rest you need

Create good sleep habits

Sleep is important. We do not feel good when we have missed even one or two nights. For those who suffer persisting sleep disturbance, this is a huge problem that requires multidimensional thinking.

Here are some tips:

1. Develop a routine of going to bed at the same time, i.e./ create a good habit.
2. Have a calming time before bed: within the routine practice mindful breathing for a few minutes.
3. Avoid stimulation via television, other devices with a screen (the light is stimulating) or reading thought-provoking material.
4. Check your evening diet. Avoid eating close to bedtime making time for digestion. If you are hungry before bed, try a bowl of cereal as this triggers the release of serotonin that may help sleep.
5. Avoid caffeine and alcohol that can both affect sleep.

Developing a good sleep habit can take some time. It is important to develop a routine so that the habit can be created and become entrenched. It is of course not just the moments before bed that are important, however, focusing upon this is a good start point. This alongside the regular practice of mindfulness, exercise, healthy work and social habits can make an enormous difference.

Visit our clinic site here: Specialist Pain Physio Clinics, London | treating chronic, persisting pain & injury with science and sense

Is there scientific proof that we can heal ourselves? Lissa Rankin talks

This is not as whacky as it may first seem. Our thinking does influence treatment outcomes and most have heard of the placebo effect that boils down to the role of expectation. Catastrophising about pain makes us more inflammatory, voodoo works on a cultural and belief basis in some cases and what we believe will drive our behaviours and choices.

We are multisensory and multidimensional beings. Thoughts and emotions have a molecular basis just as movement. There is activity in the brain when we are thinking that influences the effects of the signals that are travelling from the body to the higher centres. This is called the ‘top-down’ effect.

Lissa Rankin explores the subject here: New age gurus suggest that we can heal ourselves by simply changing our minds, but is this concept grounded in cold, hard science? Lissa Rankin, MD explores the scientific literature, reviewing case studies of spontaneous remission, as well as placebo and nocebo effect data, to prove that our thoughts powerfully affect our physiology when we believe we can get well.

What went well today?

One aspect of working with individuals suffering chronic pain and disease is to enhance their ability to deal with negative thinking and misery. For example, we know that to advance one’s understanding of the condition, pain and influences upon the pain enhances coping by changing the meaning of pain. The meaning is a vital aspect of the problem as this is determined by the beliefs of the individual that in turn drive thinking and behaviours that affect outcomes. A further potent way of tackling negative thinking is mindfulness or focused attention training that develop emotional regulation skills and one’s ability to control where the spotlight of attention lies.

It is important to be able to deal with negative thinking and to be able to continue to perform despite the feelings that arise–remembering that these are normal feelings that guide our actions; it is when the normal fluctuations of mood become prolonged that there can be an issue.

Beyond this, we must develop skills to cultivate positive emotions, engagement, meaning, accomplishment and relationships. These are the tenets of positive psychology defined by Martin Seligman. Integrating these components of wellness into a treatment and coaching programme for chronic pain and disease is a potent way of optimising outcomes and improving quality of life, in particular around the cognitive and emotional dimensions manifesting as anxiety and depression.

A simple exercise to develop positive emotion at the end of each day is to write down three things that you have done well and why they were good.

For further information about treatment programmes please contact us on 07932 689081 or visit the clinic site at Specialist Pain Physio Clinics

Seligman talks with the Dalai Lama about happiness & flourishing

Dr Seligman talks to the Dalai Lama about positive psychology, an approach that we can all embrace to develop and cultivate wellness and happiness. It is important to be able to deal with the negative situations and thinking that we all experience, but equally to be able to nourish our positive emotions, engagements, relationships, meaning and accomplishment is to achieve a state of flourishing.

These principles are very applicable on a day to day basis and in particular in chronic health and pain.

Women and Pain | Part 3

Women and pain 3

A number of women who come to the clinic with a musculoskeletal complaint will describe other painful syndromes that involve other body systems (see Women and Pain blogs Part 1 & Part 2). These include irritable bowel syndrome (IBS), pelvic pain, dysmennorhoea, endometriosis, bladder dysfunction, jaw pain (TMJ), migraines and widespread musculoskeletal pain. Often hypermobility is also a feature (see blogs here and here) . These are termed functional pain syndromes and require a comprehensive approach to tackle the physical, cognitive and emotional dimensions of the pain and associated problems that impact upon quality of life.

This recent study looked at a cohort of women in Australia and showed that the presence of one condition is associated with the development of another. Certainly in functional pain syndromes we know about the underpinning central sensitisation that is a common theme that manifests in different end-organs or body systems to create the aforementioned conditions. Using strategies to cultivate health within the systems is important, but so is using therapies to target the central mechanisms and driving systems, i.e. the nervous system, the immune system and the endocrine system (including stress physiology).

Only through a detailed assessment and the creation of an environment that permits the patient’s narrative will this vital piece of the puzzle emerge (see Oliver Sack talk about narrative here).


Clin J Pain. 2013 Mar 12. [Epub ahead of print]

The Relationship Between Incontinence, Breathing Disorders, Gastrointestinal Symptoms, and Back Pain in Women: A Longitudinal Cohort Study.

Smith MD, Russell A, Hodges PW.


OBJECTIVES:: Recent studies suggest a relationship between incontinence, respiratory disorders, gastrointestinal (GI) symptoms, and back pain (BP). However, causality is difficult to infer. This longitudinal study aimed to determine whether the presence or development of one disorder increases risk for the development of another. METHODS:: Women from the Australian Longitudinal Study on Women’s Health were divided into subgroups; those with no BP (n=7259), no incontinence (n=18,480), no breathing problems (including allergy) (n=15,096), and no GI symptoms (n=17,623). Each subgroup was analyzed to determine the relationship between the development of the absent condition and the presence or development of the other conditions. Factors with a previously identified relationship with BP were included in analysis.

RESULTS:: Women with pre-existing and/or newly developed incontinence [prevalence ratios (PR): 1.26 to 2.12] and breathing problems (PR: 1.38 to 2.11) had an increased risk for the development of BP, and women with pre-existing and newly developed BP were more likely to develop incontinence and breathing problems (PR: 1.18 to 2.44 and 1.53 to 2.62, respectively). The presence of GI symptoms was also identified as a risk factor for the development of these conditions.

DISCUSSION:: This study provides evidence of a relationship between BP, incontinence, respiratory problems, and GI symptoms in which the presence of one symptom is associated with the development of another. This suggests that common factors may contribute to the development of symptoms across this range of conditions.


If you suffer functional pains, please call us on 07932 689081 for further information or to book an appointment. See our clinic website here: Specialist Pain Physio Clinics

Change your mind, change your brain – Matthieu Ricard

Buddhist monk and deemed the happiest man, Matthieu Ricard talks about happiness as an inner state and factors that can influence our wellbeing.

All the patients whom I work with have their sense of wellbeing challenged by pain, stress, limitation and suffering to varying degrees. As well as tackling the pain and problems with movement and activity, we look at improving wellbeing both physically and mentally.

Specialist Pain Physio Clinics, London | the leading physiotherapy clinic for chronic pain and injury


A mindful task each day

To cultivate the experience of the present moment and thereby diminishing the impact of drifting into thoughts of past or the future, practice a simple task mindfully. This could be mindful cleaning, walking, drying or any other occupation that is performed each day.

Sometimes a few moments spent gently focusing upon the breath is a useful start point. Notice the rise and fall of the chest as you breathe in and out.

As you start the task in hand, notice the sensations: the feel, the movement, the smells and sounds. Be fully present for those moments, creating awareness of the moment. If you find your mind wandering, do not be concerned as this is entirely normal. Gently return your attention to the task. This may happen over and over, but with practice you will find that you can attend to the moment for longer.

Alongside the practice of mindful meditation, this is a potent way of tackling rumination, stress, anxiety and pain as part of a comprehensive approach to developing health.

Come and visit our other site: Specialist Pain Physio for persisting pain and injury

Mindfulness | Developing understanding of the concept and the science

Those who have come to the clinics for treatment of persisting pain including CRPS will have heard me talk about mindfulness. Introducing mindfulness into a programme offers an opportunity to create a potent ability to be aware and hence develop control over pain, anixety and stress. I teach simple exercises and encourage practice similar to the movement based training. Understanding why this can be an immensely valuable skill is important as a motivator to drive the continued practice that is necessary. To that end, here are several videos:

Philippe Goldin on the neuroscience of mindfulness

The neurobiology of well-being with Daniel Siegel

Professor Mark Williams from Oxford discusses mindfulness