PROGRAMME HANDBOOK WEEK 3 BODY AWARENESS, HELPFUL THINKING AND POSTURE - Connect Health Pain Services
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
PROGRAMME
HANDBOOK
WEEK 3
BODY AWARENESS,
HELPFUL THINKING
AND POSTURE
Connect Health Pain Services
Right care, right place, right time
PAIN MANAGEMENT
PROGRAMME
WEEK 3
Contents
Summary of last session 4
Strengthening Exercises 5
Common mood changes 8
The power of thoughts 11
Walking and noticing exercise 12
Thoughts and Feelings Exercise 13
Exercise – My Pain Cycle 14
Example – Sarah’s Pain Cycle 15
Black dot exercise 16
Noticing, evaluating and distance exercise 17
Posture 19
Mindfulness of Breathing – Sitting 21
Notes 23
2
3
SUMMARY
OF LAST
SESSION
What did you learn?
What are you going to do?
Connect Health Pain Services
Right care, right place, right time
4
Strengthening Exercises
Below are examples of some Some people may ache up to three
exercises that can help to strengthen days after doing exercise. This is
parts of the body to help your posture. normal. Light movement and walking
To strengthen you need to work your can help reduce the ache.
muscles. Muscles can ache after they
are worked. The less fit you are, the You can gradually increase the
longer the ache takes to come on and amount of strengthening exercises.
go away. Remember to do this slowly as shown
in the Graded Exercise section.
Abdominal Hollowing
Set your correct posture by first flattening your
lower back onto the floor, then arching it away.
Do this a couple of times, then find the mid-point
between the two positions.
This position must be maintained throughout all
of the following exercises.
Tighten your lower abdominal muscles, drawing
your belly button in towards your spine.
If you feel the contraction start to weaken, stop,
reset it and recommence the exercise if easily
manageable.
Leg Lift
Having set correct posture and abdominal
muscles as opposite.
Lift one leg so that both hip and knee are bent to
90 degrees.
Try to do this without either flattening or arching
the lower back.
Lower the leg back to the starting position.
Repeat with the opposite leg.
5
Two-leg Lift
Perform the above exercise but lift the second
leg off the floor after the first.
Lower the first leg, then the second leg.
If you repeat the exercise lead with the other
leg first.
Mini-Squat
Stand behind a stable chair and support yourself
with both hands.
Set correct posture and engage your lower
abdominal muscles.
Slowly bend your hips and knees, keeping your
back straight
Your knees should not go past your toes.
Do not let your knees turn in or out during the
movement.
Hip Extension
Stand behind a stable chair and support yourself
with both hands.
Set correct posture and engage your lower
abdominal muscles.
Take one leg backwards keeping the knee
straight and making sure you do not lean
forwards.
Return to the start position.
Repeat with the opposite leg.
Connect Health Pain Services
Right care, right place, right time
6
Clam Exercise
Lie on your side, preferably with your back
against a wall.
Line up the back of your head, shoulder blades,
buttocks and soles of your feet against the wall.
Set correct posture and engage your lower
abdominal muscles.
Keeping the inner borders of your feet together,
slowly lift your upper knee as far as you can
without your pelvis rotating backwards (like an
opening clam-shell).
You may wish to have your uppermost arm
placed on the floor in front of you for balance.
Return to the start position and repeat as able.
Repeat on the opposite side.
Setting the Scapula
Sitting or standing, set correct posture and
engage your lower abdominal muscles.
Draw your shoulder-blades back and down,
widening the collarbone area at the front.
Return to the start position and repeat as able.
Chin-ins
Focus your eyes directly in front of you.
Avoiding tipping your head forward, draw your
chin in backwards as if to create a ‘double chin’.
You will feel a lengthening in the back of the
neck.
Return to the start position and repeat as able.
7Common Mood Changes
Depression is very common, and Depression can also have physical
looking around you as you walk down symptoms, which include:
the street chances are at least 1 in 10
• Slowed movement or speech
people are experiencing depression,
however you might not be able to tell • Change in appetite or weight
by looking at them. (usually decreased, but sometimes
increased)
Psychological symptoms of
depression include: • Constipation
• Feelings of hopelessness and • Unexplained aches and pains
helplessness • Lack of energy or lack of interest
• Low self-esteem in sex
• Tearfulness • Changes to the menstrual cycle
• Feelings of guilt • Disturbed sleep patterns (for
example, problems getting off to
• Feeling irritable and intolerant of sleep or waking in the early hours of
others the morning)
• Lack of motivation and less interest,
If you’re depressed, it may affect
and difficulty in making decisions
the way you interact with others,
• Lack of enjoyment including:
• Suicidal thoughts or thoughts of • Not performing well at work
harming someone else
• Taking part in fewer social activities
• Feeling anxious or worried and avoiding contact
• Reduced sex drive • Feeling isolated
• Reduced hobbies and interests, and
difficulties in home and family life.
Connect Health Pain Services
Right care, right place, right time
8Anxiety can range from feeling Physiological effects of Anxiety
uneasy or nervous to having a
continuing feeling of dread. It is a When we are anxious, our body
normal response and everybody feels releases a hormone called adrenaline
anxious from time to time. Anxiety into our blood stream. Below are a
becomes unhelpful when there seems few examples of what adrenaline can
to be no good reason for it, or if there cause:
is a lot of anxiety. • Our heartbeat can increase so that
more oxygen can be supplied to the
People with chronic pain often feel
muscles.
anxious, you may find yourself worried
about many things such as: • Our rate of breathing can increase
so that we have more oxygen to
• The pain and its intensity
prepare us for action (i.e. to ‘fight or
• The cause of the pain flight’).
• About body symptoms such as • Sweating occurs because the body
lack of sleep requires an efficient cooling system.
• About movements and actions • Our senses such as hearing and
that increase pain sight sharpen and become more
sensitive. As a result, any slight
• About getting back to work
change is exaggerated.
• About what people think about you
• Our blood is diverted away from our
• About what might happen if you digestive system to our muscles, so
become disabled we may experience ‘butterflies’ in
our stomach.
Anxiety can be useful to help you
perform at your best and deal with • We may over breathe
danger, but high levels can interfere (hyperventilate) which can lead to
with your life, and happen when there feelings of dizziness and tingling in
is no danger. our fingers.
• Breathing difficulties, when actually
we are getting too much oxygen.
This hyperventilation can in itself
make the other symptoms worse.
9Anger and frustration are common These feelings can lead to changes in
in people who suffer from chronic behaviour and you may:
pain. Life may begin to feel like a
• Shout
constant battle to avoid pain, and you
may become angry or upset if you feel • Throw objects
that people do not understand or are
• Cry or become tearful
not listening to you.
• Storm out of the room
Anger and frustration can make
you feel: • Hurt yourself or other people
• Irritable • Be less tolerant of people
around you
• Restless and uptight
• Bottle your feelings up inside.
• Unable to concentrate
• Flashes of anger or rage
You may think:
• You are being treated unfairly
• People are deliberately
upsetting you
• Pain is ruining your life
• Everyone else is in a better position
than you
Physiological effects of anger and
frustration:
• Heart racing
• Tight feeling in your chest
• Sweating
• Need to go to the toilet
• Blood rushing to your head
• Feeling sick and stomach churning
• Muscles tensing
Connect Health Pain Services
Right care, right place, right time
10The Power of Thoughts
People have thousands and Thoughts such as “No-one likes me at
thousands of thoughts every day. work”, or “How am I going to pay my
Our thoughts are usually generated bills”. This kind of thinking can cause
automatically. Some are neutral us to react in a negative way and
thoughts, such as “I need to switch create suffering.
the lights off when I go out”. These
thoughts do not create negative We call these negative powerful
feelings or alter sensations in the thoughts stories.
body. However, some thoughts are
Take some time to think about and
highly charged and may spring into
write down, if you wish, your thought
our minds without us realising it.
stories.
We often take our stories to be true What has started to happen?
and allow this to influence how we live
our lives. Then put the phrase ‘I am noticing
I am having the thought
This programme uses a variety that ’
of techniques to help us distance
ourselves from these thoughts. This should help you to get some
distance from your story.
For example,
Another technique that some people
Think about one of the stories you find helpful is putting their thoughts
have identified above, e.g. I am a to a familiar tune, when they come to
failure. Then try the following exercise: mind.
Put the following phrase in front of
your thought ‘I am having the thought
that ’
11Try this ‘Walking and Noticing’ exercise at home:
• Imagine you are sitting on a river Distancing does not try to stop you
bank and leaves are dropping off the having the thoughts, it just helps you
trees and falling into the water. get some distance from them, so you
can see them for what they are, which
• As you sit there, you watch the
is just stories, not fact.
leaves as they pass you.
• As you become aware of your Mindfulness or awareness takes
thoughts practice. We can learn to be aware of
what our bodies are feeling, how we
• You can choose the thoughts which hold ourselves, how we move. We
you need to respond to, thoughts sometimes become so focused on our
which require action in the present pain that we become unaware of other
moment, thoughts that you can pleasant sensations in the body.
respond to
• You can allow the thoughts which
are random, distracted, or highly
charged, to just float by.
Connect Health Pain Services
Right care, right place, right time
12Thoughts and Feelings Exercise
How do you feel when you see a dog?
What goes on in your head? What goes
on in your body? What would you do if
you met this dog in the park?
The experiences that you’ve had with
dogs in the past will affect your answer
to this question. For some people,
experience has taught them that dogs
are friendly creatures who love to play.
They might have feelings of warmth and
happiness or excitement, and an urge to
stroke the dog or to throw a ball for it.
Other people may have had negative experiences of dogs in the past. They
might think that dogs are unpredictable wild animals who sometimes bite people.
Meeting this dog might lead to feelings of fear and anxiety, a racing heart, feeling
breathless and sweaty. This person would probably want to avoid getting close
to this dog at all costs and may change their route or avoid going to the park
altogether to minimise the chance of meeting dogs.
The way we think can affect the feelings we have, the things that we do, and the
way our body’s react.
It is important to recognise the
thoughts and feelings that you might
have about your pain. These will Thoughts
certainly be having an effect on you.
There is very strong evidence that
understanding pain using a CBT
model (see the diagram on the right),
is one of the best ways to help people
manage their pain and get their Physical
quality of life back.
Behaviour Feelings
13Try this: Exercise – My Pain Cycle
Imagine that you’re having a bad What kind of things do you do? What
pain day. What kind of things go effect might these things have on you
through your head? How do you feel physically?
emotionally?
Write your answers on to the diagram below. If you’re stuck for ideas have a look
at the example on the next page.
Thoughts
Physical
Behaviour Feelings
Connect Health Pain Services
Right care, right place, right time
14Example – Sarah’s Pain Cycle
Her e we go again! What did I do to tr igger
it off this time? If I’m like this now, how will
things be when I’m older? I hate this so
much. T his is so unfair.
Thoughts
Putting on weight, I know I’m getting weaker
by not exer cising. Tir ed all the time. Run
down - I’m always catching bugs.
Physical
Behaviour Feelings
Go back to bed, comfor t eat, tr y not to Sad, fr ustr ated,
move, snap at the kids. Or if it’s a wor k angr y, scar ed,
day, I’ll take loads of medication and miser able
pr etend the pain’s not ther e.
15Black dot exercise
Focus on the black dot in the centre. Did you see the grey circle disappear?
Sometimes when we focus on our pain, we lose sight of everything else around us.
Connect Health Pain Services
Right care, right place, right time
16Noticing, Evaluating and Distancing from
Unhelpful Thoughts
Sometimes when you are caught up Remember, if you were in a very
in an unhelpful thought it is difficult to different mood, the thought might not
realise it is a thought at all. It feels like even be there or it might not seem so
it is real and it is the truth. true. See the lists below to see if they
help you to see your thoughts more
clearly.
Common unhelpful thoughts Questions you could ask about
your thoughts?
Feeling overwhelmed
I can’t cope Am I catastrophising or jumping to
the worst-case scenario?
Self-pity
Why me? Am I thinking in black or white
All or nothing terms with no shades of grey?
If I can’t do it the way I used
Am I focussing on my weaknesses
to I’m a failure
and forgetting my strengths?
Stuck in the past
Why can’t it be like it used to be? Am I taking something personally?
Worst possible outcome Am I assuming that because I
I’ll end up in a wheel chair feel depressed then it is true that
things are hopeless?
Unable to move forward
I’ve tried before - it will not work. Am I blaming myself for something
Blaming yourself that it is not entirely my fault?
I ought to be able to do it
Am I blaming someone else and
Blaming others not taking responsibility myself?
The doctors should be able
to fix me Am I mind reading – assuming
that I know what others think of
Mistrust of others me?
They are only saying it, they don’t
mean it Am I expecting myself or someone
else to be perfect?
Am I exaggerating?
Am I assuming that I can do
nothing to help myself?
17Notice your thoughts. How do they Remember you may need to do
make you feel? Do they seem helpful? some relaxation, gentle movement or
Are they encouraging you to live a mindfulness practice to help you get a
better life? If there a better, more better perspective on your thoughts.
accurate thought? Is there a better
thought that will help you make Below is the Challenging Thoughts
positive changes? Table, you can fill this out to help you
with your thoughts.
What situation
started the
unhelpful thought?
What are/were the
thoughts?
How do they make
you feel?
How would you
rather feel?
Is there a thought
that is true and
could make you feel
this way?
How does it feel
trying this different
thought on for size?
Connect Health Pain Services
Right care, right place, right time
18Posture
We move our bodies through many It makes sense because we all get
positions, depending on what we are uncomfortable in certain positions and
doing. How our bodies move depends this can be an even bigger problem
on our own body structure and shape. in those with persisting pain. A lot
Our posture might also be affected by of people with long-term pain will
how we are feeling emotionally, how question if their posture is part of the
we have learnt to do things or how problem. It is also a link often made
our body feels. We also use our body by doctors, nurses, physiotherapists,
to communicate with others; sports osteopaths, chiropractors and
fans whose team is winning often look massage therapists. Often good
different to the losing side… and bad posture is taught as part of
treatment or even as part of moving
Pain can have an impact on how we and handling training at work.
move. It is natural, if you have a pain,
to move differently and seek more What is really confusing though is that
comfortable positions. In injuries, this we all know people whose posture
can be part of the process of healing, is ‘bad’ that have no big problems
protecting injured areas. In long-term with pain. I am sure you can think of
pain posture changes can be due to someone in your life who looks a bit
reduced fitness, strength and altered like the pictures below who never gets
habits. more than the occasional ache.
Because pain often makes moving
more difficult and it can affect our
posture it has long been suggested
that bad postures can be the cause of
pain.
Arched Head Arched Posture Midline
Upper Back Forward Lower Back Swayed Back Posture
19If posture was a big cause of For instance, being in a slouched
persistent pain, we could expect posture makes it harder to use your
studies to pick up on this. However, shoulder fully when reaching up. This
a big review of the research has not might be a reason to consider moving
found a very strong link between what more regularly and if able, trying
we might think of as bad posture and to change your posture regularly.
the development of persisting pain in If this is a problem for you think
the back. about how you could change this by
setting alarms or using something
Further, worrying about posture that happens regularly to prompt you
has not been found to make much to get up, move or go do something
difference in dealing with pain. different.
Collections of studies about back
and neck health have found that on Some positions will always be painful
average, working on posture does and hard for some people. Sometimes
not make a big difference to people’s though, slowly easing into a posture
pain. As a result, advisors to the NHS or practicing it regularly may make
have not made recommendations on you more confident and may make
treatments aiming to correct posture. the movement easier to do, even if it
is painful. For instance, a keen Crown
This might be because there is more Green Bowler might find their bowling
research that needs to be done. It action harder to do after a knee injury.
might also mean that something that Practice can help them return to their
we once thought was very important bowling position and get back into
may not be such a big problem. This something that they enjoy.
does not mean what you have been
told about posture is wrong, it might Sometimes, we must be creative
just not be as important as previously about doing things in different
thought. postures than we are used to. For
instance, you can sit when ironing
It is still a good idea to think about clothes, or change your garden to
how you use your body. Spending stand and use raised beds. This can
long periods in a small number be hard to come to terms with at
of positions can make us feel times, but it may help you to return to
uncomfortable, it may lead to us activity that is important to you.
not using some joints or muscles as
much.
Connect Health Pain Services
Right care, right place, right time
20Mindfulness of Breathing –
Sitting
Settling
1. S
ettle into a comfortable sitting
position, either on a straight backed
chair or on a soft surface on the
floor with your bottom supported
by cushions or on a low stool or
meditation bench. If you use a
chair, sit away from the back of the
chair so that your spine is self- Focussing on the sensations of
supporting. If you sit on the floor, it breathing
is helpful if your knees can actually
4. Now bring your awareness to the
touch the floor, although that may
changing patterns of physical
not happen at the beginning;
sensations in the belly as the
experiment with the height of the
breath moves in and out of the
cushions or stool until you feel
body, just as you did lying down.
comfortable and firmly supported.
5. Focus your awareness on the mild
2. Allow the back to adopt an erect,
sensations of stretching as the
dignified and comfortable posture. If
abdominal wall gently expands
sitting on a chair, have the feet flat
with each in-breath and on the
on the floor with legs uncrossed.
sensations of gentle release as the
Gently close your eyes if that feels
abdominal wall deflates with each
comfortable. If not, let your gaze fall
out-breath. As best you can, stay
unfocused on the floor four or five
in touch with the changing physical
feet in front of you.
sensations in your abdomen for the
Bringing awareness to the body full duration of the in-breath and
the full duration of the out-breath,
3. B
ring your awareness to the level perhaps noticing the slight pauses
of physical sensations by focussing between an in-breath and the
your attention on the sensations of following out-breath and between
touch, contact and pressure in your an out-breath and the following
body where it makes contact with in-breath. As an alternative, if you
the floor and with whatever you are prefer, focus on a place in the body
sitting on. Spend a minute or two where you find the sensations of
exploring these sensations. the breath most vivid and distinct
(such as the nostrils).
216. There is no need to try to control Then, gently escort your attention
your breathing in any way, simply back to the breath sensations in the
let your body breathe by itself. belly, as you bring awareness to the
As best you can, also bring this feeling of this in-breath or this out-
attitude of allowing, to the rest of breath, whichever is here as you
your experience – there is nothing return.
that needs to be fixed, and no
particular state to be achieved. 8. However often you notice that the
mind has wandered (and this will
As best you can, simply surrender quite likely happen over and over
to your experience. and over again), each time take
note of where the mind has been,
Working with the mind when it then gently escort your attention
wanders back to the breath and simply
resume attending to the changing
7. S
ooner or later (usually sooner), pattern of physical sensations that
the mind will wander away from come with each in-breath and with
the focus on the breath sensations each out-breath.
in the belly, getting caught up in
thoughts, planning or daydreams, 9. As best you can, bring a quality
or just aimlessly drifting about. of kindness to your awareness,
Whatever comes up, whatever the perhaps seeing the repeated
mind is pulled to or absorbed by, wanderings of the mind as
is perfectly okay. This wandering opportunities to cultivate greater
and getting absorbed in things is patience and acceptance within
simply what minds do, it is not a yourself and some compassion
mistake or a failure. When you toward your experience.
notice that your awareness is no
longer focussed on the breath, you 10. Continue with the practice for ten
might want to actually congratulate minutes, or longer if you wish,
yourself because you’ve already perhaps reminding yourself from
come back enough to know it. You time to time that the intention
are, once more, aware of your is simply to be aware of your
experience. You might like to briefly experience, moment by moment,
acknowledge where the mind as best you can, using the breath
has been (noting what is on our as an anchor to gently reconnect
mind and perhaps making a light with the here and now each time
mental note; ‘thinking, thinking’, or that you notice that the mind has
‘planning, planning’ or ‘worrying, wandered off and is no longer in
worrying’). touch with the abdomen, in touch
with this very breath, in this very
moment.
22Notes
23Connect Health Pain Services Right care, right place, right time © Connect Health Pain Services PMP Handbook v1.3 January 2021
You can also read
