Is Your Rehabilitation Program Missing a Mindfulness Piece?
How mindful movements can balance and support traditional injury rehabilitation
A few months ago, I met a lovely mother at school drop-off. I haven’t seen her often because she usually works full time and thus a neighbour takes her children to and from school. Unfortunately, she was off work due to a work related injury. She was lifting a heavy piece of equipment up above her head and strained her shoulder and was on leave for an injury and being filtered through the standard return to work procedures. Ironically this gave us the opportunity to meet and for me to hear more about her rehab experience and consider the impact of this process on her and others’ experiences with pain.
I play the role of two different characters, one as a busy mother to three little ones and the other as a movement therapist with a background in Kinesiology, Nursing and Neuromovement®. Within this decade long balancing act I have discovered how to delicately mitigate these two characters from bleeding into each other, but that isn’t always possible.
The Downside of Pain Journals
Rather than standing still in the chilly school yard we decided to multitask, as moms seamlessly do, and take a walk in the forest while we continued our chat. She elaborated on her recovery, which consisted of time off work to rest and seeing a physiotherapist once a week for check-ins. She told me that she was also getting calls from work asking her when she will be back as they were short-staffed, this was causing her a great deal of stress. Work Safe BC was also calling regularly to check in and remind her that she should not go back until she is able to lift 20lbs above her head without pain. At this point she couldn’t even lift 5 pounds without pain, needless to say she was feeling very discouraged.
Each day she followed the typical rehab program and religiously performed her physio exercises, which consisted of several movements that isolated the injured shoulder to assess function and range of motion and presumably strengthen the injured area.
“She was constantly monitoring and recording her pain level and what contributed to it”
She was constantly monitoring her pain and recording mentally what caused and contributed to it. Nearly daily someone would call her to ask about what her pain level was. I did my best to listen as a new friend, a civilian per se, as she shared her story. She was not asking my advice and it was pretty clear that she was not looking for my professional opinion, so I held my tongue. This is a practice I am still perfecting; that of not giving advice to those who do not ask for it. I successfully resisted the urge that chilly morning but felt it was such a useful story to highlight the value of mindset in injury rehabilitation.
Since opening my private movement therapy practice I have been steadily helping individuals with pain, everything from sore shoulders that were hurt at work to debilitating chronic pain. Clients with ten years of back pain that prevent them from sleeping or knee pain that prevents them from being able to get off the toilet. I have seen clients with decades of neck pain from fractured cervical vertebrae or whiplash that never quite healed, most of these clients had been to see every practitioner of every modality and they were experts on everything related to what contributed to their pain. They readily list off everything that’s wrong with them from poor posture to misaligned pelvis’ to leg length discrepancies. I do not claim to fix their pain, instead we work together on altering everything from movement patterns to mindset and slowly and more often than not, they steadily improve.
“…instead we work together on altering everything from movement patterns to mindset”
When this lovely lady tells me her story I can’t help but cringe. The whole situation screams unsustainable to me. The disjointed system she is involved in is doing its best to support her and allow her time to rest in an honest attempt to help her recover and ultimately return to work. But in the midst of the constant assessments, pain scales and grueling exercises there lies the possibility that she is training herself to seek and successfully find pain.
“…there lies the possibility that she is training herself to seek and successfully find pain”
Most of us humans are prone to being critical whether of ourselves, others, or both. From a young age we are often taught to do better, fix our mistakes, improve, improve, and improve. Only now is mindfulness starting to infiltrate into children’s education. Perhaps the increase in anxiety and behavioural problems in children along with the mental health issues in adults has highlighted a need to balance this push for progress with lessons in how to rest and be appreciative. Learning to balance our critical self with our appreciative and present self is a skill that needs to taught and continually practiced.
WHAT does this have to do with pain?
WHAT does this have to do with pain? Well, when you are on the search for pain, chances are you will be successful. Even if you do not have an injury and you are instructed to lift your arm to your maximum range of comfort (over and over again), the likelihood of being able to find some sort of pain is very high. Spending time actively looking for discomfort is counterproductive to healing. If you are instructed to track your pain on a daily basis you may then heighten your sensitivity to and awareness of discomfort. It compares to training your ability to complain, not such a fantastic idea. Thankfully, the opposite is also true as is apparent with the multitude of gratitude journals and plethora of mindfulness activities that are being marketed these days. If you intentionally devote time towards exploring movements that bring you comfort and, dare I say, pleasure, you may enhance your awareness of these positive and often overlooked sensations.
“intentionally devote time towards exploring movements that bring you comfort and you may enhance your awareness of these positive and often overlooked sensations”
Look for the Positive
Pain journals bear a stark resemblance to behavioural journals. Many parents can relate to this if they have ever been asked to track a child’s behavioural challenges? This is a common question posed in developmental assessments of children. For obvious reasons parents often leave assessments feeling deflated and isolated with a child who is falling behind something many clients with chronic pain can relate to.
“For obvious reasons parents often leave assessments feeling deflated and isolated with a child who is falling behind.”
The best pediatrician I have ever encountered asked of me, “tell me about your child…” I assumed she wanted to know all the challenges and thus began to list off their faults, but she quickly stopped me. “Tell me about what you love about your child” she said with a smile. She wasn’t denying or ignoring our struggles, but she was giving me an opportunity to bring awareness to all the negatives that had been hogging my attention. It wasn’t pretty and it definietly was hindering my relationship with my child and their potential for success. I began a practice of replacing these negative thoughts with intentional awareness of their positives. Now I make a habit or writing down or telling my children something I love about them each and every day, shifting my focus away from the constant faults and highlighting their absolute awesomeness. This is a valuable practice for not only parents, but individuals dealing with pain. Rather than charting only the pain symptoms, make a habit of writing down what activities you did that day that felt good (I bet you will list more than you initially think).
“Keep a journal of 3 activities you do each day that made you feel good”
Movement Therapy as a First Resort
As a nurse (in my previous career), I was trained to regularly monitor patient’s self-reported pain. If there was any discomfort I promptly offered medication to avoid the pain “taking over”. So as a new nurse I always performed a diligent assessment which included asking, “what is your pain level at from a range of 1-10?” The patients always paused and took a moment to become aware of what pain was present and how severe it was. Sometimes they moved to instigate the pain or stretched out the area that was afflicted and then would utter a random number to me. If I went back to nursing tomorrow my speech would change. Sure I would still assess for pain as protocol directs but perhaps I would be a bit more coy. First ask them how they were doing? Did they hear any funny jokes that day? I would try to lighten their mood before diving into how terrible they were feeling that day. And rather than straight out asking if they were in pain I would be elusive and maybe even wait for them to tell me. Low and behold, perhaps they would want to explore some other pain relief techniques prior to jumping straight to medication
With the current state of the health care system and nurses running from bed to bed the liklihood of being able to offer alternative pain relief techniques is slim. But most nurses and health practitioners are very aware of the alternative approaches to discomfort; heat compresses, elevation, massage, gentle movements etc. I am not denying there is a place for pain medication but imagine a world where physical therapy, massage, Neuromovement, mindfulness, and other manual techniques were applied as a first resort and pain medication was a second or third line of defense. Take action in your own recovery and make an effort to seek out and employ these tactics first.
I hope you are starting to get the sense that pain is much more than a physical sensation. Yes, there is a physical element, but there also is a neurological element, a psychological element, an emotional element and even a social element. Pain is complex. Old school pain science thought pain was simply a physical sensation and thus medication could easily solve the problem. More current pain science recognizes that pain is much more complicated and requires a more holistic approach.
With our current understanding of neuroplasticity (the brain can change!) we know it is possible to retrain the brain. The downside of this is that it is possible to rewire the brain to be hyper aware of pain and discomfort. The positive is that we can also rewire the brain to focus more on comfort and seek pleasure. I am not advising you to hang up on WCB or ditch the physio exercises, but I do urge you to assess your approach and make an attempt to seek balance in the time you spend FIXATING with time you spend PROGRESSING. Can you spend as much, if not more time moving for the love of it as you do exercising to fix a limitation.
Moving Forward in your Pain Journey
Let me leave you with a few strategies to incorporate into your daily routine to manage and alter your relationship with your pain/injury. These are accessible strategies you can employ on your very own.
1. Slow down. Intentionally set boundaries to slow your pace of life. Set aside time to move with curiosity and exploration each day. Time to sit at a window and watch the wind blow the sunflowers outside your window. This is often the hardest one for many people (so be realistic and start with just 5 minutes!)
2. Breathe. Bring your attention to how you are breathing right now for 5 or so breaths without adjusting anything. Then imagine air flowing in and out of your lungs smoothly and effortlessly. Is there tension you could let go of to make this easier? Could your ribs expand more to support this intention? We often hold our breath when we are in pain which exacerbates the nervous system’s fight or flight response. Take time to focus on your breath and remind your nervous system that you can feel safe and comfortable. Visit movementRX for some guided breathing sessions to aid you in this area.
3. Move within a pain-free range. Make a few small movements and do them as easily as possible. Instead of trying to do what you were capable of prior to the injury/pain do movements you are certain you can do right now, or for extra points do even less than that. You are trying to find success here. The guided sessions on movementRX can help you know what to explore if you are struggling in this area.
4. Switch things up. If you have pain in your RIGHT hand try to use your LEFT hand instead to do a few easy tasks or gentle movements. Instead of being frustrated if it feels odd, find the humour in the novelty. Variation is an essential aspect of learning and when you have pain it can be revitalizing to explore different ways of moving. Try new activities, sports and even ways to get in and out of the car.
5. Be mindful. Stop obsessing over your pain or injury. Quit googling it incessantly and instead shift your attention to being present. Instead of counting down the days to getting your knee scoped find an activity that you enjoy and is not just physically busy but mentally fulfilling as well. Try knitting, painting, writing or explore a mindful movement session!
6. Play. Find time to move playfully and with true curiosity. Drop the focus on the outcome (recovering) and instead focus on the process (moving for the love of it). Explore your comfortable ranges of movement, stay well away from the edges where pain erupts and play around in the safe zone. Move your knees and hips in different ways than your habitual, on the floor, in sitting and standing. Find more ideas in the movement sessions on movementRX.
7. Be aware of your relationship with pain. Explore your habits of thinking and talking. Notice how often you talk negatively about your pain or injury. See if you can move away from that topic intentionally and focus some of your efforts on a different topic ideally something light and fun like American Idol or the Royal Family.
8. Keep a JOY journal. If you are already keeping a pain journal, add five minutes to this routine and keep a Joy journal. Write down things you did today that felt good and easy. It could be just walking to the bathroom, or as small as rolling over in bed with ease.
movementRX can help you in your recovery
I may have succeeded in holding my tongue in conversation with a new friend but rather than letting my passion for mindfulness dissipate I poured it into this note to you. My new friend’s experience inspired me to share some thoughts that hopefully can help you alter your relationship with pain.
The mindful movement sessions on movementRX will guide you in this practice of slowing down, becoming more aware, and shifting your focus to the positive. Try two free sessions or sign up now for access to more than a dozen nourishing sessions.
