Pain Resources

Hello again!  It has been way too long since I posted something!  Time slipped away in travel and family things and work things.  But I am back at it.  As promised last July here are some resources for pain management:

http://www.painedu.org  the subtitle of this website is “Improving pain treatment through education”.  It is a mix of provider information and patient information and also describes a lot about opioid use.   It’s good to have an understanding of where your doctor is coming from.

http://www.iasp-pain.org  This is the official site for the International Association for the Study of Pain.  If you click on resources, then patient resources you will find more links that may be helpful to your particular situation.

http://www.change-pain.com  This website is devoted to educating the health professional on how to assist people in pain to change their pain.  There are resources for patients on the site.

http://patients.aan.com  This is the patient information area of the American Academy of Neurology, there are some videos for different neurological diagnosis.  Some will cost money.

http://www.msnbc.msn.com/id/26136767/ns/health-alternative_medicine/t/youre-pain-you-want-relief-naturally/#.UGiTm1HYHpw  In the non-pharmaceutical department, here are a few recommendations for supplements that have been shown to help reduce pain for different conditions.  Of course, check with your provider to make sure you don’t get any interactions with things you are already taking.

http://www.webmd.com/pain-management/guide/pain-management-alternative-therapy  Here is an article from WebMD that can give you an overview of non-medical options for pain management

http://www.youtube.com/watch?v=4b8oB757DKc  And this is a video that explains the Explain Pain model in under five minutes.  I like to use this one when educating people on pain.
I hope you are enjoying this beautiful fall!  Sara

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Pain

Many of the techniques that come out of health care, traditional or alternative, arise out of the desire to alleviate pain and suffering.   It is for the most part an unquestioned belief in our society that we should not feel pain.  This is like saying the sky should not be blue.  It is a rejection of what is a normal part of the human experience.

Those with good intentions to provide relief from suffering with medication have inadvertently participated in the current epidemic of prescription drug abuse.   I have noticed in my practice an increasing amount of fragility among the people with chronic pain, and a lack of coping skills because of over reliance on pain medication.  Medication doesn’t take the problem away.  It appears to me to allow the underlying cause to fester and grow.   The commitment to numb out to the experience of life seems to be rampant, from movies that create anxiety, television that jumps frames in rapid succession, smart phones, and endless use of computers, to food designed to trigger the addictive parts of the brain.

I understand there are times that medication is a blessing, but it is not needed as often as we might think.

A friend recently recounted to me how she has been able to use manual lymphatic drainage when she had dental surgery and she did not require any medication.

Paul Brand, in his book, “Pain, the Gift Nobody Wants” talks about the people in India, where he grew up, and how they accepted pain as a part of life.  His parents were missionaries in India and in his adult life he went back as a hand surgeon to work with people with Hansen’s disease (leprosy).  He notes that for people with this disease they do not feel pain and that lack of sensation causes great damage to their bodies.

What if you lived today as if the pain that is currently present for you is a gift?  You might unwrap it with curiosity and excitement for what is inside.  Listen to your pain as if it had a message.  Turn your attention toward it with acceptance and love.

Recently I have heard reference to using techniques to distract us from pain.  I say turn toward it, shine a light on it, embrace it as if finally hugging that part of you that has been crying out for some attention.  Treat it like you would have liked to be treated as a child, not abusively, not permissively but with loving discipline, scoop it up in your loving arms and take care of it.

Acceptance of the pain we are experiencing often lessens it.  It calls us into the present moment.

I have some links in mind to share, but I will post them later in the week.  It is time to get on with my day!  I hope you have a great one.

 

Listening

Healthcare today gives a lot of emphasis on efficiency, technology and expert knowledge.   After over twenty years of practice I have to say that the most effective tool I bring to my professional practice is the quality of my attention.   Those other qualities are important, but when I am poised to listen, the potential for a positive change opens up more than any of those other things have to offer.

Listening is a life practice. And I think there is no end to it’s possibilities.  The first time I remember listening completely was with my husband.  It was twenty-eight years ago and I can still remember the moment, sitting in a hotel room on a Marriage Encounter weekend, practicing the active listening they were teaching us.  I was aware of  physically feeling his emotions and finally understood what it was like for him.  That moment was the starting point of some big changes in our relationship.  Years later, we were going  through a rough time in the relationship.  We healed hurts and rebuilt trust by simply sitting across from each other for long periods at the end of the day.  We gave each other complete attention, to the point of noticing our breath.

In my professional life, listening is the word used in visceral manipulation to describe the process of finding the primary restriction in the body.  This type of listening is awesome because it makes my treatments more effective.  And it provides me with a practice that teaches me about myself, and helps me develop mental stability and physical relaxation throughout my day.  Interestingly, when I am too enmeshed in the other person’s field, I cannot find the primary restriction well.  When I am too concerned about my schedule and what is next, I can’t find the primary restrictions well.  When I am aware of my own body as separate from the other person and I keep my mind on the moment, I can better find what is happening in their body as far as where the tension lies.

Listening is a basic principle of embodied awareness.  Listening is something we do with our body and mind.  We can listen to ourselves and our bodies, as well as listening to others.

You can start practicing this principle immediately.  Try it in your relationships and relatings through the day.  Position yourself to hear what someone is saying to you and attempt to repeat it back to them, when appropriate to make sure you heard them correctly.  Provide affirmations, rather than judgments (I didn’t say this was easy).  Simply attempt to understand what they are trying to say.  Then let me know your experience!

There is a lot to be said about listening, so I will share some links that offer more reflection on the topic: http://www.sacredlistening.com/tlc_about.htm.  These are a couple of great books about listening as a spiritual practice.

http://socialthinking.com/books-products/all-products/u-z?page=shop.product_details&flypage=flypage.tpl&product_id=313&category_id=50   This is a poster for kids on Whole Body Listening

Full Body Presence, Suzanne Scurlock-Durana.  A book for with a therapists bent on exercises to practice presence, which is listening!

Working in the Barrier

One of the most effective principles of fascial release is “working in the barrier”.  Now if you are not a therapist, hang with me, because this principle actually has a wide application outside of body work.

In the context of fascial release, the barrier is the layer of fascia that has a restriction.  By restriction I mean an area that is shortened or that layers of tissue are not gliding easily on each other. Fascia is made up of fibers of elastin and collagen.  As the name implies, elastin is elastic.  Collagen is tougher.  To find the barrier the therapist goes into the stretch of elastin fibers, to the strands of collagen and wait for a response. When I want to effect a change in the length of these collagen fibers in the tissues I need to apply the appropriate amount of stretch for an adequate length of time.  If I apply no stretch, a change will not occur.  If I try to force the tissues to a place I think it “should” be, there are elements in the tissues that will respond by contracting and preventing a change.  So, to get the best response I want to go just to the beginning of a sense of stretch of collagen.  If I wait there a change will begin to occur.  The tissue will do it as they are able.  This is a key: when you wait at the barrier long enough, it starts to melt and it doesn’t need to be forced.  What unfolds can be like a flower blossoming, a beautiful dance.

Expanding the definition of “the barrier”.

Working in ‘the barrier’ can happen in many aspects of life.  Where are barriers in life?  They are at the limits of consciousness (what I am aware of), relationships, knowledge, skill, and emotions, as well as my physical being.

How do you engage the sticky places in your life?  Shrinking away or pushing hard?  Numbing out with distracting activities, or over achievement?  It really is an art to find the spaces that stretch us yet create an easy and joyful dance of life.

I have an autoimmune disorder, and part of what triggered it was pushing myself past my limits.  Moving in the rhythm of life, recognizing when the barriers are thicker and it’s time to go slower, or when it is looser and I can expand, has been an art form to learn.

When exercising, be aware of working in the barrier.  The challenge is to work to the limit but not past it, to engage your edges of capacity in strength, flexibility or endurance in a way that feels enlivening.  Signs of pushing too hard include lasting pain, and increased stiffness or swelling.  In my work as a physical therapist I often find pushing past the limits is a common cause of dysfunction.  I had begun to believe in these limitations.  Then my son showed me what is possible when we work effectively in the barrier physically.  He wanted to complete an Ironman with in a two year period, having never even participated in a triathlon or run a marathon.  I was worried when he said he wanted to do this, all my experience said it was a bad idea.  Then I saw a video about Team Hoyt, a father and his disabled son who did Ironman competitions, and I decided to be more supportive of my son’s choice. (visit these sites for more information:  http://sports.espn.go.com/oly/news/story?id=2631338 and  http://www.blinkx.com/watch-video/team-hoyt-m4v/tehLcLd_P7S6gIZvH7G8cA)

Over that period I learned a lot by watching my son prepare for his race.  I learned that we can do almost anything if we pace ourselves, and properly fuel our body.  He challenged his barriers, but made sure he had good food and nutrition while he trained and raced.  He made sure to self-treat after workouts. He followed a recommended training program but recognized when his body needed more rest, and modified his program.  He competed in his first Ironman at the age of 30, and completed his first marathon in that same race.  Now this isn’t the recommended approach for most people, but he did illustrate what can happen when we work in our barriers effectively.

Age, health status, current level of fitness, and body awareness are factors to consider when beginning to engage a physical barrier.

I like questions as a way to get started:

  • What does it look like when I am not challenging myself physically?
  • What does it look like when I am forcing myself physically?
  • What does it look like when I am challenging myself in a healthy way physically?
  • What is holding me back from expanding my physical capacity?

You can get started on your own, but if you have physical limitations you may want to work with a physical therapist to get started.

So how does this relate to CenesTherpeutics? Engaging the physical barrier is an opportunity to expand consciousness.  Today, I introduced two ways we engage that barrier, through body work and through physical exercise.  The goal is to effectively engage the barrier.  That would be in a way that brings about a positive change.  How are you doing with that?  I would like to hear

Fascia

Discovering the fascial anatomy and its influence was

like realizing the world was round when I thought it was flat.

Every day in my work I have to explain fascial tissue to at least one person because they have never heard of it.  When explaining what this tissue is I often say something like this: Fascia is the connective tissue in your body, it surrounds and supports everything.  If you were a potted plant, your skin would be the pot, the roots would be the structures of your body and the dirt would be your fascia.  It is even called ‘ground substance.’  It is around every muscle, every bundle of muscle fibers, every fiber and every cell.  It is the covering of the cells.  It is around every vessel, organ and nerve, and it surrounds and supports your nervous system.  It has different names in different parts of the body, but it is all the connective tissue.

I could just apply my techniques to people but I take the time to explain because understanding the body in this way has huge implications on how we operate in our body and what we choose to do to treat ourselves. Seeing the body as a lively fascial web starts to change how you see yourself and the potential for your health.

Physical Implications

We are connected from head to toe, what is happening at the base of the spine influences what is happening at the head, and vice versa. What is happening at the pelvis influences what is happening at the shoulder, and even into the arm and hand. There are anatomical links through the fascia. Furthermore, we are unified in mind, body and spirit.  For instance, fascia will respond to thought.  You can recognize an emotional state by someone’s posture.  It is an error in thinking to treat anything as purely physical or purely mental.

Several of the people I have learned from have said, ‘all illness starts as stagnation in the tissues’.  Repetitive strain studies showing increased distance between cells in the interstitial spaces (the space between the cells of the body, or connective tissue).  Fibers form in the interstitial spaces with repetitive strain and this slows the movement of nutrients through the tissues, and also the removal of waste from the tissues.  We know that cancer cells are forming in the body regularly and usually the body’s defense systems carry them away.  However, if there is poor movement through the tissues, this can give cancer cells a chance to take hold. Cancer is a very complex disease, and there is much more to it than this one simple explanation.  It is an important point though, they may give us one more thing to do for our health.  I can point to a case study within my practice of someone who had a traumatic injury that created a fascial restriction in the area of the diaphragm.  She had never had health problems before that and within two years following that injury she developed endocrine problems, musculoskeletal problems and ultimately breast cancer.  The question is what role did the fascial restrictions created by the trauma play in the development of these health problems?  I can’t say conclusively but it is something that should be examined.

Structure has a big influence on physiology and function.  Pharmacology emphasizes a biochemical approach, but creating space for the cells of the body to work can have an amazing influence on the function.  Treating pharmacologically alone is incomplete and can in the long run have negative implication on health.

Sociological Implications

The human is so complicated that we must divide our studies into parts such as psychology, anatomy, physiology, spirituality, etc.  In medical studies we examine the various systems of the body individually.  And to study the musculoskeletal system, we look at the various joint complexes individually.  But after graduating from demanding scholastic and clinical program we have to put it all together.  That often doesn’t happen.  In fact, medicine has become more segmented with specialization.  People seeking help for a dis-ease can end up going from one doctor to another to hear their specialized viewpoint.

It can be very difficult for those with medical training when it comes time to understand the holistic influence of the fascial tissue.  Exceptionally bright people with MD, PT or PhD degrees can have a hard time putting it all together.  In fact, I often find doctors struggling with these concepts.  The lay person often does not.  So this must be an illustration of human nature.  When we are taught a system or model of understanding the human experience, we try to fit everything into this model.  As adults, if new facts don’t fit our model we often don’t acknowledge it at all, or we find it threatening, get angry and attack.

As I said, learning about the fascial anatomy was a major shift for me.  And my reaction included some anger.  I had not been taught about the importance of fascia in all the fantastic training I had.  I sat with my own anger for quite a while after I started learning myofascial release, and having great success with it.  I couldn’t argue with the results and so I just kept with learning fascial release techniques.  I read many books within physics, psychology, anatomy, and spirituality trying to answer the questions that came up for me.

There are many opportunities for new learning in all this but the lesson that stands out for me:

Models are necessary for learning, and living.  They provide a platform and a grounding.    They can become a cage when I use them  to prevent new learning or experience.

There is so much more than can be said about fascia, and many others have done a wonderful job.  Here are some examples.

Follow some of these links below and you can see some examples of fascia:

If you want to read more check out these choices:

  • http://fasciacongress.org/ The International Fascial Research Congress: Basic science and  Implications  for Conventional and Complementary Health Care.  Tons of research to give relief to the scientifically minded.
  • The Fasciae: Anatomy, Dysfunction and Treatment by Serge Paoletti.  A great book!
  • Healing Ancient Wounds, by John Barnes.  A book explaining Mr. Barnes approach and all that influences it.
  • Discover Craniosacral Therapy, by John Upledger, DO.  Dr. Upledger is perhaps the largest contributor to the teaching of craniosacral therapy in the US.  This is an introductory book for the lay person.
  • Understanding the Message of the Body, by Jean-Pierre Barral, DO, PT.  Dr. Barral has developed the curriculum of visceral manipulation.  This sophisticated approach to fascial release emphasizes specificity through thorough evaluation of the fascial system.

Samples of Treatment and Self Treatment:

CenesTherapeutics

Today I wanted to explain CenesTherapeutics®.  It is a word I made up with the help of my daughter-in-law, Melissa.  The root word is cenesthesia (pronounce the ‘c’ like an ‘s’). The dictionary I looked in defined it as, ‘awareness arising out of bodily sensation’.  So, CenesTherapeutics refers to all the methods that enhance awareness arising from bodily sensation, leading to healing and better health.  These methods come from bodywork, psychology, movement and medicine. I actually went through the process of registering this word as a trademark and self-published some of the educational materials I developed under that name.  My intention, if I can find some space in my life for it, is to write a book by that title.  Those who know me would be laughing right now, because I have said I wanted to write a book for years.  A blog seemed to be a more likely way to get my ideas out in the world.  But I digress.

Here is a brief history that led to the word.   I have had a passion for working with people in pain since I was in school.  My senior project for my Bachelor of Science degree in physical therapy was a 33 page literature review on pain.  I carried around (and read) Melzack and Wall’s textbook of pain for months.  While I was in PT school we had a presentation on craniosacral therapy.  One of the professors was not pleased.  She called it foolish.  I took that to heart.  Three years after getting the BS degree, I completed a Master’s of Orthopedic Manual Therapy.  Next I conquered a hand therapy certification.  I love to learn, and at the time was driven by a lot of insecurity about not knowing enough to help the people that came to me for treatment.

By 1998, I was feeling confident and would take on tough cases eagerly. I hate to admit this because it sounds very arrogant; I thought I knew everything about orthopedic physical therapy.

Be careful when you think you know everything.

Life will have a lesson for you demonstrating you do not.

I was working with someone who had a severe pain condition and couldn’t get off crutches.  Although I was the hand therapist, I was also the PT in our group who felt up to the task of helping this person with a very unusual pain presentation. She and I would get close but I could not get her off those crutches.  The pain would flare whenever she tried. Then one of my co-workers went to a three day course on myofascial release (MFR) taught by John Barnes, PT.  When she came back she suggested we try MFR on this patient.  We worked together for about an hour.  I left to go home to my family but the other therapist continued to work.   About an hour later, I was in my living room when I heard a knock on the door.  It was the patient!  Walking without crutches!  I was amazed.  We were both thrilled.  She never went back to crutches again.

That was enough for me to cast aside the barrier I had constructed about not learning those foolish techniques and I dove in to the seminar world.  This new discovery of fascial release rocked my world.  I was trying to make sense of it, and it was impacting every aspect of my life.  I learned myofascial release (MFR), craniosacral therapy (CS) and visceral manipulation (VM).  There were so many more techniques that were being taught and I decided I had to make some choices on what to study.

I like the big picture.  I like to understand the universal principles that undergird what we are and what we do.  While studying these three techniques I sought to find the common principles that connected them.  I ran up against a sort of religious passion for these various techniques.  The idea that one technique was superior to another, or possessed some uniqueness that none of the others had was often promoted.  To some degree I see this as a way to brand a product and sell seminars to people like me who wanted to find that one thing that will make me an awesome therapist, and fulfill the secret wish to heal everyone that walks in the door.  I think there is similarity among these techniques. But promoting their separateness limits the acceptance of them in the health care realm.

This special technique-ism happens in bodywork, psychology, and movement.  We are copyrighting all sorts of things.  So, I have now registered the trademark of CenesTherapeutics and I hope it could be used as a universal word to represent the body of knowledge for all the mind-body techniques that exist to help people heal.  And there are a lot.  So this blog could go on for a long time.

And the lessons I have learned:

Life is happier and more fulfilling when I let every day be a mystery and every person be a mystery.  Life will be more fun when I curiously seek out what I don’t know.  I am more likely to help people when I let go of needing to be the one that heals them.

 And in the words of Paramahansa Yogananda, “Do not confuse agent with single cause.”

Blessings to all of you!  Let me know what you think!  With Love, Sara

Therapy Solutions

In 1999, a friend and I decided to start a physical and occupational therapy clinic together in Kennewick, Washington.  It took some doing.  For instance,  my husband, Jeff, got a law changed so that PTs and OTs could own a business together in the state of Washington.  He showed me if there is a way to do it better, don’t be afraid to make it happen.  And you can work within the system to bring about a good result.  I have to thank Jeff for showing me this.

Therapy Solutions came out of the collaboration between Sue Brendel and me, with the help of our husbands.  It has been going now for nearly thirteen years.  It exists as a haven for both therapists and people seeking relief from dis-ease.  The mission: “providing an environment for healing where all are encouraged to experience wholeness and independence.” — has proved true for many of the people who pass through the doors.  I have to say that I have benefited more than anyone.   I suppose as this blog unfolds, some of what I mean by that will come to light.

You will find us at 1455 Columbia Park Trail in Richland, WA.  You can call us at 396-3707 and you can find out more about us at http://www.therapy-solutions.us.

What I hope to do with this blog is (1) share with you what CenesTherapeutics is, (2) share all the things I can find that illustrate CenesTherapeutics, (3) tell the story of Therapy Solutions, and my story, (4) share information that can help you life a happier and healtheir life,  and(5)  make a difference in health care in America.  I don’t know that a blog can do that, but you gotta start somewhere!

To your health!  Sara