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Motion Forword - October 2023 - No4

Welcome to Motion Forword - Words of a Therapist! Number 4!

Motion Forword is about discussing the combined benefits of movement with a positive mental attitude. Using my personal/professional experiences, evidence-based research and some of your own experiences.

Bringing some hope, positivity, happiness and maybe usefulness to those, perhaps like yourself, that needs a pick me up.

Something about me - Running and Tough Mudder!

Well a few more firsts for me over the last month... On Saturday 23rd September I completed my first Tough Mudder 5km with my cousin.

Honestly, it was a lot of fun and the camaraderie of everyone around created a real positive vibe and buzz amongst the participants. There was minimal competition (that I could detect!) as it wasn’t about how fast you could do the circuit. This is ideal if you don’t want the extra stress of expectation or pressure.

Afterwards, I realised that I wanted a bigger challenge. I even had energy to run 12km the following day!

A very good friend of mine, aware of my progress with my running, was convinced I’d be able to do a half marathon (13.1miles or 21.1km). Naturally I was sceptical (as is my nature) as the most I’d ran by this point was the 12km that weekend! But on Wednesday 27th September I looked up a route and thought I’d give it a shot. Here is a before, an after and my tracking companion:

My legs were buckling underneath me, I was soooo hungry and my energy levels were so depleted I crashed on someone's front lawn for 10 minutes! But I did it.

It was yet another example of how my own preconceptions of my ability and capacity were in my own head. Back in July when I joined a running club I was constantly asked when I’d do my first half marathon.

‘Pfffff! As if’, I would say. Only cementing in my own mental block.

But as with all things, the more we practise, the better we become. Who knows where I’ll end up if I keep pushing my boundaries and breaking down those self-limiting beliefs…

Think of something you would love to do but haven’t done? Then ask yourself:

What self-limiting preconceptions about this do I have that get in my own way?

Not enough time? Worried about injury/reinjury? Don’t think you can do it? Haven’t got anyone to do it with?

Too old? Then ask yourself: Are these preconceptions true? Or are they something I tell myself?

As Henry Ford said: If you think you can or you think you can’t, you’re right.

Something for you - Consistency

If you have read my previous Motion Forword Newsletters, you’ll notice that each of my patient recovery stories came with a long drawn out process to getting them better.

It didn’t happen overnight and it took a lot of effort and many frustrations had to be overcome. This is because, like in many aspects of life,...

Consistency is key.

So if you are going through something tough (mudder) like…

A tricky and stubborn injury

A persistent pain problem

A period of grief or loss

A goal that seems always just out of reach…

Here are some tips* for remaining consistent and overcoming those obstacles…

*You’ll be pleased to know (I think) that the following came from my own head and experience, and not from ChatGPT or other AI!

1. Leave your ego/pride behind - You are on this journey for you, not for anyone else. Stick to what you are aiming for and don’t compare yourself to others.

2. Not every day is a progress day - Some days are going to be difficult. There are going to be days when you feel like you’ve gone backwards, that it has got worse, that you’ve undone all the good. But these days happen. It doesn’t mean you’ve gone backwards because you are most likely in a much better place than where you started.

3. Keep track - Everything that is measured is managed. By logging progress you are more likely to see subtle improvements. You can measure pain levels, how far you walked per day, how many steps, how long a stiffness lasted, how often you noticed the pain, what you could do today painfree that you couldn’t do before. Use an app, a journal or a diary*.

*Hell, why not all 3!? Use your phone’s calendar to journal your progress!

4. Noticing the bad is easy, search for the good - You will always find something negative, especially on really bad days. But there is always a positive, you just have to look for it. Or as Dumbledore would say…

5. Take a break - Doing something everyday towards your goals is ideal. But taking time for yourself is also important*. Chill, go for a walk, read a book, listen to music. However you chose to use your downtime, is time well spent.

*Personally (as you may have guessed from previous blogs) I like to go for a short run in as much greenery as possible, dance like no one's watching or write in my journal.

6. Have a cheerleader - Who is that person who has got your back? Your spouse? A family member? A close friend? Your Osteopath? Whoever it is, they should support you in your goals, keep you on track, empathise during the tough (mudder) times and celebrate your successes.

Even if only one of these points resonates with you, take it and run with it. Apply it and see where it takes you. For me right now, reading back over No2 is hitting hard right now and I need to give myself some slack and remind myself how I’ve improved so much!

The only reason to look back is to see how far you have come.

A story - The nocebo effect

In May 2022 I first had the pleasure of meeting Margot. A 50 year old primary school teacher who enjoys karate. She had been a long-term migraine sufferer and had been diagnosed with Fibromyalgia Syndrome (FMS). A complex condition that usually presents with aches and pains around the hips and shoulders. As well as fatigue, stiffness, headaches and IBS. Yet, she still managed to bring up her 3 children whilst holding down a full-time job and doing her best to look after herself. All the while having a positive outlook on the whole thing.

Margot’s original complaint was about her migraines, jaw restriction and pains and tightness across her chest and neck. Osteopathic treatment had helped her before but knew ‘cure’ was wishful thinking…

My treatment eased some of her symptoms and advice seemed to be helpful. Gradually getting her stretching and exercising more. But I was suspicious of a condition called Polymyalgia Rheumatica (PMR) given some of Margot’s symptoms. We discussed how it could be important to look into and she organised a blood test through her GP.

By October 2022 the results came back negative and that worry was put to one side. But the unfortunate thing was what happened next to Margot…

She was subsequently referred to a Musculoskeletal (MSk) Specialist. Maybe to provide some extra support and understanding of how she could help herself. She was seeing me later that day after this particular appointment.

Margot was not her normal optimistic-self and she went on to tell me her experience with the specialist. The way Margot described how she was treated/spoken to was really upsetting to me, let alone how it made Margot feel. Given how stoically she had managed her symptoms up until then.

Margot and I had been working together for about 5 months by this point. This specialist had managed to completely undo all the positivity Margot had created in herself and her own body.

She was told to stop karate.

She was told all the things that were ‘wrong’ with her: a scoliosis, ‘wonky’ shoulders, pelvic malalignment, neck hump and a leg length discrepancy.

She was worried she would pass these problems onto her children.

For starters, most of these things are normal and happen in people with no pain*. But if we are made to feel like they are a problem… It can make our pain worse.

*Like this study by Laird and lads, 2014 about the pelvic tilt

This is known as the ‘nocebo’ effect. The opposite of the placebo effect**. ** A nice definition: The placebo effect is when a person's physical or mental health appears to improve after taking a placebo or 'dummy' treatment. Placebo is Latin for 'I will please' and refers to a treatment that appears real, but is designed to have no therapeutic benefit.

To reassure her, I checked to see the extent of all of these so-called ‘problems’...

There was:

  • No Scoliosis

  • Her right shoulder dropped, but this is typical in a right handed person.

  • Her pelvis was good and level.

  • There was a mild neck ‘hump’ but not dramatic

  • There was no leg length discrepancy.

So not only were the specialists' comments scary and worrying for Margot with no advice given to resolve them. But their observations were unsubstantiated.

I am very grateful Margot came in to see me that day. To give me an opportunity to tell her how good she actually was and how well she was doing. Preventing a downward spiral.

A year on and Margot has been proactive in her health. Looking into allergy and nutritional advice and has seen good physios since. She still suffers from the occasional migraine and aches and pains. But she is still doing her karate, is enjoying her new(ish) job and is crushing regular circuit training all with a smile on her face and pride in her accomplishments.

Nocebo can be really powerful in a negative way and I see it all too often. Don’t fall victim to it. Make sure you have a therapist that sees the glass half full, not half empty.

Thanks for reading, until next month… Motion Forword ⏩⏩ Nathan

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