Let it snow

It’s been a challenging year. Another challenging year, I should say. It feels as though each year after

the Covid pandemic struck we’ve been hoping for a wonderful reprieve, when everything suddenly

becomes much easier. It seems that isn’t going to happen just yet.

Last week I was travelling from Dublin Airport for work. We got stuck because of the cold weather,

and were held at a gate underground for hours, in the freezing cold, until well past midnight. It

wasn’t ideal. There was a lot of grumbling going on, as we were all very cold. But then my sister-in-

law sent through a picture of a cheery snowman my nephew had made. The cold weather clearly

wasn’t causing so much upset to everyone.

It all sounds a bit cheesy, but it made me stop and think for a bit and try to look at the situation

differently. I began to think how much worse things could be – at least I wasn’t in Ukraine facing the

prospect of cold and blackouts all winter. I was certain to reach a warm bed at some point. It’s just a

few weeks until New Year, which can bring a fresh start. In the meantime, I’m looking forward to a

few days off, and hope you all get the chance for a rest or a change of routine. And I’ll be thinking

about all the wonderful things which have come out of the past year, and that 2023 has the

potential to bring.

We won!

As many of you may know, I recently worked on a study about Pregnancy-related Pelvic Girdle Pain (PPGP) with two colleagues, Alex Frankham, a physiotherapist based in Jersey, and Dr Sinéad Dufour, at McMaster University in Canada. We looked into perceptions of the causes and treatment of PPGP among physiotherapists based in the UK, using an online survey. It was a larger form or a previous study we did in Ireland, and produced similar results, with a few differences.

In the past the prevailing view of PPGP among experts has been that it has mechanical causes – things like pelvic instability, back pain or lack of core strength, or a high BMI. But some experts think the causes may be psychological – like fear or emotional stress - or physiological, like an imbalance of the autonomic nervous system.

All this, as you know, closely relates to my work. My colleagues and I wanted to find out what chartered physiotherapists thought of the issue, as this would tell us how they would be most likely to assess and treat patients.

Our results from just over 100 physiotherapists told us that they considered both mechanical and psychological factors to be causes of PPGP. They also selected both mechanical and psychological treatment options, although the latter (including explaining pain, addressing fear, and lifestyle factors) were the most popular options.

We presented our results to the Journal of Pelvic, Obstetric and Genealogical Physiotherapy’s 2022 research competition, and I’m thrilled to say we won! We were invited to present our work at the POGP virtual study day at the beginning of November. It was a great opportunity to discuss our findings, and also a wonderful reward after a lot of hard work!

If you’d like to see the poster, you can find it on the research page of the website or by clicking here.

Standing out

One of my children recently came home to visit. She moved out some time ago, but as seems to be the way with children, never quite managed to remove all of her belongings from her parents’ house. Every now and again we threaten to throw some of these things away, in the hope that our children will come and free up some space in our attic. It never seems to work. But this time, at the end of her visit she appeared in the kitchen with a heated clothes drying rack. It belonged to her, but was so big, awkward and bulky that she’d never managed to take it to her own home.

She looked at me, and said determinedly: “It’s time.” The prospect of rising energy costs in winter had finally forced her to bite the bullet, and bring home the drying rack which had been languishing at our house for I don’t know how long. The problem, it transpired, was not so much the actual carrying of the rack – it’s large, but very light, and because it has built-in handles it’s possible to carry it under one arm.

Instead, the reason my daughter had left it in our house for so long was that she couldn’t face what people would think of her. The journey back to her home involves several forms of public transport, and a connection walking through busy streets. She imagined people staring at her, judging her, and grumbling about how her enormous drying rack was taking up too much space and getting in the way. But now it had become too important, so she had to take a deep breath and bravely venture out with her luggage in one hand, and a heated drying rack in the other.

Of course, nobody noticed. Nobody judged, nobody grumbled. During her entire journey I don’t think anyone even looked at her twice. When she told me – indignant, after getting home, that she had needlessly waited so long to relocate her drying rack, based on unfounded fears – it made me laugh. Not only because of her adventures, but because I recognised something so common to all of us – we all think everyone else is much more interested in us than they really are.

It's so easy to feel embarrassed, to feel like everyone is looking at you, and to avoid doing things because you’re afraid of what other people will think. But more often than not, other people don’t even notice. While it may be a bit humbling to realise you’re not as much the subject of everyone else’s attention that you thought you were, it’s also incredibly freeing.

Building resilience

Years ago I met a woman whose job title was “resilience trainer”. I thought it sounded a little bizarre, and of course her job involved working for a big company and being sent around to regional offices to speak to staff who were being made redundant. At the time it sounded like a somewhat cynical profession, but I was reminded of it some years later, when speaking to another friend who had been made redundant early in her career.

She had been working as a manager in retail, but then used her redundancy pay to begin a master’s course in another field, which led to her next job and a thoroughly enjoyable second career. In our conversation she said she had a theory that everyone should be made redundant at least once in their lives, to teach them how to cope when things go wrong.

I don’t quite agree with the blanket statement, as I remember too many stories of devastating redundancy after the financial crash. It’s one thing when young and single with plenty of opportunities for moving on, and quite another when an entire family might be relying on one income stream.

But I do think my friend had a point – difficult or painful life events can create resilience. While of course it would be much better if they didn’t happen, everyone faces some kind of upheaval at some point or other. Sometimes the only good we can take from it is resilience.

Burning out

The concept of “burnout” has become more popularised recently. People now mostly use it to refer to professional burnout, after a difficult period at work. But it can happen to anyone, from any cause of stress, including the pressures of raising children or negotiating difficult relationships. And it can lead to chronic pain.

One popular solution offered for burnout is rest and relaxation. This is absolutely valid, and in some cases can work wonders. But in others it is not a good remedy, as a person either cannot take a break (for example from caring responsibilities), or as soon as they return to normal, the symptoms of burnout begin again.

I recently came across a book by two American sisters, Amelia and Emily Nagoski, who have an interesting take on burnout. They argue that the way to deal with it is to tackle your stress, not your stressors, by which they mean the factors that cause stress, such as work, caring responsibilities, or a difficult relationship.

To do this, they say, you need to complete the cycle of the stress response, rather than leaving your body in fight, flight or freeze mode. For example this could be by doing jumping jacks when home from a stressful commute, to communicate to the body that it is now safe.

The sisters describe emotions as “tunnels” – you need to feel them, however difficult and scary that might be, in order to process them and combat the stress they are causing. The concept has a lot of resonance with one of the phases of the Resolving Chronic Pain approach.

 In the Resolving Chronic Pain process there comes a time when the pain has reduced somewhat and the pent-up energy produced by stress makes itself known. That is the point when each individual decides how they want to vent that energy. Options include boxing a punch bag, yelling at the wind or the sea, singing loudly (and possibly out of tune!) to your car radio or favourite playlist, dancing with abandon, or running. The list goes on… thank you to everyone who has added to it over time. Are there any ideas I’ve missed? If so, add them in the comments below.

Prescribing fun

“Fun is a health intervention”. I heard this recently in a TED talk from American journalist Catherine Price, who has previously written about the importance of separation from your phone and other devices.

It struck me just how true it is: fun, as Price points out, is good for us. On one level we all know this – we all know that getting out and enjoying time with friends can give us a boost during a low period, for example, or that hospital patients have been shown to benefit from entertainment and enjoyment. But it’s surprising how often we seem to forget. Do you make sure you are getting enough fun in your life, just as you might consider whether you are getting enough exercise, or vegetables? When was the last time you truly had fun?

For some of us, it might be a while ago. All too often our busy, stressful lives crowd out any possibilities for fun. And parties, events and other activities, while being enjoyable enough, so often fall short of being really, truly fun. 

So how to have more fun? It’s a tall order if you are already facing pressures at work and home, perhaps with a busy and stressful job and constant caring responsibilities. Having fun shouldn’t be yet another thing you’re trying to tick off an already-crammed to-do list: that somewhat defeats the point.

The best advice Price has is to actively prioritise fun, recognising it as something which is good for you and worth making space for. She suggests spending time with someone you know you have fun with. I would add that it can be valuable to actively think about which activities you associate with having fun – as opposed to those where you feel like you’re supposed to having it.

For some people this might be things we wouldn’t normally think of as fun, like exercise or even some elements of work. For others it might be more traditional fun activities. Whatever they are, it’s important where possible to make sure you get those opportunities for fun. Recently I went for a swim in the sea - it was chilly, and the other people on the beach thought I was mad… but it was a lot of fun!

Looking forward

September is a strange month, isn’t it? The end of summer and “back to school” feeling can be a bit gloomy, and yet the weather more often than not grants us a few improbably sunny days, while falling leaves and crisp morning air is a promise of all the best things about autumn.

Last year I went away for a weekend in autumn – not very far, just a night, to do some walking. It was still just warm and light enough, even if I did have to trudge through the rain on one day. The break was lovely, and it tided me over through the darker winter months, giving me something nice to remember – and perhaps to look forward to, in the form of a repeat adventure in the spring.

I never got around to it due to the Omicron wave of Covid, but I’m planning to go on another walking mini-break this autumn as well. I’ve written before about trying to arrange nice things to look forward to during difficult periods - I’m very lucky to have the chance to get away for a night, but if you’re not able to do this, could something smaller-scale be possible? Perhaps a one-hour walk, or meeting a friend for a chat.

Rather than mourning the loss of summer, I’m now looking forward to beautiful damp autumn days, even if it does mean trudging through the mud!

No silver bullet

A recently-published paper about treatment of depression made a bit of a splash. The review, led by Joanna Moncrieff from University College London and published in the peer-reviewed journal Molecular Psychiatry, looked at evidence around the “chemical imbalance” theory of depression – that it is caused by low levels of serotonin. It found there wasn’t enough evidence to say the two things are definitely linked.

The chemical imbalance theory has been around for decades, but some researchers have doubted it for a long time. Some experts have said this review proves that treating depression with SSRIs (a common type of anti-depressant which increases serotonin levels) does not work, and that the only reason many doctors prescribe these drugs is because of encouragement from pharmaceutical companies wanting to increase profits.

On the other hand, the fact is that SSRI anti-depressants seem to work to resolve depression in some people. It may be that there is some link between serotonin levels and depression after all, but given other research into placebos, I personally would not be surprised if in cases where they have worked it may have been due to placebo, or the other factors such as talking therapy or lifestyle changes that the medication was combined with.

As all of my research for the textbook, Psychophysiologic Disorders, showed, there are cases when a doctor taking an interest, speaking to a patient and prescribing medication can work wonders, even if the medication itself is not effective. But as the review author points out, it is not ethical to prescribe drugs if you are sure their only effect is as a placebo.

The issue is still uncertain, and there is a lot that psychologists and other medics don’t fully understand about depression. It is a very common condition, and may have a variety of contributing factors and treatments – each of which tends to be unique to the individual concerned. This review serves to highlight the fact that regardless of whether these anti-depressants are effective or not, depression has never been an illness which can be “fixed” with one magic pill. Doctors often take a broad approach, including medication, talking therapy and lifestyle changes.

These findings may lead to more conversations about the efficacy and ethics of SSRIs. However, they will not change the fact that the only way to have a chance of treating depression is on a case-by-case basis, taking into account each person’s unique situation, symptoms, and possible treatments.

"I was spinning too many plates and my cup was empty"

As you know, I often ask people to write a letter to their former selves, earlier in the resolving chronic pain process. It can help people to reflect on their progress, and appreciate just how far they have come.

One such person, I’ll call her Shauna, recently wrote a letter. In the past she found herself struggling to get out of bed due to her pain, but after following the resolving chronic pain process she is now pain-free. She recently dealt with a very stressful family situation with great dignity, and is now hoping to move forward in her career as a schoolteacher.

Shauna had been in a difficult relationship that she tried hard to make work despite the odds. She ended up leaving it and trying to make a new start. Friends and family were supportive, and Shauna tried as hard as she could to reboot her life. But things didn’t improve, and she filled her time with more and more activities to try and distract herself. She ended up unable to get out of bed due to her back pain, and her sister came to help. Her sister had done the Pain Science Kinesiology course I taught in 2021, and suggested Shauna contact me.

Shauna had been severely affected by her previous relationship. She was treated with little or no respect, which eroded her self-confidence. Cramming her day with activities was a way of distracting herself from the hurt she was feeling. But she became worn out, and her unconscious mind created her back pain as an alternative distraction from the hurt.

Once Shauna reduced her back pain, we began work on gradually re-building her self-confidence. As you will see in her letter to her former self, she is now able to access her true feelings to trust her judgement.

Read Shauna’s letter to her former self here.

Good company

More than two years ago I wrote about the addition to our household of four young chickens. We got them around Easter 2020, in the midst of uncertainty over the Covid pandemic. They weren’t a lockdown-inspired idea – we had been planning for their arrival for some time  – but they certainly brightened up an otherwise very isolated period. 

As many of you know, I took a break from work a few weeks ago. I can recommend it! Several neighbours very kindly offered to feed and care for our chickens while we were away, and we left them in very good hands. But just before we returned home, they let us know that unfortunately one of our chickens had died in our absence.

While it was a sad moment, the context is that our breed of hens only tend to live for two to three years. She died of old age, and we had noticed that she seemed a little off colour before we left, so the news was not completely unexpected. We have always been very wary of foxes and local dogs, so consider it quite a success that we managed to evade them at least. And it must be said, the hens have as good a life as possible. They are allowed to roam free in the garden during the day, with plenty of attention paid to their needs - particularly by my husband and many other visitors to the house.

It is this last point I thought of when we were told about the hen’s fate. Having pets can bring enormous joy, and though our hens lay eggs, they are really pets at the end of the day. My husband is very fond of them – he loves wandering around the garden as they hurry excitedly behind him. I also believe he loves the structure of having to get out of the house every single morning and evening to feed them and shut them safely in their coop. 

The responsibility and sense of being needed that pets bring can be a huge benefit, as well as their entertainment and companionship. And while it’s always sad to lose one of our hens, it brings home just how wonderful they are. We have loved keeping hens since the days of my Kilmacanogue studio, and hope to keep doing so for a long time yet!