Is FEAR holding you back? A 3 step process to overcome fear.

One of my biggest concerns when I undertook my pain management course was the fear of failure. What if I can’t do this? What if I can’t change my automatic thoughts/behaviours from continuing to surface? What if old habits really do die hard? What if I keep choosing rest over activity? What if I give in to old food cravings and loose the discipline? While I was super motivated to change (I didn’t want to keep going the way I was and I was desperate to prevent any more darkest days). I was also really scared I wouldn’t be strong enough to commit.

That’s a lot of fear and worry about the future. A future that may not even occur. And while I was wasting all that time fearing my possible failure, what was I doing in the present moment? Nothing. Procrastinating and not taking action. Don’t let a fear of failure hold you back from starting something new. By the end of my course, I had realised that I was just wasting time worrying. This time could be spent taking action. So my new motto became...Just Do It (sorry Nike but it is a good, motivating mantra!) So the next time I had a worrying thought that “If I go for a walk, it might just flare my pain further”, I stopped. Took a breath and said to myself “Come on, just do it! Because there is only one way to find out!” And, of course, I soon learnt that getting outside and going for a walk made me feel much better. I was using pacing and mindfulness and daily regular exercise, so I wasn’t overdoing it. I was slowly strengthening and improving my fitness and flexibility.

There can be a problematic self prophesising which can happen when we are afraid. For example, the fear of increasing pain may trigger the stress response. We are hardwired for this fight or flight response and when it kicks in we have a rush of hormones and a quick conversion to the sympathetic nervous system. We are now ready to run or fight for our lives. In this mode, we do not need non-essential body functions like the immune system, digestion system. You can read more about it here. But if we have caused this response to fire, guess what happens to our pain? It can increase because the regulatory systems that can sometimes control (or at least mask) pain have been switched off. And so then what happens? You have pain and you say “See, I told you so!” (refer to an excellent book by Dr Lissa Rankin, Mind over Medicine).

I am often motivated to do (or not do) something from fear. Fear of failure, fear of hurting someone’s feelings, fear of not being liked, fear of pain, and fear of being vulnerable.  For me, overcoming this fear has been a critical component on my self pain management journey. So here is my 3 step process to overcoming fear. For the purposes of this, we will use the example that fear is holding you back from changing a habit. For example, we will say you are afraid to start a new exercise program.

Identify.

You need to be pretty honest with yourself, if you are to identify the factors that hold you back from making a change/commitment. You might hear yourself saying things such as “I’m afraid I will injure myself and cause more problems” or “I’m afraid I can’t commit to doing anything properly”. So the fear may be resulting from past experiences and long held beliefs about yourself and your capabilities. These can be based around INJURY and FAILURE. For me, I would often flare my pain after playing netball when I was younger. I had to give it up in the end because of the way I approached the game (no warm up and relentlessly throwing my body around). You can read more about that decision here. After this, my fear morphed into “If I do any exercise it will flare up my back. This was a totally untrue statement but based on my prior experience and my deep desire to avoid pain, this became my reality. A fear of failure will result in you never starting something new. I have now figured out that by starting small and pacing up activities (read more about pacing here), I realised it is possible and achievable to get moving again. This approach also means you are less likely to fail because small increments are based on your current capabilities. Also, once you do start to move and get stronger, more flexible, you gain confidence and your motivation increases and you just, well, keep going. To identify fear as a motivator you need to be self aware and truthful with yourself.

Investigate.

We always immediately block or run from fear (that’s the fight or flight response kicking in). But it can be very helpful to confront your fears. In fact, don't just confront them, invite them in for a cuppa and get to know them better. What are these fears based on? Are they realistic? Is this something you have always just told yourself? Does it have grounding in fact/reality? Could this fear be a result of cultural/society influences? A question that I often use to investigate my fears can be as simple as “Is this true?” If the answer could be no, then I look at some of the alternatives. So using the fear of exercise example, is it true I will injury myself? No, not if I undertake the activity in the correct way and this may lead to me enjoying it, continually improving with a long term benefit of increased strength/flexibility. Such investigative thinking can be like drawing up a list of pros and cons. What are the reasons for doing something and what is holding me back? If it is fear holding you back, then you need to work through it, question it and make a strong choice based on these pros/cons.

Challenge.

You may have seen various challenges online. For example, loose weight in 6b weeks or a 10 week improve your love life challenge. Do you know why these work? If you give yourself a challenge and you stick to it, the chances are you may have come close to kicking a bad habit. By replacing a habit with a more helpful one (even though you were initially scared to try it) you will be achieving a massive milestone and motivating force to continue. And you will see the benefits too. But don't be afraid to get some help! Maybe make your commitment to overcoming fear accountable by telling a friend or loved one you are going to try something new. Maybe even just the discussion about the fact you are scared will be enough to get you up off the couch and into something new. An you know what, if we were all honest with each other, there is probably heaps of things we do/don’t do a result a result of fear. So, you may just get an interesting response from a friend...”Really? Me too!”.

I would love to know your thoughts? Are you sometimes held back by fear? With regards to your pain, what are you most afraid of? Is it true/realistic/likely? How do you overcome fear?

Here are some motivational quotes and interesting reads based on fear/excuses.

Don’t let a fear of failure hold you back from starting.

You miss 100% of the shots you don’t take – Wayne Gretzky

"What would life be if we had no courage to attempt anything?" Vincent van Gogh

Do not distress yourself with dark imaginings. Many fears are born of fatigue and loneliness. – Desiderata by Max Ehrman

 

Some additional good references about fear and its impact:

http://www.chronicpainandlife.com/blog/the-yeah-but

http://www.copyblogger.com/f-e-a-r/

 

Helpful versus unhelpful thoughts

What is your experience?

Finding out what is the best movement for me

I loved playing netball. I represented my region and much of my time was taken up with practice or tournaments during my teenage years. I was the one who went in hard, threw myself around, no fear and some would even say, a little bit crazy (as you can see!).  But in early 2000, I was playing mixed netball at a fairly high competitive level. It was excellent fun. I played with my husband and a bunch of good friends. We were all carefree, late twenties and believed we didn’t need to train or stretch or prepare for games. We would fly in at last minute, throw on our uniform then hit the court. After running full tilt for an hour long game, we would then just stop and stand around and chat or go for a drink. My body could not cope. Almost weekly I was in a bad way the following day. Surprisingly, I never felt pain during or straight after the game, but it was always the next day, ouch! I was pretty renowned for saying “Ooh that’s gonna hurt tomorrow!”

One day after a particularly bad flare up, my husband politely suggested maybe it’s time to stop. He was brave enough to even suggest that netball just wasn’t good for me long term. Maybe it was partially the way I played (speed: go or stop) but also I just wasn’t coping with the pain that resulted. So I stopped playing. It nearly killed me because I still went and watched. It was hard because from the sidelines you always firmly believe you could surely have done that better, made that intercept. But I sadly said goodbye to the game I loved.

So, I worked out that netball was no longer the sport for me. I know now that I am better off doing something I enjoy that is not quite so rigorous (dangerous!) and something that strengthens my body in a functional way (yoga, walking, etc.).

Recently I have been giving CrossFit a trial. I love the energy and the people were all very friendly.  It is functional movements with lots of squats and chin ups and using weights to power up the legs and arms while focusing on core stability. The sessions are a lot of fun. But I was pulling up very sore and stiff. I was constantly explaining to the coaches that my approach is to start slow and build up. And I know this because I have figured out this works for me after the past 6 years of self managing my pain. But that is not really the philosophy I found behind CrossFit. They want you to go hard and push beyond your limits and try to go heavier and faster and…well I am just not sure about it.

So I am quite torn now. I cannot decide if I am going to keep it up or not. I feel a bit like a failure if I stop going (hence the reminiscing about giving up my beloved netball) but at the same time I am a big advocate for listening to your body. I have limitations and I need to be aware of them and not push beyond these limits. So it has got me thinking maybe I would be better off using function movement techniques myself in the outdoors, with the kids, in relaxed settings. There are so many opportunities for exercise in my day-to-day living. For example, yesterday I helped my husband in the garden and I was transporting some compost to him in a small bucket (~10kg). Anyway after about 5 loads I was exhausted but happy. I realized that this was exercise (and a darn good version of it). I was combining a job that needed to be done with functional movement that would help me to become stronger and fitter. I realized as I was carting these buckets that I can do a similar thing to the functional movements within CrossFit while getting some necessary tasks done. No need to stress about finding time to go to a class, no need to stress that I haven’t had time to help in the garden, no need to stress about getting the kids minded so I can exercise. I can do everything if I am clever and I plan my days to include exercise opportunities. I often do a walk everyday around my neighbourhood. It’s pretty hilly where I live. So I made a decision to walk in a different way to increase my endurance and strength. Every time I hit the bottom of a hill I turned around and power walked back up for 10 seconds. This is a perfect example of finding some strength training in a simple daily task. And next time I take the kinds to the park…watch out! I will be on those monkey bars attempting a chin up and doing my squats while they play. All sorted!

So, I would love your feedback…Stick with the tough training or find opportunities for functional movement?…How do you find the best movement for you? What is the best approach for long term adherence to exercise? Does it really matter if you chop and change your routine? Can you just try new sports or activities and not continue with them. Isn’t it just great to be out there and be doing something? Let me know what you think??!

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When fun turns to not fun (pain)

A big challenge when you self manage chronic pain is knowing when to stop having fun! Imagine, you are really enjoying some task and getting into it. Bang! Before you realise, you are sore and tired and need to rest. Sound familiar? When fun turns to not fun (pain) you have overdone it. This may result in a pain flare up. If we can recognise when to stop with greater accuracy we can prevent flare up frequency.

As you may know I have been involved in #sugarfreeseptember. It’s a challenge to give up refined sugar for the entire month and involves posting a picture for each day based on a theme. Yesterday’s theme was fun. I was having a lot of it. So much fun, I forgot to take a photo. There was plenty of opportunity too. We had a very casual Sunday at home with the kids, in the garden, preparing garden beds, we went for a walk to the shops, the sun was shining. I cooked some delicious meals (pancakes for breakfast and chicken bone both with vegetables for lunch). I even made some chocolate nut balls for the sugarfree afternoon treat. But when dinner time came around, I was pooped. My pain had increased, I was starting to feel a little nauseated and I wanted to go to bed. Problem was I had two very wide awake kids, a mess in the kitchen and no dinner prepared. I think I got lost between fun and not fun.

How to know when to stop? I am (obviously) still grappling with this one. But here are a few hints and tips:

Timed tasks: Do you know how long this task will take? Before starting, I need to assess how long it will take to set up, complete and pack up a certain job. I also need to have an understanding of how much I have left in the tank. This would involve an assessment of how much I have already done in a day.  If I believe I can do it then I need to get the timer, pace out the activity with some short breaks (whatever I have deemed my “activity” timing to be) and stop when it’s done (and that does include time taken to tidy up or put tools/things away). If I forget this important step then I am likely to complete the task but with a mess left behind. This is the bit I always seem to forget but it can cause trouble for me because it will result in loading up extra emotions (guilt, inadequacy), requiring help or feeling of overwhelm. A timer (small kitchen timer or your smart phone) can be the best device for ensuing you complete a task, start to finish, with breaks and without overdoing it. Another thing I have realised, if my tasks does involve the kids, they need to be warned in advance the timing of the task. My kids often have more energy than me and they might be fine to kick the footy for hours on end but I can offer them only the time I have determined is suitable for ensuring I don’t cause a flare up.

Reality check questions: Here are a few reminder questions I can ask myself to ensure I am fully prepared to undertake or continue a task at any point in time. Does this really need to be done right now? This is not meant to be a question to fool yourself out of completing a task you do not like (no cheating!). I will often choose to do activities that I enjoy despite the fact that I probably don’t have the energy left to complete them to a good standard (i.e. finishing without the mess part). I am particularly susceptible in the kitchen. I will choose to start baking when I really don’t have the time or effort to complete it but I choose to because I want to eat that particular food or have a healthy option available for my family. Does this task align with my goals? This can be good for determining where my priorities are and how a given task might affect them. By choosing a task that may flare my pain I need to be aware of the impact it may have on my family (reduced time spent with them, requiring their help to clean my mess).

Communicate: Sometimes the difference between fun and not fun is a short break. Maybe you need to go do some stretches or have a quick sit down. If you are having fun with others (your family, in social situations, even in the workplace), don’t be afraid to communicate your needs in that moment. “Do you mind if we sit down to keep talking?” or “Can we come back to this in five minutes I just need to do some stretches”. This might be all it needs to prevent slipping beyond fun.

It’s OK to say no: If you have done a timing assessment and asked a few reality checks and you are not sure you can manage a task, don’t start. Perhaps it is better to put off than get started and realise you have overdone it. There is a very delicate balance between activity based goals (that is, saying you are going to complete an activity regardless of pain) and not overdoing it (completing a task at the risk of flaring pain). It’s a fine line and it differs from day to day. The only way you can get better at knowing when to stop is to be more aware and undertake tasks mindfully. And, I believe, the most important part of any job is a mindful beginning, deciding whether or not you should even start.

Acceptance: Again, I am always going to have to come back to this. Sometimes I just make really bad choices, I haven’t done the timing or the reality checks and I have pushed beyond fun. It is important I accept and act in these situations. Apologise if I need to. “I’m sorry I made a bad choice”. This is OK to say some of the time. I am getting better at this and it does not happen as frequently as it used to. I need to make stronger choices once I have realised my mistake but without layering on the additional emotional pain and judgement. That will only make the situation worse.

So, when you are having fun what do you do to ensure it doesn’t slide into “not fun”?

Managing flare ups

While I have been self managing my chronic back pain now for over 6 years, I still get flare ups. I was never under the disillusion that my pain would go away. So now when pain looms, I use my flare up management strategies. I know just what to do.

Even though it can be worthwhile to reflect on the reason (i.e. Did I over do it? Have I been neglecting my daily stretches? Did I stand or sit for too long without moving?) I am less focused on trying to figure out the cause of increased pain. I find it’s more important to launch into action.

So here is my step by step approach to managing a flare up:

Accept. Often my flare ups are still caused by overdoing it! Yes, I know all about pacing, taking breaks and have a good understanding of my own limitations but sometimes I still push through and over do it. But rather than beat myself up with guilt and blame and anger…I just stop, nourish, repair, move on. I also am much more willing to accept and just acknowledge that sometimes it is OK to have a bad day (I give myself a free pass - more on this soon). Also by simply accepting the pain, I am less likely to buy into negative, unhelpful thoughts which could develop into a snowball.

Plan. I need to make sure I communicate and get help if I need it. I know my bad flare ups last maximum of a day or two. I can deal with that. Two days is not a lifetime.While this may cause a problem if I have commitments/events, I just accept that my plans may need to be re-scheduled, re-organised or prioritised.   I will work simply from a daily plan worksheet, breaking my day into small manageable chunks with lots of breaks and only the necessary jobs (of which, walking, stretches and exercises get top billing!).

Act.  I have a list of activities I can do that I know will turn down my pain dial. I choose one of these and act. I don’t rest anymore or ruminate or wallow in my pain (that gets you nowhere or backwards - fast!). Your loved ones will soon recognize flare ups coming on too and if you share your flare up action plan with them, they can help. My daughter has told me I needed to do some stretches when I told her my back was sore. My husband often tells me it’s time to go out for a walk or he sends me to my room some meditation time. So I will go sit, stretch, breathe, relax. Remove some of the mental clutter. I need to do activities that turn the dial down. Here are some examples of things that work well for me:

Helpful thoughts

Relaxation/meditation

Stretching

Going for a walk

Listening to a motivating podcast/music or reading book

Awareness (posture, thoughts, activities)

Pacing (take breaks)

Carefully preparing a nourishing meal/snack

Be: I re-connect with the present moment, I cannot change the way things are right now so if I practice mindfulness and be aware of what I am doing, I can resume my normal day to day  activities much more refreshed and ready to cope with the current situation.

What do you do? A flare up action plan might be a good starting point. Take note of helpful thoughts or activities that you know turn down your pain dial and be aware of pacing cues, timing and taking breaks.

My Story - Part 1 (Before)

My story starts with my older sister being a know-it-all! She was studying Physical Education at university and she was learning about scoliosis and decided to use her eleven year old sister to practise her diagnostic skills. She made me touch my toes and announced to my mum that “Yes, I definitely had it”. Surprisingly, no one (not even me!) had noticed - but she was right, I was out of alignment and had a large lump on one shoulder blade and uneven hips! An out-of-date local GP told me I was going to be in plaster for 6 months. We were all in shock! But X-rays did confirm I had scoliosis, and a pretty severe case too. An S shaped curve measuring 52 and 54 degrees.  

I had two corrective surgeries when I was 11 and 16. While I often brush these off in my story, they were major surgeries for a young girl. Weeks in hospital and off school, rehabilitation, I had to wear a plastic brace for 6 months and have on-going therapy. In the end, the surgeons were happy because they were able to correct the curve and now my spine is straight, with the help of a rod, screws and bone grafts. It makes for a good show and tell X-ray.

My spine X-ray taken ~2009

 

I have had chronic back pain nearly my whole life since the surgeries. There have been good days and bad days. I returned to see my surgeon often and I would explain my pain but he would offer no real explanation or solution.  My pain was generally in my lower left hand side of my lumbar spine, generally around the area where vertebrae are fused together. More recently, bone scans indicated degeneration of the facet joints and further surgery (fusion to the sacrum) was suggested.  But I didn’t want to go down the surgical path again. Alternative therapies were tried with limited success. Partially because I think I never fully committed to their suggested exercises/routines because they never “magically” took the pain away, but also because a single physical approach did not address the physiological issues surrounding my pain.  I have also tried most prescription pain medications. The side effects of these are many and varied but I often would suffer severe constipation from codeine, nausea and motion sickness from the morphine based transdermal patches or effects on mood from the antidepressant range of pain killers. With each new drug I tried it wasn’t long before the mild easing of pain became ineffective. The long term use of prescription medication for my chronic pain was not the answer.

My general approach, on a day-to-day basis, was to cram everything I could into days when I felt good, leading to days of suffering because I had overdone it. I would ignore my pain, wish to be “normal” (read pain free – what is “normal” anyway?)  and just power ahead. I didn’t tell many people how awful I was feeling (except the inner sanctum - my husband, my mum). For everyone else I slapped on my brave face (and I got pretty good at it as far as I could tell!) As I have aged my flare-ups got worse and my ability to deal with them drastically decreased.  

My husband and I were always worried how I might go having a baby. I became pregnant in March 2007.  I was working fulltime and after coming home many nights in tears from the pain. I reduced my hours but then decided to resign when I was 5 months pregnant. Once I stopped working, the pain seemed a little better but this was most likely a result of the reduced stress and travel to and from the city. I was induced at 42 weeks and had an 8 hour labour. But it was all worth it when our beautiful daughter, Olivia arrived. She was a calm and easy to settle baby but all the changing, carrying, settling, picking up really took a toll on my back, particularly as she got bigger and heavier. I was having 2-3 days in severe pain (mostly in latter part of the day) and frequently needing help. I was depressed because I felt like I was unable to look after my child properly. I was often in tears about being a bad mother, feeling like I would never be able to run and play with her whenever she wanted to, pick her up and carry her around when she needed comforting. About a year after the birth (as those pregnancy hormones were fading and as she got heavier) I was near rock bottom.

I would become almost obsessed and consumed with my pain. My negative thoughts around my pain would escalate from thinking “I can’t deal with this” to “I am a hopeless mother/wife”, and “I am letting everyone down”. My husband referred to these thought processes as snowballs. I would get wound up catastrophising every idea, rehashing past mistakes, worrying and fearing future unknown pain events and rarely in the present moment. I went from a gentle snowflake to an avalanche, careering out of control down a dangerous emotional slope. I never even realised the destructive power these snowballs had… I was too consumed by my pain. I found it hard to look beyond it to see all the beautiful things that were still good in my life.  I had so much to be thankful for…but I just couldn’t see past the pain. And the difficult thing was I felt so alone. Despite the fact that 1 in 5 Australians suffer chronic pain and that so many people suffer in similar ways to me, I thought I was the only one doing things tough and suffering. I couldn’t see the true impact my condition was having on my family. They suffered too by watching me suffer. I felt I was such a burden to them. I actually believed they would be better off without me. Pain blurred my reality to such a degree that I could no longer see beyond it. I became so wrapped up in my misery that hope seemed an impossibility. 

Please don't stop reading (its a bit depressing isn't it!?)...If you have the time, read My Story - Part 2 (AFTER) because this is when I really changed my life and began to TAKE HOLD of my PAIN!

If you can associate with any of these symptoms, feelings, thoughts, experiences, please comment below and share!