Video: Daily Exercise – Hip Abductors

Disclaimer: Please consult your appropriate healthcare professionals before making changes to your exercise routine.

This is a new exercise given to me by my physiotherapist that I have found helpful for hip strengthening and pain reduction. What are your favourite hip exercises? As always, keep making the most of it with your exercise routines!

5 Easy Chronic Pain Self-Management Skills

Today I want to take a slice of Pete Moore’s Pain Toolkit and share it with you. Who is Pete Moore? He’s a chronic pain warrior who came up with this incredible Pain Toolkit to help others struggling with chronic pain. Here’s the website: https://www.paintoolkit.org/ . The truth is, we can learn to self-manage our chronic pain. Like Pete, I have also learned to do so to a point where, yes I have pain, but no it does not affect my day-to-day life (that’s not to say I don’t have bad days, heck I had bad pain the other night and had difficulty sleeping). One thing we want to do when we have chronic pain is cultivate resilience. Now, I’ve written about resilience before in the past, so I’m not going to go into detail here. For those who aren’t familiar with what resilience entails, here are a few things: optimism, self-belief, willingness, self-control, being able to adapt, psychological flexibility, problem-solving, emotional awareness, social support, and humour, to name a few. So, here are 5 ways we can learn to do this.

Doing these things helps me manage my chronic pain.
  1. Goal Setting and Action Planning I often set goals for myself, even on days that I’m not feeling great. In our third atmospheric river (basically several days of torrential downpour) since November in BC, Canada, I’m again feeling it in my body. But I know my body also needs to move. So I set a goal for how far I will walk in the rain (which is less than my goal would normally be but appropriate for the weather, my body at this moment, etc.). So, set your goals, and prepare for barriers to them. Here’s a podcast episode I recently did on that.
  2. Engaging in Activities of Daily Living – Getting out of bed, having a shower, eating breakfast, etc. All the regular stuff we do in our lives. It can be really hard to want to do them when you have an illness or pain, but doing them can also improve our overall well-being. Check out this episode of the podcast for more.
  3. Problem Solving – Problem solving can include a lot of different things. Pacing is important and I’ve done a post on that (December 1), prioritizing and planning your days, and really importantly, having a setback plan. What are you going to do when things don’t go the way you planned (in your goal setting and action planning stage). When I was recovering from hip surgery last year, I had to problem solve how to do all of my daily activities because I couldn’t put any weight on my left foot (for 6 weeks!) and I live alone. I still had to figure out how to cook, shower, dress, and even get to some appointments.
  4. Be Active – this will mean a lot of different things to a lot of different people, but it really means to move your body. It could be walking, exercise/going to the gym, stretching, yoga. Exercise itself is an evidence-based treatment for chronic pain (here’s the podcast episode). It can be light movement, as long as it’s movement. I can’t go a day without moving my body. Even when I notice I’m having the thought that I don’t want to move or I’m in too much pain, I inevitably actually feel better if I go for a walk or do some restorative yoga.
  5. Be patient with yourself – offer yourself some compassion. Change is slow. Like it’s an average of 10 weeks for someone to start noticing differences (in their minds or bodies) when they start to make any changes. If you find you’re having difficulty being patient with yourself, try this mindfulness exercise. I’m definitely guilty of wanting change to occur quickly for myself. But interestingly, when I offer myself patience and compassion instead of criticism, change seems to actually occur more quickly than when I’m only hard on myself.
Remember, change is slow.

I hope this helps you with some pain management. I know it’s things that have helped me and many others. So, just keep making the most of it!

Video: Daily Yoga – Supported Fish

I find yoga to be helpful for chronic pain and my mental health. This is another one of the yoga poses I really like for my upper back. Please speak to your healthcare team about any changes to your exercise routine. This content is for educational purposes only.

How resilient have you been feeling lately? Anything less than an 8/10, then check out this podcast episode on how to cultivate resilience.

Keep making the most of it!

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Video: Pacing & Action Planning for Exercise

If you’re thinking about exercising to help with your chronic pain or overall health, it is important to consider two things: (1) pacing – so that you don’t over exert yourself one day and pay for it the next; and (2) action planning or goal setting so that exercise is realistic for you. Also, remember to always talk to your healthcare team before starting any new exercise routine! If you’re having thoughts about your ability to exercise that are causing you distress, check out this podcast episode.

Keep making the most of it!

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Video: Daily Yoga – Sphinx Pose

This week we’re exploring one of my favourite yoga poses. I find it to be a great stretch for my back as well as my chest as it acts as a back bend and chest opener. Make sure to check with your healthcare team before doing any new exercise routines. The information in the video is based solely on my experiences. Stretches can be great for pain that is muscular – check out this podcast interview with Dr. Yass about muscular pain. As always, keep making the most of it!

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Video: Daily Exercise – Cleaning

If you never thought of cleaning as exercise, I’m about to blow your mind. So we all know that movement is important. And when you have a chronic illness, even getting some light exercise in daily can be extremely beneficial to your health and overall wellbeing. Cleaning is a great way to do that. Sweeping, mopping, scrubbing, taking out the garbage…you’re literally moving your whole body while you do these chores. This is one of the places where changing our outlook on something can really help us! If you’re feeling a bit hopeless about where to start or about whether you can do some cleaning for exercise, check out this podcast episode on creative hopelessness.

Hopefully you can get your body moving this week and keep making the most of it!

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6 Ways I’m Managing a Weather-Caused Flare (+ 5 More Ways I Could)

Long title, I know. But nonetheless I thought I’d share some of my tips with you, plus a few other evidence-based ones I found online as I’m trying to get through this. I’m writing this exactly one week before it will be published so fingers crossed that it’s over by the time you’re reading it, but if not, then I’ll just have to accept it as it is. My flare is likely caused by a few things. First, I recently moved and moving is stressful (even a relatively easy move like I had) and stress can cause a flare. Second, I moved from a dry climate in the interior of British Columbia to the wet, lower mainland of BC. I always notice my symptoms, especially pain gets worse when it rains… but then I knowingly moved to a rainy climate (*face palm*). All jokes aside, my symptoms are increased pain, increased fatigue, really bad jaw pain, my left foot is super veiny and sore (my calf is fine though so unlikely anything super serious). How the heck can I manage all of this?

Even on a flare I’ve managed to explore my new neighborhood.
  1. Acceptance. Yes, I know some of you are rolling your eyes or saying that this is ridiculous or unlikely to work. But I find it does. I accept that my pain is here, while knowing that the intensity changes hour by hour, sometimes even minute by minute, and I know that when my flare is over I’ll go back to baseline. Acceptance is helpful. I’ve been doing body scans and other mindfulness activities to help with the acceptance, but honestly just acknowledging my experience without getting wrapped up in it is helpful. Check out this acceptance practice.
  2. Exercise, Movement and Stretching. If you read this blog regularly you know that I like to exercise. And I still pace myself by trying to stay consistent with what I do. I definitely increase my stretching during flares. Particularly I focus on the areas that seem to hurt or need it the most. For example, my jaw is the worst today as I write this, and I’ve made sure to do jaw stretches throughout the day. For more on jaw pain specifically, check out this podcast episode with Dr. Shirazi.
  3. Warm Baths. I LOVE my baths. I literally take a bath 4-5x a week in the winter months. And with the rain, I’m definitely needing them. They help relax my muscles, keep me warm, and are very relaxing. Trust me when I say I could never (and would never) live in an apartment without a bathtub. Knowing what is vital to your self-care is essential to dealing with a flare. Check out this podcast episode on it.
  4. Dressing Warmly and in Layers. Vancouver, if you’ve never been, is a city where everyone dresses in layers. It will likely rain at some point during the day, though you never know exactly when. It could also start off cool and warm up, or vice versa. So I’ve been making sure to put on 3 layers when I go out, and have a pair of mittens on me. I need to remember a hat and/or an umbrella, but I’m working on it!
  5. Hydration. I tend to drink a lot of water. Admittedly more when I’m working. Staying on top of my water intake is so important to managing my flares and really my health! I’m trying to drink 5 full glasses of water a day minimum. I basically keep a glass of water next to me all day and every time it’s empty, I refill it. Listen to my podcast conversation with Beau Berman about gut health and how important drinking water is to him.
  6. Omega-3’s and Vitamin D. I typically try to get these from the foods I eat. Lots of fish mostly (rich in both), as well as mushrooms, spinach, avocado and tofu and really a variety of others foods are rich in vitamin D. These are really important for reducing inflammation naturally and honestly are just really good for you! Also, Vitamin D is a way to combat with the “winter blues” (which I often get) and the more severe, Seasonal Affective Disorder.

So those are the 6 things that I am doing, but what are the 5 things that I’m not but probably should be?

  1. Acupuncture. This is actually an evidence-based and recommended treatment for chronic pain. I’ve had it in the past and I’m hoping to start back up with bi-monthly sessions next month. Listen to the podcast episode on recommended treatments for chronic pain for more info.
  2. Massage. I miss getting massages. It’s been nearly a year since I had one, and this is also a service I used to get bi-monthly. I’ll likely also start these back up soon as well. Clearly I need to. The benefits of massage can be heard in the podcast episode with Danielle Potvin.
  3. NSAIDs. I’m not a fan of these drugs to be honest. They can cause stomach problems when on them long term. I’ve drastically cut back on them and only take them to supplement the more natural medications I take (i.e., CBD). If you’re aware of the risks and find them helpful then this can be a helpful solution.
  4. Natural supplements. The only natural supplement I currently take is magnesium bis-glycinate which is a muscle relaxant (and I mainly use it when I’m menstruating). Other recommended supplements are fish oil, ginger (which I sometimes have in food and/or tea), turmeric (which I sometimes have in tea), and gingko. These are definitely worth checking out to use in addition to some of the other suggestions.
  5. Limit Stress. Oh I can’t wait until I’m passed the stress of the move and starting up new counselling practices. The truth is there is always some kind of stress in our lives and it really comes down to how we manage stress. I typically do a good job with mindfulness, meditation, yoga, and relaxation practices. So this might just be a reminder to do a bit more of that. And also, if you are able to avoid stress then that’s a good plan (I do not plan on moving again for quite some time!).
Taking it easy on Halloween. Needed some time to relax after the move.

So that’s it! 11 ways in total to manage a flare. Keep making the most of it everyone!

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Video: Daily Exercise – Elbows & Wrists

These are some exercises that I use to make sure I’m getting sufficient movement in my elbows and wrists, especially when they feel tight and/or sore. Remember, exercise isn’t always about strength or cardio; for chronic illness warriors it’s often about getting different types of movement because it is helpful in keeping our bodies going. However, if you want some more information on weight loss, check out this podcast episode (with Dr. Francell Hamilton). And please consult with your healthcare team before starting any new exercise.

Happy moving, and keep making the most of it everyone!

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Video: Daily Exercise – Mountain Hikes

This is not for the faint of heart. To be honest, this is great if you’ve been building up your exercise game and if you do some hiking already. I did a video post last year on more gentle hikes, which are a fantastic alternative to going for a walk. This is kind of levelling up those gentle hikes. Yes, I do this even with chronic pain. Why? Because I love hiking, and will take the time to recover (for example, the day after I did this I did a channel float where I sat on a tube for 3 hours and floated down a channel/river). Remember to please consult with your healthcare team before starting any new exercise. Alright, take care and keep making the most of it!

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Response to a Petition Against the NICE guidelines

Okay so I’m going to acknowledge that this blog post might be a little divisive. But if I look around at our society right now, most issues regarding health are. This is probably more of an opinion piece than many of my posts, which I do research (yes, I read scientific journal articles to make sure I get the facts as straight as possible for all of you). I did a post (and a podcast episode) about the guidelines that came from NICE in the UK regarding the treatment of chronic pain awhile back. These guidelines were controversial within the medical community itself because, well, they recommend against the use of pain medications due to a lack of evidence that they are effective AND that many of them can be addictive. Doctors, of course, like to prescribe medications.

The recommendations for the treatment were: (1) exercise, (2) acupuncture, (3) cognitive behavioural therapy, (4) acceptance and commitment therapy, and (5) anti-depressants. I recently saw a post on Instagram that linked a petition against these guidelines. The reasoning behind the petition was that it makes it harder for people to get the treatment (i.e., medications) that they need to manage their chronic pain. Much like doctors, most patients also feel like medications are the way to go (which is a fairly western version of pain management – check out the podcast episode with Dr. Richard Harris for an East meets West version of pain management that tends to work better). Now, I’m not saying that pain medication doesn’t work for anyone ever. And I don’t think that’s what they guidelines are saying either. They are saying that the evidence-base isn’t strong for most of those medications, but it is strong for these alternative treatments. The other argument in the petition is that the alternative treatments are expensive and not covered by insurance. I’m going to break each of these arguments down a bit further.

Me during a hike this summer.

So first, whether or not people will still be able to access pain medications. Regardless of these guidelines I find it very hard to believe that most Western doctors will stop prescribing pain medications. Like I mentioned earlier, most doctors were upset by the guidelines in the first place. Also, doctors are trained to prescribe medications, they aren’t trained (literally almost no training) on prescribing alternative treatments. It’s more than likely they’ll go with what they know. They might though be more willing to recommend alternatives as adjunct treatments. This is actually what my rheumatologist did. She recommended that in addition to the medications she prescribed, I seek out alternative treatments such as physiotherapy and naturopathy (and I did and they were helpful). I get why people are upset about the guidelines, especially if they mostly rely on medications. The guidelines do state that for some conditions (mostly CRPS) pain medications do work best (it’s best just to read all the guidelines – AND all the hyperlinks that give fuller explanations yourself – available here).

The second point that alternative treatments are expensive, is true and not true at the same time. Exercise is technically free. I exercise at home – both cardio (walking) and strength training (body weight) and have spent $0 on it since the pandemic started (I did go to the gym before that). But a lot of people with chronic pain are hesitant about exercising (check out the podcast episode with Dr. Frank Nahn). Acupuncture can be a bit pricey depending on where you live, but it is sometimes covered by insurance. I had insurance through work that covered my naturopath, who did acupuncture, for up to $500 a year. That’s about 6 sessions. I’m not saying it’s always covered, but it might be. CBT and ACT, the two psychotherapies listed are along the same lines as acupuncture. They might be covered or they might not be. In the province (Canada) that I live, it is covered up to a certain amount by provincial insurance, or short-term therapy is also covered by the provincial government. There are also self-help versions of these available at bookstores and online. Finally, anti-depressants, again may be covered by extended health insurance if you have that. Also, wouldn’t a better petition to be to try and get governments (or insurance companies) to cover these services for chronic pain and chronic illness patients? Just a suggestion…

As a therapist who went into the field to help people with chronic pain and illness (and their co-occurring mental health issues I decided to primarily use ACT with my clients due to its large evidence base).

I guess what I’m saying is that if you dislike the guidelines because you only rely on medication but also haven’t tried or even looked into these alternatives, then it makes sense that you’d be upset. I would be too! I started using some of these alternatives (exercise, acupuncture, CBT/ACT) long before these guidelines came out and I saw how much they improved my well-being, well over and beyond what my medication has ever done. I also find it interesting that I often see posted online people complaining that their medications aren’t really helping. It’s easy to have some cognitive dissonance here. We want to believe medications will solve all our problems even when we’re acknowledging that they’re not. I’m doubtful that I’ll change too many minds with this post, but my hope is that we at least get thinking about using both holistic approaches (like in NICE’s guidelines) and are medication together so that we can get the best results.

Okay, that is all for this week. Keep making the most of it everyone!

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