So Why Use ThinkStrong

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After many years of tennis coaching and working as a sport psychologist the one thing that has become clear is that winning athletes have the ability to think positively whilst under pressure. Tennis, in particular, is a hugely demanding sport where mental toughness is needed in abundance, as there is no place to hide or no one else to blame. The raw emotion I have encountered from athletes who had just lost or failed to reach their goal is immense. I labelled this the “Hurt Zone”. Supporting athletes who had been injured before a final, or had not been selected for an Olympic Games forcing them into early retirement was about about trying to put these events into perspective and helping them move on.

In counselling, I encounter many people whose lives are troubled and their emotional pain is clear to see. Approaches such as CBT (Cognitive Behavioural Therapy) empower individuals to rationalise and seek evidence regarding their current situation rather then deal with irrational beliefs driven perhaps driven by emotional turmoil they perceive surrounds them. Dealing with thoughts, behaviours, emotions and physical feelings CBT can provide a clearer picture and a route forward. A short number of sessions with goals agreed by the client and myself focusing on a immediate problem can be a very successful way of dealing with issues of anxiety or low self-esteem. CBT is recommended by NICE (National Institute of Health and Clinical Excellence) for a number of conditions which include depression, obsessive compulsive disorder chronic fatigue, behavioural difficulties in children, anxiety disorders in children, chronic pain, sleep difficulties and anger management

With CBT in particular, I believe that there is a great opportunity to reframe to a more positive experience where the client and counsellor engage towards agreed solutions and timeframes. The latest statistics show that only around 20% of men seek counselling, the common reason often given as “do not have the time”. In this frantic world where time management and life / work balance may be one of the key issues, Skype or Face Time can be the solution providing counselling when and where you are available. BACP (British Association of Counselling and Psychotherapy) list the advantages as convenience, cost-effectiveness and particularly for those who find the idea of sitting in a clinic as daunting. The BACP do recommend that the therapist should be trained, supervised and accountable with qualifications that can be checked against a list held by a mainstream organisation such as the BACP.

If you are interested, or even just thinking about how counselling or performance coaching may help you, do not hesitate to contact me – I will be more than willing to discuss your requirements.

Are we too plugged in – what do we risk if we disconnect?

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Wherever you go you will see somebody plugged in, connected to their own electronic world. Whilst running slowly at the back of my local Parkrun it was very interesting to see how many runners chose to not embrace the community spirit that this fantastic scheme represents. Having previously worked as a sport psychologist, I can fully appreciate the benefits of running with music, but I began to notice how many other park users were also in their own silent bubble, not communicating with anyone. 

What do we risk if we venture out without our phones or tablets. It would seem we have become a society  that seeks instant gratification and therefore arrangements are made at the very last minute. By doing so, it is possible to filter what offers are the most “desirable” and so doing, gain the most pleasure with the least investment whether it be time or effort. 

This extends from the world of the dating app and the concept of “swipe left” which has become a cultural phenomenon of rejecting something or someone. Is it therefore this rejection that we ultimately fear? By not engaging we cannot be swept away, discarded. At least on Tinder, we are not made aware of our shortcomings – often happening in an instant as the person seeks the perfect mate ironically often with little thought as to what is “perfect for them“. 

 Cognitive behavioural therapy often explores the context of safety behaviours normally within the framework of anxiety or panic attacks but increasingly so it is found that items such as mobile phones are used  to prevent a situation of “having to engage with someone”. This is similar to “not arriving on time” (in case you are the first to arrive), always having an escape route (or excuse) or constantly moderating moods or our own conversations. 

Safety behaviours therefore reduce our existence making life smaller and narrower. This forces us into a cycle of self-monitoring, and in doing so increases our focus on ourselves and not on the outside world and normal life. It forces us into our inner self rather than living life for the moment and what the world has to offer. 

Perhaps if more of us risked being unplugged we would engage in conversation and realise that we are social creatures and it is good to talk and even better face to face. 

Starting Prehab - Just the Beginning of the Journey

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The Beginning of Prehab: 

And so it begins…. With a diagnosis of a torn meniscus and a pending operation sometime in in the next 2-3 months, I have the choice of sitting around waiting or setting up an active prehab programme. I am aware that the former will be damaging to me physically, emotionally as well as for my mental well-being and extend my recovery period. Too much exercise and I will experience pain caused by muscle spasms / bracing  as the leg fights to compensate for the injury. 

I am not sure when was the exact occurrence of the injury but after 40 years of playing tennis to quite a high level plus a number of other sports it is possibly not surprising. The MRI revealed a small tear in the meniscus in the left knee as well as a small amount of osteoarthritis. There is discussion on the internet over the need for surgery for such an injury, but I will discuss this in relation to me in a later post. 

And so, I find myself recovering from running the slowest Park Run (5km) I could manage – 35mins to avoid the impact of my leg. It feels good with pain levels around 1-2. This compares to the 7-8 I was experiencing when I was still playing tennis and my whole leg was reacting to protect my knee. This made sleep problematic which was one of the main drivers for seeking a diagnosis. Now, playing infrequently I can manage my injury but still am very aware of the limitations it imposes on me. This is not how I want to live my life going forward so, knowing I have surgery on the horizon I am determined to get as fit as possible to be able to return to active sport a better player as well as enjoying the process of prehab / rehab.

My first purchase has been a single / fixed gear 6KU Urban Track bike. My aim is to learn how to ride the bike set up as a “fixie” i.e. a single-gear bicycle that has no freewheel, so that its wheels cannot move unless power is applied to the pedals. Why good for prehab– cycling removes the load bearing and pounding that aggravates my knee whilst building my quads and hamstrings – the two major muscle groups that stabilise the knee. Thanks to Roger for the initial advice to kick start my programme. So, after two bike sessions , a evening of volleyball and a slow 5K, the leg is feeling a little sore (pain scale 2-3) but I am feeling physically tired and content that I have challenged my body enough but will be able to function tomorrow. Day of rest then back on the bike on Monday. 

 

 

 

It hurts - should I be training

A number of you will possibly be in your final preparations for a half-marathon. Training can be hampered by the festive period along with the cold weather in January. Doubts began to creep in regarding the number of hours / miles achieved and those painful niggles can seem to be getting worse. Following on an excellent article by Tom Groom asking the question does stress slow down your running,  I want to explore how we cope with demands placed upon us along with how we deal with pain. As the diagram below shows, the human body needs stress. Too little (underload) there is no training effect and we become inactive. Too much and the body rapidly becomes exhausted causing anxiety possibly leading to panic and anger. If you continue to push yourself without realising/ denying the symptoms, there is a danger of physiological and psychological burn-out.

Therefore, in usefully loading the body in terms of training you will experience a certain amount of pain. This may be whilst performing or muscle tightness / soreness after. Whilst pain is often seen as seen as an integral part of the sport experience (no pain, no gain); it is the meaning you assigned to it that is crucial in affecting your thoughts and behaviours. Previous research Addison, Kremer and Bell (1998) have suggested a continuum of pain experienced by athletes. This is useful guide to evaluate how your body is coping with the training load and if you are possibly moving from fatigue to exhaustion

Fatigue and discomfort—normal or routine sensations associated with competition, training, and rehabilitation;

Positive training pain—nonthreatening, typically occurring during endurance activity, and believed to be under the your control;

Negative training pain—perceived as threatening and an indication that continued training is no longer beneficial;

Negative warning pain—similar to negative training pain, but more threatening, signaling the possibility of potential injury and therefore should prompt you to evaluate its cause and take appropriate action;

Negative acute pain—indicates injury and is perceived as intense and specific;

Numbness—the absence of sensation, interpreted as highly negative and typically a cause for concern.

As Tom’s article showed, increased stress has a detrimental effect in a number of ways. Pain can cause a very strong negative emotional reactions causing you increased distress which in turn, increases the pain. Depression and anxiety can also enhance pain perception possibly causing pain catastrophizing, which is a maladaptive cognitive coping strategy. This is characterized by an excessive focus on pain, possibly exaggerating the threat whilst minimizing your ability to cope. This has the effect of increasing further muscle tension and anxiety increasing further the sensitivity to the pain. This has a cognitive element in that it can reduce your ability to make correct decisions in response to the pain.

In terms of managing your reaction to negative pain, it is important you focus on your thoughts and behaviours. Muscular relaxation, goal setting, education regarding injury, following training plans, and adherence to prescribed exercise are positive choices that facilitate your rehabilitation and healing.  Fatigue, discomfort, and positive training pain should be expected during rehabilitation and ideally perceived as evidence that you are at the ideal levels of intensity to move you through to recovery. However if incorrectly interpreting negative pain, you may be at risk of treatment setbacks and re-injury.

Should you need any advice on pain management please do not hesitate to contact myself for a free 15 minute consultation or the staff at the Physio Rooms 

 

 

Cognitive Behavioural Therapy (CBT) and Pain

Advances in research have raised many questions about chronic pain but it appears the best approach is to move away from a simplistic idea of ‘this condition needs this treatment’, to an approach that takes in the bigger picture. The BioPsychoSocial Approach Rather than focussing solely on changes in the body that may not be relevant to symptoms more recent treatments consider a BioPsychoSocial approach. This includes biological changes related to pain, psychological factors and an individual’s social circumstances as shown in the picture below:
 


Using this approach we can create a better understanding of why pain continues and how to overcome it, leading to long term changes in symptoms. We want to give you the tools and knowledge to manage your pain and support you through the process. Research has previously identified a strong relationship linking pain with depression and anxiety, which can be more prevalent in the winter months. This can be exacerbated by ineffective coping such as pain anxiety and fear avoidance - not confronting what are the key issues. In particular, pain catastrophising (a tendency to magnify the pain experience) has been shown to play a part in the transition from acute to chronic issues. This can be particularly prevalent in people who worry, leading them to feel helpless when think about pain. Someone who has depressive tendencies may internalize with statements such as “It’s my fault” or “I will never get over this”. 

So what is a possible way forward. Alongside the physical therapy you receive , Cognitive Behavioral Therapy (CBT) can be used for Chronic Pain. Taking an active approach to take control and reengage with activities thereby increasing functionality rather than decreasing pain intensity. It is tailored to each patient based on the results of the initial assessment, patient presentation and their specific-goals. The approach is broken down into various stages to meet the desired outcome, whether it be return to full functionality or achieving a greater performance. 

The initial stage is psycho-educative with explanations of pain and setting of goals. There is also a discussion of acceptance versus control – for some patients becoming pain free maybe an elusive goal. For many who train and play sport on a regular basis, pain is just part of the process and it is the increase in functionality / performance that is the key issue. Activity scheduling is a key part where there is a reengaging with pleasant activities regardless of pain status, previously avoided due to fear of reinjury. This is in conjunction with cognitive restructuring to have a more positive approach that problems can be solved. The final stages involves physiological techniques to manage pain more successfully such as progressive muscle relaxation along with discussion of pain and social dynamics. This involves an investigation into how your injury is discussed by yourself / others and how this can be possibly reframed. 

If you feel this approach can help, contact me for a free 15 minute phone consultation.