WITHIN Blog: January 2021
Keep on Moving: How Somatic Practice Can Effect Living Well With Chronic Pain
By Paige Karadag & Jenna Gillett on behalf of the WITHIN Team.
Our first blog of 2021 is inspired by an event that members of the WITHIN team recently attended, which was the first public event for the Dance and Somatic Practice Network. The online event entitled “Chronic Pain: The Fear and Joy of Moving”, aimed to facilitate a discussion between physiotherapists, psychologists, anthropologists, dancers and people with lived experiences of chronic pain. This got us thinking about how chronic pain can impact exercise, movement and physical activity, with the additional notion of dancing triggering great interest to us in particular!
“The essence of dance is the expression of man – the landscape of his soul.”
- Martha Graham
Challenges of Moving with Chronic Pain
Many people reading this will know too well that engaging in physical activity can be a daunting experience for people living with chronic pain, and yet it is something that is frequently prescribed by healthcare professionals, whether in the form of physiotherapy, at-home exercise plans or more general recommendations to ‘engage in some physical activity’. Movement can be painful, either triggering an immediate pain response during exercise or experiencing lasting knock-on effects after too much exertion.
The concept of a "boom and bust" effect is a cycle which many patients may find themselves in – living with chronic pain is often characterised into ‘good days’ and ‘bad days’. When individuals have a ‘good day’, they understandably want to make the most of it, however, this sometimes results in overexertion and is followed by several ‘bad days’ characterised by flare-ups and exacerbated pain with debilitating effects. In turn, this can result in a tendency to avoid excessive movement, as some fear that it will worsen their pain (Vlaeyen, Crombez & Linton, 2016) but this can further restrict people’s quality of life (Fowler et al., 2019; Simons et al., 2020). Avoiding movement can prevent you from experiencing the physical and psychological benefits that exercise offers, including strengthening muscles, reducing intensity of pain, and even helping to reduce symptoms of anxiety and depression (Andrade, Dominski, & Sieczkowska, 2020; Saeed, Cunningham & Bloch, 2019).
A great summary of somatic practice, and what the Somatic Practice Network are all about can be found here, with a useful video we would recommend watching!
One new approach that has come to our attention incorporates the presence of pain into the movement experience; it is called somatic practice. Somatic practice uses the mind-body connection to help listen to signals your body sends regarding areas of pain or discomfort, whilst engaging in a series of movement forms. These movement forms can take the form of dance, and there are workshops/sessions run by experts who have knowledge of chronic pain. Now, by dance we aren’t talking a full-scale modern routine to be judged by professionals on a famous television show! Something quite poignant we learned at the Somatic Practice Network Webinar is that all forms of movement can be considered as dance – even just flexing your fingertips.
By increasing self-awareness and reflecting during these movements, it enables you to increase movement capacity and gain more control over movement (Meehan & Carter, 2020). In somatic practice, there is no ‘one size fits all’, it’s about focusing on your personal experience to learn more about your body and explore new ways of moving, working through challenges and alleviating discomfort. Most importantly, you should get enjoyment from the movements – to remove the fear and worry associated with pain and focus on the joy of moving.
There are a number of reported benefits from somatic practice for people living with chronic pain. Somatic approaches can help explore the triggers for fear of movement and assist with the development of strategies for moving with confidence (Meehan & Carter, 2020). In addition to this, physical benefits include flexibility, balance, reduction of days in pain, increased mobility and reduced perception of pain (Paolucci et al., 2019; Wenham et al., 2018). Another study reviewed a model of dance movement therapy for people living with chronic pain and found that the therapy increased a sense of being in control of pain management, it gave individuals a sense of acceptance, a readiness to connect with the outside world and resilience (Shim et al., 2017). These findings show that somatic practice can help people live well with chronic pain, both physically and mentally.
Take Home Message
Although moving with chronic pain can be a daunting experience, there are a number of health benefits to taking part in physical activities. These include elevated mood, better quality of life and in some cases it can even help to reduce pain. It seems that one key thing to consider when doing more movement activities whilst having chronic pain is to listen to your body, as instructed by somatic practice. By incorporating self-awareness into the movement experience, somatic practice has shown to have promising outcomes for people with chronic pain and we expect that more research will be carried out on this approach in the future. Below we have compiled a list of useful independent resources that are around accessible movement for people living with chronic pain. Please always remember to listen to your body and always consult your GP or healthcare team before taking part!
Somatic Practice and Chronic Pain Network: https://somaticandpain.coventry.domains/
The Pain Toolkit: https://www.paintoolkit.org/pain-tools
NHS recommended resources: https://www.nhs.uk/conditions/nhs-fitness-studio/
Andrea Furlan, MD, PhD University of Toronto has developed two videos:
1. Dance for Arthritis, Chronic Pain and Seniors: https://www.youtube.com/watch?v=4LukJ-HKVDU
2. Exercises for Osteoarthritis of Hip and Knees: https://www.youtube.com/watch?v=3imMU8D1-k4
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Andrade, A., Dominski, F. H., & Sieczkowska, S. M. (2020). What we already know about the effects of exercise in patients with fibromyalgia: An umbrella review. In Seminars in arthritis and rheumatism. WB Saunders.
Fowler, C. A., Ballistrea, L. M., Mazzone, K. E., Martin, A. M., Kaplan, H., Kip, K. E., ... & Winkler, S. L. (2019). Virtual reality as a therapy adjunct for fear of movement in veterans with chronic pain: single-arm feasibility study. JMIR formative research, 3(4), e11266.
Meehan, E., & Carter, B. (2020). Moving with Pain: What principles from somatic practices can offer to people living with chronic pain. Frontiers Psychology.
Paolucci, T., Attanasi, C., Cecchini, W., Marazzi, A., Capobianco, S. V., & Santilli, V. (2019). Chronic low back pain and postural rehabilitation exercise: a literature review. Journal of pain research, 12, 95.
Saeed, S. A., Cunningham, K., & Bloch, R. M. (2019). Depression and anxiety disorders: Benefits of exercise, yoga, and meditation. American family physician, 99(10), 620-627.
Shim, M., Johnson, R. B., Gasson, S., Goodill, S., Jermyn, R., & Bradt, J. (2017). A model of dance/movement therapy for resilience-building in people living with chronic pain. European Journal of Integrative Medicine, 9, 27-40.
Simons, L. E., Vlaeyen, J. W., Declercq, L., Smith, A. M., Beebe, J., Hogan, M., ... & Ploski, C. (2020). Avoid or engage? Outcomes of graded exposure in youth with chronic pain using a sequential replicated single-case randomized design. Pain, 161(3), 520-531.
Vlaeyen, J. W., Crombez, G., & Linton, S. J. (2016). The fear-avoidance model of pain. Pain, 157(8), 1588-1589.
Wenham, A., Atkin, K., Woodman, J., Ballard, K., & MacPherson, H. (2018). Self-efficacy and embodiment associated with Alexander Technique lessons or with acupuncture sessions: A longitudinal qualitative sub-study within the ATLAS trial. Complementary therapies in clinical practice, 31, 308-314.