Lessons learned from teaching rehabilitative Pilates in the presence of ongoing pain
Many years ago when still in denial about my need to retire from a rigorous dance career, a very wise Pilates instructor asked me when I was going to let it go and learn to teach Pilates instead. While it took a number of years in counselling school and a perpetually grumpy body to get there, making that decision changed the course of my life. And I have never looked back!
Now, as both a Counsellor and rehabilitative Pilates instructor, I teach people how to feel empowered in their bodies, and often by extension, their lives. Both goal-oriented and relational, this work sometimes looks like developing a stronger core or correcting functional imbalances. Other times it is more about helping a person start listening to and expressing what their body has been attempting to say. Oftentimes it’s a combination. And then on occasion, it is simply sitting in solidarity for a moment or ten as a client grapples with something insurmountable. And that ‘being with’ allows for a moving through, and therefore a sense of greater peace with what is.
I myself live with persistent pain and know the havoc that living in an over-sensitized body can create. Here are a few things I’ve learned from both my own journey as well as walking alongside that of hundreds of others.
Pain is real:
Whether it comes from chronic injury, emotional trauma, inflammation, fear and anxiety generated by our thoughts about pain or whatever else might be contributing factors, in effect it doesn’t really matter: the brain believes pain is real, and so it is.
Physical discomfort does not necessarily equal tissue damage:
Research from pain science affirms what those of us who’ve been working alongside persistent pain have long known. The brain plays a huge role in the extent to which we experience pain (Moseley and Butler, 2015). Working with a variety of spinal conditions I see this a lot. Some clients with disc compression, scoliosis or stenosis feel little to no pain, while others with relatively normal clinical findings suffer immensely. Practically speaking this is both very interesting and incredibly challenging as it further affirms the need to look at the system as a whole. My clients exist within a context, a history that includes beliefs, values, a cultural identity and millions of relational experiences that contribute to who they are. And while the brain can be reductionist and tend to choose safety over novelty under stress, it is also capable of learning and changing when given gradual, graded exposure to new experiences in an environment of perceived safety.
Relationship, relationship, relationship:
Because the perception of safety is important (and believe me, if the brain doesn’t believe you are safe, change will be laborious at best), the relationship between client and practitioner is significant. The body in persistent pain or haunted by emotional trauma can be a highly vulnerable and unpredictable place to inhabit. As most people I see have also had a whole host of negative experiences with the health care system, my work has evolved to include two interconnected streams. I know that each person’s internal world is absolutely real for them. Therefore the first one is to actively create an environment where people feel safe by really listening to them through the lens of genuine curiosity. The second is to provide skill-enhancing experiences, paced in a way that allows each person to re-believe in his or her own capacity, even with pain. The goal is to find, as Craig Liebenson says, “…the hardest thing you do well”, and then scaffold it outward from there.
Persistence and consistency build capacity:
When I first began the process of strengthening my own body, I did my exercises two or three times a day, every day. And when I say ‘exercises’, they were really the most basic, core-building practices my physiotherapist could prescribe. Even with that I flared a lot. But as I persisted in the process, I slowly built capacity and confidence and the exercises progressively became more challenging. My pain was not gone, but I could do more and more.
This incredible patience and wisdom of my physio has been my own greatest teacher in working with others. The body in persistent pain is like a scared child- it needs to know that a) you’re not going to push it to do things that it’s not ready to do and b) rather than letting it hide under the bed forever, you’re going to coax it out by helping it GET ready.
Widen the lens outwards from the body:
Over time I’ve learned that seemingly ‘dysfunctional’ patterns are there for a reason. And that trying to take these away without adequately building up a strong container to support new ones is often not helpful. This applies to both the physical container of our bodies, as well as the belief systems and emotional world of each person. As with many of my clients, for the longest time I believed the source of my pain was located solely inside my body. And while this may be true to a degree, whatever increases stress seems to exacerbate pain. Shifting the tide in the opposite direction often requires looking at ways to improve things like anxiety, sleep and nutrition, as well as resisting patterns of isolation and negative self- beliefs about being a person who lives with ongoing discomfort.
Teamwork:
Just like the old saying ‘it takes a village to raise a child’, I’ve observed that people who are connected into a community of support tend to fare better than those who are not. Most of the clients I see in either my Counselling or Clinical Pilates practice are also supported by other health care providers, which I actively encourage. If they are not already, it's my experience that helping clients find ways to connect meaningfully both with themselves and with others can be a significant way to combat the isolation, hopelessness and experience of 'otherness' that persistent pain tends to bring about.