This page is a very thorough description of how chronic pain management works with Francis and 2will physiotherapy

It's quite long (actually very long) but please read thoroughly.

There are three arms in chronic pain services that I provide and it is incredibly important that our patients and referrers have a good understanding of how these work in harmony to have a successful outcome. This is especially so if you’re a patient, because you and I will often need to have constructive discussions on how to approach your condition.

Warning: what follows is very detail-heavy. While I think the entire process works the best when my patients have a very good understanding of what I'm trying to do, it's likely that some people will literally just have exacerbation of pain by trying to read text-heavy stuff when your mind and body is not willing. If this is the case, just let me know and I'll talk you through what I think you would need. 

Or you can just watch the video below - it is essentially the same as the written text on this page (except for the Strategy Mindmap where there is a separate video further down).

The three services are

  1. Hands-on therapy
  2. Classes
  3. Coaching

Hands-on Therapy

It's generally for short-term benefits but it can work well for some

Hands on therapy

This is perhaps what has generally been associated with physiotherapy of recent times. Massages, manipulations, “trigger points” and so on. These really don't give any long-term benefits for most chronic conditions, but some people do happen to have bodytypes that respond positively to certain techniques so it is frequently worthwhile to explore this with me.

It is also worth noting that there are a lot of well-established myths around exactly how these techniques work – ranging from “putting bones back in place” to “loosening up muscle knots or fascia”. However the only theory that is remotely close to being verified by science is that vast majority of hands-on therapy work to alter the behaviour of nerves, so I will naturally be focusing on this during my hands-on therapies.

These sessions are booked in discussion with you and only if there is an evidence that your body responds positively to it. The last thing I want to do is to get you to come back repeatedly for hands-on work that does nothing for you.

Classes

Learning about the relationship between body and pain

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I have a number of slots during the week when I invite my patients to come and exercise in the gym under my supervision. Each patient has his or her own programme that would have been created prior to the first class, and the idea is that I go around checking and talking to each patient while they do their programmes.

While these kinda look like “exercise” classes, it is extremely important for you to know that the role of these classes is FAR beyond just exercising. After all, “just exercising” often does NOT help chronic pain conditions. In fact it is important that you understand the current scientific explanation for WHY chronic pain can occur before you begin exercises so you know what we’re actually trying to achieve (this should be explained in your early consultations, and it often has nothing to do with flexibility or strength).

 

For the purpose of communication I will generalise chronic pain conditions into three categories:

  1. neuro-behavioural issues (headache, fibromyalgia, chronic fatigue etc)
  2. musculoskeletal issues (e.g. traumatic injuries that did not undergo proper rehabilitation)
  3. somewhere in between (e.g. many chronic lower back issues)

You can see that I have categorised pain conditions by possible physiological sources of the pain. The aim of the “exercise” class, or in fact the entire rehabilitation itself, is to analyse

a) physiological bases of the pain
b) construct possible reasons behind them
c) focus on positively influencing them

 

For example, for fibromyalgia, the current scientific thought is that it consists of misbehaviour of your nerves. This CANNOT be seen by any scans, and that’s why no amount of X-rays or MRIs will give you a satisfactory explanation, which often is a source of frustration for many who are on this journey.

So our aim in exercise classes in this case would be to change the behaviour of the nerves. While this sounds bit vague, once you practice certain skills that help you to be aware of your own nerves not only will it begin to make sense but it will be one of the most critical skills for you learn to successfully manage your pain condition.

The classes are done at the gym at Albany Stadium Pool. I am acutely aware that coming to a gym itself can be a huge challenge for many, so if this is not going to work for you, we’ll have to figure out how to positively influence the reasons of your pain in other ways, like mindful walks on a beach, or surfing, or meditation.

The class times are set, and the cost is just casual entry fee to the gym (around $13), or free if you are a member. I do this in order to remove the cost-barrier for my patients. The fact that I have a multiple number of patients going on at the same time each with their own issues naturally means that the amount of supervision that I can give you will be varied in each sessions, but this is the best way that I can provide long-term and consistent input with minimal cost to you. Please keep communicating to me on your needs.

Coaching

Because sometimes two is just better than one

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In all chronic conditions, but especially if you do have one where we are dealing with the behaviour of the nerves, you need to come to a full realisation that how you THINK, FEEL, and BEHAVE have major consequences on how your nerves behave. You may already be aware of this to some degree, but like many, a little unsure how to go about changing this.

Like most problem-solving, development of clear and practical strategy is something we need to establish early and that’s why I provide coaching sessions. Then it is matter of practicing the actions and skills that we agree from the strategy.

I am a trained practitioner of Acceptance and Commitment Therapy (a form of psychotherapy), and a strong advocate of Socratic method in health professionals. Coaching sessions are hugely important for many, but especially for those who are struggling with emotional difficulties that can surround chronic pain (e.g. anxiety, bitterness, numbness), those who are unsure of how to deal with work or other people, and especially those who have lost a sense of direction and ability to participate in life (e.g. chronic fatigue).

The Coaching sessions are divided into two services:

  1. Strategy sessions (face-to-face or zoom)
  2. Quick checks (via phone or during class)

Strategy sessions are where you and I sit down and 1) define the problem and 2) find a strategy to execute. I cannot stress the importance of these sessions for because so many people try to treat chronic pain like they would treat a virus or a sprained joint where they look for a treatment – in most cases of chronic pain, treatment does not exist. In these cases, having open and accurate strategic sessions where you and I COMMIT to certain actions, is a very important step for a successful outcome.

At the end of the Strategy session, you'll come away with the Strategic Mindmap. Something like the following:

 

Mindmap of your pain

 

And the following video explains how a patient would interpret the Mindmap:

 

 

Once we have defined the problem and a strategy, this is when the work starts – you and I have to follow-through. For many it is coming to my classes. For some it is coming to hands-on sessions. For some it is practicing certain skills at home. For many it is all of the above.

For those who need to practice certain skills at home (especially emotional or behavioural ones which are quite tricky) I offer “Quick Checks” which are ten-to-fifteen-minute sessions so you can let me know how you are getting on with the agreed strategies. I don’t even charge you for these sessions.

But THIS is where many patients find it difficult and fall through the cracks – the process of problem solving by open dialogue. It is difficult, confronting, and often does not even give you solutions to your chronic pain.

However THAT actually is one of the first things you and I need to decide together to truly move forward – when to look for the “cure” for the pain which does seem to exist for some people at certain times and I could help you with that, or when to discard the search for the cure, and focus instead on “living well” with pain.

I know for many of you it is NOT easy to talk about your life, but I really would like to encourage you to do so, because when I think about my patients who have had outstanding success, and think about those who dropped out of the radar, the difference always comes down to the willingness to have an open dialogue.

Those who do communicate to me regularly may still have some pain or fatigue, but they are generally able to have better enjoyment of life because there would (hopefully!) be a clear strategy on how their pain is managed, and how they approach life living with pain and associated dramas.

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In many cases we have to do more than one and it IS quite a process. I will generally recommend you what I think is the best for you.

But sooner or later I need you to let me know what YOU think is the best for yourself so you really take ownership and drive of the rehabilitation process and eventually your pain.