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.
The overall approach that I take is one of physiotherapy combined with Contextual Behavioural Science (CBS). CBS is most commonly practiced in the form of Acceptance and Commitment Therapy (ACT), a form of psychotherapy.
I use and strongly advocate for other health practitioners to utilise this approach because of the following reasons:
- Looking at chronic pain and fatigue as "disease" - i.e. something that you "fix" - has been well-proven to be UNABLE to produce long-term changes. If you are reading this there is a pretty high chance that you have tried this but has not produced the result that you wanted.
- Instead the focus should be how to a LIVE WELL with the condition (yes it is very much possible). I am also aware that there is a good chance you may have heard or tried similar approach already but this has probably not worked for you.
- The problem (my opinion only) is that there is currently very little consistency in scientifically-proven clinical interventions to help people to live truly well with the chronic condition.
- ACT is an approach founded upon the science of Relational Frame Theory (RFT) which is the major theory of CBS. This is one of the most scientifically-valid, researched, and widely-used methodology to help people overcome adversities.
- So it makes sense to combine those two to approach chronic health conditions.
(And no. This is NOT "training your mind out of the pain")
The depth of my integration of CBS with strong background in musculoskeletal physiotherapy is probably the most difference-making component of my approach. I am regularly peer-reviewed in both physiotherapy and psychotherapy, I teach other physiotherapists on the subject, and I am currently preparing my Masters degree in the topic of RFT and chronic pain. So you can be assured that my practice is competent and consistent with the scientific principles.
So what I ask from my prospective and current clients is, I don't want you to think that you are coming to a "physio"; instead I'd encourage you to think that you are coming to a "clinician". This will help you to stay open-minded in our consultations so we can work together to simply focus on what's most helpful to you, whatever that may be.
in practical terms, 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 the entire process works the best when the patients have a very good understanding of the whole picture, it's likely that some people will literally just have an exacerbation of pain by trying to read text-heavy stuff when your mind and body is not willing.
If that's the case, you can watch the video below - it is mostly the same as the written text on this page . I'm only happy to talk to you as well to explain the process.
The three services are
- Hands-on therapy
It's generally for short-term benefits but it can work well for some
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.
Learning about the relationship between body and pain
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:
- neuro-behavioural issues (headache, fibromyalgia, chronic fatigue etc)
- musculoskeletal issues (e.g. traumatic injuries that did not undergo proper rehabilitation)
- somewhere in between (e.g. many chronic lower back issues)
You can see that I have categorised pain conditions by possible "physiological mechanisms" of the pain. Then, the aim of the “exercise” class, or in fact the entire rehabilitation itself, is to analyse
a) physiological mechanism of the pain (e.g. as above)
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 ("neuro-behavioural" issue - yes I'm super oversimplifying here). 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 and your body in general. While this sounds bit vague, once you practice certain skills (and they are not just "physical" skills) that help you to be aware of your own nerves not only will it begin to make sense but they will be some of the most critical skills you'll 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.
Because sometimes two is just better than one
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.
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:
- Strategy sessions (face-to-face or zoom)
- 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 practical 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.
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.
No, all this is NOT easy. It takes time, effort, a generous measure of vulnerability, and commitment to challenging actions.
But if you want a life well-lived, what other choice do you have?
Contact me and let's find a better way together.