# What does this look like in the real world ##### Untangling Pain ---  --- ## tl;dr - Choose one activity you want to return to, then find a baseline you can manage without a major flare-up. - Stay with that baseline for a few days and notice how you feel before, during, and after. - If things stay manageable, add a little more; if they do not, hold steady or step back slightly. - Use the green, orange, and red pain scale as a guide, not a rigid rule. - Pain can also rise because of sleep, stress, or work, so look at your whole DIMs-and-SIMs picture. > [!abstract]- Transcript > > So what does this look like in the real world? > > so we've spoken so much about all these different things, but what does this look like for you? > > Firstly, what I want you to do is, choose the activity that you want to return to. > > So I've done the example here as walking, but this method, it works with any activity. Whether it's gardening, cycling, housework, playing an instrument typing at your computer, it doesn't matter. It's whatever is causing you an issue but you want to get back to it, then that's the activity that you are focusing on. > > So you've chosen your activity, in this case walking, and you're gonna figure out your current Baseline. And this is the amount that you can do without a major flare up. > > I've put an example here of walking for five minutes. It may be that actually you can walk around the block or it may be 20 minutes. It doesn't matter what the time is. It's whatever your current baseline is. > > So again, for this one, we're starting off with five minutes walk every day. > > This one in particular was taken from a real life client of mine. And this is where we started. She actually wanted to get back to walking her dog, and she hadn't walked a dog for a long time because of the pain. > > Obviously we don't wanna start going out, walking a dog for half an hour, whatever it is. She had a big dog and we needed to start somewhere. > > So we started off with walking for five minutes because she knew she could do that. And she knew she felt okay with it. There was no flare up. > > Then what you would do with this is you would stick with that Baseline for two to three days roughly. Now these figures, they're not exact. It is exactly what works for you, but I tend to recommend sticking with the same thing for two to three days because we want to see what happens afterwards after those two to three days. > > So we're sticking with the Baseline. We're gonna go for a walk on Monday for five minutes, and then if we're all good, we're gonna go for a walk for five minutes on Tuesday and maybe even five minutes on Wednesday. > > And it's remembering that some discomfort is okay and that pain may increase slightly, but it should be manageable. > > Now if after a few days, so you've been for your walk on Monday, Tuesday, Wednesday, five minutes every day. If your pain hasn't worsened significantly, then we're gonna add five more minutes. Okay? So now we're at 10 minutes of walking and we're gonna re the repeat the process. > > So we're gonna stay at that new duration for another two to three days. > > So on Thursday, Friday and Saturday we're gonna go for 10 minutes walk. And we're gonna see how we are for that time. If then it is still tolerable, we can add another five minutes and we're gonna continue this slow and steady increase over time. > > Now again, this was based on a client of mine and we built this up. There were a couple of flare ups along the way, but that's life right? And that's okay. That's absolutely fine. > > And we knew to just back it away a little bit and then build up a little bit slower because her body then set off the fire alarm again, probably not damage, but it was too much too soon, and the brain and the spinal cord panicked, set off the fire alarms and created this flare up. > > So she backed away a tiny amount. She knew that she could do that little bit before, and then that's what she focused on. > > Then she would start to build this back up again, and it carried on to get to the point where we started to bring her dog in to this equation. And again, it's slowly bringing that in and adapting it over time. > > I wanted to add in this scale because when you are doing this, I have found that having this scale has helped again so many of my clients to understand when they can progress and when they need to back away. > > So when we are looking at this scale, we are thinking about how things feel for us before we're doing our thing, during our thing and afterwards. > > And afterwards for maybe two to three days, as we are doing our thing at that level. So we're gonna keep thinking about where we are on this scale. > > Now this is subjective. The numbers are subjective. And it's even more so when you have chronic pain. > > But if you are green. Then you can increase after two to three days of the same amount. So if you've been walking for three days and you're still feeling on green, then go and increase it. Okay? > > If you are orange, so you've done five minutes on Monday, Tuesday, Wednesday, and maybe on Wednesday you are feeling a bit of orange. > > Then maybe do five minutes on Thursday and Friday as well, and Saturday and Sunday if you need to. Before you then increase. > > So we're being careful because things are just about tolerable. And we just don't want to frighten that nervous system. We want to reinforce that we can do five minutes. > > It's literally, come on guys, we can do five minutes. We've done it for the past few days. Just let's chill out for a bit. I know. We can do five minutes and it's fine. And it's reinforcing that. > > Now, as long as the pain isn't increasing, then stay there. Stay at orange. Okay, that's absolutely fine. > > Stay at that five minutes and stay there doing the same thing until again, your body knows that it's safe and it can switch off some of the alarms. > > Now, if you are doing your thing and maybe you've increased or whatever it is, and you have gone into the red, then back off a little bit, change what you are doing, drop back to a Baseline that you know you're good with. > > So if you've increased to say 10 minutes and you've gone to a red back away and come back to maybe five minutes, okay. It's not backing away completely. 'cause we don't wanna be afraid of pain. But it's backing off a little bit to let the nervous system calm down. > > Now I think it's important to note that when we're looking at this chart as well if you have an increase in these numbers, so if you're going into the orange and the reds, it doesn't necessarily mean they're increasing just because of what you are doing. Remember, it's a combination of all those DIMs and SIMs. > > So it's remembering that it's not necessarily that thing that you are doing. So if you are in the oranges as well and you've been increasing it and things are going well, but it's obviously in the orange and you start going, oh my God, things are getting worse. But actually you've also got loads of other shit going on. > > People are falling out at work and you've got this stress going on and you're not sleeping and whatever else it is. Don't assume it's because of the activity that you're doing it, that's not always the case. But if you are increasing in numbers, then we need to be reducing the amount of DIMs, increasing the amount of SIMs. And this might mean just backing off a little bit, if you need to. Next lesson → [[Untangling Pain – Module 4 Lesson 13 – Some advice|Some advice]] %% ## Extra ## Version 1: Full What does this look like in the real world? So we’ve spoken so much about all these different things, but what does this look like for you? Firstly, what I want you to do is, choose the activity that you want to return to. So I’ve done the example here as walking, but this method, it works with any activity. Whether it’s gardening, cycling, housework, playing an instrument, typing at your computer, it doesn’t matter. It’s whatever is causing you an issue but you want to get back to it, then that’s the activity that you are focusing on. Figuring out your current Baseline So you’ve chosen your activity, in this case walking, and you’re gonna figure out your current Baseline. And this is the amount that you can do without a major flare-up. I’ve put an example here of walking for five minutes. It may be that actually you can walk around the block or it may be 20 minutes. It doesn’t matter what the time is. It’s whatever your current baseline is. So again, for this one, we’re starting off with five minutes walk every day. This one in particular was taken from a real life client of mine. And this is where we started. She actually wanted to get back to walking her dog, and she hadn’t walked a dog for a long time because of the pain. Obviously we don’t wanna start going out, walking a dog for half an hour, whatever it is. She had a big dog and we needed to start somewhere. So we started off with walking for five minutes because she knew she could do that. And she knew she felt okay with it. There was no flare-up. Sticking to the Baseline Then what you would do with this is you would stick with that Baseline for two to three days roughly. Now these figures, they’re not exact. It is exactly what works for you, but I tend to recommend sticking with the same thing for two to three days because we want to see what happens afterwards after those two to three days. So we’re sticking with the Baseline. We’re gonna go for a walk on Monday for five minutes, and then if we’re all good, we’re gonna go for a walk for five minutes on Tuesday and maybe even five minutes on Wednesday. And it’s remembering that some discomfort is okay and that pain may increase slightly, but it should be manageable. Increasing gradually if tolerable Now if after a few days, so you’ve been for your walk on Monday, Tuesday, Wednesday, five minutes every day. If your pain hasn’t worsened significantly, then we’re gonna add five more minutes. Okay? So now we’re at 10 minutes of walking and we’re gonna repeat the process. So we’re gonna stay at that new duration for another two to three days. So on Thursday, Friday and Saturday we’re gonna go for 10 minutes walk. And we’re gonna see how we are for that time. If then it is still tolerable, we can add another five minutes and we’re gonna continue this slow and steady increase over time. Now again, this was based on a client of mine and we built this up. There were a couple of flare-ups along the way, but that’s life right? And that’s okay. That’s absolutely fine. And we knew to just back it away a little bit and then build up a little bit slower because her body then set off the fire alarm again, probably not damage, but it was too much too soon, and the brain and the spinal cord panicked, set off the fire alarms and created this flare-up. So she backed away a tiny amount. She knew that she could do that little bit before, and then that’s what she focused on. Then she would start to build this back up again, and it carried on to get to the point where we started to bring her dog in to this equation. And again, it’s slowly bringing that in and adapting it over time. Using the scale to know when to progress or pull back I wanted to add in this scale because when you are doing this, I have found that having this scale has helped again so many of my clients to understand when they can progress and when they need to back away. So when we are looking at this scale, we are thinking about how things feel for us before we’re doing our thing, during our thing and afterwards. And afterwards for maybe two to three days, as we are doing our thing at that level. So we’re gonna keep thinking about where we are on this scale. Now this is subjective. The numbers are subjective. And it’s even more so when you have chronic pain. But if you are green. Then you can increase after two to three days of the same amount. So if you’ve been walking for three days and you’re still feeling on green, then go and increase it. Okay? What to do if you’re in orange If you are orange, so you’ve done five minutes on Monday, Tuesday, Wednesday, and maybe on Wednesday you are feeling a bit of orange. Then maybe do five minutes on Thursday and Friday as well, and Saturday and Sunday if you need to. Before you then increase. So we’re being careful because things are just about tolerable. And we just don’t want to frighten that nervous system. We want to reinforce that we can do five minutes. It’s literally, come on guys, we can do five minutes. We’ve done it for the past few days. Just let’s chill out for a bit. I know. We can do five minutes and it’s fine. And it’s reinforcing that. Now, as long as the pain isn’t increasing, then stay there. Stay at orange. Okay, that’s absolutely fine. Stay at that five minutes and stay there doing the same thing until again, your body knows that it’s safe and it can switch off some of the alarms. What to do if you’re in red Now, if you are doing your thing and maybe you’ve increased or whatever it is, and you have gone into the red, then back off a little bit, change what you are doing, drop back to a Baseline that you know you’re good with. So if you’ve increased to say 10 minutes and you’ve gone to a red back away and come back to maybe five minutes, okay. It’s not backing away completely ‘cause we don’t wanna be afraid of pain. But it’s backing off a little bit to let the nervous system calm down. Remembering the role of DIMs and SIMs Now I think it’s important to note that when we’re looking at this chart as well if you have an increase in these numbers, so if you’re going into the orange and the reds, it doesn’t necessarily mean they’re increasing just because of what you are doing. Remember, it’s a combination of all those DIMs and SIMs. So it’s remembering that it’s not necessarily that thing that you are doing. So if you are in the oranges as well and you’ve been increasing it and things are going well, but it’s obviously in the orange and you start going, oh my God, things are getting worse. But actually you’ve also got loads of other shit going on. People are falling out at work and you’ve got this stress going on and you’re not sleeping and whatever else it is. Don’t assume it’s because of the activity that you’re doing it, that’s not always the case. But if you are increasing in numbers, then we need to be reducing the amount of DIMs, increasing the amount of SIMs. And this might mean just backing off a little bit, if you need to. ⸻ ## ![[Meta/01 Attachments/Untangling Pain Attachments/Image (36).png|Image.png]] ![[Meta/01 Attachments/Untangling Pain Attachments/Image (37).png|Image.png]] --- ## Watch the lesson %%