Our client talks about mindset shift. How becoming aware of his negative self-talk led him to a whooping 95% improvement in symptoms just within four weeks of online coaching.
I am moving towards what I consider high value content. By that I mean things that are actionable that you can implement in your daily life.
Previously I wrote mostly about the technical bits of research. I’ve come to realise that knowing is not understanding. Knowing is not doing. And knowing is certainly not half the battle won.
The topic of today is language and the effects of self-talk.
What you say to yourself during exercise can change your pain threshold
This sounds totally crazy right?
How can what you say to yourself change the outcomes of exercise?
Exercise is a physical activity and self-talk is really at best a psychological intervention. Surely it doesn’t over-write the benefits of physical exercise?
A paper just published this month looked at the power of words in a study with 83 participants. They found that those who engaged in positive self-talk experienced a whopping 22% increase in pain threshold (i.e. they are less susceptible to pain after the exercise).
Guess what happened to those who engaged in negative self-talk?
Their pain threshold decreased by 4% (i.e. they are more susceptible to pain after the exercise).
That is mindblowing. In essence, you can totally negate the positive benefits of exercise (in management of pain) by just running negative-emotion conversations in your head.
Admittedly, most of us don’t remember what we are talking about before and during exercise. This is why mindfulness practice may come in useful. You can use that as a strategy to become aware of your thoughts and take action as necessary.
Most of us are familiar with the importance of having good technique and good setup during an exercise. With this in view, perhaps we should also include consciously engaging in positive self-talk during workouts.
It always comes down to a biopsychosocial approach
When it comes to pain management, we tend to over-focus on the physical aspects.
It’s common for prospective clients to talk about how they’re here because they want to find the perfect combination of exercises so they can find freedom from pain.
It’s true that exercise is one of the top recommendations when it comes to management of musculoskeletal (i.e. muscle and joints) pain or injury. But let’s not forget the other components, which are education and advice.
Collectively, they would address components of the biopsychosocial framework. Exercise works with your physical well-being. The education and advice part would cover the psychosocial bit.
Your symptom experience, doesn’t matter of it’s back pain or knee pain from running, is the outcome of a mishmash of various factors from physical fitness to quality of sleep, to personal relationships, to work satisfaction.
In this context, my free advice for you is to proactively engage in positive self-talk. It makes a difference.
The education part is really trying to understand the research behind it, the potential why that may be the case (biopsychosocial model).
Imagine if you have been using negative reinforcement to motivate yourself.
“I am so weak. I need to push myself harder.”
I can see how that would push some people to lift heavier, push themselves harder, but that doesn’t necessarily translate to improvements in symptom experience.
Taking small actions like using a mindfulness app or gratitude journaling to supplement your recovery may seem really unimportant. However, they do work on things that may not be immediately obvious to us. Research supports this!
Healthcare providers are just as guilty
It’s common for chronic pain patients to frame their symptoms with a lot of negativity. Common examples include:
- I will never be able to run/squat again.
- I will need surgery by the time I am 40.
- I will never be pain-free
- My knees are worn out.
- My core is weak.
- My spine is easily misaligned.
Believe it or not, the main source of such misinformation is often healthcare providers!
To give you an example:
“Basically all I’ve kind of been told to do by physios is to work on my core…I’ve been tested by various different physios, and Pilates, and I’m apparently ridiculously weak…. I had an abortion because I didn’t think I could have a baby. I didn’t think I could handle it…carrying it, and having extra weight on my stomach.”
This is the power of words! The excerpt is taking from The Enduring Impact of What Clinicians Say to People With Low Back Pain. If you are thinking that’s a standalone, it isn’t. This is what a patient understood from his consultation with a chiropractor:
“When [the current episode] first happened, the only thing that was going through my mind is the seriousness of my dis-alignment [sic] of my back…. I was really petrified…you get scared in the sense that you could damage your spinal cord, or anything, to such an extent that you might become paralyzed.”
What a chiropractor, physiotherapist says to you would change your treatment outcomes.
What you say to yourself during exercise will also change your treatment outcomes.
Trivial as words may be, they have a measurable, tangible effect on the sucess of your recovery.
If you check out the post I wrote about the neuroscience behind mindfulness practice, you will be able to read more about how fear is a major contributor when it comes to chronicity of a person’s pain experience. It is no good.
The fearful client
I once had a client who would apologise EVERYTIME I provided feedback on his exercise.
It was not that he was doing it wrong either. There were just changes we could make to optimise the exercises for him. I definitely didn’t expect him to have such knowledge so there was really no reason for him to be apologising.
He also engage in a lot of negative self-talk. Essentially, he blames himself or his body for this chronic pain in a meaningless way. This went on for a few visits.
As part of his recovery, I had to get him to give himself words of encouragement for every single repetition performed. It was such a contrived and challenging experience for him.
He did play along and over time it did come more naturally.
We also worked on self-awareness exercises to help him notice his own negative self-talk.
With more time, he became more confident of performing his exercises, more motivated to load his lower back more. He also started engage in positive self-talk and also make observations were more true to his experience (i.e. no catastrophising).
This was when we really started to good results.
Too often as chronic pain sufferers, we are so used to our way of doing things. We are used to living in pain. We are used to our negative inside voice. We are used to blaming ourselves for everything that had gone wrong.
When all of that comes together, there just doesn’t seem like there would be a way out. It came as no surprise that this patient’s previous treatments failed.
Don’t forget, the study I shared earlier showed that negative self-talk can negate the benefits of exercising for chronic pain.
If you are living with chronic pain and your treatments don’t seem to be working out, I highly recommend that you dig deeper to examine the pain narratives you subscribe to.
Perhaps you think you are not getting better because of the “wear and tear” in the knees. Perhaps you think exercises will make your discs “pop”. Such structural-based narratives are no longer congruent with best clinical practices. I quote:
We concluded that despite continuing attempts to shift pain beliefs to more complex biopsychosocial factors, most people with lower back pain (LBP) adhere to the traditional biomedical perspective of anatomical/biomechanical causes. Relatedly, they often see their condition as very negative. Contrary to current “best practice” guidelines for LBP management, a potential consequence of such beliefs is an avoidance of physical activities, which is likely to result in increased morbidity.
Remember, high value chronic pain management must always take into consideration the psychosocial factors at play. A structural-based diagnosis is simply not good enough.
If you have been living for chronic pain for a while now and your treatments have not given you the results you desire, book in an appointment with me to discover the difference the right care can make. Let me help you find freedom from pain.
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Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.
Our goal? To make our own services redundant to you.