I promise you some one who thinks of their body as robust and resilient is going to behave entirely differently from some one who thinks of their body as weak and fragile.

Similarly, some one who thinks that they cannot overcome their current challenge, is less likely to succeed compared to some one who believe they can.

This is why we do prep talk right?

If you allow me to share a personal example, my grandfather refused to use a walking cane or a walking aid or even allowed some one to assist him even though he had difficulties getting around. He knew that he had his limitations but he believed himself to be able to overcome them without additional help.

Because of this belief, he would rather shuffle his feet to get around than to receive help.

If you are like me, a hard science person, you may think the mind-over-body narrative is overly-reductionistic.

I’m inclined to agree with you.

However, despite my personal biases, I am willing to see the forest for its trees.

pain management, body beliefs, pain beliefs

Today I am going to discussed what are beliefs. This is based on a paper published just a few days ago titled Beliefs about the Body and Pain: the critical role in musculoskeletal pain management.

How can we step outside of our biases?

Most of my clients are executives, leaders, or leaders-to-be at work. You can imagine the COVID-19 situation has turned work into a topsy-turvy.

Everything they knew about work has changed and things are ridiculously uncertain on a day-to-day basis for most of them.

This morning, a client just texted me to explain that things are chaotic at work, his own personal recovery/exercise was put on hold, he just got back to exercising again today, and he can only see me next week at earliest.

This was my exact reply to him:

No worries at all! This is why the compassion framework and soft stuff at the early bits of our sessions is so important.

When recovery gets challenging, especially when it comes to what is outside of our control, getting good results becomes about making the best possible decisions in a given circumstance.

So having said that, this morning was a good time to start so is tomorrow morning 😀 also don’t worry about catching up. Just keep moving forward 💪🏼💪🏼

His reply?

Haha great, thanks for understanding (even though I believe you are wincing writing that, if I have learnt anything about you in the past few sessions 😉)

I’ve previously written about task vs social relationships. Sometimes we have to be willing to take a step back and take the best possible action for the biggest possible reward.

Even if it is against every fibre of our belief!

Would moping or ruminating over what you did not do or what you could have done better make a difference to your outcomes?

If not, what is the best possible decision you can make right now to change that?

Have a think about it.

My client was right. I was wincing as I replied his text.

Sometimes to step out of our beliefs and biases, we simply have to force ourselves to start with doing what is of value regardless of how we feel about it.

Like yourself, I have my own lessons to learn.

Understanding beliefs and how they are formed

What are beliefs?

According to the Oxford dictionary, a belief is something that you accept as real or true, or a firmly held opinion.

There are three considerations to a belief that we don’t think about but should be familiar with when it comes to good decision-making:

• Beliefs are not always rational
• Beliefs can be contradictory
• Beliefs can be explicit or implicit

Beliefs can be irrational

work performance, irrational beliefs, performance coach
A study published last year examining the negative effects of irrational beliefs on performance of professional golfers. Are you able to appreciate how irrational beliefs can affect not just sports but also your work performance?

The first thing to highlight is that beliefs are not facts.

Even when false beliefs are challenged with scientific research, people do not always readily change them. This is where the irrationality begins.

Even educated professionals and health care providers are guilty of this!

The “bad posture” is giving you back pain or neck pain is a narrative that repeats itself over and over again on social media. However, there’s no research to support that claim. Sometimes what we think is true is merely what fits best into our biases.

When it comes to neck pain and “text neck” (or tech neck), there is really no good papers to establish a causative relationship.

In fact, several bigger studies have demonstrated there is NO association between the two.

Regardless of these facts, chiropractors and physiotherapists alike are still pushing for patients to work on their posture if they want to be pain-free.

Some even claim that it’s a 21st century disease. However, there’s enough proof to show that “poor” neck posture existed for hundreds, if not thousands, of years.

The same goes for low back pain.

back pain, disc degeneration, wear and tear
If you look at statistics of “wear and tear” in people without pain, you’d realise it doesn’t make sense. 96% of PAIN-FREE individuals in their 80s have some form of disc degeneration. If you are in your 30s and WITHOUT pain, there’s a 52% chance you also have disc degeneration.

Scientific studies have shown for over 10 years now that structural changes commonly seen in x-ray and magnetic resonance imaging (MRI) POORLY correlate with pain. The current understanding is that these are normal age-related changes.

Like how grey hair doesn’t give you headache, spinal degeneration or disc herniation doesn’t give you backache.

Imagine trying to dye your hair black as a headache solution. Where do you think that will lead you?

We are not only sure that MRI scan will not help your case. Research repeatedly shows that patients who have undergone MRI for back pain or sciatica experience worse treatment outcomes.

Instead of helping you, it actually makes you worse.

Science tells us that.

We are so so so sure of this that medical organisations around the world are recommending AGAINST MRI for back pain in the absence of red flags.

Remember, beliefs are not facts.

If you struggling to get around some of the things I am writing about (or saying during our sessions together), that is totally okay.

Just keep them at the back of your mind and reflect on them every so often.

If health care professionals, orthopaedic surgeons inclusive, are still struggling to separate their beliefs from the true scientific facts, you don’t have to be so hard on yourself.

Take all the time you need to figure it out.

Beliefs can be contradictory

chiropractic treatment, hard truths

A pain patient can hold two or more conflicting beliefs at any given time.

It sounds terribly strange but it is common for pain sufferers to believe that exercise is the long-term pain solution for them and, at the same time, believing that exercises are damaging to their joints.

It is a conundrum.

If you think exercises are what you need to get better but at the same time you are afraid of exercising will cause you injury, you aren’t going to get very far.

For the record, exercises are not damaging for your joints. A curious study published last year was able to show that training and running a marathon over a four-month period can reverse some degenerative, osteoarthritic knee MRI changes.

Sure, you can argue that exercise can damage your joints if you push too hard.

Similarly, you can burn yourself in a hot shower if the water is boiling hot. This does not make a regular hot bath any less relaxing.

I do call out on my clients when I notice their contradictory beliefs. It’s really hard to move forward in your recovery when you are stuck in an impossible situation.

You are right to think that it is an uncomfortable — and perhaps even awful — experience to be called out. This is why I make it very clear that I only work with hard changes to deliver long-term results.

While I have great working relationships with virtually all of my clients, I do not prioritise customer service over your own recovery.

This is what you are paying for.

This is why my clients’ results outperform what they were getting at their previous chiropractors or physiotherapists.

Beliefs can be explicit or implicit

mindfulness singapore, awareness training
What you see is not what you get. The Monkey Business illusion/Invisible Gorilla experiment demonstrates that what we pay attention to is what we will find. That doesn’t mean what you don’t pay attention to doesn’t affect you! Source: The Prevention Conversation

This is a tough bit to understand so if you are already feeling the information overload, I suggest you skip this section and come back to it another day.

Explicit beliefs are what you are conscious of. They are usually deliberately formed (e.g. self-reflection) and are easy to articulate.

Implicit beliefs are what you are unaware of. In that sense, it influences your actions or behaviour without you realising it. Scary, huh?

Let’s talk about lifting heavy loads.

A client with an explicit belief will be able to tell me that to protect their back, they would squat with their knees bent and back straight every time they have to lift something heavy.

By the way, there is no evidence to suggest that such “correct” way of lifting reduces injury rates.

A client with an implicit belief however, when asked if they use any specific strategies to protect their spine, will deny that they do so. If asked to perform a squat, they may repeatedly avoid rounding their backs or actively try to correct spinal flexion on their own. All of these are happening on a sub-awareness level.

They think that they are not using any specific strategies when they actually do. It’s a pretty tricky situation to address.

It’s also fairly common for clients to say that they do not do anything to help with their pain. During the duration of their consultation however, they may be repeatedly massaging themselves or stretching or “cracking” their necks without themselves realising it.

This is why awareness training is important and why I advocate for journaling and mindfulness practice.

We have a tendency to think we know ourselves very well. In some sense it is true, we do know what we know of ourselves very well.

However, there are blind spots and unknown areas that we do not have awareness of that still influences the decisions we make on a day to day basis.

I was sharing in a blog post on coaching that our attention is like a flashlight – where you shine the beam of light on is what you would see/find.

If you are a chronic pain patient, it is likely you have been shining your flashlight on your pain experience. This is what you are already familiar with.

Part of recovery is being able to direct your attention to not just the painful experiences but also the non-painful ones so you can have a complete and accurate picture of your physical sensations.

Trust me, I do understand that this does sound soft and fluffy.

Bear with me.

I promise you that it will start to make sense if you take some time to dwell upon it. Remember, we have hard science to show that the softer bits matter.

The Ultimate Pain Solution

chronic pain, chiropractor singapore, pain solution
The Common Sense Model was first developed by Leventhal et al. in 1992. The curious thing is that while the framework seems accurate, nothing within the model is common sense!

I’d like to invite you to take a few minutes to navigate yourself through the Common Sense Model and try to fit your own recovery so far into the diagram.

Are you able to identify areas within the model that you have never ever thought of?

Are there areas in the model that you do recognise but you have never worked on in the past?

I am willing to bet that most of us have never considered that our emotional response to a pain experience is something that may also need addressing.

Have a think about your last stressful work week or a terribly difficult time at home, were your symptoms worse?

Were you able to self-care (e.g. sleep, eat, exercise, socialise, relax, stick to your chiropractic treatment) as well as you did before the challenging period?

Knowingly or unknowingly, your emotional responses to pain — arguably your state of mind at any given time — influence the behaviour you choose. In doing so, it changes the outcomes of your recovery.

self talk, exercise, chronic pain
If you told me a few years ago that what my clients say before their exercise will affect their recovery, I’ll call bullsh*t on you. That is my bias. A paper published just three months ago is using hard data to shine light on the soft science side of finding a long-term pain solution.

Studies have shown that engaging in negative self-talk before an exercise can completely negate the benefits to make you feel worse!

Moving away from the emotional aspects, let’s talk about your representation of pain.

We think that we are rational and objective beings so we can deduce what causes our pain.

Science, on the other hand, tells us that we are wrong all the time. The most popular “causes” are actually false assumptions/beliefs.

From bad posture to poor alignment or even muscular weakness, there is no research to support these narratives as “causes” of your pain experience.

The reason you are getting it wrong is quite simple – we forget that our interpretation of our pain experience is defined by our beliefs, culture, upbringing, education, past experiences, etc.

Most, if not all, of these are subjective experiences that influence how we think of our pain.

I have a good example of how our experiences can COMPLETELY change our pain experience in my post about Pain Neuroscience Education. There’s a mini-exercise in there and I highly, highly encourage that you take the time to work through it.

Optional illusions, such as the Müller-Lyer illusion above, is wonderful because it shows us that even if you know both A and B are of the same length, you still perceive B to be longer!

To give some perspective to how often we get it wrong, health care providers (chiropractors to physiotherapists to orthopaedist inclusive) are now encouraged to forget about trying to identify the root cause of pain. There are two reasons:

• First, we don’t need to know what is wrong to fix it. I’ve previously discussed why knowing is not half the battle won.
• Second, at this point with modern science and technology, we don’t know how to objectively identify what is the cause of pain.

What we do know is that the structural approach is backfiring on us. Patients who undergo MRI scans in hopes to find what was wrong often end up suffering more.

It’s pretty dramatic – more unnecessary tests, referrals, and intervention, increased health care costs, worse symptoms, delayed recovery, and poorer quality of life.

There is no nice way to say this, but the structural approach to pain management is an all-round loser.


How can I improve my pain?

To achieve pain resolution is not about going to this magic chiropractor, who is going to lay his or her special hands on you, to make all your problems go away. Even if you are willing to pay all the money in the world for it, such pain solutions do not exist yet.

For most parts, recovery is about making the right choices or the better choices in any given circumstance over and over again until you get to where you want to be.

It’s ridiculously challenging for a very simple action plan.

We are not saying that we have a complete understanding of pain. We definitely do not have a confirm-plus-chop-will-work pain solution at this time.

What we are saying is that you are not getting better because you are not doing enough of what actually works.

Research doesn’t tell me how I can heal your pain forever.

Research tells me, in an objective manner, what is more likely to work for you.

It gives me an understanding of what we should try first to maximise your treatment success.

If you are living with chronic pain and simply aren’t getting anywhere with your self-management or current chiropractor, book in an appointment with me to discover the difference the right care can make. I promise it will be like nothing you have experience before.

Your Recovery Journey Begins Now

Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, chiropractor Jesse Cai founded Square One Active Recovery to deliver recovery goals in just 4 to 7 visits.

Not getting results from your chiropractor, TCM doctor or physiotherapist? Book an appointment to discover the difference the right care can make.

*We do not offer short-term pain solutions such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.

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