Summary:
One of my readers writes:
“Hey Doc, I’ve been doing all the right things to improve my fitness. Pacing myself. Accepting my low threshold and working within it with lighter weights and shorter workouts. I’ve progressed, but I’m stuck and not able to increase my exercise tolerance enough. Why is that happening?”
In the video, I dive into some of the reasons why fibromyalgia and chronic pain can be so limiting in terms of activity. Sometimes there are things you can do to break through the barrier and build strength, endurance, and ability to function.
Check it out and let me know what you think.
Did You Know:
- You can learn to reduce pain, improve mobility, and increase energy. Movement Toward Health is an affordable online training program that helps you heal and grow in a warm and inviting community. It opens periodically for new members. You can get more information and join the waitlist here: www.MTHTribe.com
- Do you want experienced, compassionate guidance in overcoming chronic pain or illness? Dr Shiller is available for telemedicine consultation worldwide regarding chronic pain, fibromyalgia, autoimmune disease, fatigue, and stress-related illness. Learn more here https://www.drshiller.com/stage-dr/consult
- Have you learned to mobilize your most important self-healing superpower? If you balance your stress/relaxation response, it could change your life. Dr Shiller gives regular free mind-body training sessions on zoom. Even if you “can’t meditate”, he has a way of helping. Learn practical tools for transforming pain and suffering, reducing stress and inflammation. Sessions are free. You can register atwww.mindbodygroove.com
Related Posts:
- How to unlearn the mind-body patterns that create chronic pain and illness.
- Why Does Chronic Pain Happen? Empower Your Healing.
- Life-changing stuff most doctors don’t tell you about fibromyalgia, chronic pain, and chronic illness.
- LDN can be great. But here’s why it is not a miracle cure for pain, fatigue, and fibromyalgia.
- https://www.drshiller.com/why-does-chronic-pain-persist/
Full Transcript:
Hey, it is Dr. Shiller. Today, I want to talk in follow-up to a previous video in which I was discussing the suffering cycle and the disability cycle in chronic pain and chronic illness, especially fibromyalgia and related conditions, and how a person can understand that and start to break those cycles. And I got a very interesting response from one of my readers, one of the watchers, and I want to read you some of it, because you might have similar questions.
She writes, “Doc, to be honest, I have made a lot of improvements, but I never got to a place of really big improvement. I have tried gradually building my exercise. I have done behavioral modifications to pace myself. I have tried to stay within my exercise threshold. I have done things to tweak a slightly low thyroid. I do not have a positive ANA or a high inflammation marker, but I continued to get these really bad flare ups of fatigue and discomfort. My pain is much better, but the fatigue and the post exercise, just malaise and feeling horrible keep catching up with me. What do I do about that?
It is such a great question, because whether it is chronic pain, or fibromyalgia, or chronic fatigue syndrome, ME, as we call it, these are complex processes. And there are a few different things that can be going on, and I would say there are really like, four or five reasons why it can be hard to break through and actually build that activity tolerance threshold, because that is really the issue here. For someone who wants to either prevent getting more disability, disabled, or someone who wants to kind of climb out of that hole of disability and get more active, what stands in the way?
The first thing we talked about in that first video is that the threshold gets lowered, right? Like everybody has a threshold, within which we can actually be active physically without damaging ourselves. So, I can run two or three kilometers, a mile or two or three, and I can feel okay with that, but if I try to run a marathon, I would be wrecked for days, and maybe a week or longer, I might even get injured.
Everyone’s body, you included, you have a certain threshold of how much energy your cells can put out, how much metabolism your muscles can do, and above that, what happens is it overloads the system and creates a kind of state of biochemical toxicity and inflammation and acidosis. And if you are susceptible, because you have a low threshold, which is expressed in fibromyalgia, chronic fatigue, then that happens at much lower levels of exertion, and so you go over that threshold and suddenly this vicious cycle happens, which can increase inflammation, increase stress hormones, increase a whole bunch of different changes that create a flare, and so the question is, how do you work with that?
This particular person talked about, is trying to stay within threshold and doing shorter workouts with less weight, and she made a certain amount of progress, but did not really elevate her threshold, like she really wanted to. What else could be going on? One of the things is that we know that there are hormonal and immune dysregulation that happened.
We know that sometimes there are aspects of biochemical toxicity. Sometimes there are aspects of dysfunction of the mitochondria, which are your cellular energy producing organs. And all of these things are very much integrated, your degree of inflammation, your mitochondrial function, your biochemical stress, or oxidative stress, are all intertwined with each other, and when you are in a susceptible place, any one of those going up too high, can she kind of create a little vicious cycle, stuff like low grade infection feeds into that, hormonal dysfunction, whether it is your thyroid hormone, your adrenal hormones, or your sex hormones can also make you susceptible.
If you have ongoing toxicity to heavy metals or environmental pollutants, where you have got low-grade inflammation in your body from some kind of liver toxicity thing, that also makes your system more susceptible. So those things are incredibly important to address. That is a huge topic. I am trying to cover that right now. Although in future videos, I sure hope to God willing.
The last aspect that I want to bring up is really the stress response of the body. Because as we know, we already talked about it, that the stress response, the fight-flight-freeze response, which is meant to be kind of modulated by a relaxation response is intimately connected with that mitochondrial function or hormonal immune axis. They are all intimately connected, because your stress response is how your body copes, and there has been all sorts of research showing that when a person has a prolonged overactive stress response, or an acute stress response, it shifts immune function, it can shift hormonal function, it can shift mitochondrial function.
One of the ironic weird things about physical exercise is that it is a stressor, right? Like we know that to be true. You know, there is acute exercise, there is long-term exercise. But there has been tons of research that is showing that when you do exercise, your stress hormones go up, your autonomic system activates a stress response, because it is a get up and go.
The question is, when you are doing physical exercise, are you activating too much of a stress response? So, all those other biochemical things are really important. But what is going on in the stress relaxation response, is the autonomic nervous system. Which consists of that stress response and relaxation response. Is it kind of on the edge and so out of balance, that you do a little bit of exercise, and boom, you kick into a high stress state that flips off the mitochondrial function and your hormonal and so on and so on.
It is possible, it is possible, and that is why personally, from my point of view, when people are dealing with low threshold states like fibro and chronic fatigue, it can be so useful to do what you could call mindful exercise.
Mindful exercise means exercise with awareness, and it means exercise that is deeply relaxing. So, rather than going to the gym and pumping weights, even if they are small weights, we are getting on the treadmill, or doing the stair stepper, even if it is a low volume, low intensity, those can be stressors. And so, what you really might want to consider is doing exercise, whether it is a very gentle yoga, Feldenkrais awareness through motion, movement, Tai Chi, Chi Gong, things that are really meditative, with a lot of awareness, where the physical activity is not about exertion, the physical activity is about mobilization, it is about relaxation. It is about waking up your body’s natural ability to move, to breathe, to reduce co-contraction and resistance that you might have in your neuromuscular system, and so, it is a really good place to start if mainly what you have been doing has been typical gym exercise, without awareness, without relaxation, because gym exercise without awareness and relaxation can be a stressor, mindful exercise can be done in a relaxing way.
Let us also get clear, right? A lot of people say, “Well, I tried to do yoga,” but then you find out what kind of yoga and it is more the aggressive kind. There are yoga practices that are really forceful, Ashtanga and Iyengar, you know, other things that, you know, I forgot, Vikram, that can be fairly aggressive. And that is not what I am talking about here. I am talking about gentle Hatha Yoga, where it is about awareness. It is about gradually coming into a soft pose, not pushing too hard. Lots of breath, lots of awareness, meeting the edge and just relaxing into it. So, it is a different way of moving. And it could be what will help you get started and help you start to build your mobility, your flexibility, your strength, your body awareness, and what you need to progress to higher levels of physical activity.
I hope that is interesting and helpful. I am very grateful for your comments or questions. Feel free to shoot those to me either where you are finding this video, or through an email.
Thanks for watching, and looking forward to seeing you.
Fibromyalgia is Tough. Why is Disability Optional? Part B
This is part B of a two part video. Please watch part A first.
Click HERE to watch part A.
Summary:
You learned in part A of this series why the pain system gets sensitized in fibromyalgia and chronic pain, and what creates suffering, and why it can be so disabling. Click here to see part A if you missed it or want to review.. In this video (part B), you’ll learn some of the main things that you can do to reduce suffering, and break the “fear-avoidance-disability cycle” that otherwise can suck your life down the drain. This isn’t easy work. But have hope. There are things you can do to help yourself. Please let me know what you think by sending an email or commenting on this post.Did You Know:
You can receive updates about new content and learning opportunities for transforming pain and suffering, by joining Dr Shiller’s email community here: drshillerupdates.com Dr Shiller gives regular free mind-body training sessions on zoom. You can get the schedule and register at www.mindbodygroove.comRelated Posts:
- How to unlearn the mind-body patterns that create chronic pain and illness.
- Why Does Chronic Pain Happen? Empower Your Healing.
- Life-changing stuff most doctors don’t tell you about fibromyalgia, chronic pain, and chronic illness.
- LDN can be great. But here’s why it is not a miracle cure for pain, fatigue, and fibromyalgia.
Full Transcript:
Hi, Dr. Shiller here. We are continuing with part II of fibromyalgia and chronic pain. Why are they so disabling and what can you do about it? In part I, we looked at the whole variety of different metabolic and mind-body and sort of mechanical structural factors that can give rise to the disability and really loss of life and function that happens when people have chronic pain, especially fibromyalgia. In this part, we are going to talk about what you can do about it. I encourage you to watch part I if you have not seen it yet. So, look for that link connected to this video. I am going to bring back up the slide we ended with, let us look at that. So, just summing up, like you know that talk in 30 seconds that there are metabolic mind-body and sort of movement or motor mechanical system aspects to this whole process that the biology that gives rise to central sensitization is influenced by the mind-body variables, like your beliefs, emotions, and thoughts, and especially autonomic imbalance. Autonomic imbalance is that over-activity of the stress response that can happen with chronic pain and chronic illness. Fear avoidance is that, I do not want to do stuff because it hurts, because you are not active, and you get inactive, then your body gets weak and stiff, and you get disabled, and because you are not moving, that feeds into all of the physiologic and mind-body variables, and the place where you actually have therapeutic leverage is to actually work on these things, right? I am not going to talk about the metabolic part, those are incredibly important. I talk about those in other talks. So, have a look for that stuff. I am going to focus today on the mind-body stuff and the motor mechanical stuff, and summing up all of this, the things that we really can address with the right kind of mind-body and movement system care are really the autonomic imbalance, fear avoidance, and inactivity, and the rest that flows out of addressing those things. So, let us just talk about a few principles or interventions, and I am going to share the big picture, the top-level stuff. Every one of these big picture top-level things are things you can drill down to and learn more, and I will do that in other talks. I am really interested in your feedback, what you want to hear more about. So, feel free to respond in the comments as I am going through about what you need to hear more about or send an email or whatever it is, reach out to my office and let me know. The whole point of this content is for you, to help you, to empower you. So, let us go forward with this, okay. Other videos about metabolic and the mind-body stuff. There is a number of different steps to mind-body healing, and there is mind-body tools that you can learn to shift your physiology and especially your autonomic imbalance as well as the kind of fear avoidance thing and to heal your beliefs, emotions, and thoughts, and it is incredibly transformative because you stop and unwind these cycles that give rise to the suffering and the disability of fibromyalgia and chronic pain. Self-regulation is the foundation. Self-regulation means tools, like simple breathing and focusing techniques that actually shift your neurobiology and your biochemistry, stimulate the vagus nerve, the vagus nerve is this big nerve that comes out of your brain stem, serves your entire intestinal tract, and it is anti-inflammatory when you stimulate your vagus by going into a deep relaxation, it slows down inflammation. When you are stressed out, aggravated, when you have autonomic imbalance towards sympathetic, your vagal nerve is shut down, and it is a pro-inflammatory state, and that is why we got so much research showing that an overactive stress response is pro-inflammatory and that various mind-body techniques modulate the immune system in a positive way and help it function more effectively. There are various techniques of self-regulation, mindset and beliefs, where you put your mind is where you are going to go. It is like a person driving one of those race cars in the Monaco grand prix or wherever, where if they look at the guardrail or the tree, you are going run into the tree, and if you look for the open space, you are going to drive into the open space. Another way to think about it is that if you are focusing on negative stuff in your life, the pain, the suffering, the lack, the loss, the person who hurt you, the blame, the guilt, all of that kind of stuff, you are going to generate negativity, and it is going to cause more suffering for you, for you. You are going to suffer more because of what you think about, and again this is not blame and shame. This is just inviting you to start seeing that if you focus on the positive stuff and you start to give your mind over to the good things that you can do to help yourself, then you are going to move in that direction. It is much harder to do than it is to talk about it. So, there is a lot more to learn about this, but it is a huge piece, and I encourage you to start thinking about it. Mindfulness could also be described as compassionate present moment awareness. Most of us are used to thinking in an analytical judgmental, how can I fix this or change it mode, we are doing? How can I do it better? And we are all conditioned for that. We get especially conditioned for that when we are under stress and we are suffering, because we want a solution, we want to fix it. Mindfulness is turning that upside down, it is shifting into a place of being present and compassionate, and when you talk about it, when you read about it might make sense or not make sense, but either way, you are not doing it. Doing it is an experience, you need to practice it, you need to learn it, and what I suggest is you find a guide, whether it is, you know, on the internet with or mind space or headspace or apps, okay that is a good start, but find a teacher, find someone who can help you learn it, because it is transformative, and I can tell you from my own experience and seeing so many people who like thought about it, they read all the books. I know mindfulness, no. Because they get into the training and they start to do it, and okay if things are challenging and hard and then suddenly, “oh my gosh,” like they have a realization, they have an experience that shifts everything. I did not know that could happen. I did not know I could feel that way. I did not know I could have that much free choice about my life. You got to practice it, to get there. Everyone can do it to a certain extent, go for it, okay. Next thing, body awareness. I work with a lot of people who think good thoughts, they are prayerful, they are spiritual, they are religious, they are doing good things, thinking good thoughts, but meanwhile their body is in alarm reaction because of their trauma, because of their pain, because of their disease. It is completely different when you take the good thoughts, the positive, calm, happy mindful mind and you bring it to your bodily experience, and you start to send up a message of safety to your body, you start to bathe your cells in the biology and neurobiology and neurochemistry of safety and positivity, transformative. Cultivating positive emotion, healing emotion, healing trauma. We know that people who have had adverse childhood experiences get more illness, they get more chronic disease, it is a complex phenomenon, it does not mean it is all in your head, but what it does mean is that emotional trauma, physical trauma shift your physiology, and there are tools that you can learn to shift it back into a healthy state. These are a collection of mind-body tools that can be transformative, and all of these are things to drill down to. Every one of these mind-body tools that I have listed here are things that you can learn to actually develop skill and cultivate, and once you do that, once you start to build that skill, it is yours. It is not something you have to go back to every week to your therapist or your treatment person. You have got tools, you have got transformative tools, that can help you break a fibromyalgia flare, that can help you find your way out when something triggers you, that can help you change your physiology and reverse those vicious cycles that give rise to the suffering and the fear avoidance, inactivity, and the disability. Okay, let us get into the motor mechanical, the movement piece of this. One aspect of this is bodywork, and there is two main kinds of bodywork. There is the hands-on direct stuff, where a person is pushing and prodding and doing stuff to move, to crack and crunch and move you, that can be great for some people. In my experience, it is not so great with people with fibromyalgia, because it tends to flare you up. There is another kind of manual bodywork techniques that you could describe as indirect, they are very gentle, they are more about consciousness and finding the freedom in the tissue and your body, your fascia, your tissue unwinds and moves in response to that, and that can be profoundly transformative. You can find that from a good osteopath, from a good manually trained physical/occupational therapist, some very good massage therapists, and some chiropractors, but you want to ask if they have worked a lot with people who have chronic pain and fibromyalgia, if they know indirect gentle techniques to release tissue, to release neuromuscular imbalances and reflexes that are counterproductive. Okay, and then there is stuff you can do for yourself. There is movement arts, and my emphasis, my bias is towards what you might call meditative or mindful movement arts, because exercise can hurt. If you just go out there and treat your body like it is a peanut piece of meat and you get on the treadmill and just go, go, go for 20 minutes, you are going to go above your threshold, and you are going to make yourself worse, and you probably have had that experience with some well-intentioned physical therapist, exercise therapist, or family member who said just get up and go, go do it. But what happens when you get up and go is you activate your stress response, you activate counterproductive reflexes, you go over your threshold, and you create a crisis in your cellular physiology, and you actually feed into this cycle, and you get a fibromyalgia flare, and that is not good for anybody, and maybe you have been there, done that, and maybe you never want to move again and maybe you are thinking who is this guy telling me I should move, forget about that. I get that, I have heard that from a lot of people, but when they started to learn to do a meditative quiet kind of motion and movement that respects the limitations of your body, that respects the low threshold, that actually lets you drop your calm, happy awareness into the body, and you know where you can move. You develop your intuition of your own body’s capability, and you start to move with that intuition and you build, you open up your envelope, you gradually learn to develop more flexibility, more strength, more endurance, and over time, you are climbing out of that hole of disability, and that happens through meditative movement, and so whether it is Feldenkrais or yoga or Tai Chi Qigong, Pilates, or other things that somebody may have invented. Find someone who is really good at it, find someone who has got a lot of experience and a lot of compassion and a lot of humility, who is willing to meet you where you are at and be your guide. Let them teach you and let yourself learn, let your inner wisdom grow, so that you know how to work with your own body, and over time, you are going to heal, you are going to feel better. You may need to work on this for the rest of your life to stay healthy, but you are going to be able to start doing only stuff that is meaningful for you. You are going to be able to get back to stuff that matters. It might not be like you were when you were 24 or 36, it might be like you are now, and then you build from there. So, you restart and you restart and you grow and you heal. Okay, so summing up. Fibromyalgia, chronic pain, there is a spiral of lots of different factors that lead to disability and disuse, and there is a process for preventing and reversing that, it has to do with addressing your metabolic biochemical system, to get the underlying cause of the symptoms. It has to get to do with your mind-body system, addressing your thoughts, your beliefs, your emotions, and addressing most importantly that autonomic imbalance, it is about learning how to move again. This is a healing path, nobody can do it for you, it is your healing path and it is unique to you. I really encourage you to find your guides, find the people who can help you address those three aspects of this situation or maybe some people can address more than one for you, but you need to start walking down that road, that healing path, which is yours, you find your guides, you let them teach you, you become an expert in yourself, and with time, what is going to happen is you are going to become the hero of your own story, because no one else is your hero. They are your guides, you are the hero, you are the one who is making the journey, you are in a place where you are stuck, where you are feeling horrible or you are terrified that you are going to get worse, and what is on the other end of your journey is, I feel empowered, I feel capable, I feel stronger, I know what I need to do. I might not be perfect, I might have setbacks, but I know how to deal with the setbacks and what you are going to do is learn to be a fuller self. You are going to learn to reconnect to purpose, to do stuff that you care about, to start feeling better about life again. So, my work is dedicated to helping you learn and grow in that way. I want to hear about how you like this video, if it is good for you, let me know, leave feedback in the comments or send me an email, sign up for my email community, so you can get updates about when I produce more content, and I am here and at your service. Thanks for watching.Fibromyalgia is Tough. Why is Disability Optional? Part A
Summary:
In fibromyalgia, your pain is amplified. There are known biological changes that can contribute to the increased pain. Most of those changes can be helped if you know what to do. Suffering is a more complex thing. Suffering happens where pain meets your thoughts, beliefs, and emotions. There are simple tools that you can learn to shift your experience of pain and suffering. So you can be more comfortable, happier, and live better. Disability is an even more complex process. You have choices about how to mobilize your body-mind’s healing responses.Did You Know:
You can receive updates about new content and learning opportunities for transforming pain and suffering, by joining Dr Shiller’s email community here: drshillerupdates.com Dr Shiller gives regular free mind-body training sessions on zoom. You can get the schedule and register at www.mindbodygroove.comRelated Posts:
- How to unlearn the mind-body patterns that create chronic pain and illness.
- Why Does Chronic Pain Happen? Empower Your Healing.
- Life-changing stuff most doctors don’t tell you about fibromyalgia, chronic pain, and chronic illness.
- LDN can be great. But here’s why it is not a miracle cure for pain, fatigue, and fibromyalgia.