Agency is the sense, the perception, that you have some control or influence over what’s happening. I spent a big chunk of the first half of my life as an endurance athlete. I chose suffering most days. It even became part of my identity. As a result, I got better at it, adapted to it, and benefited from it. I was practicing pain on purpose. You might say I had a high “pain tolerance” in the context of sport. After a while, the pain of sport was no longer pain. It actually became pleasurable.

But as time went on, I noticed something interesting. When pain appeared that I wasn’t expecting, pain I wasn’t choosing, my ability to navigate those experiences was completely different. A herniated disc in my back, broken ankle, broken wrist, severe frostbite on my toes, road rash and contusions from bike crashes, tendon pain, muscle strains, or meniscus tweaks. While I accepted that pain was part of sport, I didn’t sign up for that type of pain on that day. So it felt somewhat out of my control. Suddenly my pain “tolerance” didn’t matter. My subconscious brain, now perceiving danger rather than safety, turned the pain up as loud as it needed to get my attention. To protect me. As a result, this type of pain stuck around, often longer than it needed to, longer than I wanted it to, because of how I related to it. Independent of whether I was actually hurt or not.

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Years ago, I overheard a guy at the rock-climbing gym talking about a major car crash he’d been recovering from. It happened 2 weeks earlier. He was the driver and was describing how he tried to avoid the crash but couldn’t. His partner was strapped in but asleep in the back seat and was startled awake by screaming, tires screeching, and the sound of crunching metal. Amazingly, the driver was already climbing again. He told his friend he really had no pain after the first week. But he shared that his partner was still really struggling and in a lot of pain. Of course I don’t know all the details of this crash, but it struck me that the driver had some control, while his partner had none. Basic pain neuroscience tells us that pain depends on context. While pain is sometimes connected to tissue damage, it tends to correlate more strongly with fear, emotion, uncertainty, and the meaning we attach to it…I wondered if this could explain, at least in part, the difference in their pain experiences. Not to mention mine.

As a young athlete, every time I had unwanted pain, I felt instant fear and frustration; I focused on it, fed it attention, freaked out at times, fought it, and tried to fix it. All the normal but harmful Fs that are pitfalls to the recovery process. I blamed it on overtraining, on bike fit, on shoes, on biomechanics, on my body not being strong or flexible enough to handle training, on damage or injury. I felt like a victim. It felt out of my control. “Why is this happening to me? Not now! This is terrible! I’ll never feel better to be able to train again!” Sound familiar? All normal reactions early in the pain cycle. But completely unhelpful to healing and recovery. The suffering that this mindset created was a whole other beast. A mindset that I learned I needed to “train” differently.

Insta @hschubiner

But was this pain really that different? Or was it simply a perceptual difference connected to my sense of agency? Maybe I already had the skills. Maybe I just needed to change my perspective. My thoughts, feelings, and behaviors about the experience.

Turns out we can desensitize our mind and body to just about anything with some intentional practice and a new mindset. Fighters adapt to the impact of punching and kicking, soccer players to kicking the ball, cold plungers to freezing water, rock climbers to tight shoes and bloody fingers, breakdancers to wild body positions and repeated hard contact with the ground, ultrarunners to hours of impact forces, and big wave surfers to intense physical thrashings and hold downs. They desensitize themselves to this type of discomfort by choosing it. Over and over again. They lean into it. Play with it. Stay curious about it. They abolish the Fs. Over time, their mind and body stop caring so much. The pain and discomfort become normal, and the danger alarm becomes much less sensitive to the things it initially reacted to. They get better at it to the point where it’s no longer a barrier. The sensitivity basically resolves.

Insta @WSL

We worry that leaning into pain we’re not choosing will result in it sticking around. But the opposite is true. When we watch sensations, like pain, with vigilance, pressure, urgency, fear, hopelessness, and a catastrophic attitude, we feed it, strengthen it, and reinforce its presence. A fear-based reaction teaches our mind and body that pain is a threat, keeping us focused on it even more. Watching it like a hawk. We believe that if we keep an eye on it, it won’t hurt us. While this is true of some threats, it’s not true with pain.

But the goal isn’t to ignore pain either. When we become aware of pain, paradoxically, the goal is to welcome it, thank it, relate to it with humor, play with it, get curious about it, detach from the need for it to go away, and allow it fully as though it’s there for us. This is agency.

Here’s what modern pain neuroscience has established about agency (the sense that you have some control or influence over what’s happening) and how it alters our symptom experience:

1. Perceived control reduces pain intensity, even without actual control. Classic experiments show that simply believing you can control a painful stimulus (a button you could press, even if you never do) lowers reported pain compared to feeling the stimulus is entirely out of your hands.

2. Uncontrollable stress produces hyperalgesia; controllable stress often doesn’t. Animal and human studies both show that the same stressor leads to greater pain sensitization when the organism has no way to influence or escape it. Controllability, not just stress exposure, determines the physiological outcome.

3. Pain self-efficacy predicts disability better than pain intensity or tissue damage. In chronic pain populations, how much someone believes they can function despite pain is one of the strongest predictors of actual disability — often outperforming imaging findings or pain scores.

4. Helplessness and catastrophizing amplify pain through attention and threat appraisal, not just emotion. Catastrophizing (a mental state closely tied to low perceived control) is associated with increased activity in attention and salience networks, effectively turning up the gain on nociceptive signals reaching consciousness.

5. Fear-avoidance creates a self-reinforcing loop that agency can interrupt. Avoidance driven by perceived lack of control leads to disuse, deconditioning, and more pain — while graded engagement (restoring a sense of “I can do this”) tends to break the cycle.

6. Active coping is linked to less central sensitization than passive coping. People who engage in active strategies (pacing, exercise, problem-solving) tend to show less amplification of pain processing over time compared to those relying on passive strategies (rest, dependence on others, waiting for relief).

7. The descending pain modulatory system (PAG, RVM) is engaged more effectively under conditions of perceived control. Control-related cortical and prefrontal signals feed into the periaqueductal gray, strengthening top-down inhibition of spinal pain signals — this is part of why placebo and expectancy effects work.

8. Placebo analgesia depends heavily on agency and expectation, and engages real neurochemistry. It’s not “just belief” — controllable, agency-linked expectation triggers measurable endogenous opioid and dopaminergic release, changing actual nociceptive transmission.

9. Locus of control (internal vs. external) predicts long-term outcomes in chronic pain. People with a more internal locus of control tend to have better functional outcomes after injury or surgery, independent of injury severity.

10. Reappraisal-based therapies (like pain reprocessing therapy - PRT, or emotional awareness & expression therapy - EAET) reduce pain partly by restoring a sense of agency over symptoms and/or emotions/feelings. Brain imaging shows reduced activity in regions associated with threat and self-referential pain processing (e.g., anterior cingulate, insula) after treatments that specifically target beliefs about control and danger, even when nothing about the underlying tissue has changed.

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A common thread here: your nervous system treats “controllable” and “uncontrollable” versions of the same input very differently. But agency isn’t just a coping style layered on top of pain — it’s an input the pain-processing system actually uses to decide how threatening a sensation feels. Luckily, the feeling of agency is driven by our PERCEPTION of control and automatic PREDICTION about how much control we actually have. You actually have agency over your feelings of agency! In terms of pain, while we may not be able to choose when and where we hurt, we always have a choice in how we respond. The relationship between perception and choice is actually one of the more interesting parts of this story.

Agency as perception: At a nervous system level, what predicts pain outcomes is the felt sense of control — what researchers call “perceived control” — not necessarily control that’s objectively verified. This is why giving someone an inert button that they believe controls the intensity of a shock lowers their pain, even though the button does nothing. The nervous system responds to a sense of control, not to a fact. In that sense, agency is a perceptual variable — something the brain constructs and feeds into its threat-appraisal system, similar to how it constructs a sense of body position, vision, or hearing. It can be manipulated, distorted, or mismatched with reality. If you’ve read any of my other stuff or follow me on Instagram, you know how I love a good illusion. If vision can be fooled, sensation can too.

Agency as choice (or at least as an act): Our perception of control is typically built from something. It’s built from actually testing our capacities, taking action, getting feedback, and updating our prediction of “can I influence this?” Graded exposure therapies (like return-to-movement programs) and pain reprocessing work partly because doing something safely and successfully changes the belief, not just because you were told to believe differently. So your perception of agency is often downstream of a choice or action, even though the perception itself is what does the physiological work of creating change.

A useful way to hold both:

• Agency-the-perception is the proximate or direct variable — it’s what the nervous system (the descending modulatory system and threat-appraisal circuits for you nerdy neuroscience types) actually responds to in real time. It’s generally automatic, subconscious, and not immediately within our control. And it has a real impact on our body AS A RESULT of our perception.

• Agency-the-choice (taking an action, making a decision, testing a limit) is often the mechanism by which that perception gets built, updated, and corrected. Just like pain can be learned through practice, it can also be unlearned. This where you have control. If you want to read an amazing new book written by my mentor and incredible human Howard Schubiner, check this out.

So you can’t always just decide to feel more agency and have it stick the way you can decide to get a drink of water. Belief that isn’t grounded in some real experience of efficacy tends to be fragile — it degrades under the first disconfirming experience, creating what we call “negativity bias”. Like when you get confident and try to run again, but flare up and walk home with your tail between your legs. Then you decide that running must no longer be possible for you anymore. Because pain and this type of learning are subconscious, “just think positive” doesn’t reliably reduce pain.

Saturday Night Live

While a shift in belief paired with a gradual return to activity often does. The latter actually generates the evidence - the awareness that your perception needs to be stable and lasting. So the leverage point of reclaiming your agency is usually action and feedback, not belief adjustment alone. Of course, the belief that pain is not due to damage and that pain can change is important. But the perception follows from real, even if small, tests of capability more reliably than it follows from willpower.

Here are 12 ways you can reclaim your agency as part of pain recovery:

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Your homunculus is a human-like representation of your body that resides, naked and in full repose, in your brain. Laid across your brain’s cortex, deconstructed and yet thoughtfully organized, allowing mind and body to stay connected in the interest of movement.

Encylopedia Brittanica

Basically, this homuncular part of the brain represents how your brain sees your body. I describe it functioning like a call-and-response center. Information travels up the spinal cord from the tissues (call), where it’s quickly interpreted by the brain, leading to an output (response) creating an action in the body.

Britannica

Above is an artist's rendering of how the brain sees the body based on how much brain space is dedicated to each part. Notice how the eyes, tongue, ears, hands, feet, and other parts that need more fine motor control, or which are more sensitive, are larger. and take up more brain space. While body parts that need less sensory attention, like the arms, legs, and torso, are relatively smaller. The other image shows how the body is laid out across the cortex in pieces that are not necessarily connected. Notice how the toes are near the genitals, which is one reason foot fetishes make complete sense.

The pink (sensory) homunculus receives raw information from the body and connects it to deeper brain areas for processing. Once those deeper brain areas make sense of the information based on its programming, informed by past experience and future prediction, the purple (motor) homunculus sends signals back to the body to direct movement. That’s an incredible amount of data crunching in a short period of time. But this allows you to adapt your movement to your environment, a bit like a chameleon, based on myriad mind-and-body predictions. For instance, if you step on something sharp, your body might quickly adapt to avoid the object or unweight the foot to prevent further damage.

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Some Key Actions and Functions Of The Homonculus

• Voluntary Movement Initiation: It sends signals for precise, intentional movements of muscles.

• High-Precision Control: The hands, fingers, lips, and tongue occupy large areas of the brain, reflecting their capacity for complex, fine-motor tasks.

• Fine Motor Coordination: It manages detailed movements of areas that require it to coordinate larger muscle groups that stabilize and support these fine and highly accurate movements.

• Action Integration (Recent Research): Updated models suggest areas of the motor cortex also link to cognitive planning, goal-driven actions, and coordination between multiple body parts, rather than just isolated muscle control.

The homunculus matters because it relies on frequent, diverse, strong, and accurate information from the environment to stay clear about how best to navigate the world. So you can stay clear on where you end and where the world begins. What’s fascinating about this brain area is that it’s always changing depending on what you’re up to. Move, exercise, and interact with the world, and clarity improves. Sit still to watch a movie or read, and activity degrades. Recent studies show that after only a few minutes of inactivity, the homunculus starts to lose clarity, becoming “smudged”. Blurry and out of focus.

Sitting at your desk, driving in the car, watching TV, eating a meal, and even sleeping start to change your brain’s relationship with your body. I call this phenomenon “sleep mode,” where a period of inactivity temporarily deactivates parts of the homunculus that aren’t needed. This is normal and healthy and is a way for the brain to save energy and prioritize other functions. Smudging is why we feel stiff and even hurt when we first get up from a chair, out of the car, or out of bed in the morning. It’s not because you’re getting old. My 18-year-old son and I both struggle to get moving after a 3-hour drive to the ski hill. The brain is like, “Whoa, whoa, slow it down, cowboy. Give me a second to reconnect”. One reason a short warm-up can improve the quality of your workout is that repetition and practice improve the quality of your movement.

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So if this transitory clarity of the homunculus is normal, what’s the problem with chronic pain?

Wait there’s more! Please become a paid subscriber to read on…

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My GoPro captured this turtle in Maui coming up for air.

I wanted to share a few exciting changes coming to my ecosystem in 2026. My goal is to expand my reach and improve your access to me and the emerging information that I enjoy sharing with you.

• My course, “Unlearning Pain For Athletes,” is going to change from a fixed cohort model with a fixed time frame to an ongoing program with rolling admission. Importantly, I believe that we learn and recover best in community. Because the recovery process is often non-linear, emergent, and different for each person, I want this program to unfold in a way that meets the needs of each participant. This also means the course cost will be overall lower and more consistent with the level of support and engagement you choose. Please reach out to me directly if you’re interested in learning more.

  

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• I’m simultaneously working on building a virtual community to better support you, your friends, and your family beyond my clinical practice. I have so much content to share, and it’s challenging to do this when I only see clients one-on-one periodically. I’m looking to host a weekly short talk on a topic followed by an “ask me anything” session. I’ll curate a library of information and resources for you to access freely. I plan to collaborate with and host other clinicians from my amazing network of mentors and experts. Essentially, you’ll be connected to helpful, current information and resources on pain, injury, fitness, and personal growth as you need them. Look for more details in the coming months.

• If you’ve worked with me, you know that I’m no longer a traditional physiotherapist. Because the work we do is so powerful and effective, my clinical practice has evolved into a more consultative model than a traditional clinic. It tends to be a short course of therapy relative to other modalities. I used to think it was my job to “fix” my clients, but I’ve learned this isn’t how it works. Instead, I aim to empower you to self-heal. Skills you carry forward into your life. The dependency model of clinical practice has many downsides, and I’m working to change it. My role is to partner with you to learn about your experience, work with you to make important connections between the symptoms and your life, share solid information, and support you with the clinical tools you need to recover from injury, trust your body, and change your own nervous system. Your mind and body. My clinical rates will increase to better align with the value I offer both in session and between sessions. And to be clear, staying in touch between sessions is maybe as important as the time we spend together in session. So I plan to continue to offer this to you. Look for these changes reflected on my booking page now. The cost for an initial 90 minute session is $500 USD and 60 minute follow up sessions are $300 USD. The increase will take effect on March 1st.

• As I expand my teaching and mentoring work to scale what I do beyond me, the clinical consultation group I host every Wednesday is growing. Clinicians from all disciplines, and from all over the world, gather weekly to review new research, discuss challenging cases, share ideas & resources, practice clinical skills, collaborate on projects, and support one another. Aside from seeing you in my clinical practice, this has become one of the most rewarding and meaningful parts of my work. When we put our heads together, we all continue to learn and improve in how we support people recovering from chronic symptoms. I’m currently working to create a directory of clinicians I’ve trained and with whom I work closely.

  

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• Lin Health is a digital chronic symptoms recovery platform that is also scaling the work I do, making it more accessible. My work with Lin is expanding as I continue to mentor their incredible & fast-growing coaching team. A new round of funding has validated what we’re doing and enabled us to improve the content and make the service more robust. Lin has partnered with some of the best physicians and hospitals in the country, including Mayo and WellSpan. Insurance coverage is expanding, making these clinical tools more accessible to the 1 in 4 people currently living with chronic symptoms. Please check it out and share it with your friends and family who might need support.

  

• If you don’t already follow me on Instagram @charliemerrill, I hope you will. I’m going to continue creating novel content on chronic symptoms, movement, and personal growth to inspire you, support you, and have some fun in the process.

Thanks again for being a part of my community and this movement to paradigm shift health, wellness, and acute and chronic symptom care. In a time of global uncertainty and change, I hope you find our connection a remedy to the challenges we all face. I look forward to connecting with you in new ways going forward. Please reach out anytime if you have questions or want guidance. I look forward to hearing from you. Wishing you and your family all the best as you navigate the inevitable ups and downs of the year ahead.

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Around the time I turned 40, I woke up. I, like many around this time, awoke to the fact that I’d been living on autopilot. Doing all the “things” we do as we move through our 20s and through our 30s, but often without a clear awareness of why. Carl Jung viewed the first half of life as a period of ego development, focused outward on building identity, career, relationships, achievement, and social standing, essentially preparing for some uncertain future. He wrote that the first half of life is about external achievement, acquiring possessions, and adapting to the world, forming a strong “false self” or ego structure. Then, Jung said, the second half involves turning inward for individuation, reconnecting with “true self”, and finding deeper meaning and purpose. I’ve heard others say the first half of life is about discovering there’s a book to write, while the second half is about writing the book. As I tell my clients who struggle with physical and/or existential pain at this phase of life, “you’re right where you’re meant to be”. I was right on time to start moving out of stoic Viking athlete mode.

As I began to take stock of how I arrived at this point, it became clear that many of my thoughts, behaviors, and feelings were automatic and habitual. A result of early conditioning. A byproduct of the reality that we all adapt by subverting parts of our true selves to navigate early life. We turn some parts of ourselves up, others down, and still others are cast out as absolutely not helpful. While we’re born with certain personality traits, those most associated with survival and safety become stronger and more dominant. We become athletes to get praise from important adults. We become conscientious students to avoid consequences. We become people pleasers to avoid conflict. And many of us learn to bury our emotions to avoid hurting relationships, steadily learning that feelings aren’t welcome or safe. I became people-pleasing, conscientious, caretaking of others (often at my own expense), achieving, perfectionistic, and quite hard on myself. Behaviors that actually lead to great success in life. But at times, this comes at the cost of feeling disconnected from our true nature.

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Some call this awakening, a new awareness of one’s early conditioning, a midlife crisis; I called it a midlife opportunity. I made massive changes in my life. Started my own business, separated from my 20-year relationship with my then-wife and mother of my 2 amazing kids, stopped racing bikes (physically competing at all), ended friendships that needed ending, and shed parts of me that were no longer serving. I started taking stock of my personality traits to see how, while they were all important and valuable, they were overbearing and needed to be toned down. And I did all of this with a newfound clarity, accompanied by a potent mix of fear, uncertainty, relief, and liberation.

My therapist at the time was instrumental in supporting me through this massive shift. At one point, he wanted me to express anger toward my partner. I resisted saying something like “I just don’t see the value in doing that at this point, the relationship is no longer viable, and I want to have a mature and respectful ending”. I’d never developed a healthy relationship with anger. I had a lot of it inside of me, but didn’t recognize it and wanted to avoid hurting myself or others. It wasn’t welcome in my family, and I saw firsthand how its public expression wasn’t attractive or helpful. So I held it in. But anger doesn’t go away. It hurts us from the inside out and inevitably comes out sideways when we try to bury it. I was hurting. It was hurting those around me, too, and I knew it was time for a change. Little did I know, a few years later I’d be supporting others in doing the same.

Uncle Hank and Luanne on emotions. Credit: “King Of The Hill”

About this time, the term “emotional intelligence” swept into my consciousness. I was in a new relationship and was starting to recognize that, if anything was going to be different this time, MY relationship with emotions needed some attention. I owed it to myself, as well as everyone in my life, to gain some skills around the nature of human emotion. This mission perfectly paralleled the shift in my career as I recognized how modern pain neuroscience was transforming how we treat pain and injury. Turns out, pain is essentially an expression of emotion, be it fear, anger, sadness, grief, or uncertainty. This is one reason why we call them “feelings”. Because we literally feel our emotions in our bodies. Try it for yourself. The next time something emotional or stressful happens, take a second to notice where you “feel” it in your body.

I devoured academic books like “How Emotions Are Made” by Lisa Feldman Barrett and “Emotional Intelligence” by Daniel Goleman. I was fortunate to connect with mentors, including Alan Gordon and Dr Howard Schubiner, who were doing research and developing clinical strategies to support chronic symptom recovery by working with fear and other emotions. And my now wife, who is a clinical psychologist, was a big advocate and supported me on this path for many reasons, professional, personal, and existential. Of course, “knowing is not doing”, and I’m still very much a work in progress. But I’m consistently blown away by how important emotions are in my life today when I make space for them.

The reality is that most of us grew up without much emotional support. While our parents were doing the best they could, healthy emotional skills weren’t modeled for them, and in turn, they were rarely modeled for us. Even if our parents “loved” us and were physically present, healthy emotionality may not have been on the menu. We either learned that emotions weren’t welcome or were actually unhelpful and so should be buried. Or we saw emotions expressed openly in unhelpful and even destructive ways. Again, unhelpful. Or both! Regardless, this encumbered version of emotional processing and expression became the “conditioning” we carried forward into our careers, our relationships, our sports, and our lives.

Before this gets too long, what I want YOU to know is that your emotions matter. There are no good or bad emotions. They are diverse, varied, and meaningful. All emotions belong. Feelings ARE NOT dangerous, despite what we’ve been taught. While we don’t want our feelings driving, we also don’t want them in the trunk. Emotions we don’t understand don’t always guide us in the best direction, which can lead to challenging thoughts, feelings, behaviors, and outcomes. So the goal is to develop a healthy relationship with feelings to find a balance where we can welcome them and allow them to inform our lives, connecting us with our deep knowing. To allow them to flow through us and “feel” them in our bodies without judgment, stories, or resistance. This is what will enable them to pass quickly and, in turn, liberate us into an incredible sense of agency, intuition, freedom, and joy.

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Many of us worry that if we get angry, we’ll stay angry. We’ll get hurt or hurt someone else. That once we open Pandora’s box, we won’t be able to control what happens next. But when you know how to work with emotions to express and release them privately and with skillful direction, emotions universally transform into information that points us toward growth in our lives. While I would never judge anyone’s life decisions based on their emotions as right or wrong, the more you understand your feelings, the more you’ll make decisions that are aligned with your values and your true self.

Since my experience with my therapist, anger is my favorite emotion to work with because it’s the most intense, powerful, and protective emotion. Much like pain, it’s meant to set boundaries and keep us safe. As such, anger is often the emotion most connected to the experience of pain. In fact, a lot of pain starts during stressful life events where anger is present. I’ll often ask people to list stressful or painful life events that are still remembered and associated with a strong sense of anger. These memories frequently connect to the onset and/or persistence of symptoms. They stay salient not because of what happened, but rather because of how they’re remembered. That anger couldn’t be fully expressed and so got stuck in the body as potential energy, remaining dormant. Even if we’re not aware that we’re angry, the nervous system can still react subconsciously, expressing those feelings as physical sensations like pain.

Nummenmaa et al 2014 - Crowd sourced body maps of somatic emotional representation

So my goal as a clinician is to share the skill of working through anger in healthy ways. To express and release it. In doing so, we’re able to connect with and express other related emotions like sadness, guilt, and grief. This leads to forgiveness and compassion, as well as lessons learned and a new clarity about how to proceed. Once you learn how to do this privately and direct it toward the memory that created those emotions, you’ll see how liberating and effective the experience can be. You’ll feel lighter and more relaxed with less tension in your body. Then you can carry the skill forward into other life stresses and challenging experiences as they arise in real time. You can do this to keep emotions from needing to come out through your body as pain or other symptoms. Here’s a recent example of how I did this after a tough interaction at the grocery store.

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Because of my experience through my midlife “opportunity” and as a mind/body clinician, I’m a fierce advocate for people learning to understand and master their emotions. I don’t believe feelings should be gate-kept, where only a therapist can help you, because we all have feelings and they’re happening all the time. It’s our right and our responsibility to own and master our emotions. Now, of course, there will be times when you feel overwhelmed, and you need some support. But the more you understand and have strategies to navigate feelings, the more you’ll be autonomous in your life. And, the more effective therapy will be. One of the most basic and essential skills you can develop with your emotions is to welcome them, allow them, label them, name them, and then notice where you feel them in your body. Simply allowing whatever is happening to happen until it passes. While this is simple, it is not easy. It also requires what I call an “emotional vocabulary”. Print this and keep it handy during your day to see how varied your emotions are, how often they change, and how they affect the way your body feels.

As you start developing this new skill, I’d like to offer you a recent recording of a “Time Traveler” exercise, where I guide you through a visualization to go back and change a hard memory. To ALLOW the big emotions that never got to be fully expressed at the time. To finish expressing those stuck feelings, so you can let them go. To learn something in the process. And because we can’t change what happened, to have the memory of the event without the conscious or subconscious emotion that drives unhelpful thoughts, feelings, and behaviors. Including pain. We can’t change the past, but we can change our memory of the past. Rather than remembering feeling fearful or powerless, the goal is to script a new memory where you have agency. Where you’re powerful and in control. Think of it like a time machine where you can go back and support your younger self in righting a wrong, saying and doing what was needed, meeting your own needs, and in doing so caring for yourself.

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Singapore - 2015 - 42 years old

Recognizing that I needed support as I navigated what I called my “mid-life opportunity”, I sought out a skilled therapist to help me navigate this big life change. As we talked about my childhood, I remember vividly telling him it was great and mostly uneventful until I was 17 and my parents divorced. I can only imagine his internal reaction as I tried to essentially bypass my entire childhood…as though it was all roses and no thorns. Understanding psychology far more intimately now, it’s almost embarrassing to reflect on my naivety. While I had a relatively healthy and safe childhood, as we unpacked all the beautiful AND challenging things, I started to see my inherited and conditioned personality traits more clearly. How those personality traits served me in essential ways, and how they did not.

Me. Naturally Joyful at Age 5

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This led to an illuminating journey of self-awareness that I am 100% still very much engaged in. Part of this journey has been learning about my anger. I was the “easy” kid, the “golden child”, the one who mostly went along with things and never really got into trouble (despite quietly rebelling and consistently testing boundaries in my way). I’ll spare you the details of my family dynamic, but suffice it to say that, like was the case for most of us, anger was not an emotion that was particularly welcome in my family. I made a habit of repressing it, theoretically, to protect myself and others. So when my therapist started to encourage me to express anger about some of the hard things that happened to me through the first 40 years of my life, I wasn’t “feeling it”.

An Anger Fueled Pikes Peak Marathon, 2000

First, I tried to bypass by trying to convince him that I wasn’t angry. Next, I tried to bargain, trying to argue that expressing anger didn’t feel helpful. Essentially, I was trying to protect myself from the depth of the anger and rage inside of me. Subconsciously, I knew it was there, but I worried about the consequences of opening Pandora’s box. He supported me in moving through this, but I’d give myself a C grade in terms of how well I expressed my anger in those sessions.

As I moved through my 40s, these skills allowed me to navigate better the massive life changes that punctuated my 4th decade. Through this new awareness, I saw my life and myself more clearly, informing a new and more intentional direction. I was more consistently tuning into my intuition. However, anger remained an emotion that I mostly subverted and kept buried in an attempt to protect other people, as well as myself. Luckily, anger is like an inflatable ball that we’re trying to hold underwater. At some point, it’s going to surface. While I still didn’t see anger as a gift at this point, I knew it was important.

Around this time, in parallel with the emergence of modern pain science, I was starting to appreciate the role of psychology in chronic symptoms. It was becoming clear that anger was one of the most important drivers of these symptoms. Dr John Sarno, MD, wrote extensively in the 1990s about how anger and rage connect to pain. His books helped me recover from an episode of back pain in my early 20s. While I understood the role of anger and rage intellectually at that point, I wasn’t yet emotionally intelligent enough to know what to do with those feelings.

All The Rage: Dr John Sarno Documentary

Fast-forward a few decades. Gradually, and with cautious curiosity, I began to explore anger’s nature and value. I started to understand that it was hurting me and others to keep it inside.

We say “sadness connects” and “anger protects”.

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Because I still wasn’t engaging with my anger in healthy ways, it offered no protection, quite the opposite. My encumbered relationship with anger was blocking me from being my authentic self, from showing up fully in my work, my relationships, and my life. So, I decided to accept and acknowledge that anger and rage were an essential part of me and that I could no longer ignore them.

Today, anger is my favorite emotion because I see how it protects me and, paradoxically, leads to massive joy and connection on the other side. Hardly a day goes by that I don’t talk about anger and rage with my clients. Once a month, I’ll work with a client who ( like I used to) declares that they don’t have anger, as if one can opt out of an entire emotion. But I have massive compassion and empathy for people who feel this way. “Anger” makes up most of the word “Danger,” after all.

We try to bypass anger in endless ways, keeping it buried as deep as possible, where it can do no harm. We use humor to cover it up, try to exercise it away, F#ck it away, drink it away, or work it away. We stay sad or depressed instead, we misbehave, or it comes out sideways as coldness, shortness, or passive aggressiveness in our relationships. When it gets too big to hold, it explodes, and we tend to express it publicly in ways that don’t serve us or others, often doing significant harm.

All of these strategies have one thing in common. They do nothing to relieve the emotion. Nothing that allows us to release and learn from it. For instance, trying to exercise anger away abstractly, without understanding why we’re angry, is a lot like masturbation. It helps in the short term, but doesn’t move us toward love and connection with others. So, how can we overcome our resistance and learn healthy anger expression?

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The first thing to know is that healthy anger expression is best done privately and explicitly directed at the person, people, situation, or target to which it is connected. Anger is best expressed by yourself and for yourself. Find a place where you can be alone, where no one will see or hear your anger. Through expressive writing, visualization, and/or movement, the goal is to let it express as fully as possible, saying and doing whatever the anger needs to do. While anger and rage can be wildly intense, they don’t tend to last long once we allow them to express fully. While repressing, or, conversely, publicly and abstractly expressing anger, leads to it sticking around indefinitely, my experience is that anger lasts less than 5 minutes once we allow it. You must call up the specific memory the anger is attached to and direct it at the intended target. While anger can be expressed somatically through the body, it’s difficult to “feel” and release it if it’s aimed abstractly.

Before you start to know your anger, I want you to understand that it’s not the end game. Anger is merely a checkpoint on the way to other, more productive feelings—emotions like compassion, forgiveness, and love. Buddhists also describe anger as the “clear mirror” guiding us toward lessons learned and clarity of action. Anger doesn’t last long, but the benefits of this powerful emotion are far-reaching and long-lasting. Here is a visual illustrating how I guide people through anger while recovering from chronic symptoms.

Time Traveler Process Starting with The Hurtful Experience/Memory

I call this the “Time Traveler” visualization, and it’s a powerful way to practice anger expression and to see that it transforms into other, more productive things. You can use the Time Traveler visualization exercise to rescript a hard memory and express and release the emotions connected to that memory in the process. Because our memories degrade, are inaccurate, and only survive through the emotions they create, we can rescript them to change them. This allows us to express the feelings associated with those memories while using them for growth.

Journaling is another powerful way to confront anger and express it privately. Consider free writing about anger for 10-15 minutes to get it out of you and onto the page. Write continuously about your feelings. Don’t edit or overthink. You don’t need to be able to read it or need to share it. Just get it out of you. Burn or trash it when you’re done.

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You can also add movement to visualization or as part of writing to make the expression of anger more “somatic” or body-based. I can support you with this process in the clinic if you’d like to add it to your gym program or movement practice in more productive ways. Movement is a powerful way to mobilize anger through you and ultimately out of you. But, most of us exercise to burn off anger without knowing why we’re angry, much less who or what we’re angry at. This reinforces anger rather than releasing and transforming it. It’s like practicing it reinforcing it’s presence. The goal is not to get stuck there.

Here’s a simple example of how I expressed my anger after a challenging grocery store interaction a few weeks ago.

Again, anger needn’t take a long time. However, the results benefit you and everyone around you and can last a lifetime. I’m consistently working on my anger expression skills to have more compassion for myself and others. I hope you’ll find it generative. And, while emotional awareness and expression aren’t always needed to overcome chronic symptoms, they’re legit the fastest way to interrupt patterns of thought, behavior, and feeling, resulting in significant change. If you’d like to learn more about how emotions and pain connect, please reach out and let me support you in learning this vital life skill.

I’m in the process of updating my recorded and guided Time Traveler visualization. Paid subscribers will receive a copy for their personal use in the next few weeks. This will allow you to work through hard memories, past and present, as I’ve described above, to grow and learn from them rather than let them hold you back. Please sign up for a paid subscription today to gain access to my new guided visualization. Or come see me as a client, and let’s talk about the role of anger in your symptoms, and in your life.

May you effortlessly convert your anger into love and wisdom. Be well, everyone.

This, my friends, is called SPECIFIC (or structural) low back pain. It’s specific because there was an obvious cause, a smoking gun, clear tissue damage that explained why I hurt and included all the symptoms to match. According to the research, I was lucky enough (insert sarcastic tone here) to be one of the 1% of people who have an actual structural cause for their back pain. The other 99% of people who suffer from back symptoms that DO NOT have an obvious cause have what we call NON-SPECIFIC low back pain. While you might think this majority are the lucky ones, non-specific low back actually tends to cause more problems than its rarer structural variant. When we know there’s an “injury” informing the brain’s decision to create the experience of back pain, then there’s something clear we can treat. Non-specific low back pain, on the other hand, often hurts more, sticks around longer, comes and goes more frequently, results in more disability, and costs society way more to treat. Why is this? Because we’re treating the 99% like they’re the 1%.

The New York Times loves to talk about pain. Sometimes, they get it right; often, they don’t. Last month, they wrote a piece called “What Works for Low Back Pain? Not Much, a New Study Says“.

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In it, they discussed the results of a systematic review of the 50 most common treatments for non-specific low back pain. The authors concluded that 90% of these interventions showed no evidence that they were effective. The other 10% showed little to no evidence that they had any ability to relieve pain. We’re talking about how, at best, people’s lower back pain decreased from a 7/10 to a 6.3/10. Not the kind of relief most people are hoping for. The study included surgery, injections, medication, manual therapies, core stability, stretching, yoga, pilates, massage, bracing, heat, ice, etc. The winner as the most effective treatment among these was….drum roll…. Advil! Y’all, what the fuck is wrong with us that we’re still leaning on treatments for back pain that are completely ineffective. While I hated this article because reading it felt like a waste time of everyone’s time stating the obvious and looking at the wrong problem…

…the author is unknowingly making an important point. None of these things work for non-specific low back pain because it’s not a body problem. It’s not an “issue with tissues.” The fact that we can’t find anything structurally wrong with the body, despite very real pain, should be our first clue. Yes, we find mechanical changes like muscle tension, transitory weakness here and there, altered movement, little asymmetries, fascial changes, and other things. While some clinicians make up stories about these things being important, they almost never add up to a pattern that explains why people hurt. The physical changes we see in 99% of back pain are a RESULT of the brain being in a state of danger alarm, not the cause of pain. They are incidental and normative findings that clear up as we address the underlying causes, like fear and other feelings. Said more simply, non-specific low back pain is solidly the result of the brain and nervous system in the absence of a structural problem.

My beef with this article was not that it was factually wrong. Most of the interventions that are commonly used to treat back pain ARE truly ineffective. I revolted more at the assertion that non-specific low back pain is somehow still a mystery. IT IS NOT. We have all the science and clinical strategies to support people in unlearning acute, chronic/persistent (ongoing), and recurrent (coming and going) back pain. But articles like this fail to share this truth, unintentionally leaving people more hopeless and fearful. And fear is what drives pain. I want you all to know (and please let everyone you know know) that:

1. All of the body-based/biomedical interventions this article mentioned work no better than placebo. In fact, when they work, it’s mostly due to placebo. And when they don’t work or make pain worse, it’s mostly due to nocebo. The nocebo effect describes the phenomenon where negative expectations or beliefs about treatments or interventions lead to undesirable outcomes or side effects, even if the treatment is inactive or harmless. Often simply because we’re concerned that the thing that is meant to help is not helping. But worse because the ill-informed things we hear from well-meaning providers themselves create more worry.

2. Most non-specific low back pain gets better when we DON’T treat it, don’t get MRIs, don’t do surgery or injections, don’t go to PT and chiropractic, don’t do core stability, and simply let it resolve on its own. Doing nothing and riding it out actually performs better than most traditional treatments.

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Here are some other evidence-based “fun facts” about non-specific low back pain:

1. It’s the worst kind of back pain, commonly starting suddenly with severe 10/10 intensity.

2. It can be totally disabling, leaving even the toughest people unable to move and terrified. It turns out our brains don’t care about our pain tolerance and can turn symptoms up as high as they need to match our “toughness.” Remember, the pain we choose (intervals on the bike, for instance) differs from the pain we don’t choose (back pain that feels out of our control).

3. MRI scans reveal changes because we all have changes in our spine. But these are mostly normal and rarely correlate with non-specific low back symptoms. This study looking at 3300 pain free people is a favorite example of things like arthritis and degenerative change are normal after 20.

   

4. It’s often characterized by intense lower back pain, muscle spasms, glute pain, and sometimes leg symptoms that are vague, move around, or show up in parts of the leg that don’t match a structural cause.

5. It often starts out of nowhere but can be triggered by some benign physical activity or AFTER a physical activity that people fear might have hurt them.

6. It almost always starts around a time of discrete intense stress, during ongoing chronic life stress, by feelings of overwhelm, or by some other “psychological or social injury”.

7. It’s quickly amplified by fear of the pain itself, on top of fear of other things like politics, relationships, life changes, finances, etc.

8. Strong athletes and people with strong cores are not immune to non-specific low back pain. In fact, core stability and strengthening have no impact on non-specific back pain. There is no correlation. While it helps with performance and aesthetics (who doesn’t want ripped abs), it’s ineffective for back pain.

9. It can come and go at regular intervals or randomly, often with no clear physical trigger.

10. Benign movements and activities like picking up a light object, putting on shoes or pants, getting out of bed, cleaning the house, routine gym workouts, and other silly things can trigger a flare-up of the most intense back pain. These things don’t actually create injury but rather trigger the brain into a state of danger alarm for various reasons.

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Please text your story or testimonial to me at 303.717.8351 or email it to me at charlie@Mperformance.com. Thank you!

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Exercise and movement have always been a part of my life. I learned sports from my parents and family, who modeled & normalized being active for me from a young age. Overall, I feel fortunate to have grown up in an environment where sports molded me into who I am. Not everyone grows up in that kind of movement-positive environment. However, I didn’t always have the cleanest intentions and went through phases where I wasn’t participating in healthy ways. While I might have been fit and fast, I wasn’t necessarily physically or psychologically healthy, nor were my relationships. Like any ‘healthy” behavior, it can become unhealthy if we don’t approach it with the right intention. Note the contrast in the following image between 5-year-old me in the park and 25-year-old me running the Pikes Peak Marathon.

When I was young, movement was mostly playful, joyful, fun, socially connecting, exploratory, and often without purpose. But somewhere along the way, I, like many of us, lost that youthful intention, and exercise became serious, intense, painful, tainted by self-loathing, pressure-filled, a prerequisite, exploitative, routine, and it started to feel like work. Young Charlie is clearly engaging in movement with a loving intention while older Charlie is, well, doing something else. Check out this Instagram parody poking fun at why many endurance athletes choose to train.

As my relationship with exercise and movement has changed over the course of my life, I’ve become aware of the importance of intention. At times I wondered if I could be fit and fast and simultaneously truly enjoy myself. To engage in a way that’s aligned with my values where I welcome the challenge of skill acquisition, growth, and improvement. But without all the encumbered mindset that we often believe we need to achieve big things. At times, I believed that pressure, urgency, and self-criticism were necessary ingredients to becoming good at anything. Was there a way to get good at something and enjoy the process so much that it was mostly a joy to do the work? Was it possible to set up my relationship with sport and exercise so I mostly WANTED to do it instead of HAVING to do it? I’ve come to the conclusion that I might have been approaching many things in my life backward all along.

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I was recently inspired while playing frisbee with a former professional triathlete friend who was just learning to throw. Ryan is an incredibly talented athlete overall and has raced all over the world. He joined my son and me on a beautiful day at a local turf field. My son is an excellent teacher and showed Ryan the basics. As often happens when one first learns to throw a frisbee, it’s initially awkward, and the frisbee flies more sideways than flat and ends up on the ground more than in the air. But I noticed that, as Ryan navigated the pre-requisite struggle phase of learning a new skill, he was having a lot of fun. He was laughing and joyful as he wrestled with the task. I noticed he was kind to himself rather than getting frustrated and beating himself up. He had a certain patience with the process and with himself that struck me. He wasn’t hung up on the goal or the outcome but seemed just to be playing with it. Within 15 minutes, Ryan was mostly throwing and catching really well. And by the end of the hour, he was already quite skilled and finding some flow. We talked about his approach afterward, and he shared how this mindset and intention served him during his career. My observation was that he learned more quickly as a byproduct of an intention fueled by patience, self-compassion, fun, and play. From that point, I set out to change the way I approach exercise and movement.

To paint a clear picture of how dichotomously an athlete’s mindset can look, here is how mine has shifted over the last 25 years

For 25-year-old Charlie, exercise, training, and racing were about:

• Proving worth

• Trying to find happiness in outcomes

• Comparing myself to others

• Doing things because I should and because I have to.

• Disconnection from my feelings & my true nature

• Pressure, urgency, and self-criticism

• Bolstering low self-esteem

• Trying to feel like enough

• Physical suffering to reduce the intensity of emotions

• Coping abstractly with life’s stresses

• Escaping life’s challenges

• Gear and keeping up with the latest and greatest

For 50-year-old Charlie, movement, and exercise is now about:

• Enjoying and reinforcing a strong sense of self

• True enjoyment of the process

• Connecting with others

• Doing things because I truly want to and choose to

• Permission to opt out of things that I’m not excited about

• Approaching exercise and movement with a sense of fun, play, & joy

• Listening to my intuition about what I need on a given day

• Starting from a place of “I’m enough” regardless of how it goes

• Physical discomfort on my terms and as a path to build resilience in life

• A mindfulness practice

• A way to work through emotions directly and privately

• Idea generation and creativity

• A process that leads to finding physical and psychological flow

• Curiosity about new places and experiences

• An enjoyment of, and gratitude for, my physical body

• Ok, I still love gear, but I can’t be perfect :)

Now, I realize I’m painting an intense picture of my old mindset and intention. Note that I didn’t do all of these things at once. Nor were they explicit but rather subtle and insidious. They existed as subconscious, automatic, habitual thoughts, feelings, and behaviors under the surface. Most of them had been conditioned from a young age by important people and experiences in my life. It took work and energy to become aware of and shift my mindset. It was uncomfortable and literally felt like a death at times. Letting go of my old self felt like a threat to everything I knew and loved. I feared I’d ruined those activities for myself as a consequence of past hard memories and experiences. It was a paradox of knowing I wasn’t engaging in healthy ways, but I worried it was the only way I knew how to do it.

But I realized that it wasn’t the exercise, movement, training, or racing itself that was the problem. It was my mindset and intention. Once that changed, everything changed. I saw through the illusion that I’d created in my 20s, 30s, and 40s that exercise was something I HAD to do. As I let go of this old mindset, my fitness in my 50s is the best it’s ever been. Both physically and psychologically. So many of my clients lament getting old and the impact it has on their athleticism. Weight gain, loss of muscle mass, fear of injury, avoidance of activities, loss of motivation, etc. While I’ll acknowledge that I’m fortunate to have grown up the way I did and that I have some inherent athletic genetics, my experience after working with thousands of older athletes is that age has little to do with athletic longevity. Longevity is a byproduct of the consistency that comes from doing things for healthy reasons that align with your values. And the reality is that this is a moving target that’s meant to change over time. If you’d like to explore your relationship with exercise and movement in your life and context, please reach out, and let’s connect so I can share more.

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Do I still go out and do hard things? You bet I do. Do I still set goals and challenge myself to achieve them? Of course. Do I find value in the struggle to learn new skills and get out of my comfort zone regularly? Yes and yes! In many cases, the objective behavior looks similar to the way 25-year-old Charlie used to exercise. However, my mindset and intention are radically different, leading to paradoxically different processes, experiences, and outcomes.

But how does this apply to pain? Well, I’m glad you asked. Now that you understand the importance of mindset and intention, the answer is quite simple. Approaching pain recovery from a place of pressure, urgency, self-criticism, or fear will consistently hold you back. When you understand that pain and other symptoms are a byproduct of conscious or subconscious fear rather than tissue damage, a simple inventory of your modus operandi will reveal a lot. Any thought, feeling, or behavior aimed at FIXING the body will invariably drive subconscious fear, even if the act is objectively healthy. For instance, if you go to the gym with the intention of fixing your shut-down glutes, your short hamstrings, your weak core, or your “slipped” disc, you’ll likely notice minimal change (or even get worse). Contrarily, if you approach the gym with the intention of moving in healthy ways that are joyful, fun, and preferred, you’ll likely notice everything changes. Since the glutes, hamstrings, core, and disc were not the CAUSE of your pain, to begin with, those variables take care of themselves and either resolve or stop bothering you. The brain comes out of a state of danger alarm, and the pain resolves. Whether it’s foam rolling, trigger point needling, joint manipulation, scraping, taping, cupping, acupuncture, strength training, stretching, corrective exercises, surgery, or injections, when those things help, it’s because they reduce fear, changing the brain’s perception of danger. Not because they fix anything. Again, objectively, there’s nothing wrong with any of those interventions. It’s your mindset and intention. Your belief that predicts the outcome.

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Note that this all depends on a certain amount of day-to-day awareness. When it comes to exercise and movement, your brain and nervous system are the “governor”, not your body. One client shocked herself when she found things like walking and massage flared up her neck pain, but that she could surf just fine and actually felt better afterward. She actually took a chance, during a moment of discomfort, to go surfing, not knowing how she’d tolerate it. Subconsciously, despite massage being objectively healthy for her body, it was reinforcing that something was wrong with her physically. She also felt trapped and wasn’t speaking up for herself to set boundaries around the quality of the bodywork. This created stress for her in the moment. Similarly, walking was connected to early memories of hiking and walking with her abusive father. It created stress as she automatically and subconsciously replayed hard memories each time she walked. Meanwhile, surfing was novel, joyful, and fun. There was no history with surfing, and her intention was not encumbered by the past. Objectively, surfing is not easy on the neck, upper back, and shoulders. However, her nervous system experienced surfing as a safe activity, partly due to her alternative intention and mindset. This is a great example of how you don’t know until you try and how we often surprise ourselves when we try something new. When it comes to pain, we often have to prove to ourselves that the body is safe and that the nervous system is the governor by “doing” rather than by avoiding. Once she disconnects walking from her dad, recognizing that now is not then, and creates a new experience through intention and mindset, she’ll be able to walk just fine. Once she starts to see massage as an act of loving self-care and learns to advocate for herself in the moment (asking for what she needs), bodywork will also be better tolerated.

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So stay aware of your mindset and intention around the important things in your life. They tend to run subconsciously and create stress because we’re unaware of how they impact our nervous systems. Regularly assess and inventory WHY you’re doing things, remembering that your “why’ is a moving target. Become aware of how certain activities connect to the past and why your nervous system might struggle to tolerate them. Do this to continue to enjoy and grow with the things you choose to pursue in your life. If your intention and mindset around certain activities change, stay open to abandoning things when they’re no longer serving you. Ultimately, the brain likes it when we have agency and we’re living in clear alignment with our values and true selves. If you want lifelong fitness and longevity, put your money on awareness, intention, and mindset over just about everything else.

Due to my own experience with how exercise and movement have evolved in my life, I’m passionate about supporting others in becoming aware, making connections, letting go of old stories, and adopting a healthier mindset and intention. if you’d like to discover a new relationship and have a new experience during movement and exercise, please reach out to learn how you can make these changes in your own life. I built a course specifically for athletes that starts next month (and has new cohorts starting each quarter). Please join the 12-week program and join a group of athletes in overcoming chronic pain and other symptoms. Learn more and register here:

https://charlesmerrill.podia.com/unlearning-pain-for-athletes

I think you’ll be pleasantly surprised about how this changes everything. You know where to find me when you’re ready.

For my paid subscribers, here’s a list of other evidence-based strategies you can apply to movement and exercise to get the most out of your fitness.

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So, after making a cooler of my infamous margaritas for our annual Pozole party on Christmas Eve, and drinking a few too many of them, I decided it was time to make a change (again). Sometimes an elimination helps me hit the rest button on an imbalanced behavior.

I’ve chosen to do “hard resets” on many things over time including sugar, alcohol, grain-based carbs, chocolate, and other non-food-based habits that will remain undisclosed ;). Partly because I can tell when my habits turn unhealthy; and partly because I’m fascinated with the act of behavior change. I like doing hard things and experiencing the challenge of discomfort. Is that weird? As an enneagram 7, sensation seeking (aka dopamine seeking) is a strong part of my personality. Like any personality trait, it’s one that I often appreciate very much while other times struggling to wrangle. So behavior change is a significant feature in my life and a nearly universal requirement for overcoming chronic symptoms—yet another reason I like to “study” it via personal experience.

Chronic symptoms, like pain, are a neon sign pointing toward the fact that we need to grow in some way. Something needs to change in our lives. Often something that’s no longer serving us, but to which we’ve become attached. Habitual, learned, automatic behaviors are driven by subconsciously conditioned thoughts and feelings. If we do too little of something, too much of something, or do something with an unhealthy intention, this can become a problem. Exercise habits, poor eating, porn consumption, conflict avoidance, social isolation, career stagnation, relationship dysfunction, etc. As the saying goes, “Everything in moderation, including moderation”.

To overcome chronic pain, we need to grow. To grow, we need change in the direction of becoming more of who we’re truly meant to be. Unencumbered by our conditioning and the subconscious loops of thought, feeling, and behavior that keep us trapped in a box of our own creation.

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So here we are at the start of 2025 poised to make a fresh start and jettison some of the habits that are no longer serving us. Maybe you’ve resolved to lose weight, find a better-paying job, get healthy, exercise more, eat better, or recover from chronic symptoms.

Insta @gorillamind

But as much as we’ve historically been inspired to make resolutions with the best intentions, the reality is that January 1st is not magically different from December 31st. Resolutions create a binary do/do not, pass/fail, better/worse, new/old mindset that’s a setup for the perception of failure. A recipe for a spiral of guilt and shame that creates stress as the early January motivation fades. Some of you might have already bailed a week in! Don’t worry failing fast is the best way to fail. It’s not too late to reset! According to Chat GPT, the research on resolutions shows:

• About 35-40% of people make New Year’s resolutions.

• Roughly 23% of people quit by the end of the first week. See you’re not alone ;)

• However, those who make resolutions are 10 times more likely to achieve their goals than those who don’t.

So, ultimately, New Year's resolutions can work, but they require thoughtful planning, realistic expectations, and a focus on sustainable change.

The reality is that progress in life is not linear and is NECESSARILY full of mistakes, setbacks, course corrections, and self-doubt. No one can realistically become a new person overnight. Nor should they. Change is meant to be a “process” because we learn everything through a journey of repetition; of trial and error. The board game chutes and ladders (or if you’re in the UK snakes and ladders) is my favorite metaphor for how we learn and grow.

So I want to encourage you to keep your resolution, but jettison the GOAL in favor of a thoughtful PROCESS. One that takes down the pressure and urgency. For instance, the best athletes in the world know that consistency beats intensity every time. Turns out the same mindset that leads the best athletic performances can also facilitate your recovery from chronic pain (and applies to any resolution).

A better alternative to a New Year’s resolution might be adopting one, or a few, of the following approaches. These are more flexible, intentional, individualize-able, and sustainable strategies:

1. Set a theme for the year so you have flexibility.

• Choose a word or phrase that reflects your overall vision for the year, like "growth," "balance," or "well-being." If recovering from pain is something you’d like to manifest, your word/phrase might connect thematically to the life-growth theme your physical symptoms are pointing you toward. ie: “being kinder to myself,” or “asking for help from others” or “exploring new hobbies”.

2. Establish gradually increasing quarterly goals that allow you to pivot.

• Set small, specific targets for the first quarter of the year, then reassess and set new targets for the next quarter. For instance if you’d like to establish a process for eating less sugar you might decide; “I’ll cut back on soda Q1, then processed food Q2.”

• If pain or other symptoms have affected your ability to move and be in your body, consider walking a mile each or doing 50 squats a few days/week Q1. Then increase as you’re able to do a higher volume or frequency for Q2. When it comes to returning to movement, there are no rules. So get creative and make it work for you.

3. Stack or pair new behaviors with existing habits

• Focus on integrating one small habit at a time by building on existing routines.

  ie: “After I brush my teeth, I’ll meditate or focus on my breath for one minute.” Then remove obstacles to make it easier on yourself. ie: keep your phone out of your bedroom so it’s not the first thing you reach for in the morning.

• One common pairing tactic I use in pain recovery coaching is to pair a reward or self-care with a new behavior that you find hard, or one that takes a lot of energy to do. Another is to notice when you fall into negativity. You can choose to interrupt that habit by switching to focusing on gratitude. Stacking a new habit on top of an old one to ultimately replace it helps us practice a more flexible nervous system state.

4. Use a progress journal to celebrate wins and notice change over time.

• Writing it down makes it real! It also keeps us focused on the thoughts, feelings, and behaviors that define our journey toward change. ie: “Today I had 50% less catastrophic thoughts about my pain, which reduced my anxiety and led to no doom-scrolling.”

• Recovering from symptoms is about small consistent changes over time. Those changes are hard to see. Writing them down daily spotlights the gradual and nuanced shifts that define any real and lasting behavioral change.

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5. Consider monthly challenges to keep you motivated and adaptable.

• Experiment with a new challenge each month, like practicing gratitude, avoiding sugar, learning a new skill, reacting less to fear, or being more kind to yourself.

• Shorter timeframes make it easier to stay motivated and adaptable. I find this keeps me consistent and process-focused allowing me to change tactics while maintaining a solid strategy. ie: In January I’ll learn more about pain science. Then in February, I’ll commit to somatic tracking. This will progress to learning more about my emotions in March. All 3 of these tactics support a larger strategy (a process) for overcoming chronic symptoms.

6. Reflect on your why and set intentions, intentionally.

• Setting intentions that align with your values and purpose is powerful. Focus on the why behind your intention and actions. Write them down, say them to yourself and out loud every day, then share them with someone you love and trust who might be an accountability partner.

• Recognize there are some positives to living with pain. It protects us in important ways and there can be hard consequences to recovering from pain (less attention from loved ones, having to do things you’d rather not do, etc). So get clear on all the pros (easy to do) and cons (harder to do) so you’re clear on WHY you want to feel better. This important step removes barriers that subconsciously sabotage even the best process.

7. Focus on improving “areas” and break them down into small steps.

• Identify areas of your life you’d like to improve (ie: health, relationships, creativity, mindset, mental health) and make small choices throughout the year that align with those areas. Create a short list of specific and individualized changes you can make within that area to stay process focused and remove pressure from the specific goal.

• Reflect on how symptoms are a message from your brain that something in your life needs to change. Breaking this larger theme into smaller steps will help focus your energy on doing the hard work of growing. I like the saying “Slow is smooth and smooth is fast”. If you take smaller steps, gradually you’ll start to see signs that your life is moving in a direction that feels more aligned with your values.

8. Emphasize positively framing the process.

• Resolutions framed positively (ie: "Eat more fruits and vegetables") are more effective than those framed negatively (ie: "Stop eating junk food")

• Similarly, when it comes to overcoming chronic symptoms, adding a mantra or affirmation that you’re body is safe is more productive than trying to NOT catastrophize. Focusing on spending a little bit MORE time in nature or prioritizing time with friends is more likely to stick than trying to spend LESS time isolated at home or in bed.

9. Social commitment helps. You needn’t go it alone.

• Sharing goals with friends or joining a group pursuing similar goals can increase accountability and more consistent success. While ultimately we ideally change and grow for ourselves, sometimes it takes some extrinsic motivation to kick-start the process.

• Consider sharing your intention and process with a trusted friend or family member. Let them know that you’re taking on something very challenging for you and ask if they’d be willing to support you consistently across time. Learning with you, calling regularly to check in, problem-solving barriers and setbacks, and cheering you on. Living with pain can feel very lonely. But chronic pain is triggered by relationships and so is ideally healed in relationships.

Finally, (I hinted at this earlier) maybe most importantly, self-compassion is a key ingredient. The most important relationship in life change, growth, and healing chronic symptoms is your relationship with yourself. Studies show that being kind to yourself (rather than being overly critical) leads to greater persistence and consistency. Consider how compassion might sound if you have a setback, change course, start to put pressure on yourself, feel urgent, make a “mistake”, have to “start over”, or revert to negative or black-and-white thinking. How might you counsel a young person or friend in your life who’s struggling with these things? No growth happens without struggle, so it helps to be prepared to be your best ally. This can feel really foreign to many of us and might be a nice stand-alone resolution to try this year. To learn more about this all-important life skill, check out Kristin Neff’s body or work on compassion HERE.

If you’d like more support with your process in the direction of overcoming chronic or recurrent symptoms (pain that comes and goes), and the life change pain necessitates, please join me and a small group of dedicated people looking to feel better and reclaim an active lifestyle. “Unlearning Pain For Athletes” is a 12-week course that includes a weekly lecture and a live component (that I host). As a group, we “do the work” of developing a recovery recipe that works for each individual. After 4 successful cohorts, I’ve reduced the price of this course by over 30% to make the information more accessible and to streamline the process for you. Please check out the landing page HERE for more information. I’m always available to do a discovery call to share more about the course. Text me at 303.717.8351 if you’re interested. We’ll start in mid to late February which, as you now know, is not too late to make 2025 a year of growth and healthy change.

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As always, thanks for reading to the end. Sending you and your families love and gratitude and wishing you a fantastic year ahead. We got this.

I wrote an article about pain as an illusion a few months ago and I appreciated the mix of responses I received from you all. This idea is sensitive because it can leave people feeling invalidated, suggesting their pain isn’t real. So, it’s important to acknowledge that all pain is real. Your pain is real. While pain is never “all in your head”, technically, all pain is constructed and experienced in the brain, regardless of the cause. However, SOMETIMES information from the body partly informs the brain’s decision to create pain. The first step in pain recovery is to establish clarity about the role of the body, if any, and to reduce fear. Mostly by educating people that pain is ALWAYS a brain-driven process. Also important is to trust that the body is reliably self-healing. Once people feel safe, trusting the body isn’t in danger and that the brain is the reason they hurt, then we can work to get back into the body and prove to the brain that the world is safe again. This drives change through the remarkable phenomenon of neuroplasticity and reliably leads to lasting relief. 

So, my goal is to evaluate the body thoroughly to see if there’s a clear pattern that might point to structural issues (broken bone, tumor) or mechanical issues (stiff joints, patterns of weakness, or other movement-related issues) that partially explain why someone hurts. Usually, mechanical changes are the RESULT of a nervous system in a state of danger alarm. But regardless, if body changes are present, we can treat them to offer short-term relief. I call this treating the brain from the bottom up. But these body-based issues are still only a small part of the brain’s decision to make pain. Remember, pain is also ALWAYS influenced by the psychological and social factors in one’s life. These include fear related to the pain itself but also fear related to other things going on in life. These things will amplify any structural or mechanical issues, creating a vicious cycle that often leads to pain sticking around way longer than it needs to. For many, even after the body stuff clears up, pain sticks around, becoming chronic.  

One of my readers, a psychology professor, thoughtfully commented that “just because pain CAN be brain-mediated and independent from peripheral structural issues, doesn’t mean that it IS.” He continued saying, “You also used several other examples of the brain tricking our perceptions. Again, in the case of pain, just because it CAN doesn’t mean that it IS.” He suggested that the example of my back pain client who couldn’t find his car had relief because of “a temporary stress-induced increase in circulating or central endogenous opioids which MASKED the pain generated by a structural issue.” While this was not the case for my client, it’s possible he’s right that the brain can turn pain off in an extremely stressful or survival situation. If you’re being chased by a lion and sprain your ankle, your brain will likely keep pain turned off until you get to safety.

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My clinical experience is that when there’s a real structural issue, this kind of relief tends to be very short-lived and incomplete. The brain won’t usually turn off a structural issue for long, especially if the person is doing something VERY physically strenuous and it happens to be the exact thing that normally triggers their pain day to day. However, when the relief is due to the brain in the absence of a body problem like it was in my client, relief can last days, weeks, or months, if it comes back at all. My client’s pain did not return once he found his car because he suddenly saw evidence that his body was safe. Seeing how his pain COMPLETELY disappeared during an acute stressor was a “click” moment. Evidence that sparked the start of his recovery after 20 years of suffering. 

My son races mountain bikes for Boulder High School. Last week at a race in Fruita, CO, he crashed hard heading out onto lap 2 (moments after the video below). His leg got caught under the bike, and he slammed and twisted his knee as the rider behind him crashed over him. He got up despite the knee pain and bravely rode the rest of the 30-minute lap. He said despite the adrenaline and intensity of the moment, while he could still pedal, his knee hurt, and he had sharp pain that limited his power.

When he crossed the finish line, I ran over to find him sitting on the ground crying and hyperventilating. He’d finished the race but was now in a lot of pain and his knee was locked at a 45-degree angle so he was unable to straighten it. Nor was he able to weight bear on it. The front of his knee was bleeding and he had a lot of pain over the medial side of his knee.  I put my arm around him and rubbed his back, encouraging him to slow his breathing and modeling calm, reinforcing that he was going to be ok. Despite no obvious signs that his knee was badly injured, he was very stressed and in a freeze state. I wasn’t 100% sure that his knee was structurally ok. He could have torn his ACL, his meniscus, or subluxed his joint. But I wasn’t going to assume anything until I had more evidence. I knew the fear, panic, and emotion in the moment was part of the reason he hurt so much and adding to that was not going to help. In his case, while adrenaline turned his pain down to allow him to finish, it was not enough to turn pain off for long; and his came back wicked strong the minute the race ended.

But, after about 5 minutes of soothing him and validating his experience, he began to calm down. I helped him visualize getting his knee straight again by relaxing his calf and hamstring muscles, which were in spasm. Then I asked him to contract his quad a few times to show his brain that his knee could straighten safely and with good control. Once he saw he could do this mostly pain-free I helped him stand up. With his arm over my shoulder, he limped a few steps, reluctantly bearing weight on his sore knee. Within a few steps, he saw evidence he could walk and I could feel him start to relax. He wanted to do it himself so I calmly encouraged him to try a more normal gait and see how that felt. It took him a minute but he suddenly began to walk almost normally. When I asked how he felt he said “It’s ok Pop, I think it’s just my brain”! Within 15 minutes he’d gone from severe pain, panic, and intense emotion to calm, regulated, and walking normally again. This is how fast neuroplasticity can happen when conditions are right. He had no pain the rest of the day and when I asked him how his knee felt the next morning he said “It feels totally fine”!

Hypothesis, theory, and debate aside, my empirical clinical reality is that nine out of ten of my clients fall into this category. They suffer from very real pain that’s brain-mediated with minimal or no contribution from the body. This type of pain is not only the most common, but also the most painful. Often far more painful than actual injuries. But I never start by assuming the body is ok. Nor do I rely on any one piece of evidence to make a diagnosis of primary or neuroplastic pain. No one bit of evidence stands alone. So I would never tell a client that their pain going away during a time of stress PROVED that it was simply due to their brain.  Like a good detective, I need LOADS of evidence to build that case. Otherwise, neither of us would feel safe shifting belief enough to do the brain-based work that leads to long-term recovery. 

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So let’s talk about evidence. My goal is always to make my clients more autonomous. For two important reasons, I like people to be able to look for their own evidence when something starts to hurt. 

1. If they can interrupt the symptoms earlier in the process, pain never becomes chronic and they can become their own best healers.

2. Pain is a normal part of life. The last thing I want to do when I have pain is to have to run to the doctor or physio every time. Most of you can use this knowledge to build the skills that will save you a lot of time, money, and frustration. 

If you can stay curious about your pain, most of the time you’ll see enough evidence that you can watch and wait. You’ll be able to keep fear low while you stay active and watch it pass. Here’s a list of 10 variables I inventory when I have pain, and when my clients are looking for answers for why they hurt. The more boxes you check, the more likely your pain is not structural, nor mechanical, but due to your brain and nervous system. Even if you had an injury or surgery originally, once the body heals, the brain can learn pain and it’ll stick around for months or years. Luckily, once you see the evidence, shift your belief, and engage in a new process, pain can be unlearned. 

1. Was there a clear mechanism of injury when pain started? Some physical stressor that happened with high force, high speed, and/or with some physical evidence of tissue damage. A loud pop, a moment of instability or dislocation, visible swelling or bruising, feelings of instability, consistent audible clicking or popping. Remember, the body is hard to hurt so it’s going to take more than picking something up or putting on your shoes. If you find yourself making up a story based on loose evidence, or if pain came on days after some physcial stressor, this is unlikely to be due to bodily injury. Dom (below) is an example of how durable the human body is. While he walked away from most of these fails without an injury (aside from the first one), it gives you a sense for what it takes to actually injure the body. Most people’s pain starts without a clear injury and this an important starting point in building an evidence list.

2. If there was no obvious physical cause, was there a clear life stressor that paralleled the onset of pain? Think about something stressful or overwhelming that happened the moment or the day the pain started. This connection can create a powerful a-ha moment for people offering a new explanation for and meaning about the symptoms. Alternatively, an ongoing stressor might have spiked or changed around that time. Remember, life stressors that trigger big emotions are common triggers for pain. But even more positive emotions (like life change around moving or starting a new relationship) can also create stress physiology that triggers the brain into creating pain. The brain’s job is to keep you safe and alive. It’s fully altruistic. While it doesn’t always feel like it, subconsciously, your brain is making decisions based on many bits of information based on many past experiences. So, pain doesn’t always make sense logically or consciously. But with a little investigation, pain often offers deeper meaning. 

3. How long have you been living with pain? Muscles heal in a few weeks, tendons in 6-8 weeks, ligaments in 10-12 weeks, nerves and spinal discs might take 3-6 months. Healing is reliable, predictable, fairly linear, and nearly impossible to stop. Additionally, if you sustained a real injury of had surgery, pain generally turns off long before healing is done. So pain that sticks around longer than 3-6 months is, by definition, no longer due to tissue damage. Trusting this is important and a powerful bit of evidence in the direction of the brain. That said, it still doesn’t stand alone. 

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The effects of observation get more interesting when we consider how we filter what we see through our lens of biases, assumptions, preconceptions, experiences, and other distortions. Observer bias occurs when we alter what we see or experience by selectively noticing what we expect, predicting based on what we’ve experienced, or behaving in ways that influence the outcome. Without intending to do so we may think, behave, and feel in ways that lead to specific outcomes unique to our personal reality.

Where this gets interesting for me, and hopefully you, is when it comes to the physcial sensations in our bodies; pain and other symptoms. Because you’re observing your own experience, you are equally vulnerable to observer bias making every sensation in your body subjective. This is one reason the bio-psycho-social (BPS) model of pain needs an update. If this is the first time you’re learning about this outdated model, I’m sorry you missed the last few decades. While it’s on the way out, I still find the BPS model helpful for people who struggle to embrace modern pain science. while all pain is technically constructed and experienced in the brain, the BPS model validates the role of the body in the pain experience. Skeptics will then open up to a both/and approach where the body is still considered important while leaving the door open to the psychological and social factors (which are usually the primary drivers of symptoms). The problem is this:

1. The BPS model no longer fits with current and emerging pain neuroscience which is moving swiftly toward a perception and prediction model.

2. People cue on the BIO prefix (they only hear “something is wrong with your body!”) which reinforces fear about the body being the cause of pain and does nothing to connect to the actual root cause.

3. The possibility of rapid change through neuroplasticity is reduced as people in pain and clinicians continue to feed fear and treat the wrong variables.

I’ve written about the brain’s predictive nature in the context of pain and other symptoms before. Basically the idea that your brain’s job to is to predict what’s likely to happen next in order to keep you safe and alive. Like this example of F2 driver Isack Hadjar reacting lightning fast to avoid a crash with a disabled car at the Monaco Grand Prix this year. He predicted a crash and reacted incredibly fast (not a conscious decision) to avoid it.

Prediction is essential to survival and thus helpful most of the time. But the brain’s predictive nature can also result in persistent symptoms when it learns (incorrectly) that certain activities, foods, people, situations, postures, and other factors are dangerous. As the brain wires these connections, based on perception, and makes them automatic, they continue to operate outside of conscious awareness leading to unhelpful pain biases. People find the prediction model a simple and actionable framework that allows them to quickly re-conceptualize why they have pain and effectively unlearn the pattern by changing or unlearning the prediction.

But what’s lighting me up these days is the addition of the “symptom perception model” of pain. The idea that what you feel is a product of your perception as the observer. Your pain experience is highly vulnerable to your brain’s mis-perception of sensation which is constructed based on your subjective and biased interpretation. Let me share some examples by way of asking a few questions.

Do you see with your eyes?

No, your eyes collect raw information. Then your brain interprets that information (after flipping it upside down and switching sides, by the way) based on what it expects to see. So you don’t see with your eyes, you see with your brain! Now, is your vision always accurate? Of course not. It’s massively influenced by interpretation based on your experience and expectations. For instance, you and I might see totally different people or details at a busy sporting event or in a store with lots of stuff. Illusions are a fantastic way to illustrate this point. How many black dots do you see?

Well they’re actually all white! But the black dots appear and disappear as your brain tries to reconcile the contrast. This happens with color too. The brain will create color where there is none based on what it expects to see. For instance the coca cola can in this image below looks red, right? But if you zoom in, you’ll see that the image is only black, white, and cyan. Your brain creates and fills in the color because you expect a coca cola can will be red…creating the perception of red.

Credit: Akiyoshi Kitaoka

Now, do you hear with your ears?

No, your ears collect raw information and feed it to your brain where it’s interpreted based on perception. Is your hearing always accurate? Of course not. Have you ever had an auditory hallucination where you thought you heard something that wasn’t accurate or didn’t happen at all (like someone calling your name)? Here’s an auditory illusion to illustrate the point. Listen to this audio and note which name you hear. Then play it for an assortment of friends and family members and see if they hear something different.

Most of you, after a fair survery of people, will appreciate that while the audio is objectively the same sound, it’s interpretated differently by others based on many factors.

What about other physical sensations? Do you feel with your body?

No, your body is a giant sensory organ that, like your eyes and ears, feeds information to your brain. Your tissues might modulate sensation but have no role in interpreting it. Like vision and sound, your brain has to make sense of that information based on it’s expectations, predictions, biases, past experiences, and many other factors. Have you ever felt your phone vibrating in your pocket only to discover you didn’t have your phone? Have you ever looked over your shoulder to pull out from a parking spot and felt your car moving as someone pulled into the parking spot next to you before you even started to back up? Have you ever felt like there was a bug crawling on you only to itch yourself and discover there was no bug? Have you ever felt actual pain from watching something painful happen to someone else? These are all mis-calculations based on your brain’s perception. These sensory halluncinations are illusions! The rubber hand illusion is a cool example of how quickly and completely the brain can, through neuroplasticity (not magic), change a person’s perception of physical sensation. There is in fact real science happening here.

Justin Willman - Magic For Humans

Please don’t interpret my sharing this as an invalidation or minimization of your pain or other symptoms. ALL SYMPTOMS ARE REAL! ALL PAIN IS REAL! But sensation is highly subjective based on your interpretation. This is why “pain threshold” is a silly measure. Your 10/10 pain is different from my 10/10 pain. If your brain wants to protect you from danger using pain, it gives no F***s about your pain tolerance. It’ll turn pain up loud enough to get your attention. As the observer of your own experience, you owe it to yourself to stay curious about the sensations you feel rather than to take accept them on face value. If you’ve been following my writing for a while, you know your brain interprets sensations based on they’re threat value. On a balance of danger vs safety. Independent of tissue injury. If your brain determines your situation is dangerous, you’ll perceive more intense pain for longer. While your illusory mis-perception of color and sound may be kind of cool and fascinating, pain has a far different “threat value”. One that pokes at our sense of safety, vulnerability, and our need for survival.

One of my clients was dealing with back pain and sciatica (nerve pain in his leg) that limited his ability to walk. After a family trip, he returned to the airport only to forget where his car was in the parking garage. He frantically walked around clicking his remote for 90 minutes trying to find his car. He noticed that, despite the stress, he had NO PAIN in his back or leg. Despite the stress of the situation, his brain de-prioritized pain so he could find his car. It knew that finding the car was a critically important and so it turned pain off. What can we learn from this? Well this was a “click” moment that his pain was not structural. Injuries don’t turn on and off when we’re distracted or immersed in something. If you sprain your ankle or break a bone, you won’t suddenly be able to walk on it as much as you want. It also showed that pain was optional based on conditions and perception. We had evidence that his pain could completely go away.

So what’s my point? Pain correlates with your brain’s perception of danger. It’s not always a sign of tissue damage or injury. Bodily injury can and does happen. But it consistently and reliably heals in a relatively short amount of time. That said, your perception of damage or injury (and the fear this generates) is enough to keep pain turned on long after healing is done (Regardless of whether there was ever an injury to begin with). The old “body is damaged” model of pain is now completely outdated. We now know that danger shows up in many non-physical forms including life change, relationship challenges, work stress, feelings of overwhelm, loss of control, and anything in our day to day lives that creates emotions of sadness, anger, rage, guilt, grief, shame, etc. Fear can even be generated by your own negative internal self talk and mindset about life. For most of us, those non-physical fear factors are the primary cause of symptoms from day 1, even in the acute phase! Especially if your pain started without an obvious physical injury.

So the next time you have pain, I invite you to get curious about your perception of those sensations, the stressful things going on in your life, and your other biases as the observer. When you understand that your observation of your own pain experience is biased by your own belief; as well as the belief of friends, family, and the clinicians supporting you based on your perception of danger, what might you learn? Does the illusion collapse and change? Is it possible that your body is just fine and perhaps there’s another source of danger creating emotion that’s manifesting as the perception of physical sensation? Regardless of whether the “danger” is real or perceived, pain demands a curious investigation to get clear on its nature. I’m here to help you make sense of your experience. In the meantime, does your new understanding of sensation as an illusion make you feel more safe or does it create a stronger feeling of danger? Hopefully the former. Let me know what you think. And if you have other illusions that illustrate my point, please share them with me. charlie@mperformance.com.

In the meantime, don’t trust everything you see, hear, or feel. Stay open to the mystery of it all.

I can’t overstate the importance of this paradigm shift. Many of you already know this, but we often compare its significance to the shift in belief toward the earth being round, the discovery of electricity, or the existence of gravity. All things that were ridiculed, resisted, and/or controversial initially; but all of which are now accepted as self-evident truths (ok maybe a few still think the earth is flat!).

Considering that 1 in 4 people worldwide suffers from at least one chronic physical symptom (not to mention the psychological and social ailments that underlie them), I believe disseminating this paradigm shift is consequential. Partly because the well-being of humanity is currently failing to thrive in a system of sick care. Pain, fatigue, insomnia, depression, anxiety, skin rashes, autoimmune conditions, and most diagnoses with the word “long” or “syndrome” are currently being treated ineffectually. The reality, based on modern neuroscience, is that the majority of people living and suffering with these symptoms don’t have to be…

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1. Change is hard.

   One clear reason people end up in chronic pain is that they resist change. As a barometer for what’s going on in your life, symptoms are your brain’s invitation to evaluate what’s not going well, what you’re resisting, and what you’re unhealthfully attached to. From a young age, we’re conditioned to be a certain way in our lives. We rarely question why, much less whether that way of being is still serving us or others. So what happens if we start to think of pain as a helpful message that’s inviting us to grow in some way?

   

   It’s clear that a bigger reason people end up and stay in chronic pain is because clinicians resist change. We had our biggest attendee turnout ever this year! However our numbers pale compared to the number of clinicians who continue to pursue learning interventions with little to no evidence and poor clinical outcomes. The clinicians who make the brave choice to take our course are special. For many of them, it’s uncomfortable at first and it takes time and energy. They’re outliers, early adopters, and even rebels to change the way they think and treat in an otherwise outdated medical system. Outside of this cohort, many clinicians are 20 years behind the research based on how they treat day-to-day. Despite the “pain” many clinicians face in their clinical practices (burnout, recidivism, poor outcomes, lack of meaning and purpose), it’s so easy to stay with what’s familiar. So people continue to suffer

   While patients and clinicians both face the discomfort of change, the reality is that change is the only constant. Change drives growth and progress in our physical, emotional, and spiritual lives. Pain demands change, and change requires a shift in belief that leads to a new way of thinking, behaving, and feeling. We know belief is the most important predictor of outcome when it comes to pain and other chronic symptoms. So what I’m asking is for everyone to believe in the importance and power of change. Especially this change. Pick your providers thoughtfully. Patient-directed care is the new reality in “health” care. You deserve a forward-thinking provider that’s on the leading edge of chronic pain/symptom care.

2. Recovering from chronic symptoms is an inside job.

   Clinicians have a hard time shifting out of a paternalistic fixing mindset where they’re tasked with having all the answers and telling their patients what’s “wrong” with them before also choosing and dispensing extrinsic solutions. The new model we’re teaching demands nearly the opposite belief and mindset where patients have agency and authority over their healing. One of the most important concepts we teach is how listening and therapeutic alliance skills (the relationship between provider and patient) are effective stand-alone modalities. When patients haven’t felt seen and heard prior, they can cure chronic symptoms without any other intervention because relationships and connection are so calming to the nervous system. Reinforcing this is the idea that the contextual factors AROUND the things we do are more predictive of someone’s outcome than the interventions themselves. This is true with manual therapies, exercise, medicine, and interventions like injections and surgery. Here’s one recent study highlighting this phenomenon.

   When we understand how belief, context, and agency are such strong predictors of outcome, we have to acknowledge that every client is unique. So, we can’t treat based on rules. Starting every session with what I call a “Vu Ja De” mindset (I’ve never been here before) is liberating and powerful. We have to remember that the patient has all the answers to cure their dis-ease and that our role is to listen to support them in becoming aware of those answers.

   It’s not our role to fix anyone. You have everything you need inside of you to unlearn your chronic symptoms and recover the things you’re missing in your life. It’s the provider’s role to reinforce what’s RIGHT with each person and then to collaborate on opportunities for positive change. Reassurance is our most powerful medicine. But, most clinicians do the opposite. Many think they can predict the future, and it’s usually in a negative direction, mostly due to a fear of liability if they over-promise. Patients need what we all need…to be seen, heard, celebrated, reassured, and supported on the journey. The clinician ultimately doesn’t do any fixing, your mind and body do it all. This new way of thinking is liberating for clinicians and powerfully healing for patients.

3. Anger, then compassion.

   I’m always blown away by the stories of recovery that are shared throughout a weekend of teaching. I wish you could all experience how powerful this work is across such a wide spectrum of different people and varied symptom presentations. The list of acute and chronic symptoms that respond to mind/body medicine is massively long and ever-growing.

   

   One story Dr. Schubiner shared was about a woman who presented with a conversion disorder where she’d lost the ability to walk and speak normally (essentially her brain took away these functions to protect her) despite nothing being medically wrong. After a single session of Howard bearing witness to her story and then supporting her in an anger awareness and expression session connected to events in her earlier life, she regained the ability to walk and speak the next day! After years of suffering! I realize this sounds like faith healing, but it’s not. It’s a testament to the importance of our emotions and to the power of neuroplasticity

   While symptoms don’t always change this quickly, the story highlights the importance of anger expression in recovering from chronic symptoms. Most would never connect the emotion of anger to the expression of physical symptoms. But the link is strong and we know that anger “held in” from any phase of life can manifest as just about any symptoms you can imagine. This is because many of us were never supported in learning healthy anger expression as children. So we either express anger in outward and destructive ways and/or subvert it to protect others, instead turning it inward on ourselves. Anger is an intense and important emotion that’s meant to protect us and spur powerful and meaningful action. But without the skills to express anger in a private and directed way, many get stuck in anger and ultimately only experience the negative consequences. Once you understand the healing power of healthy anger expression, and how you can move through it to a place of forgiveness and compassion, you’ll start to see it as an asset and a powerful force for change in your life. Here’s a visual representation of the visualization process through which I guide my clients.

   

   I’d like to offer my paid subscribers access to my new guided emotional awareness and expression audio visualization. Contribute at any level and you’ll get access to the 25-minute “time traveler” exercise (and an intro orientation to the process) which allows you to go back and process the layers of emotion around any past stressful life event, regardless of whether it was last week or 50 years ago. It’s a beautiful practice and, now that you know recovery is an inside job, I want to encourage you to try it for yourself. Please click subscribe below and contribute at whatever level you can to see the rest of this post and get access to the time traveler exercise.

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   I’m proud of you for reading to the end! Regardless of whether you subscribe, please share this with anyone in your life who might benefit. I appreciate you.

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Thanks to our new understanding of neuroscience, we now know that the brain can’t tell the difference between doing/experiencing an event and vividly visualizing that event. This is because both ignite the same brain circuits accurately enough that we see real skill acquisition in both conditions.  In many cases, the gains in visualizers can be the equivalent to those who are actually practicing/doing the activity. What’s so cool is that this effect applies to physical AND psychological skills. In fact we can leverage visualization as part of unlearning pain, anxiety, and just about any other life change you’re motivated to make. More on this in a bit. 

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Top performers in sports, business, finance, art, and music have been using visualization for decades. You’ll see athletes using mental rehearsal in nearly every discipline from rock climbing (Adam Ondra flashed one of the hardest climbs ever - 5.15/9a - on his first try using mostly visualization with minimal contact with the rock) to Mixed Martial Arts (Connor McGregor took the title from the world champion in under 20 seconds by visualizing exactly what his strategy was - he even announced what he’d planned to do ahead of the fight). Multi-time world champion skiers like Mikaela Shiffrin visualize every run vividly before entering the start house. Tennis players like Rafael Nadal consistently dominate by rehearsing a confident mindset before even getting on the court.

I recently encouraged a friend to leverage the technique ahead of brain surgery where he’d have a tumor removed. He was justifiably nervous about the procedure and the anesthesia. So I told him a story about the history of anesthesia and how it’s kind of a miracle (listen to this Radio Lab podcast about it if you’re interested). I reinforced how surgeons are incredibly skilled at what they do, and his was no exception. Then, I encouraged him to practice gratitude for modern technology, the surgical team, and his amazing brain in the weeks leading up to the procedure. He practiced the outcome he wanted weeks before surgery. His surgery went super smooth and he walked out of the OR hours later (shocking the surgical team). He had an incredible outcome. Basically, we all have the opportunity to practice manifesting what we want rather than what we don’t want. People who do this are able to have the optimal experience ahead of the actual experience to ensure success when it matters most. 

Regardless of whether you’re an athlete or not, you might be missing out on an important skill that truly applies to any aspect of life success. Want to get better at public speaking, parenting, intimacy, your career, socializing, or art? Visualization and mental rehearsal can get you there. 

Novice musicians show similar brain changes and skill acquisition visualizing piano sequences over the course of a week as those actually practicing on the piano

Novice exercisers gain significant strength and keep it by visualizing lifting weights compared to matched controls who are actually lifting weights! 

Injured athletes preserve strength, flexibility, and movement ability by visualizing ongoing daily training as they heal compared to non-visualizing controls.

Visualization not only creates real brain changes, including the identical brain connections to those who are practicing, but it actually changes our biology, including our genes! This is why visualization is so powerful as a part of behavior change, including unlearning pain. So let’s talk about chronic symptoms.

Visualization and mental rehearsal have very real impacts on the brain, and thus the body. When you remember that all pain is constructed and experienced in the brain, and that the brain is very good at learning, once the brain learns a symptom, it can run that symptom on repeat. Essentially your brain creates a neural pathway for that symptom which can manifest in real or perceived body changes. This can happen with or without an injury and the brain can keep running that learned sensation long after healing is done; if there was an injury in the first place (which there often isn’t). Then, as long as you have fear about pain, you’ll essentially be practicing pain, further burning it into your brain’s neural circuitry.

Through visualization and mental rehearsal, you can start practicing a new outcome. A new response to your pain. A new pattern of behavior despite pain. A new outcome with feared or avoided activities. You can rehearse any new reality you’d like to achieve in day-to-day life to create change. For instance, once you make a connection between your pain and how it’s caused by some stress in your life (ie. symptoms get worse when you’re at work), you can visualize how you might respond differently to that stressful situation in the future. Ponder how you might visualize a different experience with a boss you hate, a challenging relationship, a big life change, or an overwhelming trip. Where you put your attention, there goes your energy. Doesn’t putting most of your energy toward your ideal outcome make sense? Regardless of whether you're trying to overcome your fear of pain, or the fear of other things in your life, practicing the future you want will always net a better outcome than the future you don’t want. 

I’ve been sharing this short Mastery Blueprint video with my clients to help them understand the 8 important scientific benefits of visualization. Check it out.

So HOW do you use visualization to prepare for a sports competition, some important life event, and/or to overcome pain?

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First, decide what scenario you’ll likely face, and what skills you’ll need.

Then use an 80/20 rule. Practice 20% of the time overcoming negative scenarios (challenges, common mistakes, and anticipated fears). Think of how you’ll react, for instance, when your pain flares up. Plan how you’ll respond in the best way possible. Can you let go quickly when things go sideways? How will that feel? Work on your self-talk and how you’ll successfully react when things don’t go your way. Rehearse going back to the evidence that your brain is in charge of pain and that your body is ok. Rehearse a mantra or some affirmation and how you’ll reassure yourself in the presence of increased symptoms.

Then spend 80% of your time practicing positive outcomes. Add as much detail as possible. The more vivid the visualization and the more emotion you bring into the visualization the better. Emotion is the most powerful carrier of any change, so don’t skip that part. For instance, the more emotion I feel as I watch Mattieu Van der poel win Paris Roubaix, the more that feeling will translate into a strong ride the next day. Similarly, practice the pain-free run, ride, or tennis match you’d like to play. Revisit a memory of when that activity was painless and you were in a flow state. Or simply rehearse your ideal outcome. Remember, your brain doesn’t know the difference between visualization and real life. This effect goes both ways so practice what you want rather than what you don’t want.

Start with your breath to calm your mind and allow distracting thoughts to pass. Then add detail to your visualization by using the acronym PETTEP to make it feel more vivid and real:

Physical Sensations - How will it feel in your body to perform in the best way?

Environment - Picture every detail about the physical setting in which you’ll be.

Task - Practice the exact skills that will be required for that task.

Timing - Do it at normal speed, slow, or extra fast depending on what the task requires.

Emotion - Visualize how you want to feel. Are you excited, nervous, calm, confident? As you practice the hard emotions, use calming breaths to overcome these difficult feelings in your visualization. Then shift to the emotions you’d like to manifest. Remember, your brain doesn’t know the difference between visualizing those feeling and actually having them. You’re priming your nervous system to have the feelings that connect with the best performance.

Perspective - Rehearse your performance in 1st and/or 3rd person, depending on the task.

Add positive self-talk, affirmations, and mantras to strengthen the effect, especially if you can carry those into the event or challenging scenarios. 

To learn more, watch Part 2 of the Mastery Blueprint video for a “how to” example of how visualization looks in practice. 

If you’d like to learn more about mental rehearsal and visualization to overcome pain and perform better in sports and in life, reach out to book an appointment. Like my friend who had brain surgery, visualization always works better when it’s coached specifically in your context. Or better yet, join my next cohort “Unlearning Pain For Athletes” starting this week (and then again in early July) to learn more about how these skills apply to pain and performance as well as loads of other life-changing skills. Are you ready to become version 2.0 of yourself as a performer in sport and in life. Visualization is one way you can connect with that person you’re meant to be. I look forward to working with you. 

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I also care a lot about athletes. While I treat “all comers” in my clinical practice, I have a soft spot for athletes because I am one. I’ve been an athlete my whole life. While I’m proud of my achievements over time, my definition of “athlete” is pretty loose at this point. Mostly because active people get intimidated by the word imagining elites like tennis phenom Serena Williams, basketballer Kobe Bryant, skier Mikaela Shiffrin, footballer Lionel Messi, collegiate basketballer Caitlin Clark, and cyclist Mattieu van der Poel as the standard. My definition includes anyone who’s motivated to engage with the world physically in any meaningful and challenging way. No elite goals are necessary. In other words, if you are a human being, you are an “ATHLETE”.

I’ve seen, personally and professionally, how acute pain can turn into chronic pain and destroy lives, and even families. While chronic pain is defined as pain lasting longer than 3 months, all pain starts somewhere. And that somewhere is in the acute phase; in the first days and weeks of a person’s pain experience. Athletes incorrectly assume that when they have acute pain, they’re injured. This creates fear and thus primes the nervous system for more pain. So, I created a course that combines my 2 passions (pain and athletes). Mostly because athletes are not getting valid or reliable information about why they hurt. But also because I know the frustration and disappointment of being held back by pain. My new course is called “Unlearning Pain For Athletes”, and I put a shit ton of work into it so we can all keep playing. Check out the link HERE to learn more. The next cohort will start May 10th, 2024 and, if you’re limited by pain, I hope you’ll join. This is a fully immersive and interactive course that leaves you with a superpower leading to more confidence in your body, improved mental health, better performance in sport and life, and a new perspective on the meaning and growth value of pain. You’ll be an expert in pain and in knowing yourself, as a person and as an athlete.

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In the meantime, I want to share a big idea from the course that I thought you might find interesting:

Acute pain does not mean injury.

I’ll say it again another way. Just because your pain just started, that doesn’t mean you damaged or hurt your body. In fact, in 2023, 9 out of 10 new clients, in my busy clinical practice in the most active town in the world (Boulder, CO), had pain that just started but did not on exam demonstrate signs of physical injury. Those clients had no explanation for why their bodies got injured. There was no clear mechanism of injury or obvious moment where the body got hurt. It just came seemingly out of nowhere. People try to make up stories to make physical or biomechanical meaning, but mostly those fall short. So what’s going on here? Below I’ll tell you my favorite case example that I share when I train clinicians and treat clients dealing with acute pain that’s not due to injury. This one idea will forever change the way you react to physical symptoms.

The rest of this post is for paid members. Please become a paid subscriber to support my writing and stay tuned for my next post on visualization and mental rehearsal to overcome symptoms and perform your best.

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1. There are no “bad” movements, only movements your nervous system doesn’t recognize or has learned are dangerous.

Human beings are the undisputed best movers on the planet. By “best” I mean we have the largest and most diverse range of movement capabilities of any species on earth. We are also the most adaptable, partly due to our capacity for higher-level thinking combined with the amazing way in which our bodies physically change and become robust to better tolerate the things we choose to do. Here are 3 short clips I saw this week on Instagram that reinforce this idea. Your body will adapt to anything you ask it to do with practice and repetition.

Our challenge is that because we’re exposed to such a wide variety of physical demands, some of them unexpected, pain often results when the nervous system gets surprised. So while I’m not going to say that anything goes when it comes to movement, your capacity to do things is generally governed by your nervous system and not your tissues. If you want to learn to tolerate getting punched in the face better, you can adapt to that. If you want to learn to run 100 miles, you can adapt to that. If you want to learn to practice high-level Ashtanga yoga and twist yourself into a pretzel, you will adapt to that too. Training your body to tolerate things better requires doing more of that thing, not less.

What many people don’t know is that once your brain and nervous system learn, somewhere along the way, that a particular movement is dangerous, it will remember that and code it as such. Think deadlifting, running, squatting, falling, etc. Skiing many years ago, I fell off a rail on my first try when I committed to trying to jump on and slide sideways. Both my skis slipped out and I fell 3 feet to the ground with my arm overhead landing on my side. I had instant arm pain and tingling in my fingers the rest of the day along with a sore shoulder for a few weeks. From then on, every time I tried to ski toward a rail to try it, my brain wouldn’t let me commit. I could literally FEEL the incident and would pull off and avoid it at the last minute. That is until my son helped me break down the skill and gradually learn to do it safely. I’m still working through my trepidation, but I would have never learned that skill without trying it again.

“Take your pain and go play with it” -Charlie Chaplin

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2. Movement is supposed to be fun, right?

Somewhere along the way, many of us (myself included) learn that the primary goal of movement is to punish ourselves and suffer to achieve some goal. Lose weight, beat others, suffer better, look a certain way, feel less anxious, burn calories, prove our worth, add muscle, impress others, etc. Now, if your goal is to achieve some performance standard because you’re an athlete for a living, or because you honestly and authentically enjoy doing hard things, then punish yourself and suffer away. The reality is that to achieve a specific big burly goal that’s exceptional and requires significant fitness and skill acquisition, most of your “training” will be aimed at consistently working quite hard. While the feeling of punishment and suffering is probably more the result of one’s mindset, few things worth doing are easy.

As I’ve gotten older, I’ve purposefully separated exercise (which is goal-directed and structured) from movement (which is more free-form, playful, and enjoyable). There are times when I truly enjoy pushing myself hard toward some goal. But there are other times when I really just love moving and being in my body for the sheer pleasure of feeling the world around me. I literally decide what I want to do on a given day based on how I feel and what’s turning me on. I realize this improv schedule doesn’t work for everyone, but what I want you to consider when curating your movement practice is your “why”. Stay in touch with WHY you’re choosing to exercise and move in certain ways and make sure those motives align with your values. If they don’t, change it up, and while you’re at it, ensure that a good chunk of your movement is fun and joyful. My experience is that play, fun, novelty, and emergent exploration are active ingredients in terms of performance, resilience, and longevity.

Image/Artist: Gail Folwell

“Consciousness is only possible through change; change is only possible through movement” - Aldous Huxley

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3. Are you exploring or exploiting?

These terms have changed my movement practice for the better since I learned about them a few years ago. Exploitative movement is familiar, it’s expected, you’ve done it before and mostly know the outcome. It’s satisfying and gives you a reliable hit of dopamine and oxytocin every time. You count on it because it’s reliable and joyful in its predictability. Think about your familiar running route, your weekend match of tennis on the same courts with familiar partners, or your 10th day of skiing at your favorite mountain. Exploratory movement is nearly the opposite. It’s novel, unpredictable, unexpected, uncertain, and sometimes even fear/anxiety-inducing. You’ve not had an experience quite like it before and so it’s accompanied by a lovely sense of wonder and awe. Exploratory movement can feel thrilling during and afterward as you get a definite dopamine and oxytocin spike. But the nature and quality of that spike is palpably different.

Think about a run in a new city/country, playing tennis on clay with strangers while on holiday in Hawaii, or skiing in Japan with a guide in the backcountry. Same activities, different context, but yet exploratory in nature. Now picture activities and movements you’ve never done. Learning to surf, skydiving for the first time, dancing til sunrise at a nightclub in Europe, or taking your first CrossFit class. Brand new experiences that light up completely different neural networks in your brain. These are the ultimate type of exploratory movement.

Many of us steer toward exploitative movements as we get older. This results in the nervous system becoming less flexible, less resilient, more injury/pain prone, and specialized at fewer things. There’s room for this and it might even ultimately make up a majority of your movement practice. But I want to challenge you to start brainstorming how you might build more exploratory movements and activities into your life. We know that wonder, awe, novelty, play, nature, social connection, and healthy fear create wellness and health span. Are you open to working to find a balance between the two kinds of movement in your life? If so, please let me know if you notice how adding more exploratory movement enhances your experience with your favorite forms of exploitative movement. Variety is indeed the spice of life.

When there is no novelty, there can be no curiosity” -Aphra Behn

Make moves and be well my friends.

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Delayed onset symptoms remain a bit of a mystery, despite being extremely common. But neuroscience is starting to clarify the confusing, intense, and fear-inducing phenomenon. There are 2 ways delayed onset symptoms show up. One is delayed soreness, common in high-performing athletes and weekend warriors alike. People who push their bodies super hard. The other is delayed pain, common in chronic pain as people struggle to get back to doing everything from getting out of bed, to basic activities of daily living, to returning to even low levels of athletic movement. Delayed pain is one of the most common symptom behaviors that indicate nervous system-driven symptoms rather than a structural body injury. Delayed onset pain, strangely, can be triggered by a wide range of movements from the most basic to the most athletic.

So what’s the difference between the common athlete phenomenon called delayed onset muscle soreness (DOMS) and the way chronic pain behaves as you’re working to get moving again at some meaningful level? I call this later type delayed onset pain (DOPS); the type that inevitably threatens to derail your progress as you do the brave work of challenging your nervous system’s opinion of whether the world (and activities therein) is safe or not.

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For people overcoming pain, there’s often confusion about the difference because the two can feel similar. Mostly in that, there can be a delayed onset to both phenomena, but also because they both result in sensation. Both sensations can create confusion, threaten to interrupt progress, and discourage people from trying an activity again when they’re working to return to exercise. Do you have DOMS or DOPS, and what can you do about it? The first thing I want you to know is that NEITHER delayed onset muscle soreness (DOMS), nor delayed onset pain (DOPS), is dangerous. Neither is an injury or a structural problem. An important distinction between DOMS/DOPS and a structural injury to your body (ie: stress fracture or overt fracture, muscle tear, tendon injury, joint inflammation, disc herniation, facet injury, or nerve compression), is those will hurt DURING exercise. If you have pain when you start to exercise, it won’t get better the more you move if it’s an injury. Similarly, symptoms won’t come on hours or days later if you’re injured. While DOMS and DOPS are similar in this way, they have some important differences that will help you navigate better.

The first difference between DOMS and DOPS is that they don’t behave the same. DOMS tends to come on 12+ hours to 2 days after exercise and sticks around for a few days before resolving on its own.  DOPS tends to come on hours, days, or weeks after some activity and can stick around indefinitely, especially when stress or fear is present. People often attribute DOPS to something they did weeks or even months before! They’ll make up stories about what hypothetically caused the pain despite it never really adding up. However, these assumptions are not benign in that they create fear, stress, and thus persistent pain. You likely know by now that fear tends to result in pain sticking around longer than it needs to. DOPS is a perfect example of how this happens.

The second differentiator between DOMS and DOPS is that DOMS is caused by high-intensity exercise that’s significantly beyond your current level of fitness. Think heavy weightlifting, sprinting, skiing on the first day of the season, playing competitive soccer after time off, or running downhill fast when you’re not used to those things. These are eccentric movements where the muscles and tendons are lengthening under very high tension. The tissue AND the nervous system get overwhelmed by this intensity. Meanwhile, DOPS Can be triggered by just about anything, including the most benign activities. While DOPS can be caused by challenging yourself in new ways as you engage in a gradual exposure process to overcome pain, it is NOT the result of high-intensity or superhuman effort. It’s simply the nervous system’s opinion of whether you’re safe or not based on many non-physical factors. In chronic pain, the nervous system gets in the habit of predicting that lots of things are dangerous. So DOPS is very common, despite being harmless.

While we don’t know much about either DOMS or DOPS mechanistically, we do know that both sensations are constructed and experienced in the brain. There’s a shift in thinking away from a physical cause and more toward a neurological cause. With DOMS, the brain’s decision to create the experience of symptoms, including any physical changes that result, is informed partly by accurate information from the body that something significant happened to the tissues (overload beyond your current fitness level). DOMS has theoretically been associated with micro-injury, minor damage, and local inflammation of the tissues due to overload. Some propose that DOMS is like a mild version of “rhabdomyolysis” where protein spills into the blood as muscles experience micro-tearing. Contrary to a common myth, DOMS is NOT caused by lactic acid - the short-acting byproduct of exercise that limits performance during exercise. Some research suggests that not only is DOMS not caused by inflammation, but there’s evidence that creating more inflammation by moving through the soreness actually helps shorten its duration. Regardless of the cause, one benefit of DOMS is that it ultimately leads to adaptation and more fitness. So it’s actually considered positive in the long term.

On the contrary, while DOPS may be partially informed by information from the body, there is usually no objective damage or injury to the body. Most of the time, normal and benign information is being misinterpreted by the brain as dangerous. And in many cases, the brain decides to create delayed onset pain WITHOUT ANY information from the body at all! DOPS is thus likely more neurological than physical. DOPS is mostly generated by your expectations, beliefs, emotions, thoughts, predictions, context, and fear. As a part of the process of overcoming pain, DOPS is also important and helpful because it’s how the nervous system starts to de-sensitize to movement and healthy functional activities again. Without a thoughtful process of graded exposure to movement that includes regular moderate amounts of DOPS, pain doesn’t tend to ease as quickly as it does with DOMS. Paradoxically, with DOPS, you have to move into some pain to overcome pain! See my video on return to movement HERE to learn more about this process.

While mechanistically DOMS and DOPS are quite different, despite sometimes FEELING very similar, they do have a few other features in common. Because both sensations are constructed and experienced in the brain (based on your brain’s opinion of how much danger you’re in) they are both influenced by psychological and social factors like stress, fear, self-talk, mindset, your support system, and other thoughts, feelings, and behaviors that influence ALL pain. Research also suggests that both are affected by sleep quality, diet, and genetics. One article even proposed that DOMS is relieved by modalities like heat, cold, and even eating Indian food! But you’ll have to test that theory of yourself.

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Another thing they have in common is that they both tend to respond better to movement than to rest, as long as your fear level is low. While DOMS requires a mandatory multi-day course of soreness that resolves itself naturally, movement tends to shorten recovery time and support recovery. Similarly, you can learn to move through DOPS in a matter of minutes or hours as you learn the skills to do so. Essentially, DOPS is optional and responds well to reassurance and other mind/body strategies. Interestingly, while DOPS can stick around forever in the presence of fear, it can go away almost instantaneously as fear recedes.

If you’d like to learn more about DOPS and how to use strategies like mental rehearsal, visualization, somatic tracking, emotional awareness, gratitude, distraction, polyvagal strategies, family systems therapy, or inner child work, it would be my pleasure to share with you. Navigating and interrupting DOPS quickly is a critical skill in overcoming pain, regardless of your activity level. A superpower that ultimately leads to less pain. As you learn the skills, you’ll find you’re able to break through previous and existing barriers to get back to high-intensity activities. Activities that result in the familiar sensation of DOMS that athletes appreciate as a sign of overload, fitness gains, and the improved performance that follows.

If you’d like to learn more about delayed onset pain and the other symptom behaviors that we use to rule OUT the body (structural injury issues) and to diagnose brain/nervous system-driven pain, please book an appointment via my website at Mperformance.com. If you’re a clinician who’d like to learn more about mind-body medicine, the diagnostic process, and the strategies that can help your clients unlearn chronic symptoms, please message me directly. If you’re an athlete who wants support in overcoming chronic nagging symptoms, I now offer an immersive 12-week course that will teach you everything you’ll need to know to self-heal. Reach out to me directly.

charlie@Mperormance.com or 303.717.8351

In the meantime, enjoy all the sensations in your body and remember that they’re all a sign that you’re alive and lucky to enjoy this generous present moment.

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Have you ever been out on a run or a ride, on the tennis court, on the golf course, in the gym, in a yoga class, or enjoying any favorite activity and suddenly been rudely interrupted by pain? That pain that seemingly comes out of nowhere leaving you making up stories for why it happened. Maybe it’s my shoes, my bike fit, I didn’t warm up enough, too many days in a row, I’m getting old, overdid it, wearing out? It’s that oh shit moment where your mind spirals into the future and anxiety spikes with worse-case scenarios & catastrophic thinking. This is terrible, I’ll have to see the doctor or PT, maybe I’ll need surgery, what if they have to amputate, I’ll never be the same, I’ll lose all of my friends and no one will ever love me again! This is the moment when your nervous system quickly ramps up into high alert and things go from bad to worse. While this early reaction is primal and quite normal as an initial act of protection, most people don’t realize that what you THINK in this moment will make or break your outcome. Your thoughts will determine how intense pain gets, and how long it sticks around. This liminal space between the onset of pain and your reaction to it creates an opportunity to interrupt the brain’s tendency toward a state of danger alarm in the presence of sudden onset pain. 

The first thing I’d like you to understand is that pain is an EARLY danger alarm. A clever feature of your nervous system is that your brain will turn on pain to protect you BEFORE you do any damage to your body. Of course, if you fall off your bike, sprain your ankle suddenly, experience a car crash, fall on ice, or experience some traumatic moment of bodily injury, the early danger alarm never has a chance to warn you. But what differentiates these two scenarios is that the latter type of pain is often a result of true tissue injury while the former is simply a warning of potential or perceived danger.  Most of the time, pain that comes out of nowhere isn’t related to bodily injury at all. But if you freak out and spiral into catastrophic thinking, your pain experience will be similar to an actual injury. And in many cases, symptoms will stick around even longer than pain from an injury simply due to those fearful thoughts. So how can you know which type of pain you have? I’m glad you asked because I’m collaborating with a group of clinicians on a study, in partnership with Dr Yoni Ashar and UCSF, where we’re working to validate a screening tool to help people in pain in pain differentiate whether they’re injured or not. 

In my practice, 9 out of 10 clients I evaluate with acute pain (brand new symptoms that just started) are not injured. They either have pain that sticks around after an injury or surgery has healed, or they were never injured in the first place.  The first step in determining if you’re the minority 1/10 who is injured/healing is to ask yourself “Was there an obvious moment of injury?” For most there was not. In addition to some physically traumatic event, you’re looking for evidence that you actually hurt yourself. Swelling, bruising, redness, warmth, bleeding, locking, catching, instability/giving out, numbness/tingling, and/or significant tenderness to touch.  

The next question to ask yourself is “Have I hurt this part of my body before?” Remember that the brain has a memory for past injury and surgery. Those “neural pathways” go dormant after you heal but can re-activate for many reasons. Once a body part has experienced pain or injury, the brain stays more vigilant and keeps a close eye on that part. Dr. Bessel van der Kolk’s seminal book “The Body Keeps The Score” illustrated the early research on, and clinical applications of, this concept. The early danger alarm becomes a bit more sensitive than normal. So pain will come on even earlier, long before you injure your body. Most of you now know that psychological and social stressors can also trigger real physical pain in the absence of an injury. And the brain loves to turn on pain in areas that are impossible to ignore. Choosing a body part that was previously injured is certain to create fear and reliably get your attention. 

In the absence of a clear injury, the 3rd question to ask yourself is “what was/is going on in my life that might better explain the timing and location of this pain? It’s universal, normal, and common for emotional stresses to manifest as physical pain. Turns out that what’s going on in your psychological, social, and even spiritual life is a far better predictor of physical pain most of the time. Sometimes the location of pain is an important clue. “What about this moment is salient and reminds me of the last time I had pain in this area”? “Why would my brain choose this body part or this symptom to get my attention”? “Is there some metaphor or meaning to these symptoms”? Quickly shifting your attention away from “my body is damaged” and instead toward feelings of overwhelm and life stress can lead to important and meaningful insight. Not to mention how this shift in focus can create a rapid interruption of the danger alarm. Remember your brain’s altruistic job is to keep you safe and it’s simply using an effective signal (pain) to alert you to things that are potentially, or actually, emotionally dangerous.  Once you attend to those factors, the pain is no longer necessary and the danger alarm will turn off. 

One final way to differentiate injury pain from non-injury pain is using symptom behavior. The more of these symptom behaviors you notice in the first few days or weeks of pain, the more likely you’re NOT injured. Is the pain inconsistent/intermittent, does it change, spread, move around, affect one whole side of your body or one entire arm or leg, or is it symmetrical and on both sides like a mirror image? Does the pain get worse with rest, in static positions, during sleep, when you’re thinking about it, or when you’re stressed? Does the pain feel better when you’re distracted or immersed in something, when you’re physically active, temporarily after treatments you expect will help, or when you’re relaxed? Is your pain triggered by unexpected or benign factors like food, weather, shoes, chairs, beds, pillows, light touch, or during safe movements/activities? Most commonly in athletes, we see that pain is better with activity but gets worse AFTER activity or the next day/days later. And another telltale sign that you’re ok is that your pain gets worse with rest.  Rest is ONLY indicated in the very short term after an actual injury or surgery.  And even then it has limited utility. Remember after most surgeries movement is indicated and encouraged on day 1!

Pain is a massive interrupt to everyone’s quality of life. Ultimately, the goal here is to pause that initial fear reaction that unnecessarily sensitizes all of us to pain. I want you to be able to quickly identify whether you need to seek treatment or just let it ride and watch it get better in a matter of a few hours or days. Remember that while most injuries heal themselves, most pain is not due to injury. I hope you’ll be able to use pain as a way to attend to and address any life stress, feelings of overwhelm, emotional needs, or social challenges you face.  Most importantly I hope you’ll experience less setbacks in your life as a mover, in your career, as a partner, friend, family member, or parent, and as the important person you are in your life. We’re all better off when we learn to master our nervous system’s danger alarm. Understanding pain leads to more growth, better relationships, more success, and increased feelings of safety which reliably leads to more joy and contentedness in life.  Please share this with your friends and family so we can all continue to thrive, show up fully in life, and bring our unique gifts to the world. 

After reading this, can you think of a time when you had real pain that was likely NOT from an injury? Please comment here or send me a message with your insights or questions.

Be well, my friends.

I launched my new course for athletes looking to “unlearn” chronic pain last week. It’s been a labor of love to create an immersive and experiential 12-week journey that will eliminate pain while simultaneously freeing you up to perform your best next season. But this course goes beyond running faster, getting back on skis or the bike, and playing better tennis or golf. You can read more about it here:

Unlearning Pain For Athletes

To kick off the launch of this course, and encourage you to consider your pain from a new perspective, I’d like to share 3 important insights that may surprise you about athletes and pain:

1. Every December, when I look at my new client data from the prior year, consistently 8-9/10 athletes I evaluated that year had very real pain (or other symptoms) but nothing wrong with their body. How can I tell, you ask? Well, it’s crystal clear from the evidence. There was no obvious injury when the pain started, pain has often been present greater than 3 months…beyond what we’d consider a normal healing time, symptoms behave strangely and unlike what we see in athletes who have structural problems, there is no clear objective pattern when I evaluate the body, and there was often significant life stress that paralleled the onset of symptoms. But despite this lack of evidence for a body problem, nearly every athlete seeks out a body-oriented solution seeing a traditional PT, chiropractor, orthopedist, or other sports medicine clinician to “fix” the problem. Statistics indicate that 1 in 4 athletes live with chronic pain unnecessarily. We know the athlete’s brain has a pain-over-emotion bias. Almost universally, athletes use physical pain (consciously and unconsciously) to reduce their emotional pain and anxiety. As an athlete, once you understand that pain does not mean damage, the solution is a simple matter of reconceptualizing WHY the pain is there, WHAT it means, and HOW to treat it differently.

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2. While it can be helpful to treat the adaptive change and de-conditioning that is a RESULT of pain and NOT being active, the long-term solution for pain in athletes paradoxically has nothing to do with the body. Manipulating joints, needling muscles, release fascia, foam rolling, stretching, strengthening, core stability, and prescriptive exercises offer only temporary relief, if those modalities lead to any meaningful change. If they work it’s because they reduce fear, offer a sense of control, and act on placebo. While placebo is a real effect, these interventions fail to address the underlying causes of pain (see #3 below). To effectively unlearn pain, athletes need knowledge toward a modern understanding of pain science. This allows for a confident shift in belief and mindset away from the “body is vulnerable” fear that universally results from pain. Athletes then need a green light to stop resting and to start moving and getting back in their bodies. Essentially to act normally and start moving again as though they’re ok (because physically they are), despite pain. A thoughtful return to exercise with some new skills shows the nervous system that movement is safe and reduces the brain’s prediction of danger (the most direct correlate of pain). Next, athletes benefit from developing a new relationship with pain though more conscious awareness, leading to a superpower of sorts. One that offers better performance on and off the playing field/race course. This new awareness then leads to meaning-making from symptoms and naturally connects to the wisdom of one’s emotions, a new understanding of one’s personality traits, insight into the role and value of sports in one’s life, and clarity about how to move forward in the future grounded and aligned with one’s values.

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3. Pain is a barometer for what’s going on in our lives. It’s designed to protect us from something that feels dangerous. Many athletes logically assume it’s the body that’s in physical danger, attributing pain to overtraining, asymmetry, age, wear and tear, and biomechanics. Instead, physical pain is merely a distraction from the REAL danger: the pressure we’re putting on ourselves, the act of “plowing through” life trying to get it all in, the feeling we’re not supported or loved unconditionally, some lack of control in our lives, uncomfortable life change, or some violation of our boundaries. The emotion this creates is so uncomfortable that athletes (and people in general) tend to subvert and bury their feelings resulting in the brain choosing pain as an alternative mode of expression. Sometimes pain forces us to put sport away to attend to other things that need energy. Sometimes the brain doesn’t like that sport has become our only strategy to manage our emotions. Sometimes pain is a cue that we’re not having fun or doing sports for the right reason and need a change. Sometimes pain is a request to check our relationship with sport based on how it relates to our identity. There are endless reasons the brain uses pain to alert us that something isn’t working in our lives. Unlearning pain is simple, but every athlete needs a different recipe to get there. The process leads to less pain in the short term. But more importantly, athletes develop a new relationship with pain, and with themselves in the process. One they carry forward into their personal and sporting lives. Think of taking off a heavy backpack you’ve been carrying with the burden of living with things that subconsciously aren’t working for you. You’ll enjoy less pain and quickly perform better without that extra load! But more importantly, the growth benefits of this course promise to extend beyond performance to every aspect of, and to everyone in your life.

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Finally, I’d like to leave you with a question. Please share your reflections in the comments or message me directly. Answering this question is an essential part of my new course:

What is your ideal vision of your future as an athlete and as a person, and are you living that vision now?

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Please reach out to me directly with questions:

Charlie Merrill - charlie@Mperformance.com - 303.717.8351

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There was a time when all I wanted to do was race my bike. But there’s only one thing that remains constant in life; CHANGE. As the fun drained out of cyclocross racing after a decade, I was forced to re-evaluate my relationship with cycling, and exercise in general; and, in the process my relationship with myself. With my identity. This process was not without pain. I had physical pain and injury as well as emotional pain and massive upheaval in my life as part of this evolution. It was not fun, but it was an important part of becoming more of who I truly am. The athlete and the person I was meant to be.

As athletes we’re driven toward goals, to do hard things, to achieve, to prove ourselves, to demonstrate that we’re enough, to satisfy that urge to escape and find a state of flow or an exhilarating hit of dopamine. This can be done from a place of honorable intention. But it can also quickly evolve into an encumbered act that results in great suffering. I’ve done some deep soul-searching in the last decade to come to terms with my identity as an athlete and ultimately arrive at a place that feels right for me.

Sadly, for many athletes, this growth comes disguised as pain. Consciously we’re just doing what we do. But subconsciously the mind knows something isn’t right. Most athletes get sucked down a rabbit hole of fixing the body reflexively blaming biomechanics, bike fit, shoes, posture, strength, asymmetry, flexibility, wear & tear, and age. But we know from modern pain science that these factors don’t correlate with pain. Modern pain science shows us that all pain is driven by the brain, all pain is affected by our psychology and social realities, and most pain is not body problem. Yes, even in athletes. Pain is far more existential and invites us to pay attention to deeper meaning.

My experience as a clinician, scientist, and athlete led me to create a course for athletes who are stuck in the “F” mindset. Athletes who are hell-bent on fixing, who are frustrated, focused on, fearing, freaking out, fighting, and feeding the symptoms by only treating the body. Relying on biomedical strategies that treat symptoms rather than cause. Athletes who only get better temporarily, for whom symptoms jump around and consistently interrupt training, or for whom symptoms accumulate thereby slowly eroding their ability to engage in movement and removing joy from the noble act of sport. Or worse giving up sport altogether.

The goal of my new course “Unlearning Pain For Athletes” is to empower you (people who want to be active and the clinicians who support them) with information and strategies to overcome physical symptoms once and for all. Then to make meaning and learn from those symptoms, and from your life experience, to emerge a better athlete who is moving from a place of noble intention, aligned with your values. An athlete who is unencumbered by the past and truly living as a vision of the future they want.

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There are only 20 spots available for the first cohort of this course. The first cohort of 10 to register will start on January 7th, 2024. The second cohort will start in early February. Grab your spot today and let’s discover athlete version 2.0 on the other side of pain.

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A question I often get asked is “Why has pain become generalized to other non-physical factors, like emotions? Well my basic answer is always that “emotions are the language of the body”. If you’re paying attention, every emotion connects to an associated body sensation, and every body sensation connects to an emotion. Emotions are the end result of any life experience. You have a thought, make a choice to do some behavior based on that thought, and that experience causes the release of a chemical called an “emotion”. This chemical release is one way we “feel” our emotions. To explain why this came to be a part of our programming, my colleague Howard Schubiner, MD floated this hypothesis, and I think it’s a good one.  I embellished and expanded it a bit for your reading pleasure. 

A few hundred thousand years ago, early people lived as hunter-gatherers and had to adapt to a dangerous environment to survive. Homo sapiens and Neanderthals roamed the earth at the same time. For both groups, it was a world filled with physical threats. Sabertooth tigers are one obvious colloquial example!

Credit: Dave Sabey

Neanderthals were bigger, stronger, and had bigger brains. They were in many ways physically superior to Homo sapiens. But they were also very independent and individualistic often hunting and living alone or in small groups.  Thus they were not incented to, nor did they benefit from, the socioemotional relationships that we appreciate today. This factor, combined with glacial climate change, the ecology evolving significantly, and their inability to adapt their hunting methods to a changing world, resulted in Neanderthals going extinct. Meanwhile, Homo sapiens survived. 

One reason Homo sapiens might have survived is because we worked in larger more communal clans, we learned to communicate, hunt, cook, reproduce, farm together, innovate, and problem-solve.  Essentially we relied on our communities and those social relationships as a means to overcome the threats that killed Neanderthals. So we became conditioned to believe that those relationships, and the thoughts, behaviors, and feelings inherent to them, were critical for our survival. So, emotions became an important part of preserving life in more communal societies. If early people were injured physically, they could die because of that injury, especially without support from a clan or community who cared for them. Physical injury was a threat to both Homo sapiens and Neanderthal, and both likely experienced pain in these situations. But is it possible that Homo sapiens navigated and recovered better from injury because of the support of their more emotionally evolved communities?

But to understand how emotions became linked with physical pain, we have to look deeper. Due to their more relational and emotional nature, Homo sapiens had an extra risk factor that might have potentially led to injury or death. Can you imagine what might have happened if you got kicked out of your community because you stole, damaged someone’s property, beat someone up, killed someone, slept with someone’s wife, or hurt another physically or emotionally for any reason? If you transgressed in some way against the clan, you’d likely be shamed and kicked out, and that would no doubt result in a lot of emotion. More importantly, without your community, the risk of injury or death was extremely high. Due to the social nature of Homo sapiens, the emotional threat became equal to the physical threat, or greater.  

So what if the brain started to use pain to protect Homo sapiens from anything that felt like a primal physical emotional threat to the individual or the species.  Maybe our brains learned to turn on physical pain if there was an emotional stressor that put us at risk in our relationships. Is it possible physical pain became an effective way to protect us from emotional stresses related to themes of control, intimacy, change, order, overwhelm, anxiety, depression, etc?  Events connected to these themes would likely threaten the individual as well as the health of the community. The brain would essentially be interpreting those variables as dangerous cueing you to pay attention and do what you need to do for the health of everyone involved.  Maybe even to force you to reconnect with your community, to slow down, to make things right, and to heal the emotional pain that puts the individual and the community at risk. Perhaps this is why the modern brain lights up on fMRI the same way when you have a physical injury as it does when you have an emotional injury, like a breakup. 

But why is this still so common today? The end of a relationship may be really hard, but rarely does it lead to death. Some estimates indicate that 90% of people who go see a doctor or PT with physical symptoms have no injury or medical issue but rather symptoms caused by stress. 1 in 5 people worldwide deal with chronic pain and the number is every higher when you consider other symptoms like anxiety, depression, fatigue, digestive symptoms, immune conditions, etc. So what could be driving the persistent link between physical pain and emotion?

Well, it’s only been 10k years since we moved from being hunter-gatherers to the agricultural era. At this point, societal complexity increased. 223 years ago was the start of the industrial era which added even more complexity to our society. It’s only been 40 years since the first computer, and smartphones have only been ubiquitous since 2014!  The exponential increase in complexity of our society is hard to comprehend.

Credit: Dave Sabey

We are VERY adaptable as a species, but the human nervous system has never been asked to change so quickly, and it’s clear we’re struggling. Never in history have we been faced with such intense communal stress as individuals, or as a society.  The volume of and access to news, information, the lives of others through social media, the overwhelming number of options in every domain, our ability to travel/migrate, and our exposure to technology is hard to comprehend.

The “perceived” size of our “community” these days is massive, and the emotional complexity of it is even more overwhelming. Think about how many other people’s lives you’re exposed to on Facebook and Instagram alone! How many of those people are part of your actual “tribe”? Our nervous systems are being bombarded with emotional threats from every direction (a lot of it from the lives of others) that the brain interprets, correctly or incorrectly, as objectively dangerous based on our past conditioning.  While some of this information poses actual danger, most of it doesn’t threaten us directly. Probably safe to say that most of these emotional threats (from Facebook, Instagram, or other sources) wouldn’t get us kicked out of the clan and put us at risk for death at this point.  But the brain still has that primal neurology whereby emotional threats equate to physical danger, and thus physical pain. Now those neural pathways have been habituated to a state of automaticity. So it begs the question, what do we do about it? 

The first thing to understand is that we’ve also been programmed, epigenetically (through experience) to default to the negative. For hundreds of thousands of years, we were rewarded for attending to the risks and dangers in life. While they were likely more intensely threatening then, they were also far less frequent. So there wasn’t a chronic and ongoing focus on what could go wrong, on why something is dangerous, or on why this is “bad”.  That same protective trait that served early humans, has now been generalized to most of the novel information that we’re faced with every day. Some sources say we consume 74 GB of information each day.  Read more about how much information the average person consumed in 2022 HERE. 

So the frequency with which we subconsciously react to our environment with a negative bias has increased in intensity and frequency. Pair subconscious negatively biased thoughts, with habitual choices and behaviors, with the emotions that result from those experiences. Now you have the perfect recipe for chronic pain or other physical symptoms that are linked to stress and emotion based on your past programming.

So can we unpair physical pain from emotional pain? Is that possible or even in the interest of humans in terms of survival? I believe that this phenomenon of the brain using physical pain to alert us to emotional pain is brilliant, once you understand it. You know by now that my goal is to empower you to leverage this epigenetic trait to your advantage. But to do that, you first have to escape the chronic stress danger alarm state that many of us find ourselves in. Here are my top recommendations to reduce the threat and danger load on your nervous system. 

1. Learn about the new science of pain. Follow me and my colleagues for ongoing knowledge bombs about how to use pain as a superpower. One of my favorite reads about the new science of pain is Alan Gordon’s book “The Way Out”.

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2. Improve your EQ or emotional quotient by upgrading your social/emotional awareness. Many books, podcasts, and blogs cover the subject in great detail. Some benefit from having a feelings wheel in their house where they can frequently become aware of their emotions by simply identifying and labeling them. 

   

3. Use pain as a cue to tune into your emotions and to notice what’s going on for you/coming up for you in those moments

4. Do things to be “in your body”. Constantly feeding your brain information through your body from the environment reduces the brain’s reaction to the environment both physically and emotionally. Use play, novelty, fun, nature, and make it social for the best results. 

5. Watch less news and stop your addiction to doom scrolling (and excessive scrolling in general). Where you put your attention, so goes your energy. When you remember that your energy and your time are currencies. While there is some value in being an informed citizen…once you realize your time and energy aren’t limitless, you might reprioritize where you’re putting your attention. Your nervous system will benefit from you staying conscious of how you spend these currencies.

6. Protect yourself from information that doesn’t enrich your life and stimulate growth. If you consume a stressful news story from across the world or a social media post that creates stress, and you can’t take any action and have no control over the situation, question the value of having consumed that content.

   

   Credit: Amnesty Intl.

7. Get clear on your values and your vision for your future. Set boundaries with people and things that interfere with that vision. Create a force field to insulate yourself from the bombardment of information so you can stay on your path. Setting boundaries is hard but ultimately super satisfying.

8. When you have pain, avoid the Fs - Fixing, Fearing, Focusing on, Fighting, Freaking out, Feeding, Frustration. Remember fear, not tissue damage, is the fuel for pain. Instead find a clinician or a coach who can support you in making important connections between physical pain, life stress, and the emotions that drive both. 

Becoming conscious of your subconscious programming takes energy and is uncomfortable. This is why change often feels hard. If you’d like to talk about the links between your stress, emotions, feelings of overwhelm, and physical symptoms, please reach out. If you found this post helpful, entertaining, informative, or thought-provoking, please consider subscribing at whatever level feels right. Our emotions are wisdom and inform us toward the actions that align with our values. As you understand the value of emotions, you’ll see that the strategies for unlearning pain and creating a new personal reality in your life have never been more effective and accessible.

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Be well!

Inflammation often creates confusion when people are in pain. While pain and swelling can happen together, not all inflammation hurts. Many people have pain with no inflammation. My neck had a painful kink this week but there was no visible swelling. Others have swelling without pain. My wife's ankle swells off and on due to frequent twists, but rarely hurts. And sometimes pain and inflammation occur together. Inflammation is SOMETIMES a RESULT or an OUTPUT of the brain when it's triggered into a state of danger alarm. This alarm can happen for many reasons spanning the continuum from physical to psychological and social stresses. Sometimes we get inflammation because the tissues are injured (macro-inflammation), but the more common type of inflammation has nothing to do with tissue damage or injury and is just, as I call it, "the cost of doing business" (micro-inflammation). But even when people know their pain isn't due to bodily injury, the feeling or visible presence of inflammation creates its own sort of fear, and thus often chronic and persistent symptoms.

So there are 2 types of inflammation. MACRO-inflammation is the type we get after an injury like a major ankle sprain, major car accident, bike crash, high-impact fall, joint dislocation, surgery, or other incident that creates tissue damage. It occurs local to a specific and predictable area, can feel warm, creates redness and tenderness, and you can often see it. This type of inflammation is actually helpful and productive because it's part of the normal healing cascade after injury or surgery. MACRO-inflammation often occurs with pain because it's part of the brain's way of protecting the injured tissue as it starts to repair. So it's best to honor it vs. trying to shut it down; unless it's significantly limiting your function or sleep in which case you might do something to take the edge off. Gentle movement, ice, floss band, anti-inflammatory medication, electrical stimulation, etc. But ultimately, we need this type of inflammation to heal! Importantly, MACRO-inflammation comes on predictably over minutes or hours after tissue injury or surgery and sticks around consistently for a while until healing is well on its way; at which point it slowly recedes and disappears.

MICRO-inflammation on the other hand is what you might think of as more systemic inflammation. It's what people describe after a night of drinking, a hard workout, a long airplane trip, or a poor night of sleep. It's the feeling of your whole system being more sensitive than usual. Everyone has some degree of MICRO-inflammation that varies day-to-day; it's a normal universal human phenomenon and never fully goes away. It's also there to protect you as your system does the important work of daily micro-repairs that come from living life. Again, the cost of doing business. While it can be visibly noticeable or local to a specific area, it's usually not something you can see. But it can mimic MACRO-inflammation and show up in a joint or specific area like a knee, ankle, elbow, back, ankle, or wrist. Basically anywhere your brain wants to inflame in order to alert you that you're in some sort of danger. It's mediated by Cytokines that create small amounts of inflammation that we can measure in the blood as CRP or sedimentation rate. These markers can increase due to things like stress, lifestyle, diet, and sleep. Basically the increase in MICRO-inflammation ties to our negative thoughts, un-expressed feelings, and unhealthy behaviors. And these levels can decrease as we take care of and are kind to ourselves. But unlike MACRO-inflammation, they're not associated with bodily injury.

Remember that pain is also rarely connected to tissue injury but rather to your brain's opinion about how much danger you're in. This is why pain can and does turn on and off, sometimes from moment to moment. Remember MACRO-inflammation related to a structural problem doesn't come and go like this. While MACRO-inflammation relates more closely to structural pain because it's attached to actual tissue injury, MICRO-inflammation is not a sign of structural problems or injury. In fact, like stress, if we experience it in short bursts, MICRO-inflammation is healthy and leads to increased fitness, greater resilience, and anti-fragility in one's life. See Kelly McGonigal's TED talk about the value of stress to learn more. Paradoxically, while MICRO-inflammation can actually lead to health consequences if it stays elevated chronically over time, it's not a primary input that directly triggers the brain into a danger alarm state. Thus, any symptoms that parallel MICRO-inflammation correlate more with fear and the brain's opinion of how much danger we're in, not with tissue damage. Sometimes symptoms result from the fear that MICRO-inflammation is dangerously tied to injury (which you now know it's not). But more often it's a result of an unhealthy lifestyle, negative thoughts, and repressed feelings combined with a lack of self-care and self-compassion. Basically, it correlates with our psychology and social realities, our beliefs, our mindset, and our fear. This is why, like most pain, MICRO-inflammation behaves kinda weird.

Luckily, we have some control over MICRO-inflammation using physical modalities like cold plunging, hot sauna, and restorative movement like a social walk, yoga, play, and time in nature. We benefit from building more healthy, moderate, playful, social, and joyful movement in nature into our lives. We can eat less inflammatory foods including sugar and processed foods while eating more whole foods that are plant-based as well as healthy protein and fat sources. We can all stand to prioritize sleep, rest, recovery, and more frequent self-care. We can aim our thoughts and feelings intentionally directed at what we want rather than what we don't. We can make it a priority to recognize, honor, and express our feelings in healthy ways. We can focus on daily gratitude and watch our negative self-talk reinforcing self-compassion. We can cut off unhealthy relationships and surround ourselves with people who are life-giving and love us while challenging us to grow. And we can seek meaning and purpose in our lives. Read about the Japanese concept of "Ikigai" and the South American concept of "Plan De Vida" to learn more about the importance of meaning and purpose. By the way the Netflix limited series "Live to 100: Secrets of the Blue Zones" covers this and is an excellent guide to managing MICRO-inflammation and longevity.

NETFLIX - Live to 100: Secrets of Blue Zones.

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One key takeaway here is that inflammation does not correlate with pain and should be considered an independent variable. But more importantly, there is nothing dangerous about inflammation. MACRO-inflammation is more associated with injury and healing and has a clear and productive purpose, resolving over time as we heal up (as we all do within a few weeks to a few months) and get moving again. Similarly, MICRO-inflammation is within our control day to day based on our habitual thoughts, feelings, and behaviors. So maybe it's time to stop fearing inflammation, stop associating it with pain, and live our lives fully respecting that inflammation is a normal and important part of life. Just a part of doing business. Maybe even a helpful message that we can welcome, thank, and learn from. Be well, my friends. And please reach out any time if you have any questions about inflammation.

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