Happy Holidays from all of us at CTS!

Thank you for trusting us with your health in 2019! We wish you a happy and healthy holiday season and look forward to our continued partnership in the new year.

CTS will be closed on Christmas Day 12/25 and New Year's Day 1/1.



Say hello to the newest PRPC certified physical therapist - our very own Emily Cozine, PT, DPT, PRPC

Congratulations to Emily on completing her Pelvic Rehabilitation Practitioner Certification!! The PRPC (pelvic rehabilitation practitioner certification) is the culmination of completing many hours of coursework dedicated to pelvic physical therapy and is capped by an intense exam. We're so proud of Emily, who just passed last week!

Emily's dedication to pelvic PT is evident not just in this certification but also in her interactions with patients. She is passionate about PT and cares about the people she is treating. In addition to her pelvic PT education, she has taken multiple courses in visceral and craniosacral therapy.

When not working you'll find Emily running up Torrey Pines, swimming Alcatraz, or doing downward dog in yoga class.

To schedule an appointment with Emily, call (858) 457-8419.

Pain and Language

I just attended a fantastic course (held at CTS) on the developments in pain neuroscience research over the past decade or so, called "Explain Pain." Since taking the course, I have been thinking about the language we use to talk about pain, and how that affects our beliefs about pain.

I have thought about the language of pain before in a different context, because I am a certified birth doula. In the doula world, we talk about how language can shape a client's experience during labor and birth. If you want to know if a woman in labor is having contraction, and you ask, "Are you having a labor pain?" you express through your language that all contractions are painful. However, if you ask, "Are you having a contraction?" you don't express anything about pain, and only ask whether her uterus is contracting or not. Keeping your language neutral as a doula helps women to experience labor in their own individual way, without being influenced by other people's preconceived ideas of what labor does or doesn't feel like.

But back to Explain Pain. One critically important finding of pain neuroscience research is that pain is not a thing-it's an experience.

The experience of pain is created by our brains in response to incoming input from our body.

The input that comes from our body that signals harm or potential harm is called nociception. But nociception does not always lead to the experience of pain. Whether the nociceptive input is experienced as pain or not depends on a wide variety of factors which occur in many different areas throughout the brain, as well as the tissues of the body, the spinal cord, and the immune system.
How does language fit into this? Well, what I realized was that some language implies that pain is a thing, while some language implies that pain is an experience. If I say to someone, "On a scale of 0 to 10, how would you rate your pain right now?" my language implies that pain is a thing ("your pain"), an entity affecting them whose emergence is automatic and beyond their influence. However, if I say to someone, "On a scale of 0 to 10, how would you rate your experience of pain right now?" my language communicates that pain is an experience, a current event whose emergence is multifactorial, with some of those factors under their influence.

Another example involves the neuroscience research finding that pain is not an input from the body to the brain, but rather an output of the brain. If I tell someone that they have joint pain, muscle pain, painful nerve endings, pain pathways, or pain drivers, my language communicates that pain is an input from the body to the brain (which is incorrect). However, if I tell someone that they have nociceptive input from the body that is contributing to their experience of pain, my language accurately communicates the science of how pain can emerge.

Understanding how pain emerges, with all its contributing factors, is a key step in understanding how the experience of pain can be lessened.

This course reemphasized to me that the language we use both expresses and influences our beliefs, and those of the people we interact with. Based on what I learned, I am going to be more deliberate and accurate in the language that I use related to pain. I hope these insights might be helpful to you as well!

My Experience with Hypnotherapy

I have always been interested in health and wellness. Exercising and eating well have been a part of my life since childhood. (Thanks, Mom!) Early this year an impending surgery created motivation to kick my health and wellness habits into overdrive. I took it as a personal challenge to be as healthy as possible by the date of my surgery. The following 8 weeks were a whirlwind of diet modifications, therapy, sleep adjustments, various forms of exercise, essential oils, dry brushing, castor oil packs, meditation, and journaling. One of the most helpful and interesting of the things I did was hypnotherapy.

I had no idea what to expect with my appointment with the hypnotherapist. Cartoons taught me to expect my eyes to spiral as I marched around the room on the hypnotist's command.

Instead, my 90-minute appointment with a lovely hypnotherapist began with a thorough explanation of the application and mechanism of hypnotherapy. She explained that the state of hypnosis was not something out of a sci-fi novel, but was instead a state of mind that everyone experiences on a regular basis. This is the state of mind that can be experienced right before falling asleep, right upon waking, and otherwise in deep physical and mental relaxation. When the mind is in this deep state of relaxation it allows access to the subconscious mind. This access point allows reframing of the subconscious to create real, physical changes. In my case, hypnosis would allow me to reframe my anxieties around surgery to encourage positive beliefs surrounding outcomes and expectations. Sounded good to me.

The next stage of the appointment was to identify my specific concerns. She delved deep into my anxieties and desired outcomes regarding the surgery. Based on this interview we agreed on a list of suggestions that she would read to me once I was in the suggestable state of hypnosis. These statements would allow my subconscious to accept positive suggestions and imagery.

Once we had decided on the suggestions she then had me lie down in a comfortable position. I donned dark glasses and headphones playing relaxing music and her voice was projected into the headphones. She started with something I was already familiar with: a body scan meditation for relaxation. This entails mentally scanning the body from head to toe and noticing and relaxing muscles along the way. It felt like getting a brain massage. Once I was in this relaxed state, she counted down from 10 stating that with each descending number I would sink deeper into states of relaxation. She then walked me through imagery of a relaxing, healing, hospital setting. All the while describing how calm and relaxed I will feel throughout each stage of my experience. She described the healing hands of all the professionals I would be interacting with as well as the ease with which surgery and recovery would occur. She continued by describing pain as being nothing more than a gentle reminder, encouraging the body to rest rather than creating alarm. With each suggestion she encouraged the subconscious to believe that these things would actually occur.

She recorded the session and I was left with instruction to listen to the recording twice a day up until the day of surgery and once in the morning before going to the hospital. I found the guided relaxation easier to stick to than the free form meditation I had been doing on my own. With nothing to lose I did exactly as she recommended and also began repeating some of her suggestions to myself outside of my daily hypnosis time. It felt good!

On the day of surgery I woke up to do my tape and felt encouraged that some of the suggestions and prompts were actually happening. I could feel the professionals I met at the hospital were passionate, caring, and truly had healing hands.

After weeks of feeling anxiety around surgery and anesthesia, on the day of surgery I felt strangely calm and trusting in both my own body and the skills of my health care team.

Following surgery, just like my prompts suggested, the surgeon greeted me in the recovery room and told me surgery had gone well. In the hospital room I reminded myself pain was gently reminding my body to rest.

The surgery came and went and I feel fully recovered. Some of the habit changes I made leading up to surgery stuck and some didn't. Of all the preparations I made I was most pleasantly surprised by my experience with hypnotherapy. I do feel that this technique requires some buy in into the process, but it comes with no drawbacks. I recommend anyone preparing for surgery to consider a session with hypnotherapy.

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