In this episode of Stay at the Top, I’m joined by Claire Richardson, an Advanced Pain Management Osteopath and pain clinician with more than 15 years of experience. Claire leads a team of seven practitioners across two private practices in Melbourne and runs Wayfinder Pain Consulting, her online clinic dedicated to helping people improve their quality of life while living with chronic pain.
We explore why chronic pain is different from acute pain and why it requires a completely different approach. Claire breaks down the science behind pain processing and the role of the nervous system, explains why “resting it out” or “pushing through” both backfire, and shares practical strategies to help people find their Goldilocks zone for movement, recovery, and everyday life.
With one in five Australians experiencing chronic pain at some point in their lives, this is a powerful conversation that will benefit you directly or someone you know.
In this episode Claire shares:
- The difference between acute and chronic pain, and why the terms are often misunderstood
- Why chronic pain is primarily a nervous system issue and how that changes treatment
- The boom-bust cycle and why neither extreme rest nor overexertion works
- Practical examples of finding the “Goldilocks zone” to stay active safely
- How the brain decides how much pain to produce, and why context matters
- The concept of “pain pizza” and how everyone’s contributors are unique
- Simple, evidence-based strategies to support neuroplasticity and reduce nervous system load
- Why social connection, sleep, and daily habits play a bigger role than most people realise
Key Quotes
“You can’t rest your way out of chronic pain, and you can’t push through it either.”
“Pain doesn’t exist until the brain decides it exists.”
“Everyone’s pain pizza looks different. You need to figure out what your biggest slices are.”
“Small, consistent behaviours are what support nervous system change.”
Episode Resources
LinkedIn: www.linkedin.com/in/claire-richardson1
Website: www.wayfinderpain.com.au
Jessica Spendlove Website – www.jessicaspendlove.com
Jessica Spendlove Keynotes – JessicaspendloveKeynotes – Jessica Spendlove
The High-Performance Profile Quiz https://jessicaspendlove.com/quiz/
Jess Spendlove Instagram https://www.instagram.com/jess_spendlove_dietitian/
Jess Spendlove LinkedIn https://www.linkedin.com/in/jessica-spendlove-64173bb8/
About Claire
Claire is an Advanced Pain Management Osteopath and pain clinician with over 15 years’ experience. She leads a team of seven practitioners across two private practices in Melbourne and runs Wayfinder Pain Consulting, her online pain coaching clinic dedicated to helping people improve quality of life while living with chronic pain. Since specialising in persistent pain care in 2018, Claire has combined clinical expertise with compassionate coaching, believing that knowledge is power when it comes to regaining confidence and control over life with pain.
About Your Host
Jessica Spendlove | Wellbeing Speaker & High Performance Strategist
Jess Spendlove is an international wellbeing and high performance speaker, coach, and advisor. With over 15 years of experience across corporate leadership, elite sport and the military she is known for helping ambitious leaders and teams optimise energy, build resilience, and sustain peak performance.
As one of Australia’s leading performance dietitians and a trusted voice in executive wellbeing, Jess delivers science-backed strategies that empower individuals, teams and organisations to thrive under pressure and achieve long-term success.
Episode Transcript
The following transcript has been automatically generated and not checked for accuracy
Jess Spendlove (00:05.804)
Welcome to another episode of Stay At The Top. Today we’re tackling a topic that one in five Australians will experience in their lifetime, chronic pain. Now the truth is you can’t rest your way out of it and you can’t push through it either. So what actually works? To answer this question today, I am joined by Claire Richardson. Claire is an advanced pain management osteopath and
and pain clinician with more than 15 years of experience. She leads a team of seven practitioners across two private practices in Melbourne and also runs Wayfinder Pain Consulting. Her online pain coaching clinic dedicated to helping people improve their quality of life while living with chronic pain. Since specializing in persistent pain care in 2018, Claire has combined clinical expertise
with compassionate coaching, believing that knowledge is power when it comes to regaining confidence and control over life with pain. In today’s episode, Claire helps explain why chronic pain is different from acute pain and why it also needs a completely different approach. Claire also helps us unpack why you can’t rest your way out of it and why pushing through with an all or nothing mindset doesn’t work either and how pain is shaped by the nervous system.
We also explore many factors that influence pain like stress, sleep, exercise, nutrition and hormones and also how neuroplasticity and offloading the nervous system is key. We cover a lot of ground, you’re going to get so much value from today’s episode and with one in five people experiencing it or will experience it, this is a conversation that will benefit you directly or someone you know.
On that note, let’s get into today’s episode.
Jess Spendlove (00:39.352)
Claire, welcome to Stay At The Top. Thank you so much for joining me today.
Claire Richardson (00:43.691)
Thanks so much for having me on, it’s a pleasure.
Jess Spendlove (00:46.798)
Claire, I’m really looking forward to today’s conversation purely because I think it’s a conversation which a lot of people will benefit from hearing, whether it’s themselves, whether it’s a loved one or whether it’s a future chapter in life. And I really think there’s a lot in this discussion which people just won’t be aware of. Some of the tips and the tricks and the stats and the facts they may have heard of, but from a different lens. So I’m really looking forward to this.
I guess just to set the scene for the listeners, like you’ve spent a career helping people not just manage their pain, but truly understand and regain control over life with persistent pain. I guess it’d be, you know, it’s always great to hear what sparked someone’s interest or how you’ve ended up specializing in this specific area.
Claire Richardson (01:40.589)
Sure, so I am an advanced practice pain management osteo, which means that I’ve specialised in the treatment and management of chronic pain, like you mentioned. I’ve been an osteopath for 15 years and I originally got into it, originally I wanted to do medicine, I’ve always been involved or interested in health and human capacity. I was attracted to osteo at the beginning because it is a whole body approach to health in its purest form.
So Ossipass are interested in the way that a whole person functions. So it’s not just focusing on say it’s an ankle injury, we’re not just looking at the ankle, we’re looking at the whole body and it’s all of its mechanics. And when you take that concept and expand on it further, we start to look at the whole person in their environment. So how do they function in their world? How are they showing up to work?
What impact is their function having on their ability to engage with their whole life and their loved ones and the flow and effects that that then has to, you know, lifestyle and work and hobbies and psychology and all of the parts that go into being a human. And that was really fascinating to me. And as I was practising in my first few years, I’ve always been in private practice. So I work one-on-one with clients and I get a lot of time with them, which is the benefit of being an allied health practitioner, as you probably know yourself.
But I was seeing more and more people who were presenting with chronic pain and we’ll go on to define that later in the conversation, but pain that’s been hanging around for a long time that’s not amenable to regular strategies of management. And the more I dove into the literature and the more study I did around that, I was so shocked at how much of an endemic that is within our society. So the current statistics say that one in five people in Australia will experience chronic pain at some point in their life.
So it is huge and it really does fall under the invisible illness umbrella or spectrum in the world. So chronic pain is not something that other people can see and it’s not something that can be necessarily fixed with something quick fix like a massage or an injection or something like that. And it has such an influence over that whole person’s environment and their habitat. So their whole world, their family, their hobbies, their ability to progress in their career, et cetera.
Claire Richardson (03:57.451)
I just really thought it was such a worthwhile pursuit and such an interesting area of science and when we talk about the science it’s really complex but it’s so fascinating and so empowering to know that there are things that we can do to help to move the needle for these people who may not have had any help or hope.
Jess Spendlove (04:13.902)
20 % of the population, that’s a huge statistic. So, this is definitely a conversation people need and want to hear for themselves or a loved one. I think let’s define it from the get-go. You’ve just touched on it there. I think it’d be good to, people probably, we’ve all probably had acute injuries in some way, shape or form, but define an acute injury and then define chronic pain. And I guess where the lines might blur if they do.
Claire Richardson (04:17.335)
Yeah.
Claire Richardson (04:41.973)
Yeah, sure. So the words acute and chronic are generally misunderstood. So a lot of people who are not in the health world and are not exposed to it every day may think that those two words are indicative of the severity of how something feels and that they’re absolutely nothing to do with it. So we can have acute pain that is, you know, one out of 10 on the scale and we can have chronic pain that’s one out of 10 on the scale. The words are nothing to do with the how bad it feels in the body.
They are purely to do with a time frame as to how long the pain has been present for. So acute generally means something new. So a really easy example is like an ankle sprain. So you’re running around, you roll your ankle, feel something go and it hurts and it’s bit bruised and swollen. So that’s an acute injury. It’s a new injury and it generally, you know, the pain that we feel is indicative of something that’s damaged or broken and our body then goes on to heal that injury.
Chronic pain is when pain has persisted for the literature and the arbitrary numbers somewhere between three and six months. And past that point is when it’s defined as chronic pain. And the reason why this is different, the reason that we need a delineation between the two is that in our body, the way that our body processes and feels pain and produces pain,
is different when it’s been hanging around for a long time. We have changes that occur within our nervous system and our brain and our tissues to a point that would change the way that we receive and process that information that turns into pain. So we need to treat them differently because they behave differently in our body and chronic pain may or may not be to do with an active injury. So it doesn’t mean, like just because we still have pain does not definitely mean that there’s still an active injury present.
and that’s where it gets really messy is that we still have this nervous system that’s producing pain even though the original injury may have healed.
Jess Spendlove (06:38.19)
Yeah, interesting. And I can see how exactly like you’ve said that the terms get used interchangeably with the acute injuries. Is it safe to say, and correct me if I’m wrong, that there’s a clear mechanism, you know, something happens and then that is really like off the back of that as opposed to, guess, like you said, the chronic pain is not necessarily anything like that.
Claire Richardson (06:59.105)
Yeah, in general terms, yes. So the vast majority of time there will be a mechanism for the actual injury and it might even be something that we could see on a scan or we could see some bruising or we would see a laceration on the skin or something that’s obvious that we could test for and I suppose quantify. Sometimes we can get acute pain that is to do with acute inflammatory states and I’m going a little bit off topic here but it could be like an autoimmune disorder or
you know, like a rheumatoid arthritis or something where, you know, we may not see a mechanism per se, but there is still a mechanism there if we tested for it and that might be a sudden onslaught of inflammation or something like that. But as a general rule, acute means new to do with something that’s caused it and chronic means that it’s hung around for a long time and it may not have a clear reason for its presence. Yeah.
Jess Spendlove (07:51.222)
Okay, fantastic. And then I guess with that, and you know, I’ve had these kinds of conversations with other allied health practitioners before around certain mindsets and maybe behaviors that come off the back of that, you know, such as that all or nothing approach or particularly with an injury, that kind of boom bust cycle. Why, you know, I mean, why do you think this happens? And also I can imagine neither of these approaches are the right approach, particularly when we’re dealing with chronic pain.
Claire Richardson (08:04.525)
No.
Claire Richardson (08:20.853)
Yes, so we’ll talk more about like the nitty gritty of the way, the science and the way that our nervous systems process and produce pain as we go. But in general simple terms, both the rest it out or wait it out approach and the boom bust approach are not helpful for chronic pain. And we talk about, or at least I talk about with my clients,
finding their Goldilocks zone, so not too little, not too much. We need to make sure that they’re remaining active and that can be physically active or it could be mentally active or it could be socially active and not overdoing it at the same time. And the reason why we have to walk that tightrope and we have to find that narrow band where they can function to do enough but not too much is because chronic pain is primarily a nervous system issue. So…
We are talking about a situation where our nervous system has become sensitive and it is over protecting us and we’ll talk more about that as we go. So we’re producing more pain and it could be disproportionate to the amount of injury or inflammation present. And if we, let’s talk about the weighted out first. So if someone was to be experiencing persistent lower back pain and that’s one of the most common experiences that we see in practice.
For someone who approaches it with a weighted out or I’ll just wait till this pain goes away before I exercise or I’ll wait till this pain goes away before I increase my hours at work or I’ll wait till this pain goes away before I attempt to go and stand up at a party. What we see there is that people are inevitably going to do less with their body. So they will just be less physically active, they will move less in the world and that can lead to deconditioning of their spinal musculature.
So they’re muscles that run either side of their lower back. And when we decondition, when we don’t move and we’re not challenging our muscles, they get a bit weaker, we get fatty infiltration of the muscles, and that means that we’re actually less tolerant to movement. So we’ve started, you know, we have pain, which means that we’re not tolerant to a lot of movement anyway. And by resting, we actually reduce our tolerance to movement and we predispose ourselves to further injury.
Claire Richardson (10:35.701)
And it could be the difference between, you you may be someone who goes to the gym and you do a 50 kilo deadlift. And something causes you to get back pain and it develops into chronic back pain. So six to 12 months later, you are waiting for this back pain to resolve before you go back to the gym. And if you continue to wait, we actually see a reduction in the amount that you’re actually able to lift. So we then get to a point where maybe 18 months later you would try and return to the gym.
and it only takes 10 kilos to start to flare that back pain up, whereas your capacity used to be 50 kilos prior to the injury. And that’s not to do with the fact that there’s an active injury at that point. At 18 months, we know that the vast majority of back pain or the injuries that cause back pain will have healed. So if there has been any tears or if there’s been any disc injuries or if there’s been any inflammation, at 18 months, it’s usually resolved quite well in most cases.
But we can have this overprotective response where we still have pain, but not moving is not the way to approach that. So deconditioning can be quite problematic for people who are in a pain experience. The other thing that happens is that with less overall activity, which is what happens when we try and rest it out, and that could mean that people become socially isolated, it could mean that they’re going to work less, it could mean that they’re less physically active with exercise and hobbies.
we see an increase in systemic body inflammation. So general health is so dependent on just incidental exercise and movement throughout the days. So much of our overall activity is walking to the train station or it’s taking the dogs for a walk after work or it’s going to get a coffee down the street or catching up with a friend or whatever it is. And we see a reduction in this incidental exercise when people are waiting it out with chronic pain.
And that means that they’re more predisposed to unhealthy internal environments in their body and we have an increase in systemic inflammation. And the other slightly left to feel but really important thing to remember is that waiting it out results in social isolation. And that can be, don’t want to go to the birthday party, I don’t want to go to my friend’s wedding because I can’t stand for too long, I’m going to avoid going on holiday with my friends because I don’t want to be seen to be a whinger because of my pain.
Claire Richardson (12:52.737)
And this social isolation is hugely predictive and predisposing of poorer mental health. And we know that there’s a really, really large correlation between poor mental health and a worsening of chronic pain.
Jess Spendlove (13:05.13)
And you’ve raised some really great points there. And in particular, I guess the training one, you gave the example of the deadlift. I can totally appreciate every case study and every individual and every client is different, but is then the general rule of thumb, keep doing the deadlift, but just do it at a lighter capacity or modify that movement. So you’re working the same muscles or…
Claire Richardson (13:19.554)
Mm.
Claire Richardson (13:29.833)
Yeah, great question Jess. So both of those approaches are possible. What we don’t want to see is a total prevention of that movement or a total movement away from or total avoidance of that movement. For someone who is experiencing pain with say spinal flexion, which is when you bend forward like you would in a deadlift, we’ve got lots of nifty ways that we can make that
movement feel safer. So we could get someone lying on their back and bringing their knees up to their chest. So we’re changing the context of the movement so it feels safer. And then when that movement becomes easier, which it will with practice, we might get them standing up and practicing the movement without weight and then we might add some weight onto it. And then we might get them to practice doing it with less stability, like on one leg or something like that. But the idea is that we’re gradually providing them with
a load and a stimulus to create adaptation. And when we think about that, that makes sense. As the general public understand that in order to build big biceps, you have to lift weights. You have to lift a bicep weight over and over and you can’t just do 100 kilos 10 times on one day a week. That doesn’t work. You have to do slow and consistent exposure to load repetitively over time and gradually increase that. And when we’re trying to train someone back into movement after they’ve had
painful experience. We are working at strengthening the muscles in the painful area so that they’re nice and safe and protected but we’re also looking at creating an adaptation in the nervous system so that it doesn’t give as big of a pain response to that movement. So when we re-familiarise the movement, when we de-threaten it, when we make it feel safer, we’re actually allowing that movement to, the nervous system to allow the movement and to do it without protecting and creating as much pain.
and that is as much a training response as say the muscle building is.
Jess Spendlove (15:25.504)
Yeah, wow, very interesting. you know, I guess as I, as I hear you talk about this, like is, is the summation or isn’t safe to say that chronic pain is a spinal injury or it has to be related to a spinal injury or can there be cro- Okay, no. Yeah. Cause just the way we were talking about it, I was thinking, does have to be spinal, you know, nervous, but no.
Claire Richardson (15:41.877)
Absolutely not. Yeah. Yeah. That’s a really great, great question. Okay. So we talk about spines a lot in chronic pain because that tends to be where a lot of people experience it. And I’m so passionate about this because it is such an interesting area of science. So chronic pain can occur anywhere that we have sensation because our
If we think about our nervous system, what we mean by our nervous system is our nerves, our spinal cord and our brain. And we’ve got nerves throughout our whole body and that can be in our tummy, in our gut, it can be throughout our musculoskeletal system in all joints and all muscles in our body. can even be things like migraines can be considered chronic pain in some sense of settings.
Wherever we have nerves that help us to understand sensation, we can develop chronic pain. We use the spinal stuff as an example because it’s so common and so many people experience it. And as we get on and talk more about the brain’s role in pain, this will make more sense. But we do see in people, a good example is that in Australia and in the Western countries,
People know what you mean when you say I’ve got a bad back. So Jess, if I said to you, I just have this bad back, you have these connotations of someone who has recurrent back pain, maybe they feel like it goes out of place or something weird when they bend over and pick something up, maybe they’re less tolerant to lifting. But that is something that our society has sort of got this connotation towards and we don’t see it as readily in.
other societies and there is a correlation between whether or not people believe that they are weak or believe that they are vulnerable and we see that more in Western society than we do in others and there’s a relationship between the statistics with back pain. So what I would say is that spinal pain or lower back pain in particular tends to show up
Claire Richardson (17:59.169)
the most and tends to be the most concerning and the most debilitating and the most worrying. So we talk about that a lot in our examples, but the same processes can be at play anywhere throughout the body wherever we have sensation.
Jess Spendlove (18:11.574)
Yeah, interesting. And I guess before we move on, because I’m really interested to understand and get your perspective on how pain is created and processed. what is happening that it is the lower back? Why does that generally tend to be the place for the majority of people? You’ve referenced that a few times.
Claire Richardson (18:18.432)
Yeah.
Claire Richardson (18:28.737)
Yeah, so lower back pain tends to be the case for a few different reasons. So like I said, there’s cultural reasons for that. So we have more of an awareness and a concern around our lower back in certain cultures. It also tends to be something that can be quite preventative. it can get, if we experience a lower back injury.
it can get in the way of what we’re able to do a lot more than say a wrist injury, for instance. So because your lower back is something that’s so important for you to be able to mobilize and ambulate, so in other words, for you to move around the world and walk and walk stairs and lift things and carry things and pick stuff up. All of those movements are really important for our activities of daily living, like getting on and off the toilet, for instance, or showering ourselves and all of these things that are really important for us to kind of live our lives.
Lower back pain is a lot more inconvenient than say a wrist problem or maybe even an ankle problem. And it’s not that we can’t, we absolutely can see severe chronic pain in those other areas, but lower back pain, because it is so much more inconvenient, there is a lot more influences over the severity of the way that we feel it to do with stuff like social isolation, inability to go to work, stress.
sleep, will flow on more from a lower back injury than it might from somewhere else in the body. So I think that’s informed by the literature but also my opinion.
Jess Spendlove (20:04.984)
Yeah, well, and that’s exactly what, you know, the listeners want to hear because it’s definitely, everything you’re saying is clearly very evidence-based, but you’re an expert in this space that you are living at, you’re breathing at, working with people on a daily basis in multiple businesses and clinics. So I think that anecdotal is the word which kind of takes away from what it is, but it’s that blend of the two, which I think is the value.
Claire Richardson (20:29.911)
Mm.
Jess Spendlove (20:31.116)
And so I guess, I really love to get your definition of how pain is created and processed in the body. And, you know, is there anything that predisposes it to them becoming long-term?
Claire Richardson (20:44.203)
Yes, so we have multiple areas that are key in pain processing and this is an area of science because it is so complex we’re going to try and boil it down to the simplistic terms and also just as a disclaimer it is a really highly researched area of science and the science is always being updated so what I’m saying today may need to be updated in five years or ten years time but as we understand it today
there tends to be some key areas where pain is processed. So the first thing to note is that to the best of our understanding, pain doesn’t exist unless our brain decides to make it exist. And what I mean by that is that we do have nerve endings. Let’s just use, I’m gonna use an ankle sprain as an example for this. So if we have an ankle sprain and we overstretch the ligaments in our ankle, we will get local inflammation. That means we get a release of
chemicals into the local area that will cause it to get swollen and bruised and the point of those chemicals is that it stimulates healing. So that’s supposed to happen in an acute injury, it actually helps us to get better. But it really hurts. Those inflammatory chemicals will send, they will get released into the tissue and then they will set off what we call a nociceptor and a nociceptor is not a pain receptor but it’s a nerve ending whose job it is to relay information to our brain about potential damage in our body or danger.
So when we get the inflammation being released into our ankle, these nerve endings get stimulated and they will send a message up to our spinal cord, which then carries it onto the brain. So when we have a lot of inflammation, we obviously get a lot of those messages being sent. So that is nociception. And it gets carried all the way up to the brain and then our brain receives that information and it goes, oh gosh, there’s something damaged in my ankle, right? At that point in time,
Our brain’s job is to work out just how important it is to keep us safe at that point. And it has lots of different information available to it. So it could be considering where you are in space, like what can I see around me? What previous experience do I have with injuries like this? What is my internal health environment like right now? Am I well slept? Am I well hydrated? What’s my nutrition like? Where am I at with my hormones? And all of these…
Claire Richardson (23:12.065)
bits of information are available to our brain to access immediately. So when our brain has taken all of that into consideration and worked out how important is this danger message that I’m receiving from my ankle, it will then produce the pain. The pain comes out of the brain, not from the ankle up to the brain. That is an information, that’s one piece of the puzzle, then the brain puts all of the pieces of the puzzle together to decide how much pain to create. So…
The ankle is important and it provides a lot of information from the inflammation, but it is not the deciding factor on the exact amount of pain that we feel. Now, as pain becomes more chronic, so the inflammation in the ankle starts to die down, so we’re getting less of that nociception. But when pain becomes disproportionately chronic, when it lasts too long past normal healing time, we see changes in the spinal cord and in the brain that actually
Jess Spendlove (23:43.438)
you
Claire Richardson (24:08.343)
can either misinterpret non-dangerous signals like pressure or touch or vibration or temperature as being painful. So it can kind of let that no-susceptive information through to the brain more than it should. And we’ve got these areas in the spinal cord that can basically let more information through. And then we can also have other parts of the brain around what does this pain mean for me? So is this preventing me from going to work? Is this causing excessive stress?
Does it mean that I’ve missed out on relationships and exercise and all of the stuff that makes my life worth living? Is it getting in the way of me being able to work at my peak performance? And so all of those other concerns start to light up other parts of our brain that get basically hardwired into the pain experience and that can amplify it as well.
Jess Spendlove (24:55.724)
Yeah, wow, there’s just so much going on and it’s, I think that’s a tagline. think you need that information is, information from inflammation. I think you need that as a tagline somewhere. But I guess what I’m hearing is like pain is not physical and there’s a whole heap of other factors going on there. How does that conversation go with your clients? Like, is there anything that helps paint that picture because
Claire Richardson (25:19.309)
Yeah.
Jess Spendlove (25:21.548)
As someone who has experience and is currently experiencing chronic pain, I feel like I’m a little bit more across all of this because the, and all of that stemmed from the standard treatments were not resolving the problem. So I’m in my own kind of deep dive in this space at the moment. But yeah, for people who do think, it’s physical, it’s attached to the injury, or how do you have that conversation and start to paint that picture?
Claire Richardson (25:36.215)
Yeah.
Claire Richardson (25:48.269)
So I talk about a thing called a pain pizza and look, I agree with you Jess in that pain is not purely physical is what I would say. In some cases and in some interests because every single person who experiences this because their contextual influences, so their lifestyle factors, their beliefs, their understandings, their meaning behind the pain is so different from person to person.
High achieving athletes are one example. you know, an ankle sprain for someone like that, it means something totally different if it means that they’re missing out on part of their season or maybe it happens two days before the grand final, whatever. That meaning is far different to say me when I’m just walking the dog down the street and it doesn’t really matter. I can afford to take a couple of weeks off, right? So everyone’s contributing context to their pain experience is different.
and everyone’s lifestyle factors are different. the thing that we don’t, a lever that we don’t have available to us to pull to help them is genetics. So some people are unfortunately more genetically predisposed to chronic pain states than others. But from a perspective of pain isn’t physical, that can be true, but in a lot of cases there might still be a physical component. The question that we have to ask is to what degree is that the thing that’s driving the experience? And in…
what you’re discussing, I would say that if there was an injury, we haven’t chatted about your injury, but if there was an injury and the traditional methods weren’t working, then we would maybe start looking further aboard to see what your big contributors are, because maybe it’s not the original injury that’s the big contributor right now. But I talk to my clients about a pain pizza. So if we imagine a pizza with lots of different slices, sometimes you…
get the cheap one from the corner shop and they don’t do a good job of cutting it up, right? And we have got some slices of pizza that are almost half the pizza size and some teeny tiny little slices that wouldn’t fit a fly. that’s kind of the wonky pizza is what we’re dealing with here. And we don’t know which of the contributing factors are which slice of pizza until we start doing a bit of a deep dive on an individual level.
Claire Richardson (28:01.951)
And that can mean that there is a bit of trial and error. So for someone, their big slice might be sleep. Or for someone else, it might be regular movement. Or for someone else, it could be stress management and relaxation strategies. Or someone else, could actually still be physical. And maybe we just need to have a look at improving their internal environment and their predisposition to inflammation. So maybe we…
can try something like a cortisone injection if that is relevant to them, but it’s certainly not relevant to every single person experiencing chronic pain. it’s not about saying it is either physical or non-physical, it’s about trying to work out what that person’s individual contributors are.
Jess Spendlove (28:49.334)
Yeah, great. And thank you for clarifying the, you know, the, cause the language sounds, it sounds so important and it sounds like it’s, I guess with a lot of areas of health multifactorial, everything is intersected and it’s figuring out, what is the hierarchy for that individual? I just had a curiosity, like how long is an initial session? Because it sounds like you’re covering so much ground. How does that even, yeah. How long do you get?
Claire Richardson (28:59.808)
Mm.
Jess Spendlove (29:18.168)
Do you like to spend with a client to kind of start working through that?
Claire Richardson (29:22.067)
Yeah, so it really depends on that person’s pain experience and their journey. And in some cases when the pain is really impactful, like when it’s having a huge influence over their life, we talk about these tentacles. It’s not just about the physical sensation of pain in their body. It’s the meaning that it shows up for in their life. has it meant that they have missed a promotion? Has it meant that they’ve missed deadlines at work and they’re starting to have negative outcomes on their career?
has it meant that they’re not as present with their family or when they are they’re very snappy and they have no energy and they feel zapped and is that then having a big snowball effect onto mental health and ability to be in the world? So in that case that’s a really big case with lots of tentacles going out into lots of aspects of it and we would be talking more around pain related distress in that situation. So we can almost separate out the severity of the
what it feels like in your body and that’s just one thing on its own and then we can have all of the layering effect of how it can negatively affect lifestyle and life. So for a person like that it might be multiple hour long appointments and in a pain program that I work in we see people for 18 sessions for an hour and that’s quite severe cases. For people who are functioning quite well in the world and they might be
impacted by their pain and frustrated by it and it might be preventing them from getting to the level that they’d like to be at. But generally they function quite well in the world, maybe they’re just bit sore here and there and they can’t exercise the way that they want to. That generally can, well it can be if the people are amenable to it. A shorter trajectory it could be that we need 45 minutes to an hour in the first instance and we can create a treatment plan and they sort of stick with it and see some changes over a couple of weeks.
Again, I wish I had a number for you. It’s a bit of a how long is a piece of string, but the reason for that is that everyone’s nervous system and everyone’s contributors to their pain experience is totally individual.
Jess Spendlove (31:29.142)
And I mean, I can imagine in this space, you’ve probably seen it all. Like you’ve probably seen, I don’t even know. I can imagine people like some working with someone like yourself. And I feel like it’s kind of like me in the work. I do now, I’m not someone’s first stop. I’m not someone’s, they don’t come to me when they first have a goal of wanting to, know, improve their energy or improve the overall, you know, like performance in life or.
Like I’m not the first stop. What are some common, I don’t know if they’re misconceptions, myths, like paths people go down before they probably find someone like yourself who can really help them work through that.
Claire Richardson (32:12.289)
The really sad part about, the thing that I find distressing and sad about chronic pain is that because it’s really poorly understood in the general public, unfortunately it can mean that people get on what we call the merry-go-round of intervention and that can be that they try one thing and that doesn’t work, so they try another thing and then that doesn’t work and they try another thing and that doesn’t work and…
The problem with multiple failed approaches, if someone has been down that path and they’ve been to multiple different people and they’ve failed therapy in multiple different ways, is that it leads to this real erosion of hope. So it means that people start to internalise these ideas about themselves of like, am fragile, I am broken, this is never ever going to get better.
And those deep-seated beliefs can really change the way that people engage with a proactive approach to recovering from chronic pain. Because unfortunately, we see that active approaches where the person is the one who is empowered through, maybe they work with someone like me and I help them to understand the information that they need to get better, but they’re still the ones doing the work. They’re still the ones having to do the exercise or having to do the mindfulness or having to work on their sleep.
And that’s what we call an active approach when the person is the one doing the work through like a coaching relationship or an educational relationship. Passive approaches are where the therapist is the one doing the thing to you. And that could be something like massage or it could be, you know, those sort of approaches. And those have their place. But what we do see in the literature is that active approaches tend to resolve chronic pain far more quickly and more effectively than passive approaches do.
So we use passive approaches judiciously to allow for people to re-engage with important stuff, but that’s not a well-known fact. So if I could myth-bust stuff, it’s that passive approaches will fix me and that I am not empowered. If I could sort of almost provide a bit of hope and say that we know that when people involve themselves in their care and focus on lifestyle factors like sleep or mindfulness or physical activity,
Claire Richardson (34:28.085)
their chances of recovering from chronic pain are so much better even if at the same time they’re peppering in some passive approaches as well.
Jess Spendlove (34:35.918)
Yeah, that’s really interesting. And I can imagine like for everyone that that progression, the treatment, the treatment plan, the journey, I always cringe when I say the word journey, but that is exactly what it is. I can imagine it looks and feels different. So for some people, can it be a matter of they’re in this phase of quite intense pain and then not overnight that it goes, but then it drastically improved or is it more of a gradual progression? They can have a few days without like
Or is it everything in all of the above?
Claire Richardson (35:09.259)
Yes and yes, yes and yes. So when we see, I suppose, the drastic quick turnaround of something that’s been there for a long time, it’s usually because we’ve unearthed one of their slices of pizza that they weren’t aware of and that all of a sudden they start paying attention to it and they get a really good response to that. that could be, an example that I had last week was a client who came to me after, I felt like we were sort of,
bashing our head against a brick wall for a long time. We were trying a lot of different things and it wasn’t working. And this client came to me after keeping a sleep journal and following some sleep hygiene advice that we’d been through at the previous session and came in and went, my gosh, my pain has gone from an average of seven out of 10 down to a four or five, which is a big change for someone who’s had pain for 20 years. And that was a really quite a quick noticeable change.
Jess Spendlove (36:01.698)
Wow.
Claire Richardson (36:08.033)
But in most cases, we’re working with stuff that has become the normal functioning of the nervous system. So our nervous system has trained itself into the pain state and we sort of need to train our way out of that. And that’s what neuroplasticity is, our nervous system’s ability to create new connections within itself and create a new normal, which is what we’re trying to work towards with these small and recurrent and consistent behaviours. And that’s why it can take a long time.
but to kind of consistently and gradually improve.
Jess Spendlove (36:41.422)
Yeah, fantastic. And I guess like, let’s like sit in this talking about the nervous system and neuroplasticity because I think it’s something people won’t have heard. I think it’s probably an area which a lot of people don’t necessarily know that much about. They might’ve started to hear about it. feel from as a consumer of content, I see it getting spoken about on the podcast in different ways, shapes or forms, like definitely more from a cognitive…
ability retaining your cognition, know, preventing that cognitive decline. But from this perspective, yeah, I’d really like to, to spend some time here. So I guess at first thinking about the, the nervous system, are there some simple habits that people can adopt today that will help reduce that load and that pain which tends to spiral?
Claire Richardson (37:32.513)
So it’s great that you bring up the idea of people’s familiarity with, I suppose, the concept of neuroplasticity from a cognitive point of view, right? So if we’re talking about attention or ability to absorb content and our concentration, for instance, they’re all trainable. And learning itself, when we learn a new skill like a musical instrument or another language, that is neuroplasticity in action. That is our brain creating new connections and new circuitry.
to allow us to do something new. And that doesn’t just happen with cognition, with our thoughts. That happens with anything that requires our nervous system to control it. So the way that babies will grow and learn to move when they’re starting to walk, when they’re crawling, that’s neuroplasticity. That’s their brain creating new connections between it and its body and the control that we have over our body. And we used to think, we, the medical fraternity, used to think,
years and years years ago that we didn’t know that existed. We thought that you became an adult and it was set. And we now know that people have got the capacity to continue to adapt their nervous systems and the way that they function throughout their life. So whenever we have sensations or things to do with our body, we can train and adapt that in the same way that we can when we learn and we expose ourselves to a new skill. But from a perspective of
How can we use neuroplasticity or what are the skills that we can use to promote neuroplasticity. It really boils down to a lot of the skills that you discuss regularly on the show, which is sleep, stress management, good nutrition, physical exercise. And I would go so far as to say that with chronic pain, the really big important one that I would tack on to
is social connection. So being supported and around people that we love has a calming influence over our nervous system and means that we’re less in that fight or flight state. We’re actually able to deal with stress and with difficulty in our world and that involves chronic pain better when we are supported by friends and family members. So from a really easy idea, a really easy
Claire Richardson (39:51.935)
analogy that we can use with what we can do to buffer ourselves against chronic pain. If we think of a set of scales and we’ve got one side is all of the stressors that we are exposed to in our daily life and that could be the things that create inflammation. So it could be sedentary behaviours, could be poor diet, it could be poor sleep and then we get a little bit further afield and we think of like our mental stressors. So if we’ve got a really big deadline at work, if we’re under the pump financially,
if we are burning the candle at both ends and really going hammer and tong at work, if our kids are sick, if our parents are elderly, all of these life factors that may feed into it, and then even just down to the things that we put into our body that aren’t food, are we taking medications that have side effects, or how’s our hormone levels, and we see this in, unfortunately, women in peri- or menopausal states.
all of those things that could, I suppose, negatively influence our nervous system or add load to it in a negative way, all of those things can contribute to the severity of our pain experience. So if we want to try and offset that, we can think of the other side of the scale and what are the things that we can do to fill our cup to assist our nervous system? And that could be meditation, it could be mindfulness, it could be physical activity or sleep, or it could be…
know, nutritious food, could be social connection, it could be something as simple as making the effort to listen to your favourite music in the car ride on the way to work to offset some of that stressful experience. whatever we can do, like even if they are tiny, tiny little influences, it all adds up. So the more of these tiny influences, if we can, you know, mindfully sip our coffee rather than just gulping it down.
These are all things that we can do to support our nervous system and to reduce the burden of the experience of the chronic pain.
Jess Spendlove (41:50.326)
Like you said, it’s all brick by brick. And I guess in this context, it’s relating to pain, it’s, know, for what I talk about, it’s really for any, a lot of areas, whether we’re talking mental health, physical health, performing at your best, which I think is a really great thing for people to understand that a lot of the time, regardless of which lens or the goals in life or the season of life, like a lot of what gets discussed here.
transfers and translates. And then it’s really just having that right support person, that practitioner for you, whatever goals that you’ve got, whether you’re managing pain, whether you’re trying to achieve some sort of sporting outcome or anything in between that can really help you navigate that. And you know, that’s how we actually started talking. We connected on LinkedIn and you shared with me that this podcast, you often refer it to a lot of your clients because a lot of the content that gets spoken about, which I was…
really chuffed about for a number of reasons, but yeah, we’ve spoken a bit off the back of that and I thought, you know, let’s do an episode because 20 % of the population have or will experience chronic pain. And I think you referenced it before, the idea of the bad back in the Western world and it’s something that kind of just gets thrown around. Like it’s a little bit of this stereotypical kind of generic framing. Like, you know, there’s a lot of value that this can add because
There’s a lot of people experiencing pain in different ways, shapes or forms. yeah, it’s something which can impact whether it’s a baseline level of living or whether it’s a high performer who has big audacious goals. What really resonated with me is, you know, someone who isn’t exercising at the capacity they want to. That’s probably the one that speaks to me. And it’s just a reminder of having that those right people around you.
I guess as we get to the end of the episode, it’d be great to know from all of your experience in working with people in pain in so many different ways, shapes or forms, is there anything that continues to surprise you or has surprised you the most when working with people in pain?
Claire Richardson (44:01.706)
Yeah, think that so obviously pain can be so impactful on life, It can really steal away energy from, you know, it reduces our overall ability to be in the world and our overall energy to do the things that we want to do. So I see particularly the high performers that I treat and this is
probably your audience, I see a lot of people who, a pain experience, if they have a bit of a growth mindset around it, and this can be a really difficult thing to adopt when you’re obviously suffering, when something is really horrible and yucky that you’re going through, but when people do adopt a bit of a growth mindset around it, it really helps them to narrow down their why. Like it really helps them to understand where they need to be putting their energy because it’s quite finite. So they…
are more clear on their goals and sometimes that can actually drive a determination to reach their goals and it means that they’re more focused on doing what they need to do to recover from chronic pain. And certainly that’s a difficult thing, like that’s a very difficult mindset to get into when you’re experiencing hardship and suffering to do with chronic pain. But a lot of people do get there on their own bat after they’ve learnt the science and I’m always…
really inspired by their tenacity and just how resilient these people can be when they are given the right information to recover from chronic pain.
Jess Spendlove (45:36.866)
Yeah, fantastic. you know, I think we touched on it a little bit before and we talked about the literature and the anecdotal, but are there any particular lessons from just, you know, the 15 years working and being in this world that goes beyond the science that you can share that hasn’t already been mentioned?
Claire Richardson (45:57.645)
Yes, so the literature is very clear to say that our brain is super powerful and pain is weird and we don’t, and you know, because it is so complex and we’re still learning so much about pain, we don’t understand it properly yet and I think that that area of research will continue forevermore. But I’m always so, in my patients, I’m always so surprised at
the types of things that can influence their pain. So I can go through the list of things that we’ve discussed in this episode and it won’t resonate with someone and then all of a sudden they’ll come back and go, gosh, I went to my psychologist and we discussed some childhood trauma or something and now my pain’s gone. Or they might come to me and say, I got a promotion at work and now my pain’s gone. they might, know, so pain’s so slippery and so weird and just because we can’t narrow it down to one contributor doesn’t mean that the search
ends. Like we never ever know what someone’s iceberg is. So I always say that like the discussion that I have in the room with someone and even what they’re cognitive of as their pain contributors is the tip of the iceberg and then there’s all of the stuff underneath that they might not even know themselves. So we can always continue to help that person understand what their healthy behaviours are that
that improve their chances for neuroplastic change and they can always do some self-reflection and some mindfulness that might show something up over time as to what their contributors are.
Jess Spendlove (47:29.55)
Yeah, fantastic. I would normally do this bit, I think to do the episode justice, I actually want to throw this to you and it’s the episode recap. So I think if you were to pick three to five key points that you really want to drive home or emphasize to those listening, what would you call those out to be?
Claire Richardson (47:51.661)
So working with chronic pain is really hard and we’ve discussed it in a way that sounds simple and sounds like it’s methodical and sounds like it’s process driven and to a point that’s true but acknowledging and remaining, for the person experiencing pain, remaining self-compassionate and recognising that it is a marathon not a sprint and we do not want to let perfection get in the way of progress and I think this is something I’d like to kind of add on to an answer I’d said before.
We spoke about the problems with resting our way out of pain and that not being the solution but we maybe didn’t expand properly on the boom busting behaviours which is where in pain contexts we see people who might have a day where they’re not having as much pain and they’ll try and jam in as much as they possibly can. Like I’ve woken up today and I feel okay so I’m going to do the shopping, I’m going to do a 10 hour day at work and I’m going to go for a walk because I haven’t exercised this week and today is my window of opportunity and what that generally does
is causes people to have a giant flare afterwards that might flatten them for two days so they can’t get out of bed in some circumstances. And obviously the more that cycle repeats, the more flares they’re going to have. And that actually further sensitizes their nervous system and makes them produce more pain. So we want to walk that line where we recognize that we’ve used up our allocated amount of activity for the day and we stop because if we do further, we’re going to push ourselves into a flare. And when…
we might spread that out evenly across the week so that people are doing a similar amount on every day regardless of whether it feels like a good or a bad day for pain. And when we approach it like that, it might feel like they’re having to hold themselves back on their good days and push a little bit further on their bad days, but they actually get net more done in a week. And so this is what I mean by not letting perfect get in the way of progress. So…
We want to try and make sure that we’re moving towards our goals and that we’re doing the things that we can do and focusing our energy where we can, but also being really compassionate to ourselves on the days that we can’t. So we might try that pacing plan that I just mentioned where we try and do a similar amount every day, but it’s not going to work every day. Sometimes we’ll fall off the bandwagon and all or nothing thinking in that situation might lead to, gosh, I’ve thrown the whole week, may as well just, you know, what’s the point? I’m just going to have a horrible week and I’ll…
Claire Richardson (50:12.983)
I’ll try again next Monday. Whereas we know that small consistent behaviours, even if we’re trying to offset big yucky behaviours, are still really helpful to buffer pain and to kind of dig us up out of the hole. So there’s that. So self-compassion when dealing with pain is really important, but so is consistency. And sometimes the really simple and getting back to basics stuff around regular physical activity to the best of our capacity.
regular sleep and making sure that we’re getting enough of it and for people with chronic pain that could be like seven or eight hours at minimum and making sure that we have social connections and the reason being is that pain is not only contributed to by our body but also our nervous system and our brain so we need to be nurturing all of those factors if we’re going to address pain properly.
Jess Spendlove (51:02.594)
Yeah, wow, it’s really highlights the importance particularly. I mean, in any area, you want to have the right people on the bus. You really need the expert who really knows the space. But I think really with something like this where people are, it’s emotional, it’s challenging, it’s frustrating and really having somebody to, you know, walk the path with you who truly understands the space and has your best intentions at heart.
Before we kind of, before I throw a question to you, where’s the best place for people to find you, the work you do? I know you have a few businesses and a few different ways that you work with people and your team. So where’s the best place for people to connect?
Claire Richardson (51:47.393)
The easiest place would be my website which is wayfinderpain.com.au but I’m also quite active on LinkedIn so the link for that will be in the show notes.
Jess Spendlove (51:59.394)
Yes, definitely all the website and the links and all of that. we’ve spoken a lot today about your expertise and added a lot of value to people, but you’re a busy lady doing a lot of things. And I really like to ask my guests, what three habits or behaviors or things help you do everything that you do and stay at the top?
Claire Richardson (52:25.921)
So, you’re right, I’m really busy at moment and something that has not come naturally to me or easily to me is exactly what I said before, which is the self-compassion part and recognising that I can’t do everything perfectly all of the time and I’ve got two little kids and a husband and multiple businesses and staff that I really care about and I feel like I’m consistently dropping the ball in one area and that feels really yucky so I’ve done a lot of work to try and work out some self-
compassion around that which has really changed my outlook on my ability to show up in those domains. So I think being kind to myself and recognising we’re aiming for progress not perfection. And sleep is a really important one. I function so much better. It’s night and day and it’s, you know, within two days I notice a difference of my mindset and my energy levels and then some regular physical activity in sunshine is another one.
my favourites and I think really important, you mentioned in an earlier episode recommending that people actually get out for a walk around the block at 3pm instead of reaching for a coffee and I totally agree, I think that that’s a game changer. Yeah.
Jess Spendlove (53:35.51)
in so many ways, shapes or form. It’s just like, how do we set the reminder or the trigger to make that happen? Because it’s so much easier to walk to the coffee machine. look, those three really land and resonate with me. And I think there’s something about being a healthcare practitioner where, you know, our role is we really want to help people and it is reminding ourselves that.
own oxygen mask on first and we can only do what we can do and that changes with different seasons. It’s definitely shifted for me at the moment with a nine month old.
Claire Richardson (54:08.493)
Yes, absolutely. Yeah, I feel like it’s that whole making sure that we’re focusing on the fact that we are doing our best and that we have continued opportunity for learning.
Jess Spendlove (54:19.822)
Claire, thank you for joining me for your expertise, for your value that you’ve given and your generosity. And I’ve really gotten a lot of value out of this episode and I know a lot of people will. Thank you for those who’ve tuned in for another episode of Stay At The Top. If you’ve liked this episode, please make sure you share it. If you know anybody experiencing chronic pain, definitely share it and make sure that you connect with Claire and follow her amazing work.
On that note, that’s all for me this week and I’ll be back again next week with a solo episode helping you not only reach the top, but sustainably stay there. I’ll see you all then.