SIM Seeking
SIM seeking in Tofino, May 13th 2024. SIM stands for Safety in Me. This was a day full of Super SIMs!
“You will have pain when your brain concludes that there is more credible evidence of danger related to your body than there is credible evidence of safety related to your body.” from Noigroup’s ‘Explain Pain Handbook Protectometer’ handbook, p. 21
According to the World Health Organization, number six of the Top 10 global causes of disability adjusted life years (DALY) in 2021 was chronic back and neck pain (DALYS — one DALY represents the loss of the equivalent of one year of full health). Noigroup declare that “Ongoing and severe pain is the most costly health condition facing the planet. Why? Because it can be so bad, so distressing, so disabling and so persistent, that it stops people from doing the things they want to do — the things that give life meaning.”
Having lived with ongoing neck pain for the last 10 years, I can affirm that this can be the case. When pain first struck, it was sudden, and I was terrified. I stopped working, stopped doing the things I loved, withdrew from the world. Thankfully pretty quickly I started working with a brilliant physiotherapist who understood the biopsychosocial model of pain and set about educating me and reducing my fear and anxiety. Many things, often surprising things, can contribute to pain. Pain can be understood as a complex experience influenced by biological, psychological and social factors, not just the injury/possible structural issue itself. The light went on! I was back to work in three months (initially at least!)
I believe that one of the most powerful treatments for persisting pain is understanding it. Truly understanding it, at a bone-deep level. Repeated studies have shown that there is nothing better for chronic pain than acquiring knowledge about how we make pain. We can then use this knowledge proactively, changing the things we do, think, say, and of course, our pain! For me fear was a huge driver of it. Understanding pain empowered me and reduced the fear (that had included a subconscious fear of movement).
So, I love the straightforward concept of DIMs and SIMs that are laid out in the Protectometer (a great little book that accompanies Noigroup’s fantastic 'Explain Pain’ book). DIMs are ‘Danger in Me’ and SIMs are ‘Safety in Me’. DIMs are anything that’s dangerous to your body tissues, life, lifestyle, job, happiness, your day to day function — a threat to who you are as a person. SIMs are anything that makes you stronger, better, healthier, more confident, more sure and certain — within and about yourself.
There are seven categories of both DIMs and SIMs:
Things you Hear, See, Smell, Taste, Touch (HSSTT — the senses)
Things you say
Things you do
Places you go
Things you think and believe
Things happening in your body
People in your life
In Somatics terms, this is the whole Soma! This encompasses the experience of being a whole human, not just a body part that needs fixing. Our bodies are bioplastic and ever-adaptable and believing there is hope, even in the face of significant persistent pain associated with a sensitized neuroimmune system is vital and empowering (there is significant emerging evidence that the immune system and the nervous system work together to accomplish specific bodily functions).
Pain is about protection. Our survival is dependent on being able to detect signs of threat or harm to maintain homeostasis and our well-being. Our bodies, thankfully, have significant capacity to adapt to the perceived and predicted demands required to maintain or regain homeostasis (a process called allostasis). We are a process. If our pain protection level is set on high, there are many ways we can reset this protection level. Things can change. From a movement teaching point of view, the neuroimmune system (you!) needs movement to maintain homeostasis and to facilitate robust health of the system. Moving is essential. Vital.
Movement would come under the ‘Things You Do’ category. For example, gentle movement, such as walking or somatic movement can be a huge SIM. In contrast, a DIM in this category might be only taking painkillers, staying at home all the time on the couch (I’ve been there).
Hiking, for me, is usually a Super SIM! In the photo above I’m with my beloved dog and husband, in one of my favourite places on Earth, Tofino, out in nature. The sun is shining, I believe I’m fully capable and there’s nothing to worry about. Structurally I know my body is fine (confirmed by X-rays, CT Scans and MRIs), I’m in relatively good shape and we ensure we don’t hike for too long. I know that even if I do get into a little of a flare up pain wise later, it is temporary as I have loaded my tissues hiking, it will pass. SIMs galore, on this occasion!
But, more recently, I took on a hike three-hour hike, when pain levels were already high. I had fearful thoughts as we sat off, doubted my fitness and worried, falling back into old habits of believing I was fragile. I fretted about scoliosis, bears, you name it! DIMs galore this time! Even though the sun was shining and I was out in nature doing what I loved, accompanied, I had a monster flare up for the next few days. We really do need to understand that many things can contribute to our experience of pain.
In summary, an active (rather than passive) approach is required to live well with pain, and how I personally manage it. There is a great deal of self-efficacy found in active approaches to pain. Practising some gentle somatic movement at home for me is more empowering than waiting for an ‘expert’ to ‘fix’ me. I’ve found insight and understanding have led to personal behavioural changes for the better and re-engagement in meaningful activities. My somatics practice, walking, gardening and ‘Strength and Stability’ classes keep me moving well and enjoying life. I have a solid understanding of pain science that I can share with others. And at the end of the day, I know the presence of pain is my beautiful, intelligent, nervous system ensuring I survive, looking out for me. I can thank it for doing it’s job, accept that that’s how it is right now and choose to be a SIM seeker! And always remember that we are always changing, adapting. We are never stuck. We’re a living, breathing, amazing process! We are movement, and movement is life. Now that’s a Super SIM!