Mind your body

Having worked as a Paediatric Critical Care physiotherapist for over a decade, it wasn't until I had a serious ankle injury following a bouldering accident that I began to see things differently. Suddenly, I could see my circumstances through the lens of being the patient rather than the physio. What surprised me was how much my mental state and feeling of wellbeing impacted my body's ability to heal and rehabilitate.

The link between mind and body became particularly evident as my body was physically healing. As the full extent of the impact my injury would have on my life became more apparent, I, not unsurprisingly, noticed how much my frustration, anxiety and disillusion increased. But I also began to realise that when I went to my rehabilitation sessions with these emotions at the forefront of my mind, my overall success in these sessions was poorer. The emotional state I was in each day was directly and blatantly impacting my overall physical rehabilitation and vice versa. 

Although I continued to find fulfilment and satisfaction in my health professional role, I became more and more aware of the importance of treating the 'whole patient'. Working in multi-disciplinary teams in the NHS enabled me to see psychologists at work and I realised that I was finding the psychological aspects of therapy more interesting than the physical rehabilitation therapy I had been trained to deliver. It was then that I began to think about exploring a career in Psychology. 

The mind-body connection

Of course, the mind-body connection is long recognised by psychologists worldwide. The basic premise being that mental health affects physical health and vice versa. Emotions and thoughts don't simply exist in the mind and feelings can indeed be physical: why else would people get 'hot headed' when angry or frustrated? Why would we experience butterflies in our stomachs when nervous or anticipatory? On a day-to-day basis, our physical health is often judged by how our body 'feels' but if the mind and body become significantly disconnected, minor niggles can quickly evolve into an apparent overwhelming illness, profoundly impacting our lives. 

Having personally witnessed the importance of maintaining a 'healthy mind' whilst rehabilitating from a physical injury, with my interest in psychology re-invigorated, I decided to take the leap, leave my comfortable, secure band 7 physiotherapist role, my home and social network and explore the possibility of a career in Clinical Psychology. My decision took me from Manchester to London, where I received a scholarship to undertake a MSc in Psychology at the University of East London. In order to support myself while studying, I began working part-time as a physiotherapist for a Long Covid service. Working closely with psychologists and with patients exhibiting both complex physical and mental needs, I began to understand just how incorporated the mind and body are and I began to research more on the mind body link. Furthering my own understanding and knowledge I began to familarise myself with the workings and theories of Aaron Beck and Bessel van der Kolk. It is acknowledged that holistic health practitioners should strive not to separate mind and body when assessing illness and formulating treatments, and it's well recognised that patients commonly don't acknowledge a separation between body and mind. This was certainly true for many of my own clients. 

When I finished my MSc, I was fortunate to secure additional work as an Assistant Psychologist in the same Long Covid team, meaning I now worked a dual role, part time Physiotherapist and part time Assistant Psychologist. Working as an AP has really helped me to appreciate the importance of a 'healthy mind' for a 'healthy body' to thrive and vice versa. The two are intrinsically and anatomically linked and as professionals, whilst we strive to be 'holistic', at times we can lack the training, time, resources and understanding to address mental and physical client needs in synchrony. The dual role has allowed me to support clients by using interventions from both aspects. It has enabled me to hopefully provide advice for colleagues when they ask, which might assist them with both the physical and mental rehabilitation of their clients. 

Techniques to try

Having tried various body-mind integration techniques, initially on myself and subsequently as part of a patient therapeutic package, I can see how several techniques, including 'mapping of emotions', mindfulness, meditation and relaxation and participation in yoga and tai-chi increase awareness and strengthen the mind-body link. Personally, I find that engaging in mindfulness practices alongside my physical rehabilitation improves my mental health and in turn my physical ability. When I attended my physiotherapy sessions or rehabilitation classes in a more present state of mind and relaxed, I was able to achieve more and push my body further. Potentially this may be because mindfulness practice can redirect attention to the external environment and reduce negative thought patterns and in turn, pain and discomfort. Post-Covid syndrome (Long Covid) produces very real and significantly disabling physical symptoms which are extremely debilitating for sufferers. I began to recognise that practices which incorporated both mind and body rehabilitation, such as yoga and tai-chi, appeared of greater benefit and helped improve patient outcomes over and above simply exercise or mindfulness practices alone. By incorporating treatments that helped patients both physically and psychologically, it helped improve symptoms of anxiety, stress and overall function. As a service we were able to set up links to local community services which enabled free access for patients to continue with these practices post-discharge.

If emotional states and individual emotions can manifest in the body as physical sensations then it is reasonable to suggest that physical sensations can produce corresponding emotions. This idea and reaction is perhaps not a conscious process, but something we experience every day. By developing body intelligence as individuals, we can more readily recognise body sensations and mental state, and focus on improving our health and happiness. 

Meditation often focuses attention on the inhalation and exhalation of air through the nose. By focusing attention to the breath, we naturally reduce our respiratory rate, which can help the body relax and reduce feelings of anger, stress and anxiety. One of the key physical problems associated with Long Covid is breathing pattern disorder (BPD), which causes patients to breath predominately through the mouth, breathe fast and hard with the upper chest muscles. Patients can find themselves getting short of breath or tired from minimal exertion or more so with exercise than they did previously. I found that attempting to assist patients suffering with BPD using physiotherapy techniques alone was often ineffective, as patients tended to begin to panic, raising their anxiety and causing increased gasping for air and respiratory rate. However, when I incorporated meditative practice and breathing re-education techniques, the outcomes were of increased benefit to patients and enabled more effective rehabilitation.

With time and service development, I was able to personally integrate or provide details of practitioners able to teach, progressive muscle relaxation techniques, mindfulness-based stress reduction practices, meditation, mindfulness, singing, yoga and tai chi as treatment techniques into the Long Covid service, all of which encourage body-mind collaboration and connection strengthening. I had experienced first-hand the benefits of these practices in my own physical and mental recovery.

The two greatest tools

My dual role has enabled both advancement of my prior physiotherapy clinical skills and knowledge, while hopefully moving towards my new goal of being accepted for and completing a doctorate in clinical psychology. I feel the job-role has also been of benefit to the Long Covid team in helping improve patient outcomes and satisfaction, enabling effective communication and improving team dynamics. It has allowed for consistent psychological representation to be present in MDTs and meetings/case discussions that would otherwise not be possible due to the nature of the service and part-time/hybrid working. Whilst my dual role had its initial teething problems, mainly in regard to wider MDT understanding of the role and an increasingly busy caseload, with efficient time management and open communication, the incorporation into the wider team has been well received by both colleagues and patients.  I am grateful to my service team leads (both past and present) for having the foresight to allow this job split to happen and for supporting me with my career aspirations and goals. I am assured they feel that the role has been as beneficial to the service as I acknowledge both personally and professionally it has been to myself.

While I understand my position and previous experience is unique, my dual role has really shone a light on the importance of MDT working and professional expertise. Going forward, body-mind integration appears to be a relatively under-utilised phenomenon in clinical health. The mind and the body are arguably the two greatest tools we have to enable positive health and wellbeing. By improving individual body intelligence we can achieve better overall outcomes.  From my own experience of recovery, together with the improved patient outcomes I observed when treating Long Covid patients, perhaps more dual roles are an idea for the future.