Ep. 45: Mags Clark-Smith – Resolving Chronic and Unexplained Pain

One thing is absolutely true – and that is that you’re a unique human being.

And even though we’re all in one way or another aware of this, we still allow in a way to be crammed into a cookie-cutter approach when we’re faced with injuries or chronic pain (or pain that just appears ‘out of nowhere’).

Mags Clark-Smith is a pain relief movement specialist, author, and university lecturer with a diverse background that spans from psychology and non-verbal communication, to theater and dance. With her approach to treating pain through movement (and focusing on the uniqueness of each person), she has a number of seemingly miraculous healing stories she can share, and also a very important message.

In this episode, you’ll discover:

  • Why your pain is not just in your head and how to resolve it.
  • What to do when you experience unexplained pain and doctors can’t help you.
  • How our belief system affects the level of pain we experience.
  • What steps you need to take to resolve pain.

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Show notes & links

The show notes are written in chronological order.

  • Mags Clark-Smith’s website: http://www.resolvingchronicpain.com/
  • Mags Clark-Smith’s book: Psychophysiologic Disorders: Trauma Informed, Interprofessional Diagnosis and Treatment [get it here
  • Clark-Smith, Mags & Tichband, Lisa & Dufour, Sinéad. (2019). Irish Physiotherapists’ Perspectives: Pregnancy-related Pelvic Girdle Pain. 2. 1-5. 10.31579/2578-8965/029. [read it here]
  • David D. Clarke, MD: They Can’t Find Anything Wrong [get the book here
  • John Sarno, MD – Dr. Sarno was a pioneer in mind-body medicine. His books are helping many patients to become free of pain after “mainstream medicine” fail to help.
  • An Introduction to Tension Myositis Syndrome (TMS) [discover more here]
  • Roland Morris Disability Questionnaire [discover more here]

00:00 – excerpt from the episode
01:24 – intro (listen to discover a little more about your host. Martin will tell you a new lesser-known fact about Dr. Maya)

02:04
Dr. Maya Novak:
One thing is absolutely true – and that is that you’re a unique human being. And even though we’re all in one way or another aware of this, we still allow in a way to be crammed into a cookie cutter approach when we’re faced with injuries or chronic pain (or pain that just appears ‘out of nowhere’).
In 2019 Dr. Lissa Rankin connected me with Mags Clark-Smith and we had an amazing conversation on my Mindful Injury Recovery World Summit. It helped so many people and because I know there’s a lot of invaluable information here, I want to share this interview with you on my podcast as well. Please enjoy.

02:48
Dr. Maya Novak:
In this interview, I’m joined by Mags Clark Smith:, who is a pain relief movement specialist, author, university lecturer, and researcher. She has built up her knowledge of the body and mind relationship through psychology, theater, dance, and nonverbal communication and combines all of these approaches to help people to move with confidence and overcome chronic pain. Mags, thank you so much for being here.

03:14
Mags Clark Smith:
You’re very welcome, I’m delighted to be here.

03:18
Dr. Maya Novak:
I have to say that I am really excited about this interview because I know that we’re going to go deep into this topic, and not just answering the question if this pain is normal. Because pain is, many times, not just something that is happening with our physical bodies - it can be a reflection of what is happening with our inner world, with our thoughts and emotions. Before we go really deep into this juicy stuff, can you please share a bit about your story and how you got interested in pain?

04:00
Mags Clark Smith:
I’d be delighted to share my story. I started, as you’ve alluded, as a university lecturer and I was working in the theater studies department and I became very interested in nonverbal communication and interested in how we feel inside, how that reflects on how we conduct ourselves in society and amongst friends. In particular, I was teaching a dance course and one of the students – and it turned out to be many more than one by the time I had completed by teaching there – had an eating disorder. I noticed that the approach that I took with choreography, with movement, helped her enormously and she wrote to me for years because it helped her overcome her thoughts about her body image. She started to think internally about how she was moving and she didn’t put her focus on what she looked like. That was really the beginning. That was the spark. That’s how I started this interest in what is there that we can delve into a little bit deeper. Then I was actually giving a presentation on low back pain and a doctor was in the audience and he sought me out afterwards. He explained that he had an older lady who had really got very upset about the fact that he had scheduled a hip replacement for her and he said he’d never seen this sort of resentment or resistance before. It had turned into resentment and I think that’s why he was personally quite upset about it. He said did I think that I could do anything for her, and I suggested that perhaps he might hand on my details and we’d see whether she got in touch, which she did immediately. I worked with her and the hip replacement was scheduled for – it was a six-week timeline – and she didn’t have it. She got rid of the pain. I was as surprised as she was, I have to say, and delighted for her. That made me think about the power of the min because she was really determined and she said she would do anything. Anything I asked her to do to avoid having that operation. I’m still in touch with her today, and she has not had that operation, still. So that made me think there must be something going on here and because my background is in academia, I wanted to ask questions. I know that we’ll get onto that later because I really do want to research this and find out what’s going on. So that’s how I started.

07:09
Dr. Maya Novak:
Goodness, I got teary eyes because of two things - two things that are really close to my heart. First, I was a dancer as well and how you helped that lady is just incredible because I had a different kind of experience. When my body started changing, I got a bit of – I heard something nasty from my teacher and that definitely scarred me. So I know how incredibly important it is how we talk to each other. I am so extremely grateful for you knowing what is also important. The other thing, hip replacement – I mean I didn’t have a problem that would require a hip replacement, however, two years ago I was struggling with chronic pain in my hip. I know how powerful the things that we’re going to be talking about are – how powerful this is. So thank you so much for sharing this. Do you remember your first patient with chronic pain?

08:17
Mags Clark Smith:
This was the first one, the lady who had – who did not want to have the hip replacement. And I want to be really clear; I think in some instances, hip replacement is absolutely the right thing. What was significant here was her resistance and that’s the part that I think is really interesting for us to delve into more deeply. Because what I’ve learned since is that resistance that she had may well have tripped up the healing. We can’t say one way or the other because she didn’t have the hip replacement, but I am now very aware that the attitude that someone might have to an operation, a big operation such as a hip replacement, may matter. That really may matter.

09:11
Dr. Maya Novak:
Yeah, and I love that you said that because sometimes there are some interventions that are necessary.

09:18
Mags Clark Smith:
Of course.

09:19
Dr. Maya Novak:
It’s not enough to just think positive thoughts and everything will be super awesome. [laughs]

09:22
Mags Clark Smith:
No, no! [laughs]

09:23
Dr. Maya Novak:
That’s not the case!

09:25
Mags Clark Smith:
No, it’s not the case, definitely not the case!

09:27
Dr. Maya Novak:
No. So let’s talk about this pain. Many times we hear that it’s just in your head. So is this really something that is in someone’s head? Can you talk a bit about this?

09:45
Mags Clark Smith:
Yes, I can and first of all, absolutely – it’s not in your head. I think I want to say that and I kind of feel a reaction to that phrase because there is something derogatory about it. That might be that within different cultural settings we’ve attached some distain to that phrase, but it implies that there was a choice. It implies that the patient has chosen to make a fuss and although I would have every faith that a lot of medical practitioners don’t really think that, there is an interpretation that the patient might take, that some health practitioners might take, from it all being in your head – meaning that it’s a conscious choice. I would say no. The work that I’ve done has shown me that it’s not the case. No, it’s not all in your head. That creates a huge puddle of misunderstanding. So I would want to step away from that puddle and say, no that’s a confusion. This is physiological. It’s about the autonomic nervous system. In the autonomic nervous system, there are two modes of operation that we’re particularly interested in when we’re looking at chronic pain. We’re looking at the sympathetic and the parasympathetic nervous system. So we’re looking at we would commonly refer to as the stress response and the relaxation response. Both of those have their merits. It’s really good, the stress response – the fight or flight. If a child is in danger, you want to have that flood of adrenalin and race into the road and swoop the child up so that it’s not run over, or whatever. That’s really important and we know that the stress response can be good. But equally, the relaxation response is good because it facilitates healing hormones and healing from within the body. What, I guess, the phrase “it’s all in your head” refers to is how the stress response has sort of got into a grumbling mode so that it’s on when it doesn’t need to be on. You might say that that’s our lifestyles and we’ve brought it all on ourselves. So we have mobile phones, and they’re bleeping and we can’t switch off from that and that, maybe, provides us with the stress response being on the whole time. We can’t switch off. But if we stop and think about that, that is a physiological switch. It means hormones are brought in. It’s not about all being in our head. It is actually a physical response. So it means saying “it’s all in our head” isn’t correct.

13:11
Dr. Maya Novak:
Yeah, so true because the entire biochemistry of the body is changing when we are in that stress response.

13:24
Mags Clark Smith:
Absolutely, and so we know that. We can feel the flood of adrenalin because the heartbeat is faster. That gives us the energy to run, to swoop up the child. If we’re going to take an important exam, a professional exam, for example, we absolutely want the stress response to be on because otherwise, we’d go to sleep at the desk and not even write our name on the paper, and that’s not really going to be very handy at the end of it! So it’s a good thing, but to have it on long-term, there are drawbacks. Because it’s an on-off switch - you can’t have the stress response on 30% and then have 70% of the relaxation response - it doesn’t work like that. So it’s preventing the healing hormones, the healing from within taking place when it’s on even just a tiny little bit and that’s where my reference to the mobile phone, or whatever, is relevant.

14:30
Dr. Maya Novak:
I love this, and I experienced firsthand how important this is. Now this is my experience, and I’m not sure of others, or what is your experience with patients – but I really had to make a conscious decision on starting to do things differently. And not doing things differently in terms of not just doing, but how I perceived things.

15:00
Mags Clark Smith:
Yes. I agree!

15:05
Dr. Maya Novak:
So what is your approach? You talked a bit about pain and that it’s not just in your head. What is your approach and how is it different from other approaches? Or something that your patients might already have experienced before they came to you.

15:24
Mags Clark Smith:
That’s a really good question. I guess we’ve all been brought up imaging that there is someone with the answer, and our body is – that analogy here is a little bit overworked perhaps – but if we imagine the body to be a car and there’s something wrong with the tire. We would take it to the mechanic and we would say could you fix that tire, please. We’ve sort of grown up with that idea about our bodies. That we take our body to the doctor, to the specialist, maybe it’s going to be the physiotherapist, maybe it’s an osteopath. We’re going to go to that person and they will fix it. I think the big difference with my approach is that I really want to invite you to learn some tools, some skills to help heal yourself. So you’re not handing over that responsibility to someone else but it’s a partnership. So as I said before, in some cases, there is a very clear need for an intervention. That intervention medically may take place in a hospital. It may take place in a physiotherapist’s office. But in addition to that, we can also prepare the body. By preparing the body, we’re allowing the body to be in the most fertile state, if you like, for healing. So my approach differs because I’m not necessarily looking to see where the structural damage is. I’m looking to see how the autonomic nervous system is out of balance. That premise is relevant when the pain has been around for over three months because the body is designed to naturally heal itself within a window of about three months. So if you break your leg and go and get it set, then by the end of three months the cast would be off and there would have been maybe a course of physiotherapy to help you with your walking style and your gait, and then one would expect that everything would be grand. But actually, if that pain persists it means that the neural pathways have got into a habit and they’re continuing to issue pain to alert you to something that is not as it might be. That’s where the balancing of the autonomic nervous system comes in to allow the body to heal itself.

18:35
Dr. Maya Novak:
I love this. So, what do you then say to someone who has had pain for, let’s say eight months, but let’s also say that it was a serious injury. So it’s not just something that happened all of a sudden. It’s not like the person just started experiencing this pain - let’s say that there was a bit more of a serious injury. Would you say that after three or four months it’s especially essential to start looking into other things as we are discussing here? Or is it enough to wait for another few months and then maybe in another few months it’s going to get better?

19:23
Mags Clark Smith:
One of the things about people coming and finding me is that the route they’ve taken, and sometimes they’ve gone to every person that they can think of, they have felt that they’re not progressing, that they’re not healing. To me, I’m constantly taken aback by how people know themselves. It’s like a gut reaction. This does not suit me. I’m not progressing here. I need to find a different route. I guess anyone who’s listening now, if they have that feeling, and perhaps that’s why they are listening, that’s – then follow your gut. Really listen to where are you being drawn? Who’s making sense to you? So one of the things that I would also say is different about the work that I do is very much a respect for each individual. So the work that I do with each person is – well, it’s different – because each person is different. They will gravitate towards the skills that I introduce them to, the ones that suit them and they’re always given permission to say, oh she has no idea what she’s talking about, I’m not doing that, right. And this other thing, this worked perfectly – that really suits me. So I will introduce the different things and hope to get it right, but for some people, there will be, no, that’s not the right thing for me, but this is. That encourages autonomy. It encourages people to be empowered. The whole process is empowering. So if someone had a serious injury, as you just stated, and they weren’t getting anywhere, doing this work on balancing the autonomic nervous system can do no harm. So they could do that alongside whatever else they were doing.

21:53
Dr. Maya Novak:
I love this. Yes, absolutely, it cannot harm. So at the end, you might actually gain something but if you do not, then you’re not going to be in a worse state.

22:06
Mags Clark Smith:
Yeah.

22:07
Dr. Maya Novak:
So what about when we’re talking about unexplained pain? When something happens, the body goes through a transition of acute pain and then it might become chronic pain. But what about the pain that is unexplained? So the person goes to the doctor and they look at everything, and then the answer is, there’s nothing wrong with you, we don’t know why you’re experiencing this pain, so we actually don’t have the answer, and then the person is usually left alone. The pain is there, but nothing is wrong. What is your view about that?

22:51
Mags Clark Smith:
Most of the people that come to me, that is their experience. So they’ve gone through different health practitioners and the story they keep hearing is we can’t find anything wrong. The textbook that I’m editing at the moment, one of the editors who is working with me is called Dr. David Clarke and his book is actually called They Can’t Find Anything Wrong. I think it’s a brilliant title and I keep telling him so, because if somebody with a white coat on who is meant to be the person who fixes your body says we can’t find anything wrong, that is extremely disturbing information. So it can make you feel fear or anxious because having a label is actually quite helpful. It allows us to map out a route, to get a plan together, to work out how we’re going to move from this point where we’re experiencing pain to a point where that pain has diminished or gone. In answer to your earlier question about what is different about the work that I do, that is actually something that’s really different. I am – my expectation would be that the pain would go or it would dramatically diminish. I think that, for some people, is a fresh approach because often people have been told oh, you’ll just have to get used to that or we’ll be able to reduce it a little bit, but that’s your lot, as it were, this is going to be the way it will be for you. I think that that’s quite disheartening as well. So one of the things we want to be is completely honest. We don’t want to raise expectations when there is no basis for doing that. But in many cases, balancing the autonomic nervous system can actually diminish the pain. The unconscious mind, which controls the autonomic nervous system, has been switching on the stress response. It has been issuing pain to protect the body and the reason it’s protecting the person through that pain is it’s trying to send a signal that there is something out of alignment. If one can address those things, and they’re often referred to as triggers that emotionally fire up someone, then you can see that that puts you into the stress response and that prevents the healing.

26:14
Dr. Maya Novak:
Mm-mm. Being in chronic pain, many people use medication. So when a person comes to you, and if they’re on pain medication, do you suggest they stop using it so that they can really start observing the body, or how do you then deal with it? Because pain medication is kind of numbing you, so you actually don’t know what is happening. What is your approach to this?

26:50
Mags Clark Smith:
I have a very open approach to pain medication because just like the stress response which gets a hard time, so I feel I have to defend it, I also feel I have to defend pain medication on occasion because if someone is taking pain medication and it numbs the pain it allows them to move. So one of the things that I feel passionately about is if I can restore someone’s confidence in moving, they will initiate a reduction in their pain medication when they are ready. But often health practitioners have suggested that perhaps movement should be restricted because of pain and what that can do is perhaps make someone quite anxious and nervous about moving. A lot of my experience of this is about low back pain with people explaining to me that their back is fragile and I will reply no, your spine is a robust bit of kit. It’s there to bend. It’s set up, if you look at the biomechanical structure of the spine, it’s designed to move, and it will support you. For someone to rediscover that that’s true, then to be able to do gentle safe movement can restore their faith and movement. If they manage to do that partly because of the pain medication, that’s actually fine because then they will find that they’ve got more confidence in their own body. That, to me is a great starting point.

29:17
Dr. Maya Novak:
Yes, I’m hearing you, you’re saying that yes, movement is important when it comes to resolving chronic pain, any type of pain, but how do you actually start? Because I know how it is from my experience, and I’m sure that there are many people who are thinking the same. If I’m in pain, moving is actually not my top priority because if I move, it’s going to be painful. So it’s like I don’t want to move, I’m just going to wait here. How do you actually start to move your body so that you do not go from a bit of a pain to more pain, or let’s say from five out of ten to eight or nine and suffer even more?

30:03
Mags Clark Smith:
Okay, so the golden rule is first to be no suffering, we won’t have any of that, right!

30:13
Dr. Maya Novak:
We'll continue in just a moment. I wanted to quickly jump in for two things. First, thank you for tuning in. And second, I’m sure you have at least one friend, colleague, or family member who would very much appreciate this episode. So share it with them and help us spread the word. Now let’s continue…

30:34
Mags Clark Smith:
So we start with deep breathing. Just placing the hands on the rib cage with the fingers just overlapping a tiny little bit and if the body is in the stress response and you breathe in, you will find that if you were to count the seconds of the in-breath it would be maybe one or two and then you’ll breathe out again. So we start, and we just work out how many seconds can you breathe in for? Can you feel the rib cage expanding? And as I talk, and so people concentrate in it, and so it might go from one second to maybe two, and then three, and then slowly contracting so the out breath is becoming slower. Then we breathe in again and now it’s to four, and back it goes. The optimum is to get to breathing in for eight seconds and then breathe out, and you can breathe out for as long as you like. But it’s the breathing in that allows the body to switch from the stress response to the relaxation response because the concentration is on that breath. I ask people to think about their shoulder blades and the back of the rib cage. Feel the back of the rib cage. Is that actually expanding as well? As we discuss the action, that physical activity will switch the body from the stress response into the relaxation response. What that does, is it’s an approach that meets the patient where they’re at. So they’ve arrived, and they’re really interested in the structural makeup of the body because that is the approach that they’re familiar with. So if we start with the breathing, then I might suggest that we’ll just see if we can move the spine a little bit. So we might go onto all fours and just move the spine a little. Up until now – I’m going to touch some wood – no one has ever said that that has exacerbated their pain. In fact, every time they’ve been amazed that the pain has not kicked in. That tells me that we’re talking about the autonomic nervous system here. That’s the issue here because the deep breathing is allowing the body to go into the relaxation response and the body is, therefore, able to move without pain being signaled. Then we’ll move on to other small exercises that will restore confidence. I try to do that within the first session so that there is a real sense of feeling the body returning to being reliable. So one of the things that I would do as a measure – here is the researcher, I can’t help myself – so I would count the number of steps that someone could walk at an ordinary pace in a minute. Then we have that and we can compare it to after maybe five sessions. We can look at are you walking any faster? So if we are in a lot of pain we tend to walk slower. There’s nothing better than seeing that you’re walking with ease and walking a little bit faster. That helps with the confidence and feeling that you can rely on your body.

34:57
Dr. Maya Novak:
Beautiful. So would you suggest for the person to – if, for example, they were doing this or if they wanted to test their body – to start, absolutely, with breathing and then try to do exercises? And the other question that is connected to this: if someone is in a PT program and they are doing exercises for their hips, or ankles, or any type of injury that they have, and especially when they are a bit further into the recovery and can move around, there can be a lot of things to do that come before the exercises. So they can go through, say, five exercises as fast as possible, just so they can tick them off their to-do list. Is it really important to stop and take a few minutes to calm and then do the exercises or not?

35:58
Mags Clark Smith:
Yes. So the movement work that I would do with people is quite meditative if you like. That’s because I want to concentrate on the deep breathing and I want to really tap into the autonomic nervous system. So it’s a dual approach, and I will explain that in the first session. So we’re going to look at the autonomic nervous system, we’re going to look to see if there is something that’s spiking an emotional response that’s sending the body into the stress response. But we’re also, at the same time, going to look at moving the body just to restore some confidence. Then we might talk about lifting the breastbone and posture so that there is a sense of the body informing the mind that there is openness and a willingness to embrace new experience. So you lift here, that’s kind of the message, the nonverbal message you’re giving other people. Whereas if you’ve experienced a lot of pain recently, you’re likely to close down, concave and the eyes will go towards the floor and you’re actually just gently closing off interaction with other people. So one of the things that I think is quite normal for someone who’s been experiencing chronic pain that means they’ve been in pain for over three months, that’s some time and some of the people I’ve worked with have been in pain for 25, 30 years. Dealing with other people is a trial sometimes for people who are trying to manage their pain so their body will naturally go into the concave as a protection. So one of the things that I gently introduce is having the confidence to embrace other people, opening out and that gives us a link to enjoyment in life rather than managing pain – which actually isn’t very enjoyable. So then, I have to work really hard on the other bit, which is to diminish the pain so that it all knits together.

38:42
Dr. Maya Novak:
This is so valuable. Thank you so much for sharing this. A few minutes ago, you were also talking about belief and you mentioned what people believe. So my question here is, is there any connection between what we believe – our belief system – and how much pain we are experiencing?

39:07
Mags Clark Smith:
Beliefs are really, really important. My understanding is, from the number of people that I’ve worked with, that the beliefs that we have hardwired into our unconscious mind came about during our childhood and most people have an intention as a child to please. As we try to please, because actually, that makes life much easier for us, we ascertain what is expected of us, and what beliefs are commonly held within the place where we live and by significant others around us. So that might be parents, it might be a dominant next-door neighbor, it might be a schoolteacher, it might be a priest. It’s going to be those people who have influence and their beliefs will have some impact on us as children because as children we’re, as I said, trying to please so we’re trying to work out what’s the right belief here, what’s the right way to conduct ourselves. Then one of the things that I always say to everybody is we need to just dig into those beliefs so we get an idea of what they are, and then there’s the adolescent years and let’s take that up to about the age of 25 because they’re like washing machine years because there’s hormones going around. We just don’t want to – just step away from them – we can’t be dealing with them. Then look at their adult beliefs, and then let’s see if there’s a disconnect between the adult beliefs and the childhood beliefs and therein likes lots of helpful information about what might be spiking that stress response because the unconscious mind will revert to the childhood beliefs. The unconscious mind is there to make sure we’re breathing, to ensure that our organs are functioning. We don’t get a message saying breathe in, breath out. That’s all happening. So the unconscious mind might decide to try and protect us because we’re outside of alignment of a childhood belief. A good example of this might be that when we were a child we knew that it please significant others around us if we made sure the light was off. Don’t leave the light on. Turn the light off. That filtered through to money is short. Money doesn’t grow on trees. We have to be careful about money. Okay. So that is a childhood belief. But then let’s suppose – let’s just, you and I, just leave for a minute. We’re now multimillionaires. No, we’re billionaires. So now, as adults our belief might be – apart from the environment – we can leave the light on, but the unconscious mind might not have caught up. So the unconscious mind is still got to turn the light off, money’s short. The adult belief therefore of you can – it’s fine – we have lots of money, we can leave the lights on. Maybe that’s not a great example, but I think you get the point.

42:57
Dr. Maya Novak:
Yes.

42:57
Mags Clark Smith:
That the unconscious mind hasn’t caught up, so it might trigger some pain to protect you because you’re vulnerable, because you’re out of step with significant others who believe the light should be turned off and you should be saving the money.

43:18
Dr. Maya Novak:
How can you recognize these triggers? You just explained with this example, but how can a person really recognize that something is a trigger and this is causing more pain, or if that’s not a trigger and it is really connected just with the body?

43:39
Mags Clark Smith:
So I think that’s the process of looking at the beliefs. Your question was are the beliefs important, and I think they are. Then there are several ways of looking at those beliefs and exploring them to see whether they actually are significant and whether they are triggering. Once we’ve established that, then we can work out right, how do we need to address that disconnect between the adult belief and the childhood belief? That will differ in every case because they are all different beliefs.

44:23
Dr. Maya Novak:
Can a person do this on their own? Or is it really important to work with someone who can look into this from the outside? My question here is, when we are so close to the problem we sometimes don’t see it. So can a person really recognize on their own what is triggering, what kind of beliefs there are, what comes from their childhood and then adulthood, or is it better to have someone who can help you with this?

44:57
Mags Clark Smith:
In general – I mean that’s difficult for me to answer because people have come to me, so…

45:04
Dr. Maya Novak:
Of course!

45:05
Mags Clark Smith:
… I’ve seen the results and I’ve seen so many people reduce their pain or get rid of it completely, but they’ve gone through this process with me. But occasionally, I have had people who have read books about it and have helped themselves to a certain point, and then they’ve wanted help with a stumbling block that they’ve identified. So I don’t know if that answers your question. I think it’s a really personal thing. It seems, to me, completely believable that some people might be able to look at this and be objective, but I actually really agree with what you’ve just said; it’s very hard to see the wood from the trees when you’re in it.

45:55
Dr. Maya Novak:
Mm-mm.

45:56
Mags Clark Smith:
It’s actually quite good to have someone to, most importantly I think, give a structure – here’s a framework, let’s see if we can walk through these steps and see if that leads to this reduction in pain because on paper it should. What that does, is it gives hope and I think from what we know about the placebo effect, hope is so important. So to have hope, if you’ve been experiencing chronic pain for many years, I think that’s a big ask to ask that person who has been effectively putting their body out to tender to anyone – with what do you think is wrong me, and what do you think’s wrong with me? It’s really hard and frustrating that no one can say this is what’s wrong. Then for that person, it may just be a step too far for them to have to solve all these issues of which beliefs are triggering, or what. I think in a lot of cases, it is completely understandable that someone would benefit from having an objective viewpoint. My job is to walk by someone’s side and allow them to lean into me when they’re feeling a little bit vulnerable and for them to know that I’m there and I will gently just hold them in that spot. Then when they’re ready to take the next step, off they go.

47:55
Dr. Maya Novak:
Yes. I so agree, and my experience –why I asked you this – years ago I was the type of woman who thought I could do everything on my own. And that meant that it took me so much longer. So if you have someone who can help you and work with an expert, as yourself, you can get to that or you can do many more steps faster than if you are doing it on your own. I mean, of course, we will survive but it’s the difference between surviving and thriving with the help of an expert, as you are.

48:46
Mags Clark Smith:
You’re right I think. I’m careful not to say that it isn’t possible, because I think it is, and for some people, their personality is such that that is the right route for them. So my encouragement would always be to just listen, like what is right for me to do? So I wouldn’t want to discourage people, but I also feel that it’s an overwhelming thing for other people, that it would be helpful – and why not? Like I spent years studying this stuff, and so if there is something that I could offer that would facilitate recovery and that would be a shortcut so that it would save three months of trudging through it on your own, that seems to me like that’s worthwhile.

49:52
Dr. Maya Novak:
Yes. I love this. So in your line of work, you have mentioned that you teach patients and that you do not treat them. And at the beginning you said that we were brought up so that when something is wrong with you, you go to the doctor and they will treat you, but your approach is different. Why is that?

50:20
Mags Clark Smith:
I’m a trained teacher and I’m trained to teach teachers too, so that’s what I do and within my remit as a health practitioner, I regard respecting each patient as probably the most important premise. We start with respect. That respect means that each person is an individual. They come with their preferences, with their foibles, with their personalities, and what I want to do is give them an array of skills that they can pick from. So it is my job to teach them about those skills and how to use them. If I teach in such a way that that person, it’s clear from the feedback they’re giving me that they don’t really understand, and then it is my responsibility to change the approach and to teach them in a different way until that skill is grasped. Then it is absolutely the prerogative of that patient to say yes, I have this, I can do this, but it doesn’t suit me, how else can we do this? So then … we could it this way instead. It comes back to that word empower. The lifting of the breastbone and the opening up to new possibility. That is so important if you’ve been experiencing pain because by taking the body in the same way as you took the car to the mechanic, you’ve been submissive. And I want everyone to just step into their potential and to blossom. I don’t see a lot of room for being submissive in there, in that scenario. So that’s why I teach.

53:00
Dr. Maya Novak:
And it is really important, and you having so much experience with people, with chronic pain, I’m sure you’ve come across people who are losing hope about their healing. What would you say to someone who, right now, feels like they don’t know if this going to get better or if there’s any hope left? What would you say to that person?

53:30
Mags Clark Smith:
Don’t lose hope. Don’t ever lose hope!

53:36
Dr. Maya Novak:
How? Because, you know, when a person is really down, what do you think would help them get the most to get out of that?

53:47
Mags Clark Smith:
I think I would definitely say don’t lose hope. It’s possible you haven’t found the person that speaks your language yet. That language is a mixture of nonverbal communication and how people approach the pain that you’ve been experiencing. I would want to encourage them to keep searching for that person. One of the things that I’m very aware of, it hasn’t happened to me, but I can see a scenario where it might – where I’m a steppingstone. I might just be a bridge. I might be the right person at this moment in time, and then someone else will be the right person. I think that part of the hope is acknowledging that all of the steps you’ve taken to this point, they have all helped to get you to this point. If this point is one of despair, then there will be hope springing up from that despair because when we’re taken to that low point sometimes it encourages us to close a door and that helps us open another one. So then, we start to find yep, actually, this is it. This is what suits me. Whatever that might be, with luck that will be the thing that resolves the pain or it will be a stepping stone or a bridge to the next way of working. I think intuitively once each person values that they know what’s right for them, that hope will grow.

56:09
Dr. Maya Novak:
I love what you said, that you just haven’t met a person who is speaking your language yet. This is so true. Also, going back to what you mentioned so many times, and it’s something very close to my heart as well, is to listen to yourself and your intuition. Because many times we do have all the answers but we are afraid to listen to them because someone else – in a white coat, for example – said that this probably is not going to work.

56:47
Mags Clark Smith:
That’s so interesting that you say that because you’ve reminded me – I did a presentation for Chronic Pain Ireland and one of the things that became apparent that I needed to address was that the Chair began by saying, now, of course, we all need to be doing meditation. I think it was meditation, or mindfulness, one or the other, which is dreadful that I can’t remember. Anyway, there was this groan, this ripple that went through the audience. So I came on and said I’m not going to do that. I’m not going to make you do that. It’s okay if it doesn’t suit you, but let’s just think about that. If Aunty Mary down the road says, you must go to this health practitioner because they’re brilliant and you go, and you don’t have a great experience, that doesn’t mean that that health practitioner is no good. Most health practitioners have gone into their profession to help people, and you know what, it worked for Aunty Mary but it doesn’t work for you and that’s okay, that’s grand. So it maybe cost a bit, but that’s all right, you closed a door not going to that person again because it doesn’t work for you. That doesn’t mean that the person isn’t skilled. It doesn’t mean that Aunty Mary is wrong. They both have their perspective and that’s grand. Leave them away with it. You’re different and you know, everybody does, what suits you. It’s building up that confidence to say no, it’s fine, that’s not right for me. No offense to Aunty Mary and no offense to the health practitioner, I’m going to do this. So no, I’m not going to do the meditation, I’m not going to do the mindfulness if that’s – it was very clear that they didn’t want to do that! That’s fine, so maybe getting some watercolors and sitting by the beach and painting the sea. That might be it for you. It’s inviting yourself to look at the different possibilities. Taking the concept and running and thinking about how that would work for you and having the confidence to do that. Really, the whole process of the work that I do is about that. So we start and we look at beliefs. We work out where the triggers are. We look at other stumbling blocks that might be causing issues along with way. But we’re working towards, within the loose framework of that Lissa taught me, we’re getting to step five, which is a prescription. It is a prescription of what’s made up that what suits you to calm your stress response so that the relaxation response will come on and it’s made up of the things that work for you. So it’s that empowerment really.

01:00:13
Dr. Maya Novak:
You mentioned two things that stuck in my mind here. Calming the nervous system down with breathing, and then you mentioned maybe going to the beach and drawing the sea, or whatever. How else can we calm our nervous system down?

01:00:35
Mags Clark Smith:
Calming the nervous system down is about ensuring that you’re giving the opportunity for the relaxation response to come on. The way that you can do that, one of the things that I encourage everybody to do and to put into their prescription somewhere, is an activity that suits them. Which is why I start with the gentle movement, which builds up those muscles so that you can then decide that walking is the right thing for you to do, or running, or abseiling, or kayaking, or whatever it’s going to be. That activity might calm you down. It’s a really individual thing. It’s a great question because all of those people in the audience of the presentation for Chronic Pain Ireland did not want to feel guilty because they were bored rigid by trying out meditation and it didn’t suit them, or whatever it was. So it is about what working out what makes your heart sing. What makes you happy? What brings you joy? That, I think, if there are people listening who are experiencing pain, is really quite difficult to relate to and I want to emphasize that. That’s why we have steps to get to that point. We can’t jump to that because if you’re used to managing pain it may almost seem just irrelevant to talk about what would bring you joy because reducing the pain is the only thing that matters. So it is important just to note that it’s part of a process and calming the nervous system down most effectivity initially is the deep breathing.

01:02:36
Dr. Maya Novak:
I think that you already answered this question, but I will ask it again. Do we actually have any effect on how much pain we are experiencing? I know we were talking about the nervous system and calming the nervous system down and things like that. But how does it connect, for example, the mind and body – are they connected? Do we have any effect? And if we do have it, is it just about breathing? Is it just about meditation? Is it just about being active in an activity that you enjoy? Or is there something more?

01:03:21
Mags Clark Smith:
I think there’s a definite relationship between mind and body, but I actually believe there’s a relationship between body and mind as well, which is why I go for the two-pronged approach. The body-mind is lifting the breastbone, feeling open and ready for new experiences. The mind-body is noticing what might make you feel anxious, where there might be fear. As TMS practitioners (tension myoneural syndrome), one of the things I’m very alert to is that fear can be the root of the autonomic nervous system being out of balance. It doesn’t have to be rational fear, and that’s the link to the beliefs. It doesn’t have to be rational fear, but it can be fear and that can upset the unconscious mind that issues pain to protect you because there is the possibility of fear. So, I think, there is definitely a link between body and mind and mind and body, but I say it cautiously because it takes us back to “it’s all in your head”. No, it’s not. It’s physiological!

01:04:54
Dr. Maya Novak:
Yes. I love that you mentioned fear because at the beginning when you were talking about the lady with the possibility of a hip replacement surgery. And I shared my experience when I had problems with chronic pain in my hip and I was, back then, diagnosed with hip bursitis. What I discovered, if someone had said to me a few years ago that you can actually resolve chronic pain in a really short period of time, I probably wouldn’t have believed them. But my experience was that I realized that behind that pain was fear, and when I addressed that, the pain decreased significantly. It was basically 24 to 48 hours between being in pain and being pain-free after seven or eight months. But that’s my experience. I know that this is not for everybody, and fear might not be the case, but what you mentioned – yes – body-mind, mind-body, it’s everything. It’s connected.

01:06:16
Mags Clark Smith:
Absolutely and Dr. Sarno would have talked about repressed rage. He coined the term TMS. That repressed rage is connected to fear. So feeling safe can make a dramatic difference to the pain that we experience. Again, we’re looping here, that’s why I would want to be very specific that I teach and I don’t treat because what I’m hoping will come as an outcome of the process is each individual feeling safe and self-assured, and that safeness comes from within. Whereas treating, to me – and it may just be me, is there’s an implication there that you’re handing over and that someone is fixing it. I feel that for long-term healing, yes, I am walking by your side for this short period of your life but if I’m run over by a bus, you can still sort it out because you’ve got those skills within you. You’ve got the confidence that you know how to deal with possibly the fear, maybe the repressed the rage, the anxiety, whatever it is that is triggering that stress response. You asked earlier about – I interpreted it as markers – and I talked about counting the steps in a minute. With the stress response, in our research, we do cortisol swabs and we do that specifically so that we can actually take a reading of how much cortisol is in the body and relate that specifically to the stress response and tie that in with the pain that’s being experienced at the time. I’ve just gone off a little bit, but I wanted to just throw that in because I think that’s really important that there is a scientific basis to this. I feel that’s really reassuring when someone’s been experiencing pain and someone, as you said, in a white coat says they can’t find anything wrong. There is an interpretation that that could be dismissive and if it is that the autonomic nervous system is out of balance and we can actually take cortisol swabs. We take them at the beginning of the treatment – someone’s going to go through and it’s me teaching as I mentioned there – and then we take it afterwards. We see how the stress response has reduced and that’s in line with the pain reducing.

01:09:31
Dr. Maya Novak:
Mm-mm. I think it’s so important how you said you are teaching your clients and not treating them because what you give them, it’s not just about this problem, this situation that they have. It’s something that they can take and use for the rest of their lives and really benefit from this, right?

01:09:59
Mags Clark Smith:
Yeah absolutely, because that’s the essence of teaching. It’s giving something away and somebody making of it what they will and them taking it forward. That, I think, is the essence of long-term pain resolution. Though I kind of say to patients this isn’t a boomerang. This is a teaching environment for you to learn skills so that that leads to independence eventually.

01:10:39
Dr. Maya Novak:
I’m – like I said at the beginning – I was super excited about this interview, and this is so, so important. Thank you so much for being here. Now, I want to touch on something else. You have expertise in PGP, which is pelvic girdle pain.

01:11:02
Mags Clark Smith:
Yes.

01:11:02
Dr. Maya Novak:
Can you talk a bit about this? What this actually is and what your research shows?

01:11:10
Mags Clark Smith:
Yes, I can and thank you for asking because I feel passionately about pelvic girdle pain in pregnancy. My passion comes from the wonder of pregnancy and bringing a new life into the world, and in an ideal world, according to me, every woman who is carrying a baby would have a pain free experience. So this area of research evolved because an obstetrician from the National Maternity Hospital in Dublin referred a patient to me and asked if I could help and she had pelvic girdle plain. She was in a wheelchair and unable to walk. She rang me in tears and asked if I could help her and I’d actually closed my clinic for Christmas. So what I might have done, if I was a different person, was say no. But actually, she cried. So she came to see me and I gave her some movement work and I explained, as I have explained to you, about the process. She worked diligently and came to see me between Christmas and New Year, and the most amazing thing was that even after the first session, she got up out of the chair and she walked to the door herself. Then she was significantly better again in the second session, and then she went back to the obstetrician, who rang me and said you’re a miracle worker, I need you right here. Whenever I went to the hospital to see him, the midwives would say the same thing. So that started the number of women who were referred to me by obstetricians and midwives. But because of my background as an academic, I wanted to know why. Like what is happening here? I really need to know more. The research grew from that question and we have, at this stage, completed two pilot studies and part of the research is the cortisol swabs, and also the Roland-Morris Questionnaire so that we see exactly how much pain the patient is experiencing and we can score that. Because to have any scientific validity we need to have means of – ways of actually scoring the pain and the amount of cortisol that the patient has in their body and relating that to the amount of pain. What we’re seeing time and time again is through - the patient works with me, so they within the study they do two sessions, and the difference in their pain levels is huge and it goes down. So that means we all feel – because it’s now a team of us working on it – that this is something that we want to pursue and see whether we can do a bigger study and whether this information can make a difference to women all over the world who are experiencing pelvic girdle pain in pregnancy.

01:15:05
Dr. Maya Novak:
I am glad that you are doing this. But like you said, the doctor said to you, you’re a miracle worker and miracles - usually, we refer to miracles if something is unexplained, we cannot explain it.

01:15:26
Mags Clark Smith:
Yes.

01:15:26
Dr. Maya Novak:
My hope and vision for the future is that miracles will – health miracles, injury-related miracles – they will become something normal. So it’s not just something that people view as an anomaly, as a thing that happens to others, but isn’t really possible for them. And the stories of your clients and what you shared, it just shows that it’s not just for special people.

01:15:57
Mags Clark Smith:
Absolutely, and I think that’s – it makes me smile when people would say that because I know they’re saying it as a compliment and yet I had to train myself not to hear it as – no, no I’m not! Because that would be very rude, and I don’t want to be rude, but it has led to is really igniting my curiosity to say no, let’s explain it. Let’s find out what’s happening here and then we can duplicate it. It doesn’t just have to be me. It can be anyone who is trained in this, and that is the way forward that will help all women who are experiencing pelvic girdle pain. That’s where my passion is really, and yes, let’s make those tests within the research as stringent as possible so that we can really dig into this and see what’s going on. So there’s my drive really. There’s lots of work to do!

01:17:11
Dr. Maya Novak:
Great. I have two more questions that I would love to ask you. The first on is your number one advice that you would give someone who is recovering from an injury? What do you think is a really important thing?

01:17:31
Mags Clark Smith:
I think my number one piece of advice to someone who is recovering from an injury is to take a moment just to monitor the number of seconds that you breathe in for and breathe out. If you breathe in for two and then feel you’re holding your breath that is a signal that the relaxation response is not having the opportunity to turn on, and therefore the healing within the body may be restricted. So the number one piece of advice is just practice that a little bit and see if you can increase that to maybe three seconds or four seconds, all the way up to eight. But take that gently. So if we breathe into eight by forcing ourselves to do that you can feel dizzy and that’s not great. So all of this is small change, little incremental steps.

01:18:48
Dr. Maya Novak:
The last question is a bit more fun. If you were stuck on a desert island with an injury and you could bring only one thing that would help you heal perfectly, what would that be? What would you bring?

01:19:08
Mags Clark Smith:
Me personally, or?

01:19:11
Dr. Maya Novak:
You.

01:19:11
Mags Clark Smith:
This is a really difficult question! I think to heal perfectly I would need a mat so that I could move, and then I could make a shelter out of it and things!

01:19:29
Dr. Maya Novak:
Beautiful, I like it. Yes. In regards to movement, you do have a DVD, is that correct?

01:19:40
Mags Clark Smith:
That’s right. Yeah, so this is my DVD and it’s possible to get the DVD on my website. My website is resolvingchronicpain.com. If anybody listening wants to contact me they can also contact me on resolvingchronicpain@gmail.com, so they can send me an email as well, but I think those details are on your site as well. So within our research for the pelvic girdle pain, each of the women with pregnancy-related pelvic girdle pain had one of these DVDs, which meant that they could practice the gentle movement between the sessions and that was a significant part of it. Not only that when we’re pregnant it’s very difficult to remember at anything at all, so it’s good to have the DVD, but also it’s the continuity because it’s only me that speaks on the DVD, of having someone who you can relate to and you feel that they’re walking by your side. That takes us back to that whole thing of feeling safe, which I think relates to your story of your pain going down when you realized it was fear. So there must have been a sense of feeling safe for that fear to dissipate.

01:21:10
Dr. Maya Novak:
Absolutely. It is feeling safe versus being in a panicking mode with fear and this is exactly what you said. So you mentioned that you have a textbook coming out?

01:21:28
Mags Clark Smith:
Yes.

01:21:28
Dr. Maya Novak:
Will there be information on your website? Or how can people get that?

01:21:34
Mags Clark Smith:
Yes. So the textbook is due to be published this year and all of the proceeds go the Psychophysiologic Disorders Association, and it’s a textbook on pychophysiologic disorders. There’s lots of different contributors and there are four editors, and I am one of them. So yeah, we’re very excited about that and there’s a chapter about my work in that textbook and a history of this way of working within the textbook as well.

01:22:10
Dr. Maya Novak:
Perfect. Mags, that was amazing. Thank you so much for being here and thank you for your work. Thank you for – I’m thanking you in the name of your clients past and future because I know how important it is to have someone like you to work with. So thank you for being here, and for everything that you do.

01:22:34
Mags Clark Smith:
Thank you very much it’s been a great pleasure. I’ve absolutely loved it, so thank you.

01:22:41
Dr. Maya Novak:
Thank you for tuning into today’s episode with Mags Clark-Smith. If you haven’t done it yet, subscribe to my podcast on whatever platform you’re using to tune in. Of course, also remember to share this episode with your loved ones and help them out. To access show notes, links, and transcript, of today’s talk go to mayanovak.com/podcast. To learn more about The Mindful Injury Recovery Method visit my website mayanovak.com and find my book Heal Beyond Expectations on Amazon. Until next time – keep evolving, blooming, and healing.

Love and gratitude xx
Dr. Maya

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