Persistent Pain: Movement and (Mis) Communication

by Micia de Wet

The Somatic Practice and Chronic Pain Network held a webinar on the topic of Persistent Pain: Movement and (Mis) Communication on 5th of May 2021. The event included short presentations and discussion with panel/ participants. Here we share a summary of the chat at the webinar.

An overview of what was on offer

In his talk, Rob Young (writer and artist) presented attendees with the metaphor of pain being a kaleidoscope, a constantly changing pattern of experiences. An attendee noted the challenge of finding the language to articulate how the pain presents itself on a day-to-day basis, which is an evolving and dynamic experience. Rob also emphasised that “we are more complex than broken machines that need fixing,” important for understanding how to treat pain.  

Artist-researchers Anna Macdonald and Ceri Morgan shared a film from their project called Circling, which explored pain, movement and writing. The intimacy cultivated by the film stood out to participants and panel members alike. Intimacy was seen as a process of communication that invites dialogue in how pain is expressed. Additionally, there was interest in how the film demonstrated the support that surfaces within one’s home can provide, for pain relief and healing.

Communicating Lily’s Pain Project – Image credit: James Munro

Professor of Nursing, Bernie Carter’s presentation inspired reflections on listening as a transformative tool, including reference to her project Communicating Lily’s Pain. An attendee at the webinar noted how understanding an individual’s experience of pain often arises from “long-term deep listening .” Another attendee shared that when anindividual is afforded time and space in order to express their experience, there is a direct impact on their autonomic nervous system, which in turn influences the perception of their pain. One attendee who is a somatic practitioner noted that he often uses a “light touch to listen…” with patients experiencing pain, emphasising listening to the body. 

Toshio Nomura (professor of health and technology) presented on the socio-cultural roots of language and its relationship with the communication of pain. One attendee noted that “how the body is recognised in Chinese and Japanese medicine has a great deal to offer Western medicine models.” Another suggested that the language a person chooses to use “leads to completely different expressions of pain,” and influences how pain is treated and managed by physicians and practitioners.

(Mis)communication, pain and community 

Image credit: Rob Young

A central point of interest was the communication process between healthcare professionals, somatic practitioners and patients. Bernie Carter offered useful insight regarding reassurance as a tool, referring to her work in children’s pain care. However, the way medical professionals communicate with their patients was noted as a generally underdeveloped skill by an attendee. Rob suggested that “we need to create a safe space first before trust can be exchanged.”

Moreover, the experience and communication of pain influences caregivers and loved ones. An attendee stated that “observing extreme pain regularly is very difficult in a [romantic] relationship.” Reflecting on her work with children, Bernie relayed that parents similarly “talk about how desperately difficult they find it to live alongside their child’s pain.”

Down-playing pain was discussed as a coping mechanism, especially in relationships chronic pain sufferers have with their loved ones. An attendee offered insight that “If I talk about it all the time then it is there all the time. If I can shut it down some then it sits in the background…”. Rob Young asked if reserve is more problematic than we realise, arguing that humans are “sociable creatures” who “strive to communicate pain as a natural survival tool, so it is counter-productive to stifle that through shyness or cultural conformity.” 

Visual and tactile aids, such as drawing and crafting materials, were noted by Bernie Carter as effective resources in getting adults and children to articulate and describe their pain. The cathartic power of sounds was also widely acknowledged by the attendees and panel members. Sarah Charles (from the webinar organising team) mentioned that sound can be useful in the articulation of specific feelings of pain. 

Communicating somatically: the body, movement, and pain

Image credit: Rob Young

Movement practices, such as walking and writing, were discussed as effective approaches for managing and communicating chronic pain. However, it was also mentioned by an attendee that the practice of walking as a healing or restorative practice only worked for them because they had a natural joy in walking. Whatever movement practice a person with pain undertakes, it was suggested that the person can find enjoyment, rather than adopting it as a type of rigid treatment plan.

Distinctions were also made by attendees and panellists between somatic processes such as healing, and the expectation of a cure from medical practices. “Expectation of a cure comes from within healthcare itself,” stated an attendee. Adversely, another attendee suggested that “healing is always available and this gives so much hope.” The discussion prompted the realisation that healing should be allowed to happen, rather than something that a person tries to make happen through force. Bernie Carter reflected that, “the idea that people’s expectations are different within the context of arts is really interesting. I think that within health services, the expectation or hope is that a cure will be possible.”

Moving into the future

Connections were made between ritual and pain (see here on birth, and emotions), geopoetry and creative writing, and movement scores for dealing with pain. Bernie Carter noted the impact of changing one’s environment for pain management, exemplifying the Cheetahs Wheelchair Club. The impact of vagal nerve stimulation through cold water immersion and swimming was also mentioned as an alternative way of managing pain, both mental and physical. On the horizon, research such as that undertaken currently in Australia by Professor Tasha Stanton on mental imagery (visualisation) and pain was mentioned by an attendee as a promising alternative treatment option. 

The attendees and panellists acknowledged that creative arts practices, such as movement, dance, and creative writing, could positively work alongside England’s NHS healthcare for pain management. Bernie Carter noted that working this way offers “support for the whole person.” This creates an integrative and wider view of the narrative influencing the person’s pain. The question remained for attendees however, of how artists can become integrated into mainstream healthcare. For many, this means acknowledging pain has not only quantitative affects and outcomes, but also qualitative aspects. There also needs to be recognition that artists are not there only to provide distractions from pain, but rather are integral to the process of healing and rehabilitation. 

Micia De Wet is a PhD candidate in somatic practices, actor training and intuition at Coventry University and provides research support for the network. She has co-created practice video on somatic practice and chronic pain, drawing from her own experiences.

Dance, Parkinson’s and Pain

In this video, Dr. Aline Haas discusses her project on dance for those with Parkinson’s disease to improve quality of life. Based in Brazil, Aline and her team work with Samba and Forró dance rhythms. During the global pandemic, her team adapted to delivering the dance material through WhatsApp, Facebook and Youtube. Pain is also a challenge for people with Parkinson’s and Aline notes how dancing online together supported a reduction in pain, even if it did not replace in person contact.

Aline Haas on video discusses dance and Parkinson’s disease in Brazil

An audio only version is available here

Aline Haas is an Associate Professor in Dance at the Federal University of Rio Grande do Sul (UFRGS), Brazil. She has a BSc(Hons) in Physical Education and a PhD in Sports Science. She leads the ‘Research Group in Arts, Body and Education’ at UFRGS. Her research focuses on dance science and dance in health, including working with people with Parkinson’s, stroke patients and older people – who often experience pain. She has been delivering dance workshops online with people living with Parkinson’s during the pandemic. Contact: @DrAlineHaas Dance E Parkinson Facebook

Dance and Parkinson’s Online Video Trailer, Porto Alegre, Rio Grande do Sul, Brazil, 2020

The Psychobiology of Pain: How does pain work, and how could somatic practice help?

Sarah Charles

Sarah Charles preparing blood for analysis
Photo by Sarah Charles (2019)

Highlighting the biological and psychological mechanisms that lead to pain can help provide some insight into how movement in general, and somatic practice in particular, might help those living with pain.

One of my major interests is the “science of emotion”, with a particular fascination with how taking part in certain behaviours (music listening/performance, dance, ritual, etc.) might affect emotion. I am interested in the chemistry of the brain and finding out which chemicals play key roles in our emotions.

In my work, one set of brain chemicals that I have studied in-depth are called “opioids”. This is a word many people may have heard of, especially those living with chronic pain. This is because of the prominence of opioid-based pain medications that are often prescribed to those with pain (e.g. codeine and morphine). However, your body naturally produces opioids, too. The best-known of these naturally occurring opioids (and the body’s main codeine-/morphine-like opioid) is named “beta-endorphin”, sometimes named “endorphins”. These endorphins give you the rush known as the “runner’s high” after exercise (Boecker et al., 2008).  As a consequence of studying opioids, I ended up researching pain, and how the activities mentioned above may alter the pain experience.

Mechanics of Pain

Why We Have Pain

Pain is, evolutionarily speaking, a useful tool for all animals (including humans) to let us be aware of when a part of our body may be damaged in some way (be it via heat, pressure, or some other damage). There is extensive literature on the purpose of pain for mammals in general, as well as humans in particular.  Some pain is a necessary component of a functional life: we need to know what is dangerous and what is not so that we can react accordingly.

Acute Pain experience

Pain is an incredibly complex phenomenon, with no one chemical being the “be-all and end-all” of pain. However, opioids do play an important role in the pain experience. Consequently, many medical professionals will use opioid-based medication as a way to help alleviate pain for those experiencing it. This is because opioids alter the point at which you start to feel pain (pain threshold; Fillingim et al., 2005; Hagelberg et al., 2012; Huang et al., 2008; Kialka et al., 2016), helping lessen the pain experience. Our body naturally releases small amounts of endorphins in response to pain to help lessen the intensity of pain, but sometimes this is not enough. This is why you will often be given morphine or a similar pain killer after major surgery or a major injury: this will increase your threshold to pain so that the same strength of painful stimuli (e.g., the broken bone, or the surgery wound) doesn’t feel as intense (see Graph 1, below).

Graph 1. Dummy data depicting the perception of acute pain with different strength of painful stimulus under normal conditions (blue) or if the person has been given an opioid drug (red). An opioid drug increases the strength a painful stimulus must be for the onset of pain to occur. After the onset of pain occurs, pain intensity can still increase like normal.

If you are only exposed to your body’s endorphins, they do not seem to lose effectiveness with time/age. i.e., the human body does not become more resistant to your natural pain killers. If it did, all humans would become hyper-sensitive to pain.  Using this logic, for many years, it was thought that the same principle shown in Graph 1 could be applied to chronic pain. There was, at the time, no major reason to believe that opioids would become less effective at treating pain over time. Consequently, many people living with chronic pain were prescribed opioid medications to help alleviate their symptoms.

However, when it comes to chronic pain, opioid medication is now acknowledged to not be nearly as useful as for acute pain (Ballantyne, 2017). This is because, much like with many drugs, consistent use of strong opioids (i.e., codeine, morphine, heroin etc.) can lead your body to become less responsive to the effects of opioids. This includes becoming less responsive to even your body’s endorphins.  This means that, over time, consistent use of opioid drugs can actually lead to a greater sensitivity to pain (Mao 2002, 2006; DuPen et al., 2007; Higgins et al., 2019), as your body’s endorphins are no longer enough to increase your pain threshold to a functional level themselves. Graph 2 shows this visually. This is a major reason why the prescription of opioid drugs is not always the “go-to” treatment for all people with chronic pain issues (also, more consideration is given to the other side-effects of opioid drugs, and their addictive properties).

Graph 2. Dummy data depicting the perception of pain with different strength of painful stimulus under normal conditions (blue) or if the person has been on long-term opioid treatment (red). Long-term opioid treatment lowers the strength a painful stimulus needs to be before you experience it as pain. After the onset of pain occurs, pain intensity still increases like normal.

Pain and Somatic Practice

“So?” I hear you ask, “What does this have to do with movement or somatic practice?”

Somatic practice is a guided practice, where a practitioner works alongside their client to help them become aware of their body, and the sensations their body is experiencing. Somatic practice is often performed in a one-on-one setting and, often, to help the client become aware of their bodily sensations, this involves some form of touch. It has long been shown that social touch (such as one-on-one touch that occurs in somatic practice) changes the way the opioid system activates in humans (Dunbar, 2010; Nummenmaa et al., 2016). It usually leads to the release of opioids in a way that leads to positive emotions and increases in pain threshold (Nummenmaa et al., 2016).

Similarly, many of topics covered elsewhere on this blog, such as synchronised movement (Lang et al., 2017; Mogan et al., 2017) in the form of dance (Tarr et al., 2015, 2017) and yoga (Suri et al., 2017; Yadav et al., 2012) also cause the release of endorphins. Given that yoga can be included as a form of somatic practice, and that dance is often incorporated in the work of many somatic practitioners, it is no surprise that many of them have seen positive outcomes in their client’s pain experiences after conducting sessions.

Concluding remarks

In summary, pain is a very normal, and useful, part of the body’s response to being damaged in some way. The body’s opioid system plays a key role in pain perception. While long-term opioid drug use can lead to issues with increase pain sensitivity, the body’s natural opioids do not lead to increased pain sensitivity. So, those who suffer with chronic pain may find some benefit in taking part in activities that help their body release endorphins, such as yoga, dance or other forms of somatic practice.


Ballantyne, J. C. (2017). Opioids for the treatment of chronic pain: mistakes made, lessons learned, and future directions. Anesthesia & Analgesia125(5), 1769-1778.

Boecker, H., Sprenger, T., Spilker, M. E., Henriksen, G., Koppenhoefer, M., Wagner, K. J., Valet, M., Berthele, A., & Tolle, T. R. (2008). The runner’s high: opioidergic mechanisms in the human brain. Cerebral cortex, 18(11), 2523-2531.

Dunbar, R. I. (2010). The social role of touch in humans and primates: behavioural function and neurobiological mechanisms. Neuroscience & Biobehavioral Reviews34(2), 260-268.

DuPen, A., Shen, D., & Ersek, M. (2007). Mechanisms of opioid-induced tolerance and hyperalgesia. Pain Management Nursing8(3), 113-121.

Fillingim, R. B., Kaplan, L., Staud, R., Ness, T. J., Glover, T. L., Campbell, C. M., … & Wallace, M. R. (2005). The A118G single nucleotide polymorphism of the μ-opioid receptor gene (OPRM1) is associated with pressure pain sensitivity in humans. The Journal of Pain6(3), 159-167.

Hagelberg, N., Aalto, S., Tuominen, L., Pesonen, U., Någren, K., Hietala, J., … & Martikainen, I. K. (2012). Striatal μ-opioid receptor availability predicts cold pressor pain threshold in healthy human subjects. Neuroscience letters521(1), 11-14.

Higgins, C., Smith, B. H., & Matthews, K. (2019). Evidence of opioid-induced hyperalgesia in clinical populations after chronic opioid exposure: a systematic review and meta-analysis. British journal of anaesthesia122(6), e114-e126.

Huang, C. J., Liu, H. F., Su, N. Y., Hsu, Y. W., Yang, C. H., Chen, C. C., & Tsai, P. S. (2008). Association between human opioid receptor genes polymorphisms and pressure pain sensitivity in females. Anaesthesia63(12), 1288-1295.

Kialka, M., Milewicz, T., Mrozinska, S., Sztefko, K., Rogatko, I., & Majewska, R. (2016, May). Pressure pain threshold and [beta]-endorphins plasma level are higher in lean polycystic ovary syndrome women. In 18th European Congress of Endocrinology (Vol. 41). BioScientifica.

Lang, M., Bahna, V., Shaver, J. H., Reddish, P., & Xygalatas, D. (2017). Sync to link: Endorphin-mediated synchrony effects on cooperation. Biological Psychology127, 191-197.

Mao, J. (2002). Opioid-induced abnormal pain sensitivity: implications in clinical opioid therapy. Pain100(3), 213-217.

Mao, J. (2006). Opioid-induced abnormal pain sensitivity. Current pain and headache reports10(1), 67-70.

Mogan, R., Fischer, R., & Bulbulia, J. A. (2017). To be in synchrony or not? A meta-analysis of synchrony’s effects on behavior, perception, cognition and affect. Journal of Experimental Social Psychology72, 13-20.

Nummenmaa, L., Tuominen, L., Dunbar, R., Hirvonen, J., Manninen, S., Arponen, E., … & Sams, M. (2016). Social touch modulates endogenous μ-opioid system activity in humans. NeuroImage138, 242-247.

Suri, M., Sharma, R., & Saini, N. (2017). Neuro-physiological correlation between yoga, pain and endorphins. International Journal of Adapted Physical Education and Yoga.

Tarr, B., Launay, J., Cohen, E., & Dunbar, R. (2015). Synchrony and exertion during dance independently raise pain threshold and encourage social bonding. Biology letters11(10), 20150767.

Tarr, B., Launay, J., Benson, C., & Dunbar, R. I. (2017). Naltrexone blocks endorphins released when dancing in synchrony. Adaptive Human Behavior and Physiology3(3), 241-254.

Yadav, R. K., Magan, D., Mehta, N., Sharma, R., & Mahapatra, S. C. (2012). Efficacy of a short-term yoga-based lifestyle intervention in reducing stress and inflammation: preliminary results. The journal of alternative and complementary medicine, 18(7), 662-667.

Sarah Charles is a psychology and neuroscience researcher interested in exploring the neurochemical mechanisms underlying cognition and behaviour. She has taught at Coventry University, Nottingham Trent University and currently works as a research associate at King’s College, London.

This blog does not provide medical advice and the views and opinions expressed in each blog post belong to and are the responsibility of the author(s) of the blog posts. Any information that you use is at your own risk.  You should always consult with a health care professional about any general or specific health concerns.

Children’s Chronic Pain: Thinking Outside the Box

In this interview, pain specialist nurse Jenny McHugh discusses working with children at Alder Hey Children’s Hospital, with Prof. Bernie Carter.

They talk about the kinds of persistent pain children present with, and the role of a multidisciplinary team in working with them.

By thinking ‘outside the box’, Jenny has successfully introduced acupuncture into the children’s chronic pain service. This is to address not only physical pain, but also associated issues such as sleep loss and anxiety.

There is a need for ways to support children and young people to get moving again while experiencing chronic pain. This points to the potential role that dance and somatic practices could play in the future.

Some terms you might hear:

MDT – Multi Disciplinary Team

CAMHS – Child and Adolescent Mental Health Services

Skeletal dysplasia / exostosis – bone disorders

Neurofibroma – nerve tumour

Deconditioning – physiological change following inactivity

Oncology – study of cancer

Anaelgesia – medication for pain relief

NICE guidelines – National Institute for Health and Care Excellence

CDEG – Clinical Development and Evaluation Group

CBT – Cognitive Behavioural Therapy

Staff members at Alder Hey are occasionally visible in the background, but they have given their consent.

Future Projects in Somatics and Pain: Using the KJ Ho (Method) to structure ideas

Toshio Nomura and Emma Meehan

Future projects

In February 2020, we asked network members to generate project ideas about somatic practices (SP) and pain that needed to be addressed. In this blog, we present a qualitative research approach, called KJ Ho (Method), used to structure these ideas into areas of future research that we aim to pursue. 

KJ Ho – Chaos to Order

The KJ Ho (Method) is a qualitative research method for creative thinking and problem solving. It was originally invented by Japanese cultural anthropologist, Professor Jiro Kawakita (1920-2009). The basic KJ Ho is a card-based method to organise data and thoughts, to create a comprehensive, spatial, structured arrangement of data (Figure 1).

Here we primarily focus on the phase of this process which is about problem definition. In the full method, this leads to a series of other phases including data collection and analysis, hypothesis generation, implementation strategy, experimentation, and verification.

KJ Ho Basic Steps. Image: Toshio Nomura

Kawakita stated over 30 years ago, ‘the complexity of our world has far outstripped any ready-made theories or hypotheses, and a priori assumptions and wishful thinking are useless’ (1991). This was certainly true as we had to adapt the KJ Ho to our circumstances – locked down due to the COVID-19 pandemic – creating new online ways of using the method.

Online Chart Making in a Pandemic

The network session resulted in 30 future project ideas; these ideas were wide ranging but not always obviously connected . Using the KJ Ho, the ideas (data) were analysed in a bottom-up approach and five overarching themes emerged.

In March 2020, we started the KJ Ho process using physical KJ Ho cards. Unexpectedly, soon after that, the lockdown due to Covid-19 began. Unable to have a face to face meeting, we began to conduct the chart construction remotely using Zoom and Powerpoint. This was a challenge since KJ Ho is usually a face-to-face collaboration and often produces beautiful hand-made cards.

However, by ‘screen sharing’ a Powerpoint slide of labels, one person could manipulate the file while talking to the other over Zoom. Although not a truly shared environment, we could both read simultaneously with one person editing the file. Each step required a lot of time to reflect and consider, facilitated through Zoom discussions and emails, in order to reach consensus. 

Step 1. Label making. Image: Nomura, Meehan, Carter (2020) ©

Label making: We created labels in relation to the collected data or project ideas. Only one fact, thought or concept related to the problem of concern should be written on each label. 

Step 2: Label grouping.
Image: Nomura, Meehan, Carter (2020) ©

Label grouping: We would ideally have spread labels around on a table or a floor – but we did this on Powerpoint. Labels that appear to belong together should be arranged to form a group (or an island). You do not group based on similarity, for example, similar words being used, but rather themes or concepts.

Step 3: Group label naming. Image: Nomura, Meehan, Carter (2020) ©

Group label naming: We summarised each group by describing the essence of all labels in that group. Once a title is decided, it is written on a new label, which is placed on top of other labels that are grouped together.

Step 4: Spatial arrangement. Image: Nomura, Meehan, Carter (2020) ©

Spatial arrangement: After several label grouping steps, final groups are obtained. These are usually spatially spread and arranged on a large sheet of paper. We did this on Powerpoint to layout the underlying methods, core components and future modes of sharing.

Step 5: Relationships. Image: Nomura, Meehan, Carter (2020) ©

Relationships:The following relationships are used in KJ Ho chart making between labels and groups: Cause and effect, Contradiction, Interdependence, or Correlation. We linked ideas that were interdependent mainly, though some were more output oriented, and therefore a form of ’cause and effect’.

Step 6: Chart making.  Image: Nomura, Meehan, Carter (2020) ©

Chart making: All cards are expanded and grouped, and spatially re-arranged where needed. Circles are added around groups, and relationships are included to complete the process. Playing with Powerpoint formatting was needed in order to find a visually appealing way of spreading out and grouping the ideas.

Step 7: Verbal or written explanation. Image: Nomura, Meehan, Carter (2020) ©

Verbal or written explanation: The last step is to explain the chart. The explanation should begin with an overview of the problem, and then become more specific. This step helps to understand the interrelationships among components of the problem. We produced a document including information on the network’s aims, and then explained the the KJ Ho chart groupings, starting from the centre.

What next? A cyclical process

The stage we tackled above is the first ‘problem definition’ phase. Now, more time needs to be taken in deepening an understanding of the core pillar of the KJ Ho chart: what somatic practices can be matched with the specific requirements in chronic pain. 

The Somatic Practice and Chronic Pain Network propose to do this through a) interviews with people living with pain and healthcare professionals b) discussion with network members and c) conversations in a series of online public events to bring in different perspectives.

Additionally, Meehan and Carter are writing a paper on what somatic practice could add to existing pain management practices and the gaps in knowledge. All of information we collect from this work will form the data we will use in the next phase of the KJ Ho process.

Co-Creation and Creativity

The core of the KJ Ho is to try to understand the problem and issues and to identify possible solutions. In this network, we do this is through listening to people with chronic pain and healthcare professionals. Somatic practitioners also need to be part of the process in understanding what they have learned from working with people with pain. We focus on people and their experiences as well as the environments that shape them.

In this sense, the KJ Ho approach is field science extensively using ‘fieldwork’, as opposed to laboratory/ experimental science or office/desktop-based science. In the modern marketing terminology, it may well be called consumer-driven (or consumer-end) innovation and co-design/co-creation of solutions.

Within the fields of somatic practices and chronic pain some experiences and ideas are better described with photos, sketches, and drawings and even videos and animations. There is such extended KJ Ho (called Photo KJ Ho) where data are photos and drawings. It is certainly worthwhile trying out this newer approach in the future where movement and dance are an important part of the data.


Kawakita, J. (1991). The Original KJ Method (Revised Edition), Kawakita Research Institute.

Nomura, Toshio et al. (2013). Introduction to KJ-Ho – a Japanese problem solving approach. Creativity and Human Development, Issue 6. ISSN 2050-5337.

Images copyright of Toshio Nomura, Emma Meehan and Bernie Carter at the Somatic Practice and Chronic Pain Network, funded by AHRC and supported by Coventry University/ Edge Hill University (2020). All rights reserved.

With thanks to the Somatic Practice and Chronic Pain Network members who generated the ideas analysed in the KJ Ho chart.


Professor Toshio Nomura gained his DSc degree in Systems Science from Tokyo Institute of Technology in 1980. After a period at universities in Canada, the US and UK, he moved into industry’s R&D divisions. He is an expert in innovation, technology development and technology transfer in the Sciences and Arts. He has a particular interest in promoting cooperation between Japan and UK/Europe. Between 2009 and 2012, he held the post of Professor in Kyoto University’s European Office, London, to promote global collaboration and innovation. Since 2012, he is Visiting Professor of Yamaguchi University, Japan, pursuing interests in global engagements in innovation. In 2019, he was appointed as Honorary Professor of Systems at the University Hospital Coventry and Warwickshire (UHCW). Toshio supports several charitable projects, including the UK-Japan Young Scientist Workshops programme, and Japan Care UK (JCUK) an organisation planning for future retirement of older Japanese people resident in the UK. In the past 2 years, he has been suffering from chronic pain of post-herpetic neuralgia in his left leg. 

Dr.Emma Meehan is the Principal Investigator at the Somatic Practice and Chronic Pain Network, and Assistant Professor in Dance at the Centre for Dance Research, Coventry University.

Dynamics of rest

More reflections on somatic practice, pain and resting

Tamara Ashley

University of Bedfordshire students,
photo by Amalia Garcia (2019)

Following on from Glenna Batson’s post on Constructive Rest, I am going to look at the dynamics of rest in embodied practice. In particular, I look at the interplay between doing and not doing in somatic practice, in pain and trauma contexts. My reflections are situated in my practice as a yoga, dance and somatic teacher.    

In my practice, I am continually negotiating between practicing for changes that bring about a greater sense of ease and clarity, and trusting the body to find that clarity through its own wisdom.  Embodiment practices can guide this process by offering soft and subtle interventions of patterning that trigger organisations of the body-mind towards health and well-being.  

The sensitivity of the practitioner and the teacher can also explore what tools to use, how much information to share, and when to stop and rest. Batson (2020) points out that many somatic practices include ‘a resting phase of varied duration commonly interspersed between various points of active movement’. The resting phase allows self-regulation and integration of what has been experienced. 

The resting phase might commonly be included as a savasana at the end of a yoga practice, or a rest might be taken after the exploration of a particular body pattern, which is common in Feldenkrais.  In pranayama, one of my teachers, Petri Räisänen makes space for resting between each form, as well as resting at the end of a session. These little rests, or moments of ‘not doing’ in between ‘doing’, are restorative and integrative, and allow the body and mind to recuperate and settle. 

Extended rest

It is helpful to think of embodiment practices as interventions providing guidance that supports the organism’s self-regulation towards health. This can be a different mode of thinking from dance and physical training, where there is often emphasis on developing, extending, or at the minimum, maintaining a physical capacity through practice sessions. 

When a practice is not focused on external goals but on health and well-being, extended rest with a complete break from physical exercise beyond a few days can be beneficial to healing.  I have observed in my own practice that extended rest (10 days or more) reveals: 

Photo by Amalia Garcia (2019)

1. The importance of resting to let things release, loosen the tissues and connections, let some patterns soften, trust the body to heal without intervention.

2. The feeling of coming back to familiar patterns after a break often leads to a different comprehension of the organisation and experience of the body.

3. Decoupling therapeutic exercise from the area of the body that they were prescribed to help thus giving a chance to reflect on the on-going need for its continued practice, or making changes. 

4. That rest from practice gives the chance for the body and mind to self-organise. Its not a rest where nothing is happening; its giving space for the body and mind to express and speak without intervention. 

Rest in the context of pain and trauma

From a yogic perspective, pain and trauma in the body are not just in the physical layer. As a yoga practitioner, I think of the person in many layers, known in yoga as the koshas; the physical layer, the energetic layer, the mind layer, the knowledge layer, the bliss layer.  While movement and patterning exercises might be approached through the physical layer, the affects of exercises can trigger changes in all the layers, some perceptible and some perhaps not. Practice offers the person a great deal of information and time for integration is important.  

Additionally, with trauma and injury, it can be hard to know whether or not to rest or to move.  Sometimes movement brings energy to the affected area and helps to mobilise what might have become stuck. At other times, however, pain is immobilising and it is not possible to move in a conventional sense. From a yoga perspective, physical and emotional pain can both be experienced physically because the layers are intermeshed. Many injuries carry with them some form of emotional pain; and emotional pain can also lead to immobilisation of particular parts of the body, or the whole body, as a trauma response (Levine, 2008). 

Tamara Ashley, photo by Amalia Garcia

An intentional approach to rest can be helpful as Gail Parker points out in her book Restorative Yoga for Ethnic and Race Based Trauma. She says ‘because it is practiced in stillness, Restorative Yoga teaches you how to immobilize without fear’ (2020, p. 72).  Decoupling stillness from fear and trauma can enable the body and mind to re-organise and find deeper states of rest. Additionally, inviting stillness to an area that is immobilised can enable a deeper sensitivity of sensation to arise, and perhaps, if not shift the physical layer, make shifts in the mind and energy layer.  

Rest between resting

It is also useful to cultivate a positive attitude towards rest and stillness. Parker further elaborates that ‘just because you are doing nothing doesn’t mean nothing is happening.  Your body is recalibrating, repairing, and rejuvenating’ (2020, p. 74). I also include a resting phase between exercises in my own teaching, and when I teach restorative yoga, I include a rest between forms – a rest between the resting!  In restorative yoga, even though each form is in stillness, the body is still organised distinctly in terms of energy and systemic flows. 

Inversions, for example, re-orient the flow of fluids in the body. Resting in a chosen form afterwards, I have observed, allows for deeper recuperation and integration. Different qualities of resting can be observed. Learning to rest, giving space to the body-mind systems to find their own way, is to trust in the ability of an organism to self-regulate, heal itself and trust in nature itself. 


Batson, G. (2020) Somatics at the Nexus of the Pandemic and Pain: Part II – Constructive Rest [accessed 5 September 2020]

Levine, P. (2008) Healing Trauma, Boulder: Sounds True Books

Parker, G. (2020) Restorative Yoga for Ethnic and Race Based Trauma, USA: Singing Dragon Press   

Tamara Ashely is a dancer, performance artist, yoga and somatic practitioner, teacher and researcher interested in exploring the moving body-mind for the development of creativity, freedom, self-expression and healing. She is senior lecturer in dance and director of the MA Dance Performance and Choreography programme at the University of Bedfordshire.

This blog does not provide medical advice and the views and opinions expressed in each blog post belong to and are the responsibility of the author(s) of the blog posts. Any information that you use is at your own risk.  You should always consult with a health care professional about any general or specific health concerns.

Somatics at the Nexus of the Pandemic and Pain: Part II – Constructive Rest

Glenna Batson

While scientists continue to investigate modes of pain management, self-help methods that highlight sensory awareness and rest are gaining currency.  

In the last blog, I suggested an easy sensory awareness tool: a quick, reflective moment of checking in with yourself to see how things are going.  This simple practice only takes a blink of an eye to determine whether you are becoming more stressed – thus, I coined the term body blink. Body blink is a potent way to pause – take a breath – and step back from unnecessary mental and physical effort.

In this blog, however, I will invite you to indulge in a lengthier rest period: 20-minutes of constructive rest. Rest is an integral part of our circadian rhythm, allowing mind and body to go ‘offline’ from the accumulated stress of a work day (Batson 2009). Yet, rest can be intentionally constructive – suggesting mindful mental work is going on without stressing the body. 

Carving out this time for yourself each day is a critical act of self-care. Although the final word is not out for pain management, it appears that twenty to thirty minutes of constructive (meditative) rest is recommended to calm the nervous system and restore homeostasis.1 This time protocol was established by mindfulness expert Dr. Jon Kabat-Zinn – one that helps shift from being stressed towards a more restful, embodied state of wellness (Kabat-Zinn 2017).

Rest and Somatic Practices

Augmented rest is a basic hallmark of somatic education (Batson & Schwartz 2007). A resting phase of varied duration commonly is interspersed between various points of active movement. Benefits include restoring physical and mental homeostasis, memory consolidation of movement or motor learning, and – perhaps best – helping hone awareness to our needs (Batson & Wilson 2014; Batson 2009). These needs often lie deep within the soma (body-mind working together), surfacing only when given the time and space to allow the body to speak.

These mind-body approaches find evidence in science for multiple chronic pain conditions (Skelly et al, 2018), with solid research studies supporting somatic approaches for alleviating chronic back pain using Alexander Technique (Little et al, 2014), and Feldenkrais Method (Paolucci et al, 2017).

As I mentioned in the first of this blog series, a body blink is a form of rest that is possible in any position. It’s a great tool when ‘on the go.’ But when a longer interval of time is needed, lying down is best. This offers a way to surrender weight into gravity, and suspend all the daily ‘doing’ tasks. 

While multiple options exist for resting while lying down, there’s value in constructive rest position (CRP) for pain transformation, where it is possible. CRP is the commonly known ‘semi-supine’ position (or hook-lying) – on your back, knees bent, arms relaxed by the side. Ideokinesis pioneer Dr. Lulu Sweigard (Sweigard 1974)2 , used the CRP distinctly distinctly to put all body joints in as near an anatomical neutral as possible (Ibid, p.216).

Glenna Batson, Constructive Rest Position, Photo by Pat Murphy

Restoring anatomical neutral means positioning the body (spine and head, ribs, pelvis), and all peripheral joints, such that the muscles exert the least activation possible (passive pull or stretch). This helps restore joint space and rest muscle length – a wonderful way to facilitate the redistribution of fluids to offset the work done in gravity.

This is a radical form of resting because it allows the body to self-regulate without otherwise trying to fix a problem, that is, it is not imposing on your body’s wisdom by over-directing.  Even if the mental mantra is to ‘relax,’ the body cannot translate this command if it has not experienced a deep sense of ease and letting go. Instead of being led by good intentions to fix oneself, given enough rest and physical support, the sensations of relaxation can arise without interference.  


Let’s give it a try. You could read below and then try it out, or ask someone else to read it to you as you are resting.

Find a quiet spot to lie down on your back if you can. Place a small towel under your head, and one under your arms, so you remove the weight of the extremities. If other body parts need support (such as the tail bone), you can continue to bolster them with folded hand towels or blankets. I call this ‘pontooning’ – removing the friction of body-to-surface and helping restore joint neutrality, so the body parts can ‘float.’

If you encounter pain during the process, see if there’s another way for a small pillow or towel to support you. And if supine lying is problematic, you can try ¾ lying or side-lying with a bed pillow in front of your torso to support an arm or between your thighs, for example.

Once settled, close your eyes. Use a small eye covering to block out bright light. Remain doing nothing for at least 2 minutes – and I mean, do nothing. Just give body and mind time to settle down. You might be surprised how long it can take for the noisy mind to start quieting down.

Begin then to follow your breathing – not as air volume, but as movement – allowing the breath to ‘do itself’. Note how your breath channels through multiple pathways, pauses, swirls and changes direction. Trust that your breath is doing what you need. You do not need to enhance it through deliberate intention such as taking larger breaths, or directing it to any place. 

Focus on sensing the midline of your body, the deepest recesses of your middle – perhaps that place behind your heart is a good place to start. Imagine slightly drawing in all of your body parts towards midline, each joint gently coupling with another. You are inviting your body to become more integrated and receive more wholistic support.

You may need to set a timer, but you can also just decide to follow the resting interval you feel you need. Note, though, that you might be short-changing yourself with less than 20 minutes. So, if it’s simply not possible to indulge your daily sensory bath today, then 10 minutes will suffice and tomorrow awaits you.


  1. Homeostasis is a unifying principle of biology where in the various control systems of the body restore and maintain a constant internal environment in response to environmental changes. Various feedback mechanisms to these different systems help bring sympathetic and parasympathetic impulses of the nervous system into balance.
  2. Ideokinesis is a form of mental practice with a long legacy that dates back to the early 20th century.  The concept that using the imagination alone would prime the motor nerves needed for efficient action was first used widely by sports psychologists. Called ‘mental practice’ or ‘mental rehearsal,’ athletes could use their mind’s eye to train the mind-body connection through covert (imagined) sports practice. Through the work of physical educators Mabel Todd, Barbara Clark and Lulu Sweigard, the concept was adapted for use within dance circles and the lay public. Dr. Lulu Sweigard popularized the word Ideokinesisi from the word roots ideo (idea) and kinesis (movement) (Sweigard 1974). Ideokinesis was one of the earliest of the somatic practices widely employed within dance training. To practice ideokinesis, dancers would assume the constructive rest position, and use only their imagination alone to visualize an action (thereby inhibiting muscle activation). In Dr. Sweigard’s classic protocol, students would learn to visualize her nine ‘lines of movement’ without muscular engagement. The uniqueness of these ideokinetic nine lines (as opposed to mental rehearsal) was to improve muscular balance and skeletal alignment that would lead to better coordination. Sweigard’s work continues to inform dance training to this day. For further information about the legacy and for references see: and

References cited

Batson G. The Somatic practice of intentional rest in dance education – Preliminary steps towards a method of study. Journal of Dance and Somatic Practices, 2010;1(2):177-197. 

Batson G, Schwartz RE. Revisiting the Value of Somatic Education in Dance Training Through an Inquiry into Practice Schedules. Journal of Dance Education. 2007;7(2):47-56. 

Batson G, Wilson MA.  Rest and Recovery: Making it Doable for Dancers, In: Wilmerding, V. and Krasnow, D., (Eds.), Dancer Wellness, Champaign, IL: Human Kinetics Press, 2014.

Harvard Health Publishing. Harvard Medical School. Six ways to use your mind to control pain. April 2015,

Paolucci T, Zangrando F, Iosa M, et al. Improved interoceptive awareness in chronic back pain: a comparison of Back school versus Feldenkrais method. Disability in Rehabilitation 2017, 39(10) 994-1001.

Little P, Stuart B, Stokes M, et al. Alexander technique and supervised physiotherapy exercises in back pain (ASPEN): a four-group randomised feasibility trial.  NIHR Journals Library, 2014.

Skelly AC, Chou R, Dettori JR, et al. Noninvasive nonpharmacological treatment for chronic pain: a systematic review. AHRQ Comparative Effectiveness Reviews. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Jun. Report No.: 18-EHC013-EF.

Mindfulness Staff. Jon Kabat-Zinn: Defining Mindfulness. What is mindfulness? The founder of Mindfulness-Based Stress Reduction Explains.Blogpost 11 January 2017, Accessed 27 July 2020.

Glenna Batson, ScD, PT, MA

For nearly 5 decades, Glenna has worked at the intersection of dance, somatic education, human movement science, and rehabilitation medicine. She currently is an independent scholar, teacher, and advocate for in the somatically-based dance with higher education and healthcare both in the USA and in Ireland. Her pioneering work in improvisational dance for people living with Parkinson’s disease has been disseminated within multiple communities, conferences, and publications.

This blog does not provide medical advice and the views and opinions expressed in each blog post belong to and are the responsibility of the author(s) of the blog posts. Any information that you use is at your own risk.  You should always consult with a health care professional about any general or specific health concerns.

Somatic practices, VR and chronic pain

In this interview, Dr. Eugenia Kim discusses her work on illness narratives through Virtual Reality (VR). She talks about how she translated somatic practices into a virtual landscape, and the challenges of this process. The discussion also questions how VR may be useful for people living with chronic pain, and what somatic practices have to offer. She advises that those with lived experience of pain should have a strong voice in the process of developing new projects and she promotes the value of working across disciplines.

Interview with Dr. Eugenia Kim

Eugenia S. Kim

Eugenia S. Kim is an interdisciplinary creator and researcher. Her background is primarily dance, digital archives/humanities, and multimedia with formal education in other visual and performing arts as well as information technology. Previously Eugenia worked in the Emerson College Archives, New York Public Library for the Performing Arts, and Purdue University Libraries while choreographing and producing dance in various cities in the USA. She ran her own dance company, Penumbra: Movement, from 2013-2015. Before beginning her PhD studies, Eugenia received grants from the Cambridge and Somerville (Massachustetts) Arts Councils for choreography and dance history projects. She holds a PhD in Creative Media from City University of Hong Kong, an M.S. in Information Science from University at Albany and a B.S. in Electronic Media, Arts and Communications.

References (in order of reference in the video)

Interaction Design Lab:

Dr. John McCormick:

Professor Kim Vincs:

Anna and Daria Halprin – Life /Art Process: David Leung:

MoCap: motion capture

Rokoko suit:

Ruth Gibson:

Seth Hutchinson:

KINECT: motion sensing device

Sascha Roubicek:

Skinner releasing technique:

Body Mind Centering:

*correction: The network is co-led by Professor Bernie Carter (rather than Dr. Bernie Carter)

Somatic sensibilities in VR: crossovers with pain

In this blog post, dance artist and researcher Lisa May Thomas introduces ideas from her work in Virtual Reality (VR) and somatic practices, exploring how this might enable participants in exercising choice over perceptions and experiences of chronic pain.

Somatic sensibilities in VR: crossovers with pain

Lisa May Thomas

The visual environment seen from within a VR headset moves in correlation with the movement of the eyes and head, and this creates a sense of immersion in that environment. The senses are dominated by vision, and the brain rallies to fill in the gaps. This results in a sense of ‘being there’ – being present in the virtual environment. Whilst the physical world has not gone away, it becomes ‘backgrounded’, even momentarily lost.

Somatic and dance improvisation practices train a synaesthetic modality for sensing – the body, other bodies and the environment. That is, they use processes which de-habituate vision as a dominant force over and above the other senses, while tuning up non-visual, tactile relations with the body in relation to others.

Putting on a VR headset, I felt an immediate tension between my feeling, sensing body and the visual virtual environment presented to me through the headset. A perception gap between seeing and feeling. Lisa May Thomas (2017)

Many technologists and artists working with VR technology have sought to reduce the perception gap (Thomas and Glowacki, 2018), so that the participant can be fully immersed in the visual world. In contrast, in my work – developing participatory workshops and performances with VR technology – I have been exploring the uncovering and opening of the perception gap.

Image by Leticia Valverdes with Soma dancers and participants.

I bring the participants attention toward the visual pull of the technology, and invite ways through which to discover alternative ways of sensing whilst in the visual, virtual environment. The aim is to find a shift of attention – and therefore of perception and embodiment – between the virtual and physical environments and the bodies at play within them. This work has led to many insights into the ways in which the senses are habitually used and the ways in which technologies (of vision) use these sensory traits. 

VR and pain

There have been successful uses of VR for pain relief, and Jo Merchant (2017) suggests that shifting focus away from pain could help. She writes about Snow World, a VR application used for pain relief developed by Hunter Hoffman and David Patterson, noting that ‘Visual imagery is a particular potent form of distraction’ which helps to ‘focus attention away from the pain’ (2017, 118-119). 

Furthermore, ‘Researchers see the effects not just in subjective pain scores but also in brain scans too, with activity in pain-related brain areas almost completely extinguished’ (2017, 120). However, whilst Snow World is very good at relieving pain for short periods of time, ‘the effects disappear as soon as they take off the goggles’ (2017; 124) and the relief is, of course, reliant on the technology.

I am interested in the possibilities for combining somatic practices and VR technology to explore and ‘train’ human attention to support pain relief in the longer term. This could be to investigate imagery of the body in the virtual environment (VE), and then later to play with the physical body (which is in pain) whilst in the VE. That is, exploring the possibilities for increased agency in directing attention toward and away from the pain, as a way of being able to choose when to focus on it.

Technology could be used to access a backgrounded physical world and physical body, in combination with somatic practices to enable a sensing back into the body. The question remains of whether there might there be ways in which it would be possible to ‘recall’ this shift of attention towards and away from pain after using the technology.

Image by Leticia Valverdes with Soma dancers and participants.

Social, physical, phycological aspects of pain

In my experience of running VR workshops, participants comment that being in a multi-person VE with others, can ‘level the playing field’ shifting perceptions of body and identity and habitual conventions of social engagement or interaction. Participants can become more playful and explorative in these environments. VR is also used very successfully in addressing physical and psychological distress (Slater and Sanchez-Vives, 2016), and experiences of pain interconnect with both of these. These VR applications could therefore support other routes into dealing with pain. 


A key element in working with technologies is the consideration and ethics of care (Madary and Metzinger, 2016). There are three key areas of care here. The first concerns the relations and roles of those participating, whether on the inside of the VE or present in the physical environment. The second, is the consideration of the participant in their entry into and the exit out of the VE. Lastly, is the understanding of the effects the technology has on the participants – physically, mentally, emotionally. Dance-somatic practices can support a giving of agency to the participant in their own understanding of the ways in which the technology changes the body – in its sensing, perception, and physicality. 


Jo Marchant, 2017, Cure: a journey into the science of mind and body, Canongate Books.

Lisa May Thomas and David Glowacki, 2018, Seeing and feeling in VR: bodily perception in the gaps between layered realities, International Journal of Performance Arts and Digital Media, Volume 14, Issue 2.

Mel Slater and Maria V. Sanchez-Vives, 2016, Enhancing our lives with immersive Virtual Reality, Frontiers in Robotics and AI.

Michael Madary and Thomas K. Metzinger, 2016, Real virtuality: a code of ethical conduct. Recommendations for good scientific practice and the consumers of VR-technology, Frontiers in Robotics and AI.

Lisa May Thomas 

Lisa is a dance artist and researcher at the University of Bristol. Her practice-as-research PhD takes a dance-somatic approach to investigating multi-person Virtual Reality (VR) technologies. Recently developed VR participatory performance Soma is due to launch at the Bloomsbury Theatre in 2021. She is a long-term resident at the Pervasive Media Studio in Bristol and 2019 Quest Lab Network artist at Studio Wayne McGregor. She is currently developing her project The Touch Diaries – exploring ‘expanded’ notions of touch in the Covid19 Lockdown, supported by Studio Wayne McGregor and in partnership with IN-Touch lab at UCL.

This blog does not provide medical advice and the views and opinions expressed in each blog post belong to and are the responsibility of the author(s) of the blog posts. Any information that you use is at your own risk.  You should always consult with a health care professional about any general or specific health concerns.

Injury and persistent pain in dancers

During the pandemic, we are adding new resources to the website. One resource is this online interview with physiotherapist Dr. Ross Armstrong. His research examines screening tools for predicting injury in dance, looking at hypermobility in dancers as well as fatigue. We discuss how injury can turn into chronic pain, and what dancers can do to prevent it. Ross comments on his experience of somatic practices, and how they could support healthcare professionals, dancers with pain, and also people living with fibromyalgia.

Interview with Dr. Ross Armstrong

Ross is a physiotherapist and university lecturer who has worked in the NHS, military, private practice, and professional football clubs. He also worked at the London Olympics, Rio Olympics, Glasgow Commonwealth Games, and London World Athletics Championships. His PhD is in musculoskeletal screening from Edge Hill University, and he has published over 30 peer-reviewed research articles.

Dr. Ross Armstrong