Let’s Talk About Chronic Pain
Experts discuss the healing powers of dance
Sima Chowdhury talks with three experts about how dance can help chronic pain patients.
“I have chronic pain” and “I should go dance” are not thoughts that typically go together – yet. However, to manage chronic pain, 150 minutes of moderate exercise per week is a standard recommendation. In April, I wrote about my struggle with chronic pain after two car accidents in an online column “Dancing Before Walking” for The Dance Current. In it, I spoke of the trials and tribulations of using ballroom dance to successfully heal.
Chronic pain does not have a cure, but symptoms can be better managed for longer periods of time through dance. It’s also fun, and that encourages people to attend regularly. The art form requires strength, flexibility, timing and coordination, which all challenge the brain to form new neural pathways. Unfortunately, without good quality research, many health professionals do not acknowledge the power of arts.
To do my part to fill the gap, I expanded my focus from clinical social work to include this kind of research. Dr.
Fenton Litwiller at the University of Manitoba (where I study), expressed interest in helping me explore the connection between dance and chronic pain at the undergraduate level, giving me a head start as I plan for my master’s degree.
To delve into the power of dance and education around pain management, I spoke with three experts in the field. Andrea de Almeida is a registered dance/movement therapist who works at the National Centre for Dance Therapy at Les Grands Ballets Canadiens de Montréal. Rebecca Barnstaple is a graduate of the National Centre for Dance Therapy and a PhD candidate in dance studies and the neuroscience graduate program at York University. She provides dance and movement programs for people with chronic pain, Parkinson’s disease and other conditions through the Chigamik Community Health Centre in Midland, Ontario. Dani West is a physiotherapist at Indepth Physio in Calgary and holds a BA in dance from the University of Calgary and a master of science in physical therapy from the University of Alberta. The following is an excerpt from a much longer conversation.
Sima Chowdhury How did you get started in dance for chronic pain?
Andrea de Almeida I did dance for my undergraduate [degree] together with education, and then I worked in dance education for a long time. With dance education came the passion for the kids with autism. Through the autism, I discovered dance therapy. The dance therapy program, you have so many windows because your internship is with many different populations, but not with chronic pain. I was working in the hospital with people with eating disorders who have a lot of chronic pain; it’s the fatigue in the skeleton that hurts the body parts including the spine. It’s very complex, eating disorders, so is chronic pain, right? We started working specifically on how to do some sessions for a few girls that have issues more on a physical level. And then I started running a [chronic pain] group for Les
Grands Ballets. We did it for two or three semesters, but we didn’t get enough people. It’s good to have this interview because people don’t look for chronic pain and dance; they will go to rehabilitation. … They don’t know this whole integration of the body and the mind combined. Sima, good, you got the body and the physical strength with the coach that pushed you into that space, but on the emotional level you got it too. He was not focused on the therapy session, but he clicked on the emotional level that brought you into what you wanted to do.
Dani West I came to dance, and then chronic pain found me. I got my BA in dance from the University of Calgary and I just wanted to perform and train a little bit more, as a past dancer. That led me down the route of physio. I decided to combine the two because it’s such a unique world, treating dancers. I see dancers but I also like treating pediatrics and started taking classes based on Lorimer Moseley and David Butler’s book Explain Pain which lit up a passion in me. Even the general pain population falls through the cracks. In a traditional physio clinic … there’s no time to talk about pain or how patients [are] coping. They don’t know what to do other than wait for a referral to a chronic pain centre, and by then they’ve gone through the
whole gamut of being ping pong balls or [have gone] from health practitioner to health practitioner being fed different things. By the time they get to a chronic pain centre, a lot could have been done in the interim to prevent that snowballing. It’s great that they have chronic pain programs. But shouldn’t we be doing the education and the chronic pain programs earlier? Maybe even in the education system for kids in elementary schools, when school can be a thing again? I’m trying to teach these kids while they’re in dance, using dance teacher workshops as an avenue to start talking about ‘So, what do you think of pain? What’s your perception of pain right now?’ when you’re eight. So that by the time you’re forty-five, we don’t have to break apart some of those painful threads that they’ve kind of built and misconceptions about pain because that’s ten times harder.
Rebecca Barnstaple Dance has been transformative for helping me change the way I feel, including how I inhabit my body. After I finished the dance therapy training at the National Centre for Dance Therapy, the first place I approached was a community health centre. They were interested in programming for people with chronic pain because they did not have services for them. Dance is a spectrum of mind and body engagement; the idea of a separable mind and body is ridiculous when we start dancing. Pain is similarly complex. You cannot separate components, especially chronic pain. My background is in dance and somatics. Somatic work involves feeling the body and changing how we are in the body, which seemed like an interesting concept to work for people who are experiencing chronic pain. Because I’ve been working with people with chronic pain for four or five years now, in community health providing dance therapy-based programs, it’s important that there’s a lot of time. I take my time to develop and explore an idea because what I have seen is also evoking coming back to befriending the body again. Your body has become a place that feels uncomfortable or alienating and you don’t want to be there. Finding the time and space to be in and with your body again in a way that feels good is a priority. When I first started working with chronic pain classes, I would come in with a lot of ideas. I’d do, like, two of them or three, and new things emerged. If people are interested in developing programs with different styles, whether it’s dance therapy or other kinds of therapeutic programs, allowing time for the participants is so important.
SC What kind of time are you thinking? Six weeks, six months or within the class perspective and specifically within the class?
RB Extended time because when I was working on a six-, eightor twelve-week program, when people ended they were like, ‘I’m not done. I’m not better.’ It’s called chronic pain. It won’t instantly be gone. There was one session where we met with more frequency, twice a week. It was good. You need time for change to occur and time to experience your body differently. That is both within the class itself and over time longitudinally.
SC In the research, it says twice a week, minimum.
AdA It’s a slow pace through the session. I set off to do too much, but because people don’t move much, I adjusted the choreography and then it worked well. Focus on the body first, connecting the two and doing everything very slowly with a lot of awareness. … It’s a process, a slow session
DW Manage people’s expectations before they start because people expect you’re a magician. It’s hard getting a sense of what their expectations are because this is going to be a long road, so buckle up. That’s been very challenging, gauging people’s expectations before they even come on board.
AdA I just say, ‘Look, it’s a process. It’s just like you go to your psychologist: you need to be there. You talk and it’s going to take time. It’s not one session. It will be many [and] you’re going to come out with whatever you have to.’ The same with this therapy and with the chronic pain; you have to work within this long period of time.
RB In my work, and in Andrea’s work as well, I work with people who probably never danced before. I’ve had a couple of older people in my classes who have probably never even imagined
IT IS IMPORTANT FOR STUDIOS TO START TO THINK MORE BROADLY. DANCE IS SOMETHING FOR PEOPLE AT ALL STAGES OF THEIR LIFE ~Barnstaple
themselves dancing in any way, but they have a lot of pain and they want to try something. And one thing that I found is interesting is the further this is from somebody’s wheelhouse, the more potential benefit they can get from it.
DW This is very interesting too because dance therapy must be more common out east.
RB The only program in Canada right now is the one at National Centre for Dance Therapy in Montréal. Otherwise, people trained in the States for the most part, or in England.
DW I’m a physio[therapist] and I work with a lot of dancers. I want to encourage participation in their already existing classes. But then I have to do something totally different with them because they’ll have associations with, ‘As soon as I do a grand battement, I’m going to get pain.’ I use Pilates instead. It’s on the same page of like, ‘motion is lotion.’ Movement is the medicine. I also want to encourage them to keep dancing but finding that happy medium of [knowing] when are you going to flare. We also don’t just want you to sit out and do nothing.
AdA It’s all integrated: the neuroplasticity of the brain and other theories working with mirror neurons, and having people feeling [sensations] that their body could not feel previously. Sometimes in dance therapy sessions that can happen. With one of my fibromyalgia patients, she was feeling [sensations] and said, ‘Oh, I could not feel this before.’ She danced for a couple of years with me until now. She’s not able to move much without the medication, but she was doing this therapy and avoiding the medication for two years.
RB Good. Something that somebody said in my fibromyalgia sessions that stuck with me as a nice metaphor: they said, ‘When I come to this session, when I leave, it’s like this window opens. And the window stays with me and I can go home.’ The brain fog disappears. The program allows them to function in their life, for a longer period of time. Pain interrupts so many things.
SC I used to go to the studio, perfectly healthy as a twenty-yearold and leave crippled. Now I’m forty and in the studio crippled and I leave feeling great!
SHOULDN’T WE BE DOING THE EDUCATION AND THE CHRONIC PAIN PROGRAMS EARLIER? MAYBE EVEN IN THE EDUCATION SYSTEM FOR KIDS IN ELEMENTARY SCHOOLS... ? ~West
RB There’s strategies that you have learned to take care of yourself. That’s something that unites what all of us are doing, whether working with dancers or people that never danced before. You’re helping develop strategies for coping, whether it is continuing to dance or to drive your car home or go to the grocery store.
SC How do we make this more popular?
RB We’re not going to discourage people from offering programs to people with chronic pain because we need things like this to happen. It needs to be done carefully, with as much of an understanding about this population and their needs, and not only as an extension of a studio’s offering. It is important for studios to start to think more broadly. Dance is something for people at all stages of their life, in all stages of health and in all stages of ability. With dance therapy, it’s a master’s level program. It’s not to say that someone couldn’t do something with a different approach. But I would encourage anyone who’s
thinking of getting into this to learn about chronic pain, read what research there is. I would love to do more research with this. It’s so crucial that chronic pain is better understood. People can start to look at how and where can we offer services that support people with chronic pain that include dance.
DW The studios that I work with, I’m starting to talk to the kids about their injuries, how they can self-treat and how to not freak out because they sprained their ankle. You see one kid from one studio, you’ll start to see the whole class. When I started doing onsite treatments at different studios, working more closely with certain ones, the injury reporting would peak. It was a cool thing to have an injury and be doing your exercises. After about two months, when people started taking ownership, not freaking out every time their pinky hurt, injury reporting plummeted. I wasn’t doing a high-quality study, but some of the studios asked, ‘Can you fill out a pain form or an injury report form?’ It was a way to communicate to the teachers to reinforce what I was telling the kid. … We kept a few forms and found pain reporting went down when kids started getting the tools of, ‘Oh, I don’t have to freak out.’ ‘Oh, I could keep dancing even though if my ankle is not fully healed.’ Pain reporting and participation reporting from the teachers is where I can gauge ‘Am I doing what I need to do?’ because that’s just telling me indirectly they’re starting to get it. They are participating more, and the teachers say no one’s brought up any injuries. They’re [not] trying to hide them either because at some studios they’ll be scared to report.
AdA I find it wonderful Dani is doing work with the kids. I haven’t thought about kids because [I’ve been] so focused with adults or young children. It’s an indication about how to place chronic pain in other settings. How can we address that? Because for people to come and take chronic pain and dance therapy or chronic pain motion, they will not come to Les Grands Ballets. They will feel ‘This is not what I really need. This person is a dancer; she’s not going to work with my rehabilitation process.’ There’s a big problem with perception.
RB I’m part of a multidisciplinary team [at the community centre]. There is a physiotherapist, mental health counsellors, an addiction counsellor, and if someone is in my session that is struggling, or something comes up in a session, I can also consult with or refer them to someone else in the building. Or I can also ask someone like their doctor because people come taking many different kinds of medications. There needs to be support of some sort and awareness of resources for the patient because it does have this emotional and traumatic element. If you are a dance teacher and you’re doing a program and a lot of emotional material or someone has a story come out, what are you going to do with that? You need to have a plan beyond what’s happening in the dance studio.
AdA You need to have the training. You’ve got a debriefing process at the end, so it has to be someone who’s trained. That’s not going to be an easy thing to offer things for chronic pain because people are not prepared to take it or to teach it. At Les Grands Ballets, we had two, three sessions and then people vanish because they are going to the hospital or they were coming from the hospital. They get sent back to the hospital and into other rehabilitation centres.
DW Yes, like Rebecca said, have it run by the right people or a team like anything else should be. Lead by somebody properly trained.
RB I could imagine something like that developing over time. But it needs to be framed with all these other things because some of the basic tenets that we talked about, like introducing new ways of moving, having time, whatever kind of program you’re offering, this is important. We’re at the beginning of something. We know a couple of things, but not enough that we could say, ‘Here’s what you need to offer a chronic pain program through dance,’ but we have some hints. That’s what’s important about this article, Sima, is to at least get people thinking more about the idea because dance can be anything. It’s not an exercise program; it is an exploration of our embodied being in the world. … great for pain.
SC And everything else.
RB Absolutely everything else.
This conversation has been edited for clarity.