Bridges between dance and health: how do we work with pain?

By Bernie Carter and Emma Meehan

The Somatic Practice and Chronic Pain AHRC-funded network explores what somatic practices, such as Alexander technique and Feldenkrais, offer to people living with chronic pain. Somatic practices work with self-reflection on movement habits and opening up movement capacity, and have been integrated into many dance and theatre training programmes. In this network, we ask: how might the principles of these somatic movement practices be of value in supporting people living with pain? We also consider how the experience of working together can inform the practices of health professionals and dance artists, such as how they use touch and language.

Somatic Practice and Chronic Pain Network Video

In this series of two blog posts, we will firstly give an overview of some of the topics that we have explored to date in the hope that this may be of value to theatre and dance practitioners who work with health and/or live with pain. In the second blog post, we share our experiences of working across disciplines and reach out to readers to tell us about your experiences of 1) how you have worked across performing arts and health 2) how you have worked with pain through theatre and performing arts techniques. We aim to develop a larger project from the network in the longer term on somatic practices and pain, so your viewpoints, concerns and ideas will support this process. By posting on the TDPT blog, we want to interrogate arts-based perspectives on health topics, and also acknowledge that many performers suffer pain and injury throughout their career.

The network operates currently through a series of small and focused workshops to invite exchanges between researchers and practitioners in health, dance, and digital technologies. The first workshop focused on defining somatic practices through discussion and movement, thinking through how the practices might be understood by health professionals; and how they might support pain management. We also gathered opinions on somatics, chronic pain, assessment, and treatment. This was to gauge an initial understanding of members attitudes, for example on working across disciplines; or on observing/describing bodily movement as a form of pain assessment. 

Image by Christian Kipp

The second workshop theme was ‘dialogues across disciplines’, which included presentations and hands on sessions from dance, somatic practices, psychology, occupational therapy, physiotherapy, and nursing. Topics covered include the relationship between somatics and psychology; systematic reviews and arts based research methods; working with children in pain; qualities of touch in patient care; along with ideas of physical and social support in pain management.

The next workshop will focus on the role digital technologies could play in sharing somatic work with a wider number of people, such as those who cannot travel or have not yet accessed treatments. This is important since so much somatic work is currently only available in fee paying, one to one sessions, that exclude a large number of people. This workshop will also explore the different ways we could utilise technology, whether for patients to practice alone or to develop creative ways of expressing pain to family members and staff. In addition, there are impact and public engagement events such as an introductory session for pain management staff; and in future there will be a workshop for dance artists working with their own or other peoples pain.

Image by Christian Kipp

Central to the network is the enquiry into how to work across disciplines. As dance and health professionals come together, it is clear that we come from epistemologically different starting points. The way we use language is embedded in distinct frames of being and, typically, approaches to research tend to arise from differently framed research questions. Touch, movement and physical interaction in our disciplines arise from belief systems informed by the contexts we work within. Core to our network is valuing each other’s knowledge and expertise, using the meetings as opportunities to expand our horizons, challenge assumptions and think in new ways about our practice and praxis. Ultimately this brings surprises, new ideas and questions.

In the next post, you will find the voices of the two people leading the network, dance researcher Emma Meehan and professor of children’s nursing Bernie Carter. We share personal experiences of working on the network, and at the end will turn the invitation back to you to share your own experiences of working with dance and theatre training techniques in health contexts; and in working with pain.

More information can be found on our website

Bridges between dance and health: how do we work with pain? #2

Emma Meehan: As a dance researcher, I have felt quite protective of somatic work and dance research methods. In health-led studies on somatics in chronic pain, often a practitioner has been brought in to deliver movement material rather than shape the research. This has left me wondering how to integrate dance and somatic researchers into the design of the study so it is collaboratively created. I have also queried why static measurements are taken of a complex movement process and what information is missing from this. However, being part of the network has made me see that health researchers face the same frustrations of wanting to do person-centred research, responding to traditional criteria and formats for credibility and ultimately to ensure that their findings get embedded in health institutions in the long term. I have learned the value of thinking through in a step by step manner some of the restrictions inherent within health settings and the need to make a clearer case for the work to be taken on board. 

Image by Christian Kipp

It has been much easier to engage dance artists and researchers in the network. Healthcare professionals can have last-minute work emergencies which means it can be difficult to commit. Somatic work can be hard to explain, so for those unfamiliar with it, it might seem like an unnecessary addition to an already full workload. At the same time, we have had a stable core group of health researchers and professionals, who are already curious or committed to the area. How do we bring in people who might be sceptical and challenge us? This has meant going into the healthcare setting, and adapting the material to time slots available, such as offering a pre-work morning session for staff at the Walton Centre Pain Management Programme in Liverpool. While there was interest, I realised that there is a need to match the somatic principles to the clinical needs in order for the approach to be better understood. The lived experience of people with pain is another important facet of the work but there are ethical issues when doing health research which need to be considered, such as the potential to do harm and expectations for recovery. We are developing ways to reach people living with pain for their viewpoints through a consultation process. 

The main challenge of working across disciplines for me has been in describing and conveying the value of somatic practices to people who have not experienced it before. We have spent a lot of time with network members trying to define these practices, with some comments as follows:

  • An attempt to open up a conversation with a body (dancer)
  • Somatic Practices: Easy word + easy word = confusing phrase (writer)
  • Listening to and working with the whole person – being empathetic, giving time (dance artist)
  • A form of mindful movement that requires the person to focus on the movement and have an awareness of their body & the movement within the environment (nurse) 
  • Allowing the body to move whilst experiencing the sensation of movement (physio) 
  • Reinforcing the ‘wonderment’ of the body (physio)

Another concern for me is how this network can feed back to and support dance artists, whether they are working in health settings or supporting their own health. It became apparent during the course of the network workshops that chronic pain was a daily experience for many dance practitioners, and I hope the network has something to offer back to them.

Bernie Carter: Despite being published over 50 years ago, many healthcare professionals are familiar with McCaffery’s (1968) statement that “pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does.” However, familiarity with this person-centred statement does not mean that people living with chronic pain are universally believed. Outside of specialist centres or teams with expertise in chronic pain, there also remains a tendency towards a focus on the physical aspects of pain (intensity, duration, sensation). This network tries to bring in physical, emotional and social aspects of pain through dance and health approaches.

Image by Christian Kipp

My engagement with the network has been a real journey of discovery; it’s been liberating, exciting, confusing, challenging and wonderful. When Emma first spoke to me about being a co-applicant, I was gently sinking under the workload associated with existing research and I was tentative about committing to anything else but I’m so glad I did. Emma has been a good teacher, guiding my early and still developing understanding of somatic practice and laying the foundations for me to learn from the other somatic practitioners I’ve engaged with during the workshops.

My initial reserve about being a non-dancer undertaking movement activities with dancers was overcome by their warmth and absolutely non-judgemental response to how I moved within the activities. My concern about whether I would be doing something right, perhaps reflects a very health-oriented concern. The people I have ‘moved with’ have always been more interested in that ‘we were moving’ and that ‘we were being and experiencing movement together’. It’s a beautiful and liberating thing to experience, and learning about attending to your body has been intriguing.  I’ve become more curious about somatic practice and dance and how it can help people with pain. Like Emma, I would love to have had more health professionals attending the workshops but those who have attended have reflected on their practice and have shared their aspirations for enhancing how they care for and support people living with pain. 

The physical environment we are in and the props we use shape the way we think and act. Reflecting on this has led me to explore the way in which movement is approached within health and somatic practice/dance. Within health settings, movement activities for pain are often led by physiotherapists who wear uniform and whose environment is typically something like a gym – a place to work out – whereas the somatic practitioners wear looser, less formal clothing and the studios we have used for our activities have been made comfortable with mats, cushions, and blankets with instructions to be comfortable. The difference is palpable.

Image by Christian Kipp

Although I perhaps expected that tensions in thinking might arise between the two main ‘tribes’ (dancers and health professionals) it’s been fascinating to see the differences in thinking within the tribes (say between nursing and physiotherapy) and between members of these tribes (different somatic practitioners).  Some physiotherapists’ focus may be solely on improving mobility and function in a specific part of the body, using a validated, structured and objective intervention for that ‘part’ of the body. Nurses may take a wider more person-centred approach acknowledging the person’s aspirations, goals and the challenges of pain and consider a broader way of working with the person. In terms of somatic practices, people work with a range of distinct methods and individual styles and can describe their work differently.

Questions

We would like to ask blog readers to respond through the ‘Comments’ below, describing their work across disciplines of performing arts and health: What have you learned and what has been difficult? How do you describe your work with dance and performer training techniques in health contexts? Finally, as a performing arts professional, have you experienced persistent pain and if so, have you worked with your theatre and dance training techniques to manage it? 

More information can be found on our website

Bernie Carter, is Professor of Children’s Nursing at the Faculty of Health and Life Sciences, Edge Hill University

Emma Meehan is Assistant Professor in Dance at the Centre for Dance Research, Coventry University