Where does it hurt? Some thoughts on pain...
What has pain got to do with theatre? Nothing, except that the last two years have decimated our industry, outside of which our workforce is simultaneously grappling with the pain of grief, losing loved ones and losing so many of the small joys that give life meaning (although the latter are returning as the world opens up again).
But this isn’t really anything to do with theatre. It’s just some collected thoughts on how to manage pain in a time where there’s more of it about. I suffer from back pain - mostly in my lower back (side note - I don’t know anyone who’s given birth to a child who doesn’t suffer lower back pain, apart from maybe my hardcore circus mum friends - damn you and your excellent core muscles) and have done since I was a teenager. It went from a periodic (and often period-related) issue in my teens and twenties to something more chronic after an emergency C-section (I mean they literally cut through your abdominal wall) and the unavoidable lifting involved in parenting young children. It has got progressively worse over the last 12 months (due to a bunch of circumstantial changes - as a director I am moving for most of the day, but in the absence of any directing work I have adopted the more traditionally sedentary lifestyle of all writers and my back is complaining because of it.
Ironically moving out to the countryside (which we did during lockdown) means I do less walking in a day because instead of the 4 miles working to and from school twice daily that commute is now 30 seconds. Which is amazing, don’t get me wrong, but means I have to very actively create time to walk daily or I immediately start losing mobility in my spine.) It’s always worse in winter because the cold makes the muscles contract, so I have to expend a lot more energy on pain management (mostly applying heat, stretching in the morning, evening and increasingly throughout the day and using a massage gun to try and unwork some of the muscular tension in my hips that has accumulated over the day in a compensation for the slight curvature in my spine / weakened core.) Waking in pain, being in pain all day, and going to sleep in pain is a bit draining frankly - but I’m about to go into full time rehearsals again (for the first time in 2 years) which I can guarantee will improve things because the constant low-level physical activity will mean it’s in much better shape during working hours.
But as the back pain has got worse I have finally got much better at protecting my boundaries around it. People are generally more accommodating at adapting their behaviours in response to something visible. We see this all the time with the compassion and accommodation afforded someone whose relative has just died and is suffering with the pain of grief, but not with the millions of people who live with invisible mental health conditions that leave them suffering with the pain of despair, anxiety and existential struggle. The truth is that even the people who love you most in the world can forget that you are sometimes in constant pain. But the strange gift of chronic pain becoming constant chronic pain is that it becomes much easier to say no. Of course it’s still upsetting not to be able to lift your child - my 7 year old just asked if he could sit on my lap and I lasted 90 seconds before I had to ask him to get off. But the constancy of pain for me at least gives a much greater clarity around saying no and being at peace with that. This week we have had guests staying but beyond 9pm I need to be horizontal. In the past I would have just sat with it (literally) but now I just go to bed.
Some pains have an end-point - I am rarely floored by the pain of anxiety or depression or grief, not because I don’t experience them but because they are not (for me) a constant in my life, so I can wait it out until they are no longer colouring my reality with a dull greyness. The pain of being misgendered (especially by friends or family) is sharp but short-lived. Similarly the pain of social interaction - no party, no press night, no social interaction lasts forever (though I also highly recommend moving to a rural isolated village as an effective way of reducing social interaction if that causes you anxiety). I find pain with an end point far easier to endure than this chronic pain which can be managed to greater or lesser degrees but never eradicated. Despite knowing this the eternal optimist in me still welcomes everyone’s suggestions and recommendations (see below for what I’ve tried / found effective - feel free to share your own experiences and suggestions for pain management) but the key for me is knowing when to say no to the demands made on me by the rest of the world / work / children.
Which is I suppose how it all comes back to theatre - our famously unboundaried industry which is predicated on saying yes to everything, and in which the unhealthy culture of overwork and underpay is endemic. But alongside my optimism I am a realist. Our sector's unhealthy relationship to the capacity of its workforce is chronic. I don’t want to paint a bleak picture but I don’t think it’s something that can be healed. There is no end-point. So all we can do is take personal responsibility for our own boundaries and capacity and protect them as best we can.
Even that is easier said than done - making work healthily in a chronically underfunded system simply means making less work, and with smaller companies - doing less. But of course the equally chronic oversupply or flood of talent wanting to make work is in direct tension with that. Compartmentalising one's working hours to maintain a healthier work life balance is also complicated if one has caring responsibilities that intersect with a working day - it’s the bane of many theatre parent’s lives that they are reprimanded for communicating during anti-social hours, but sometimes those are the only hours left. But it’s equally problematic for those maintaining their own boundaries to feel under pressure to respond at the evening or weekends. And it’s all well and good for me to advocate saying no (as someone privileged by being in leadership roles), but harder as an actor or other creative where there’s a legitimate fear that doing so will have negative repercussions on one's reputation and future employability. I just had a colleague, who’s highly respected within our industry, confess that they are recovering from chronic fatigue syndrome - but they rarely disclose that in case it affects people’s willingness to employ them. Of course Equity and the unions can continue their work in setting a baseline of healthy working conditions but that can never take account of the diversity of a given individual's needs within that system.
The truth is we are all hurting, and probably all of us now more than in the ‘before times’. We can’t always account for the kindness of the world, but we can redouble our efforts in being kind to ourselves - in whatever way best helps relieve the respective pains in our own lives.
These thoughts are perhaps a little scattered. Ironically, but perhaps unsurprisingly, I am in pain right now (I would say a 4.5 out of 10) but I’d like to articulate these thoughts in some form, and people are still so reluctant to share these things, that it feels like a valuable use of my time.
Take care of yourselves.
(and if you want to pitch in with your miracle cures for back pain… see below)
My personal list of effective pain management techniques (predominantly for physical pain but also added benefits of relieving stress as well as muscular tension)
- mindfulness and meditation (doesn’t change the pain, but helps with the attitude towards it)
- stretching exercises, yoga, short walks, low-impact workouts (once when I was attempting to train for and run a half marathon my physio recommended bikram yoga to counteract the negative impact that running was having on my back - after 6 weeks they said my back was unrecognisable, in a good way, but alas the downside of living in a rural isolated village is the lack of proximity to a bikram studio)
- heat (electric blanket, hot water bottle, baths, hot tub, and any chance to get in steam room/sauna
- massage (though I did once have a practitioner who refused to work on my back because they said it was too dangerous. That wasn’t a happy day.)
- memory foam mattress and pillow (expensive but felt like a worthwhile investment)
- shakti mat (like a modern day bed of nails. In itself also intensely painful each time you use it, but I find it very effective in the evenings and helps me to relax the muscles enough to get to sleep more easily)
- hemp gel (also have found deep heat effective in the past)
- lying down in meetings (admittedly easier when it’s zoom and you can turn your video off, but I have definitely been known to lie down in rehearsals too… again perhaps easier when you’re the director...)
- acupuncture (expensive but my dad re-trained in acupuncture so now I get freebies)
My personal list of non-effective pain management techniques
Chiropractor (I found this moderately effective short term but too expensive to maintain)
Osteopath (ditto)
Pain killers - occasionally I’ll reach for the ibuprofen but not something I want to be taking every day
Alcohol (effective short term but not really a viable lifestyle choice)
Standing desk (good to try it but standing for long periods of time exacerbates my back pain… might work for other people though)