what is a flare up and how to manage it

What is a Flare Up and How to Manage One Safely

What is a Flare Up?

For most of my life I’ve had flare ups, although I didn’t label them as such. In fact, as with many things, I learnt about flare ups from my students. Students with chronic fatigue and pain would talk about experiencing flare ups of intense pain, often in response to a particular incidence.  As I listened, I started to realise I’ve been experiencing this kind of thing as long as I can remember. 

Flare ups are an intensifying of pain or discomfort in areas where you might commonly experience “ordinary” aches or symptoms. There is a lead up to the experience (pre flare up); then it peaks; then it goes down to the usual level. Generally, flare ups put you into bed. They are often accompanied by nausea, weakness and all round wrongness. There is no way to carry on with life, work, daily tasks, all of this must be put on hold. The flare up takes over. These are not the sort of ailments that you can take a couple of paracetamol and get on with. Generally, the drugs don’t work. However, if taken in the first stage (pre-flare up) painkillers can take the worst edge off of the pain. 

Bed is the only answer, at least at the peak part of the experience. The experience is debilitating. You can’t do stuff. You are forced to rest. This might be different for different people with different conditions. Please do share how you define your own flare ups, if you have them. This might help other people identify what is going on for them. 

Once we label something, we can start to separate it out from the rest of our experience; we can look at it more closely and consider it more deeply. This is a really useful thing to do with flare ups. For in understanding what they are and why they occur, we start to have more understanding of and control over them. 


What Conditions are Associated With Flare Ups?

There are certain conditions that are associated strongly with flare ups. Some examples are: lower back pain; migraine; pelvic pain; MS; sciatica; neuropathy; arthritis (all types); chronic pain; chronic fatigue; hypermobility; Ehler’s Danlos Syndrome; fibromyalgia, allergies, asthma, skin problems and IBS. This is not an exhaustive list. Some of these conditions are not well understood by modern medicine. Many of them are associated with physical, mental, environmental and emotional stress. Yoga can provide us with tools to help manage the symptoms and lessen the frequency and intensity of the flare ups. Yoga can also help us cope with the stress of having to manage such a condition and come to terms with it being a part of our life experience. 

What Causes Flare Ups?

Flare ups are generally preceded by being exposed to physical, emotional, environmental or mental stressors. It’s worth taking a closer look at these and considering how they affect us. Flare ups can be caused by a big dose of one stressor, or a combination of lower doses of different stressors.

Physical stressors are the most obvious to us, as we associate physical activity with physical pain. Then environmental, as we associate physiological processes like digestion and inflammation with these. However, we tend to not factor in mental – emotional stressors. Yet, looking at these more subtle stressors can be the key to cracking the flare up issue. For an in-depth look at this aspect of chronic pain see Dr John Sarno’s work. 

Environmental Stressors

Common stressors are ingredients of our food and beverages such as alcohol, caffeine and high carbohydrate foods, especially sugar. The natural and chemical micro ingredients in certain foods can also be a problem for many people. Substances such as tyramine, solanine, lectins, xenoestrogens, micro plastics, histamine, pesticides (including glyphosate, which is found in most non-organic food) and food additives can cause all kinds of problems if we unknowingly take in too much for our system to handle. If you have strange responses to certain foods it might be worth researching some of the substances above. Also, chemicals that are inhaled (perfumes, off gassing from furnishings, paints and cleaning fluids) can cause problems for many. 

Physical Stressors

Taking more than your usual exercise and movement can be stressful to the point of causing a flare up for some people. For instance, having a longer or more demanding walk, run, PT session, bike ride, yoga class or dance class than usual. Having a deep tissue massage or osteopathy can also be physically stressful too!  Heavy lifting, intense gardening/digging etc, respective movement or being unable to move freely (due to travel or desk work) all fall under this category of stressors. 
The physical stress of not having enough food of the right type or enough water can also compound the effect of the other physical stressors. 
Hormonal shifts such as puberty, menstruation, ovulation, and the menopause are also physical stressors. We need to take extra care of ourselves during these times. Generally we’ll need more protein and good quality fats in our diet when our hormones are fluctuating. 

Emotional and Mental Stressors

There is a very useful theory put forward by Dr John Sarno that emotional and mental stressors can be a root cause of chronic pain and flare ups.

Many of us were encouraged as a child to not express our anger, rage and other emotions. So, we got used to stuffing them down and bottling them up inside. That energy has to go somewhere! Sarno put forward that the body can express this energy as an inflammatory condition rather than through an emotional outburst. John Sarno’s theory is that the painful or inflammatory condition distracts us from the emotional anger, frustration and rage. He put forward the following idea: We experience an intense increase in already present chronic pain when emotions are bubbling below the surface of our consciousness. As these emotions threaten to break through into our conscious awareness, our body creates the distraction of pain. Due to the unconscious nature of this process it is quite tricky to recognise it within ourselves. We might say “oh I never get angry.” However, this is precisely the point!

One thing I’ve found on my lower back care courses is that pretty much most people who attend are really lovely, accommodating, nice, reasonable, forgiving and patient people. In fact most of my students are! For this I am deeply grateful and I would not want to change any one of you in this respect. However, it is important to know that being accommodating, kind and reasonable can lead to pain and suffering for yourself. This is not to say we should go dumping all our rage, frustration and anger on others. There is a middle path.

Obviously, counselling can help us enormously in this regard, particularly if the counsellor is trained in Jungian approaches and working with the shadow. However, John Sarno says that counselling is usually not needed; we simply need to recognise that we are stuffing down the anger and fully acknowledge it with humour and grace. Many people have found relief from chronic pain by reading Sarno’s books or listening to his lectures.

Working With Stressors and Flare Ups

Being aware of the stressors that affect us in particular, can enable us to plan our lives a little better. For instance we might choose not to use alcohol to deal with stress, if it ends up causing us more stress. We might choose not to push ourselves hard at the gym if we are having to cope with a frustrating situation in our work or family life. During menstruation we might choose to rest more. A simple way to decrease our stress levels is to choose to eat simpler, nourishing foods that we digest well, in addition to taking care to hydrate ourselves well throughout the day. 

Pacing – A Practice to Lessen the Incidences of Flare Ups

Learning to pace ourselves appropriately is the key to lessening the impact of chronic pain. Taking it slow and steady lessens the tendency for pain or symptom to flare up causing us to put our lives on hold. Learning to conserve and preserve our energy is key. This can be a challenge if we are driven, passionate and ambitious in the way we engage with life. However, in the long run, we are forced to listen as our body teaches us to take the middle path on the journey of life. We learn to burn slowly like a glowing log on the fire, rather than being a flash in the pan, that burns brightly but quickly exhausts its energy. 

Practicing the slower versions of yoga and somatics can really help us to pace ourselves in our everyday lives. We start to see that we can create positive change without burning ourselves out and that slow movement actually builds energy and resilience. The restful nature of mindful movement, breathing and relaxation calms our nervous system bringing it into the parasympathetic state. In this state we can repair, detoxify, restore and calm inflammation and pain.

What to Do During a Flare Up

The first thing is DON’T PANIC! Recognise this is an experience that you’ve had before and you came through before. Remember there is a beginning a middle and an end to the experience. Do your best not to create a story around the pain. Do not add the stress of worry, speculation, despair, wishing and wanting to the original discomfort. This will cause more stress and discomfort.

During a flare up it’s important to rest, nourish yourself (take broths, light soups and warm water with lime) and sleep. Consider taking in protein (let your body guide you as to which) to balance your blood sugar. Much of the time you will want to be still, in the dark and quiet. If the pain is ongoing, it might be worth using distraction (watching a funny film or listening to some of your favourite music) so that you distract yourself with something  enjoyable.

Simple breath practices like three part breath can be very useful. It is good to spend time focussing on the parts of the body that feel good rather than those parts that are in pain. Although, if your focus is drawn to the pain, you can rest your attention there and breathe into it, imagining that your breath is a healing balm (prana) that can be applied anywhere to create space, comfort and ease. 

Once you are over the most intense part, doing very gentle yoga (such as the somatic classes on the timetable) can be helpful. As a general guide, for a back pain flare up, it is good to rest and work with your breath for three days, before doing exercises specifically for the back. If you take a class, work with the sore areas very slowly or only in your imagination until you can move with greater ease and confidence, without any increase in pain. You might find that you move in micro movements to stay within the comfort zone. Remember “Less IS More!” It is important to pace yourself and rest during the exercises that feel too taxing physically or increase the pain.

Celebrate and Learn from Your Body

Once you are over the worst of the pain, it’s good to have a little celebration that you have gone through the process and recovered. In this way you can build a memory of the other side of the pain incident. Consider having a special meal, a candlelit bath or some other way of treating yourself. Celebrate the healing power of your body and remind yourself that it is teaching you to take better care of yourself on all levels – physically, environmentally, emotionally and spiritually. Have gratitude for your life and your breath. Another ritual to consider is to reach out to people you know who are also dealing with pain – maybe they are ill, lonely or recently bereaved. Taking some time to connect with your loved ones and show you care is a healing process for everyone concerned. Often, people with experience of pain in their own lives, are more able to be empathetic, understanding and of great support to others with similar experiences. 

Let me Know Your Thoughts

I hope this article helps you if you are experiencing chronic pain/symptoms and flare ups. Regular gentle yoga practice plus cranial osteopathy and a clean diet has greatly lessened my own symptoms. I hope you can find relief for your own symptoms. Do share what works for you below. Similarly, if you have any questions, do use the comments box below and I will answer them as best I can, drawing on the resources I have. In this way you can help others who may be going through similar challenges. 

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