EDUCATION

So what are my options?

Many people are unaware of what effective treatment options are available for osteoarthritis. The information provided in the PDF attachments below will help cover a range of treatment options that you can pursue:

Weight Loss
Exercise & Physical Activity
Pain Coping Activities
Medication
Injections
Surgery

After reading this information, you should have an idea of what you can do to help reduce your pain and do the things that matter to you!

These resources will help answer common questions about different effective treatment options including:

• Am I a suitable surgery candidate?
• What’s involved as part of the treatment?
• What are the benefits?
• Are there any risks?
• How long will it take me to feel better after the treatment?

You can download a copy of this information to print   

There are many different forms of exercise that provide benefits in terms of improving pain and function for people with hip and knee osteoarthritis. This includes strengthening exercise, aerobic exercise such as walking and cycling, warm-water exercise and mind-body exercise. Yoga is an increasingly popular low-impact, mind-body exercise requiring minimal equipment. Yoga combines physical exercise in the form of static and dynamic postures with mindfulness strategies such as deep breathing and relaxation. This combination may be useful for people living with osteoarthritis.

In addition, low levels of general physical activity are common in people with osteoarthritis. Scientific evidence shows that people with osteoarthritis are less active than people of the same age who do not have osteoarthritis. This is because many people with osteoarthritis worry that doing physical activity can increase their pain. This leads many people to change the way they do things- for example, taking the elevator instead of the stairs, reducing the hours that they work, avoiding trying new activities and taking more rest during the day. For some people, the fear of pain increasing is enough to stop them from being active. A habit of under-activity can occur.

What types of general physical activity can I do?

The good news is there are lots of options! The table below lists some ideas you could consider.

How intense does the activity need to be?

Tips for increasing your general physical activity levels:

1. Small changes to your daily routine can have a positive effect on your overall health as well as your osteoarthritis.

2. Avoid long periods of inactivity in your day.

3. More frequent short bouts of activity work best for people with osteoarthritis.

4. Perform physical activities over realistic timeframes

5. Gradually increase your physical activity and/or your intensity

6. Vary your activity by changing the environment (eg walking in water or at the local park instead of around the block)

7. Pace your activities- even on bad days.

8. Time yourself to help you pace your activity and make sure you don’t over- or under-do it

9. Use a pedometer or activity monitor (such as a Fitbit) to record how many steps per day you take

10. Perform moderate intensity activity in bouts of at least 10 minutes. That means you are puffing for 10 minutes continuously.

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What’s stopping you? Get moving!

Barriers are things that get in the way of us being physically active and/or doing the exercises that have been prescribed by a health professional.

Low energy or fatigue as a barrier

People tend to find that exercising actually gives them more energy once they’ve managed to get themselves started. While you might feel tired initially, as you continue you will start to feel more energised. Also, people often sleep better and therefore feel less tired during the day. Regular exercise and physical activity can help break the negative cycle of feeling tired and doing less activity, which leads to feeling even more tired and lethargic.

Do not enjoy exercising

There are very few people who are lucky enough to actually enjoy exercising just for the sake of exercising. There are many forms of exercise and physical activity; it often comes down to choosing activities that you dislike the least. Boredom can be a real problem in maintaining enjoyment and motivation. Vary your exercise routine. Keep a look out for other ways you can be physically active that you might enjoy a little more, at least for a while.

​There are also ways that you can help make physical activity a more pleasurable experience. For instance, meet a friend for a walk or join a group, walk or ride in a beautiful place, listen to music that lifts your spirits while you are doing your exercises.

Other Barriers

Caring for others

This not only takes up time but it takes up your emotional energy too. Sometimes you can feel guilty for putting yourself first even for a little while. But by keeping physically active yourself, you are preserving your own physical and mental health so you will be better able to help your loved ones over the longer term.

Sickness

Everyone gets sick from time to time. It’s OK to stop your exercise routine while you are sick and recovering, but it is surprisingly hard to get back going again after a break. When you are on the mend, start thinking ahead and make a plan or set a date for when you are going to start adding your physical activities back into your daily routine again. You might need to build up gradually all over again, but it is worth it. The activity will probably help speed up your recovery and will certainly help maintain your health over the long term.

Holidays

Holidays disrupt routines and can cause set-backs if you don’t plan ahead. Sometimes holidays provide new opportunities to vary your exercise routine or try new types of physical activity. Try doing some research before you go and make some plans on how you can build some activity into your holiday. You might plan to ask the hotel reception staff on your first day there to recommend a nice local walk. You might plan to hire some bikes for a day, or book a walking tour. A break from your routine is not such a bad thing as most people will get bored with doing the same thing over and over. When you come home, make sure you set a date for resuming your exercise and physical activity back into your daily routine.

Strategies to overcome barriers

Reminders

If you have a tendency just to forget to exercise, you can try some little tricks like leaving your shoes or exercise clothing out where you can’t miss them, leaving yourself notes or setting alarms or reminders, or scheduling activities into a calendar or diary. Most smart phones have reminder and calendar applications naturally built into them that can be used along with alarms to help remind and reinforce exercise routines

Rewards

Some people find a reward system really helps them to keep motivated to do something they don’t feel like doing. Examples of rewards include:

• Giving yourself points each time you achieve an exercise goal and planning to do something nice for yourself each time you reach a target number of points.
• Rewarding yourself with some relaxation time with a book or a nap.
• Set yourself some targets and plan a treat such as a new pair of (walking) shoes when you reach your target.

​Be creative with your rewards (but don’t reward yourself with a week off!)

Social Support

Enlisting someone to help you do your exercises or become more active can help you stick to your plan. Even better, if you and your buddy do it together, you can help motivate each other.

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It’s hard to predict how your joint will feel when you start a new exercise or activity. It’s important to start slow.

Increase gradually as you become more capable, and your strength improves. Initially, do less than you think you can manage. If you cope well, do a little bit more next time. Keep building up gradually.

Managing ‘normal’ pain and discomfort

Starting an exercise program can cause some discomfort or pain in/around the joint. This is a normal response to exercise. Even for people who don’t have arthritis. Often this pain will settle within 24 hours on its own. If one particular exercise or activity is making your joint feel worse, leave it out of your program. Or make the exercise easier until the pain settles.

Managing severe symptoms or injury

Sudden increase in warmth and swelling or severe pain in the joint

If this lasts for more than 48 hours you should:
1. Stop the exercise program.
2. Seek help from your regular healthcare provider. They will give you advice on how to manage your symptoms.

Onset of severe symptoms elsewhere in your body

If this lasts for more than 48 hours you should:
1. Stop the exercise program.
2. Seek help from your regular healthcare provider. They will give you advice on how to manage your symptoms.

Serious incident

A serious incident includes chest pain, severe shortness of breath or a fall that causes a serious injury.
Serious incidents are highly unlikely from following the My Joint Yoga program.
But if they occur you should:
1. Seek emergency treatment straight away.
2. Please contact your country’s appropriate emergency services or go to your local emergency room.

Activity pacing

Overactivity and its consequences

It is often tempting to do activities or jobs on days when your joint symptoms are mild, or to do a lot more in a shorter period of time to make up for days when you felt tired or your pain was worse. Overactivity can happen when you increase the load placed on your knee by a large amount and in a short space of time, for example, by doubling your usual walking distance in a single day to get all of your household chores done quickly. Although the increase in pain felt after this type of overactivity does not mean the joint has been damaged, it can be uncomfortable and requires rest to settle it.

There are many negative consequences of being caught in the over activity cycle. In the short term, these include:
• Increased severity of pain
• Anticipating severe pain with physical activity
• Increased tension, worry and anxiety
• Avoidance or cancelling activities, including pleasurable activities that make you feel good

Over time, this can lead to a worsening of the problem as you engage in less physical activity and become deconditioned, losing muscle strength,
flexibility and general fitness.

How should I manage my physical activity?

“Pace your activity” by breaking everyday activities and exercise into smaller portions. Rather than one long session of physical activity, do shorter periods of physical activity or exercise, with a rest in between. Pacing your activity means finding the middle road – and not overdoing or underdoing physical activity. Activity pacing is important in pain management because it helps you stay active doing the things you want to do and helps you to avoid pain flares.

To pace your physical activity, you should focus more on the amount of time you spend doing an activity rather than on the amount of pain experienced. Think about the distance you have walked, or the time you have spent standing up, to tell you when to stop the activity and take a rest.

You can gradually build up your physical activity over time using this approach by increasing the distance walked, or time spent being active, before taking a break.

Some pain is to be expected during physical activity and exercise, and when you are trying to increase your physical activity levels. Comfortable levels of discomfort and pain are OK. If you are feeling good about your physical activity, it can be tempting to quickly increase your amount of activity over a short space of time. Avoid this as you may fall into the over activity cycle!

Some benefits that you might experience from pacing activity:
• Continue doing pleasurable activities rather
than cutting back.
• Stay involved in important daily activities.
• Control the amount of symptoms you have during
activities rather than having the symptoms
control you.
• Avoid extreme flare-ups of symptoms.
• Become more productive in the long run.
• Gradually increase your general levels of physical
activity and therefore gain improvements in
strength and fitness.
• Less pain, tension, and fatigue.

You can download this information here.

Learn more about how weight loss may help! 

Being overweight is associated with many health issues like cardiovascular problems and diabetes, but it can also contribute to the pain you feel in your joints and difficulty with everyday activities. Losing weight is therefore recommended for people with osteoarthritis (particularly for those with knee osteoarthritis).

How does losing weight help osteoarthritis?

Being overweight places extra stress on the joints of your legs, in particular the knees. Each kilogram of body weight results in an extra 4 kilograms of load going through the knees during usual daily activities. Even a few kilograms of weight loss can substantially reduce the load on your joints. Excess weight can also lead to higher levels of inflammation in the body which contributes to your knee osteoarthritis. Weight loss noticeably improves the amount of pain and stiffness experienced by those with knee osteoarthritis and helps them function better. Maintaining a healthier body weight might also help delay or avoid the need for medicines or surgery.

How much weight loss gets the best results?

Research in people with knee osteoarthritis shows that most experience improvements (e.g. less pain) after losing 5-10% of body weight. That means if you weigh 90kgs, you should notice you have less pain after losing between 5-9kgs. The more weight you lose, the greater the improvements in pain and function. Reduced pain and improved function is also greater if you combine dietary modification with exercise. There has been limited research investigating the effects of weight loss on joint symptoms in people with hip osteoarthritis.

What do I need to do?

Losing weight involves making changes to your eating and drinking habits, as well as regular exercise.
While this sounds simple, we all know that losing weight and then keeping the weight off can be extremely difficult.

Some tips to help you include:

• Set yourself realistic goals and be patient. Don’t beat yourself up or give up if you ‘fall off the wagon’ – get back on track and re-focus on your goal.
• Get your friends and family on board to help keep you motivated. Even better is to find someone who wants to lose weight with you so that you can help each other
• Keep a food record of what you eat
• Learn about healthy food choices
• Eat slowly and savour every mouthful
• Drink water regularly
• Get enough sleep. Not getting enough sleep at night has been shown to contribute to weight gain and may even affect the amount of pain you experience in the knee
• Plan exercise and physical activity into your schedule

Key points

–    If you are overweight, losing weight will help reduce your pain and disability.
–    Aim to lose around 5-10% of your body weight.
–    Combine weight loss strategies with some exercise and physical activity.
–    Think ahead to what eating habits you will change to help you keep the weight off long term.

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This information will help you identify obstacles that could get in the way of losing weight.

Losing weight can be challenging and difficult. Barriers are things that get in the way of your plans to lose weight. Some examples include:
•    Lack of time
•    Eating when you are not hungry
•    Lack of knowledge about healthy eating
•    Holidays/Special events
•    Lifestyle choices

​Some barriers you can anticipate and plan for with some prepared strategies. Others you will discover as you try something new and then fail to achieve it. You will get better at finding ways to overcome barriers to weight loss with time and determination.

For each problem, you might think of several possible solutions. Try one and if it does not work, try something else. Some solutions may take some time to work out. Be creative and don’t be afraid to try out ideas even if they seem a little crazy.

Lack of time

There never feels like there are enough hours in the day. Time is a barrier that we all need to deal with so you’re not alone. Consider a busy day at work so you quickly grab some food on the go or trying to find the time in the week to plan meals and get to the grocery store. Being busy can also get in the way of finding those extra 10-20 minutes in the day for exercise/physical activity.

It may be helpful to spend the weekend planning your healthy meals for the week and what you will need to buy from the grocery store. Take your own lunches to work with you to reduce the urge to grab a meal from a fast food chain.  If you find it difficult in the morning to get meals made for the day, try preparing them the night before. We all run on different schedules so take some time now to think about your own routine and what has previously made an impact on your weight loss plans.

Eating when you are not hungry

Many times we eat even though we are not hungry. This can be due to a number of reasons.  We may eat because we are bored or lonely.  We may eat to distract us from pain. We may use food to reward ourselves. Another major factor that can also influence weight loss plans and even increase osteoarthritis pain is stress. We all respond differently to stress and it can get in the way of us being physically active. Stress can be a trigger for many people to eat and drive us to choose foods that may not necessarily be good for us (for example, that block of chocolate!). Other people will end up eating less or may miss meals. If you are a person that uses food to help soothe difficult feelings routinely, you may need to explore options other than food such as listening to music, seeking a friend to socialize with, or even taking a walk around the block.

Reducing stress can give us a sense of control over our lives to find more time to do things that are good for us such as getting physically active. Planning your routine and becoming more conscious of your daily routine may help reduce your stress. Other strategies including relaxation training, mindfulness therapy or modifying your thought processes to stressful events can be helpful. Your local community may offer such courses or you may need referral to a health professional from your GP to pursue these options.

Lifestyle – Eating habits

Many people have coupled certain events with their eating and drinking and developed some unhealthy habits. When this occurs, these events alone may begin to make you feel hungry. For example, if you routinely eat while watching the news or reading the paper, then every time you do these activities it is a trigger to eat.

To help break these eating habits, consider some of these strategies to separate these events so that you can identify and respond to actual hunger. Try to not do anything else while eating. If it feels uncomfortable at first this may be a good sign that you need to continue to practice this as you have developed the habit of eating with other activities. When you are distracted, you also pay less attention to how much you eat. Plan an eating schedule that fits in with your lifestyle and attempt to eat at one place. For example, eating breakfast at 7:15am at the table (NO reading or news), 12:45pm at work in the kitchen or away from the desk for 15 minutes.

Try to keep a food diary as well to help you monitor what you are eating. Track everything and as soon as you eat it! Your food diary will not be as accurate if you forget to capture snacks you eat throughout the day. Sometimes we don’t realise that all those extra foods we eat here and there all add up.

Knowledge

Knowledge is power, but it can be difficult to make healthy choices if you’ve never been taught about healthy eating – what to eat and how much to eat. Grab something from your pantry and have a look at the food label. There’s ingredients, health ratings, daily intake %’s and more. It can be a little overwhelming and make us choose foods that we are familiar/comfortable with at the shop based on our experiences. One strategy to incorporate healthier choices is to become a more informed consumer by learning how to make good food choices.

Holidays/Special events

Holidays or special events are to be enjoyed. But they are also a prime time for us to give into our food desires and can be a trigger for most of us to over-indulge. The social aspect with lots of people around and all the variety of food choices can be a driver for people to over eat.

The key is to plan how you will deal with the event. For example, you might bring your own meal that you can enjoy or you may eat less at other meals to make up for it.

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Learn more about strategies for pain management!

Living with pain can be one of the hardest parts of having osteoarthritis. Pain is actually a lot more complex than most of us realize. Sensations from your joint are processed in your brain and those pain messages are influenced by all sorts of other messages in the brain before they become the awareness of pain that you experience. If you live with chronic or persistent pain, you’re not alone. It’s a common and complicated problem that affects 1 in 5 Australians.

There are two important factors that influence your pain experience, which are useful for you to understand:

1.    The first is related to the amount and type of sensations coming into your brain. The pathway to your brain is like a motorway that can only take a limited amount of traffic. The motorway gives preference to certain sensations over others. ‘Normal’ sensations for movement, touch and warmth are given preference over pain sensations. The more ‘normal’ sensations that come from your joint, the less pain sensations that get through to your brain and therefore your awareness. That is why pain can feel worse when there is not much else going on, and better a few minutes after you start walking. That is also why we sometimes rub our joint to make it feel better, and the main reason why a heat pad provides relief.

​2.    The second factor relates to how your brain amplifies pain sensations. It’s like there is a volume control knob in your brain and things like your mood, stress levels or other thoughts can turn the volume of incoming pain messages up or down. For example, it is well known that stress, anxiety, depression, fatigue and negative thoughts can all turn the pain volume up. Thus relaxation techniques and dealing with depression and negative thoughts can really make a difference to the level of pain you feel. Thinking about other things, or distraction techniques, can also help turn the pain volume knob down. These techniques require practice for them to work well and can be hard to learn on your own, but you might feel some benefit from trying out some simple distraction, such as thinking of pleasant experiences when the pain gets bad, or reducing tension with relaxation.

It used to be thought that pain was just a simple message from your body straight to the brain. However, lots of research has shown that pain is much more complex than that, and that the brain can change how we interpret messages of pain. So, if we are feeling stressed, for example, we know that this can often affect our blood pressure or our gut, and we now know that it can also impact our feelings of pain. So, pain, like other things happening in our body, can often feel worse when we are stressed or anxious. Many people notice that their thoughts and feelings can have a major effect on their pain.

The good news is that there are many things you can do to help manage your pain. It’s a good idea to try a few different things so that you have a choice of different strategies and tools that you can call on when needed. This will give you more control over your pain.

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Relaxation is one of the most important skills for controlling and decreasing pain and other symptoms of OA, as well as stress, fatigue and difficulty sleeping.

Relaxation is a skill that can be learned just as any other skill such as driving a car or typing.

Progressive muscle relaxation teaches you how to pay attention to feelings of tension and relaxation in your body. This is done by tensing various muscle groups. By tensing muscles, it makes it easier for you to release them and become more relaxed. You will learn to keep tension in your body at a low level.  Less tension usually means less pain.

How to start:
First you need to find a comfortable place to sit or lie down.  Make the environment as relaxing as possible, turn down lights, turn off your phone, put on some gentle music to block out any distracting noises. If you are comfortable to do so, close your eyes.

Relax your body. Breathe slowly and evenly. Take your time to focus on smooth, even breaths.

Starting at your feet, point the toes of your right foot, slowly flexing and tightening the muscles.  Notice the tension, hold this for a few seconds, then relax.

Now do the same with your left foot, slowly flexing and tightening the muscles, and noticing the tension. Hold for a few seconds, then relax.

Move onto your calves. Slowly curl the toes of your right foot, pointing your foot so that you are tightening the calf muscle. Notice the tension. Hold for a few seconds, then relax. Move onto your left calf.

Continue to work your way through your muscle groups, tensing the muscles as you go, noticing the tension and holding for a few seconds, then relax.

• Right foot – point your toes, relax
• Left foot – point your toes, relax
• Right calf – curl your toes pointing your foot towards your calf, relax
• Left calf – curl your toes pointing your foot towards your calf, relax
• Right thigh – tighten the muscles, relax
• Left thigh – tighten the muscles, relax
• Buttocks – squeeze the muscles, relax
• Stomach – suck it in, relax
• Chest – breathe in deeply filling your lungs and chest, then breathe out
• Back – pull your shoulder blades together, relax
• Chest – breathe in deeply filling your lungs, then breath out
• Back – pull your shoulder blades together, relax
• Shoulders – shrug your shoulders up to your ears, relax
• Neck – pull your head back slowly as though you are looking at the ceiling, relax
• Forehead – raise your eyebrows as far as possible, relax
• Eyes – squeeze your eyes shut, relax
• Jaw – open your mouth wide, relax

TIPS:
Don’t tense your muscles so hard that they cramp or you feel pain

Don’t tense and relax areas where you’re having intense pain. You might want to try a different form of relaxation, or skip that muscle group.

This relaxation technique can be done anywhere, and can be done sitting or lying down.

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Using the progressive muscle relaxation technique is a great way to gain deep relaxation. 

Mini relaxations are similar, but can be done much more quickly and easily. It’s a good idea to practise both, so you can add them to your tool kit of strategies to help manage your pain.

A Mini relaxation can be done in 30 seconds or less, and they can be done anywhere and at any time.  This skill can be very helpful when you are feeling increased tension or pain by reversing the tension you feel and replacing it with a feeling of quiet relaxation.

​To do a mini relaxation, begin by stopping to focus on yourself.

​Let go of as much tension as possible throughout your body.

​Focus on relaxing the muscles in your stomach or diaphragm and breathe deeply.  As you exhale slowly, say the word RELAX to yourself.

​Place your arms and hands in a comfortable position. With your body as relaxed as it can be, take a slow, smooth, deep breath (3-5 seconds), pause or if you prefer, hold it (3-5 seconds) and exhale (3-5 seconds). This tells your body to quiet itself.

​Now allow your body to breathe on its own and focus on relaxing your muscles.

​Think of a relaxation “wave” flowing down across your forehead, your jaws, your neck and shoulders, your hands and arms, your midsection, legs, and feet. Feel the relaxation spreading down through your jaw.

​Allow sensations of heaviness to flow downward throughout your shoulders, through your arms and hands, down into your stomach, and your legs and feet.

​After 30 seconds, go about what you were doing—regardless of how well you have succeeded in relaxing.

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Pleasant imagery is a technique that uses your imagination to create a pleasant scene, a bit like what you do when you daydream.

This relaxation technique allows you to focus on a favourite place – real or imaginary – that’s safe, calm and pain-free.

Studies have shown that imagery is a very effective technique for reducing stress and pain.

Imagery can help you in two ways. It distracts you away from unpleasant thoughts or experiences. When you are concentrating on something pleasant, you are not able to give as much thought to your discomfort. It can help you to relax.  You can use imagery along with muscle relaxation exercises to enhance the benefits of relaxation, or you can use it alone.

Common pleasant imagery scripts that people use include a walk on the beach, or a walk in the garden.  To practise this, you can create your own story or you could listen to some music or online script.  If you are doing it yourself, try and come up with as much detail as possible – think about the things that you see, feel, taste, smell and hear.

Find a comfortable position. This may be in a chair, on your bed or outside somewhere calm and quiet.

Find your own calm, safe place to go to in your imagination, and build up a picture of that in your mind…

Here’s an example of a script but you can choose any that suit you:

Close your eyes and imagine you are on a beach.  It’s a small, sheltered cove.  You have the place to yourself. It’s a beautiful clear, blue sky day, perfect for walking.  There’s not a cloud in the sky.

The waves are coming in slowly and the water sparkles in the sunshine. The air is fresh and salty. Inhale the clean air.  While you breathe in, imagine the air is filling you with energy. As you breathe out, feel your pain and anxiety go out with your breath and fly away over the water.

You hear the cries of gulls as they fly overhead.  Watch as they swoop and dive and perform the most amazing acrobatics.  As you watch them, feel their joy and excitement as they play in the air currents.  

Under your feet, the soft sand is lovely and warm. Curl your toes and feel the crunch of grains of sand.  The warmth from the sand travels up your feet, making your whole body feel warm, relaxed and calm.  

You move on and walk slowly along the beach.  You notice a small crab making its way along the sand, leaving tiny prints as it goes.  Shells glitter in the sand. The trees along the edge of the beach are swaying in the breeze. It all feels so calm and unhurried…….

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Mindfulness focuses your mind on the present moment. It trains your mind to be alert and pay attention to the thoughts and sensations you feel and to accept them without judgement. Being mindful is being aware of the present moment.

Regularly practising mindfulness has been shown to improve mood, relieve stress, improve sleep, improve mental health, and reduce pain.

A good way to start practising mindfulness is to be conscious of your breathing. For most of us, breathing is something we take for granted. We never think about it. By focusing on our breathing, we can bring our mind to the present moment, and this is a technique that can assist with pain management. You can do it anywhere, any time.  It’s often useful when you are trying to sleep or waiting for your pain medication to kick in.

Mindful Breathing

Find a comfortable position. Relax your body, especially your shoulders, chest and stomach.

If you want, close your eyes. This can help you to become more relaxed and block out distractions.

Clear your mind. Put aside your thoughts, worries and anxieties.

Focus on your breath in, and then your breath out. Count your breaths if that helps. If thoughts intrude, don’t worry about that, just watch the thoughts glide by, without judgement, like you might watch clouds float across the sky.

Come back to your breath, in and out.

You will feel your muscles start to relax, and your mind will begin to calm.

This is often a technique that people use as a starting point for practising mindfulness meditation.

To practise mindfulness meditation, you can join a class, listen to a CD, learn a script from a book or play a DVD or online video.

A simple technique to give you a further taste of mindfulness meditation is to do a body scan. It helps you become aware of your body in the present moment.

Simple Body Scan

Find a comfortable position. Close your eyes and relax your body.

Breathe in and out slowly and gently. Take your time and focus on smooth even breaths.

Notice how your body feels. The weight of it as you sit or lie. Keep breathing in and out, slowly and evenly.

Now focus on your feet. Notice any feelings or sensation, tension, warmth, coolness, pain, discomfort. Just notice these feelings, they’re not good or bad, they simply exist. Keep breathing smoothly in and out.

Move to your legs.  Focus on your legs.  Notice any feelings or sensations. These feelings are not good or bad. They simply exist in the moment. Keep breathing smoothly, in and out.

If your mind starts to wander at any time, that’s okay, just gently bring your attention back to your breathing, in and out. Then move back to your body scan.

Continue scanning your body, noticing each body part as you go, and any feelings or sensations you encounter.

None of these are good or bad – they are just there.

Keep breathing smoothly in and out.

After you have reached your head and face, take time to notice the feelings and sensations in your whole body.

Focus on your breathing, noticing it going in and out. Open your eyes.

Practise mindfulness regularly.  When you are trying to sleep, after a busy or stressful day, at your desk before a meeting, when you’re out for a walk. Notice how you feel, the things around you, use all of your senses, be present and pay attention to the moment.

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