S3E8 A holistic approach to MS pain and stress management with Dr Amy Novonty

Geoff Allix  00:01 

Welcome to Living Well with MS. The podcast from Overcoming MS for people with Multiple Sclerosis interested in making healthy lifestyle choices. I’m your host, Geoff Allix. Thank you for joining us for this new episode. I hope it makes you feel more informed and inspired about living a full life with MS. Don’t forget to check out our show notes for more information and useful links. You can find these on our website at overcomingms.org/podcast If you enjoy the show, please spread the word about us on your social media channels, that is the kind of viral effect we can all smile about. Finally, don’t forget to subscribe to the show on your favorite podcast platform so you never miss an episode. Now, without further ado, on with the show. In this episode, we’re going to discuss pain awareness breathing relief, or PABR . Joining me for this episode is Dr. Amy Navotny. Dr Navotny founded the Habit Institute with a mission to provide pain, stress and anxiety relief to those who seek a naturalistic form of treatment when other treatment methods have fallen short. Her unique approach comes from her experience treating in a variety of settings and with a wide range of patient populations over the past 12 years. So welcome to this show. Dr. Novotny and firstly, may I call you, Amy? 

 

Dr Amy Novonty  01:23 

Absolutely and thank you for having me, Geoff, I really appreciate you bringing me on the show and give me a chance to share with your listeners. 

 

Geoff Allix  01:30 

Thank you. Can you tell us about your background? 

 

Dr Amy Novonty  01:36 

Sure. So I originally got my doctorate in physical therapy, and pursued that career for a while for about five years and then I started looking at how our diaphragm and asymmetries in our trunk really affect our body and can influence pain that we might have, influence abnormal muscle tension or tone, and can influence how we move. So when I started doing some coursework in that, I was at the time, I was also training to run some marathons and try to qualify for the Boston Marathon. And I realised that when I started playing with how I breathed and how I positioned my body, my nervous system responded in a different way, and it calmed me down and it freed up a lot of tightness and abnormal tone in my body that allowed me to perform and move at a much higher level. So when I did that, and I started realising that there’s almost a technique to it, I started experimenting on some of my patients at the time, who were just doing traditional rehab type of protocols and I realised they got better faster. It started branching out to people in with different type of neurological conditions, including MS and they were getting function back that they weren’t getting with additional methods. So it then became a mission of mine to start to teach this and try to train people on how to change their figh or flight nervous system to regain mobility, reduce pain, regain strength, improve endurance, and everything else. And so it led me to travelling around the world after being hired by a photographer to get out of a couple surgeries and then I started my own business now, a couple years ago.  

 

Geoff Allix  03:18 

So you’re the creator of the PABR method. And you’re its main practitioner through your work at that PABR Institute. So could you give us an overview of this technique? 

 

Dr Amy Novonty  03:32 

Sure, absolutely. So the reason I use the word PABR, because people are in all different types of pains, whether it’s mental, emotional, physical, or virtual, we’re in different types of pain. And if we can transform from pain to relief, using awareness, training, and breathing, we can achieve things that we didn’t know we could. And so what I do with people is teach them how to calm that fight or flight nervous system. So that their body releases certain muscle tension that has developed over time with often without our awareness to free up the body. And a lot of times our emotional and mental trauma is stored in our body, as well as a physical trauma. And so when we start to shift people out of that fight or flight state, and they can sense muscles release and sense their body go back into neutral, they get huge amounts of relief. And they see it in terms of functional gains, and their performance in daily life activities. And so that’s what we’re doing with someone and now I do it through zoom. So I have clients virtually, and I watch them move and I teach them and I train them as they’re, as I see what’s going on. We work with how they breathe and their ribcage position and then how they sense muscles relaxing or letting go and other ones activate to stabilize or to give them that sense of stability. So there I can calm down. 

 

Geoff Allix  05:01 

So specifically because this is an MS-based podcast, so specifically for people with MS, how can PAPR be helpful for that condition? 

 

Dr Amy Novonty  05:14 

Absolutely. So obviously, with MS, there’s all different types of, of presentations of MS. Some people, you know, are walking in ambulating other people are not. All of us have this autonomic nervous system that impacts our muscles and the way they work the way they move. This nervous system is broken up into three parts, your enteric, which is your gut, and you have your parasympathetic, which is that Rest Digest relaxation mode. And then sympathetic, which is that fight flight or freeze mode, that those those states impact us and impact people even with MS. So often with with MS, you have a whole slew of symptoms that show up or signs that show up and affect our body. Now, there are stressors that come on with it. I used to help people I used to help with an MS clinic. And so I know that there are many, many stressors that go on in a person’s life with MS, even more so than someone who doesn’t have it. And so with each of those stressors, it’s going to add another layer of muscle tightening up on top of what’s already going on because of the disease process. And so if we can get a person to sense and feel the muscles release and their body go back into neutral, and change the way they breathe, that’s huge. We have to change the way they breathe, their body starts to release, some of the tension and movement can return some strength returns. And I’ve worked with clients who have MS specifically doing this. And I’ve seen gains if, for instance, I have one lady who when I first started working with her, she was walking with a cane kind of wobbly. And she didn’t go very far. But she loved running. And her goal was to run a half marathon. So we started off, she started off as a client of mine just doing basic, let’s get your muscles back to working. And then we started adding in this breathing and body repositioning. And she was able to run longer run faster. She still had her cane with her but she was able to do half marathons into two hours and change. And she progressed immensely. And she became a little bit addicted to that because, you know, it gave her power. She had some control over it. But she had to work on her breathing and calming down her nervous system so that she could feel her muscles work differently and control her arms and legs. 

 

Geoff Allix  07:45 

Some exciting news, we are pleased to announce the launch of OMS circles online, the new digital hub for OMS circles, our global network of community support groups. OMS circles online will allow you to easily interact with other members of your circle, and share your thoughts, ideas and support all in a safe and secure environment. It was co-produced and designed in partnership with OMS circle members to truly reflect the needs of community. Please visit our website overcomingms.org to find circle nearest you and sign up. And stay tuned for an upcoming webinar to walk you through all the cool new ways to connect with your community using OMS circles online.  So a basic level would you say if people were doing at a very basic level, if if you’re using breathing in many of us do with mindfulness practices. And then concentrating because there’s a lot of different mindfulness and mindfulness part of the OMS protocols. And some of those are concentrating on muscles while you’re breathing and actually consciously thinking to relax muscles. Is it a similar sort of approach to that? 

 

Dr Amy Novonty  09:02 

In essence, in the idea of it is yes, but in the actual method and methodology now. So a lot of mindfulness, just thinking about a muscle, what we’re doing is actually changing your anatomy and physiology. So you feel it release, it’s not just a Mind over Matter thing. It’s let’s put you in the position and have you exhale. So there is an actual physiological change in the muscle and the muscle releases and you can sense it. So it’s more than let’s think about the muscle and get it to relax. As a voluntary control thing. It’s about releasing the muscle from internally and working on the physiology to get that to happen at the internal control and nervous system level. So actually having a release 

 

Geoff Allix  09:52 

And are there specific symptoms of MS that your technique is most suited for? 

 

Dr Amy Novonty  10:01 

So things like so basically, muscle releasing best strength, also balance having you walk. Because there are a lot of times we walk where we don’t sense certain muscles work. And we often overuse our back muscles, which then increases that abnormal muscle tone. So this can help with that, as well as learning how to walk differently, or moved in differently ambulate differently, however, that you know, the person is, is moving. And so it can help with the mobility for that as well. It can also help people with stress and tension and some of the anxiety so there is a emotional component that it can help with because it gives you control over the stressors that typically imprint in your body, you kind of ward that off so that the heightened aspect of that stress is lessened, and sometimes even reduced enough, where a person really feels that they have control. 

 

Geoff Allix  11:00 

And could you explain a bit about the process of how you would train someone to learn and apply the techniques? Or what would be the process of someone that signed up with you from the start? 

 

Dr Amy Novonty  11:13 

Sure. So I send them paperwork to get to know them a little bit and say, Hey, can you fill this out, I just want to know a little bit about your medical background. And then from there, I take a look at it, we get on a Zoom call, we go through any of the details. And then I start to have them move to some basic movements. So I can see how they reach the squat, they bend all of those things. And then from there, we I’ll explain the science of what I see in their body and how their body can shift. And then right when we start changing the way they breathe, and how they position their body so they can start to learn how to sense the muscles release and let go. And so that’s all within that first session. And then I give them time to practice and I say, hey, go take a week or so let’s have you practice let you have you understand what you just went through. And I record the sessions. If they’re okay with it, I give them the recording and say, Here you go, you have all the explicit instructions, you can see what your body’s doing. You can see my demonstrations, give them handouts, and also instructions by email. So they have all possible ways of trying to get this information into their body and learning it so they can absorb it. And then follow up sessions we progress from where we left off and see what their body has absorbed, what they can feel what they can’t feel. And then we start changing positions, we start maybe adding in some type of arm position or movement or relaxation or activation. And then same thing with the legs. And we do it based on what the body needs, what person’s goals are, and how they want to progress and what they want to achieve. Now, we can I also teach basic stuff as well, too. And we can go over any of that if you’re interested. 

 

Geoff Allix  13:00 

Absolutely, yeah, I mean, I’m really I’ve not had the technique before. So I’m very much interested in how it works. 

 

Dr Amy Novonty  13:12 

Sure. So I can I often teach to groups, how to do this setting just to give people a little bit of a introduction into it. So they can see if it’s something that resonates with them and their body before they decide they want to dive down into, you know, more one on one session. So if you don’t mind, we can go through that what we can do seated, if that works for you. Yes, that’d be perfect. Okay, so the first thing I say is sit back in your chair, let your low back, relax into the chair back, let your upper back sit all the way back into the chair back and let your tailbone tuck under you a little bit. So for a lot of people that may feel like slouching, but what we’re doing is turning off the low back so it doesn’t stimulate that fight or flight nervous system that causes muscles to contract abnormally. Now your feet we’d like them planted firmly on a surface. If it’s the ground, that’s great. If it’s some foot rest is great. Or if you need some books under your feet, put some books under your feet. Ideally, we want your knees at the level of your hips or slightly higher. And we’re going to put yourself in that position. And then let’s put one hand on your chest, one hand on your belly. We’re going to let the belly come out. So try not to suck that belly button in. When we stuck the belly button in. It lifts up our ribcage and it creates this guardian and protective mode. When we’re doing this breathing technique, it’s going to feel very counterintuitive to a lot of people. And that’s okay, we want to change your breathing so it relaxes you because a lot of the breathing that we do right now is in this fight or flight mode and it’s very shallow, that hurts our muscles hurts our body and so we want to shift away from that. Now in this position with our hands on our chest, on one hand on the belly, we’re gonna do four breathing steps. I’m gonna go through them first. And then I’ll guide you through a little bit of a practice. So the first step is breathing in through the nose. Then we pause a second, blow out through the mouth, and then pause and hold our breath for three seconds. When we blow out, we want the mouth open as if there’s a straw in her mouth, and we’re opening up our airway and letting pressure out. Okay? And we’re going to breathe like that. And go through this process, we’re gonna get into a rhythm, and I’m gonna explain a little bit more detail as we go. Okay. So first things first, let’s just get started. If you need to close your eyes, get rid of any distractions and we’re going to focus on our body and this type of breathing. Here we go. So we’re gonna do gentle breath in. Breathe in your nose, gently pause and blow out through your mouth. Hear the air coming out of your mouth as you blow out. Then, hold your breath. Hold your breath, and breathe in. Gently breathe in your nose without effort. Pause and blow out. Blow all the way out the air whooshing out of your mouth. Then hold your breath. Hold and breathe in. Gently breathe in, feel the air go in your nose, directing towards your throat. Pause and blow out. Hear the air come out of your mouth as your chest melts in away from your hand. Hold your breath hold and breathe in. Gently breathe in your nose and direct the air to your throat. And out. Chests melts in. Good ribs are dropping down but that belly spill out as you blow out. Hold and breathe in. Gently breathe in your nose passively to your throat. Blow out. Chest melt in. Feel your collarbones drop down. Your armpits relax belly comes out. Hold and breathe in. Gently breathe in your nose to your throat without effort. And blew out. Feel your collarbones drop down. Your chest melts away from your hand away from your shirt your belly spills out. Hold and breathe in. Feel the air go in passively as you breathe in your nose towards your throat. Pause and blow out. Chest melts in. Feel your arm and breathe in. Keep the ribs down as you breathe in. Feel the air go in passively and blow out. Chest melts in. Ribs are dropping down. Let that low back go. Hold. Hold and breathe in. Keep the ribs down as you breathe in, feel the air go in passively and blow out. Chest melts in. Let that low back go. Belly comes out. Hold hold and breathe in gently breathe in, feel the air go in without effort without lifting your shoulders without lifting your head. pause and go out. Chest melts in. Let that low back go. Feel that belly come out. Hold, hold and breathe in keep your ribs down as you breathe in feel the air go in passively and blow out. Chest melts in feel the ribs drop down your low back relaxes your butt cheeks melt, hold, hold and take their break. So that is the beginning stages of getting your body to calm down to go into it. relaxation mode. And from there, we can then start moving differently. So did you feel some changes in your body Geoff? 

 

Geoff Allix  20:11 

I certainly Yeah, tension changes. So yeah, I do feel much more relaxed. And I mean, for me, we’re in different time zone. So it’s the end of my day and the start of your day. So I’ve been sitting at a computer all day and working. And you get, like, because because you’re not active enough, really, I think, probably that you do get those likes and pains. And yeah, certainly, I feel left fresher, if that makes sense to me. 

 

Dr Amy Novonty  20:40 

Yep, absolutely. So what you’re doing is you’re taking energy that was diverted to creating this fight or flight tension mode in your body. And you’re now diverting it and taking it away from your body. And now it’s available for movement for doing other things in your life. It can help with focus performance, anything with job related, so I use that as well to help people. 

 Geoff Allix  21:04 

Do you do that often? that practice? Because presumably, you can just do it yourself? 

 

Dr Amy Novonty  21:11 

Absolutely. So once someone knows how to do this, then I say, Okay, let’s do it for about five minutes, a couple times throughout your day, it’s great to do it when you first wake up. And then before lunch, before dinner, and then even before bed. You can also sprinkle in other times as well. But I say if you could do it those four times at minimum, you start to shift your nervous system in a really nice way. 

 

Geoff Allix  21:36 

And has PABR techniques help to you personally anyway, to deal with pain. 

 

Dr Amy Novonty  21:43 

So especially when I was running marathons, you know, when you’re running long distances, you kind of have some aches and pains that develop. And when I started doing this and developing it, the pains went away, I stopped stretching, I stopped rolling, I stopped scraping, I stopped doing all these things that were externally applied to me to try to get my muscles back into a resting position. And now I can use this and I can release muscles. And I often do it during a run too. So I’ll run a marathon pain free, 50 Miles pain free, because I calm my nervous system back down. And so the muscles that were pulling me out of position, they release and they go back to normal. And so this also allows me and to move pain free, I can go out for runs, I don’t have to worry if I go do something new, I may have some muscle soreness, but I make sure that the muscles calm down. So it doesn’t affect my joints. And it doesn’t affect me in any long term sense. 

 Geoff Allix  22:40 

And what’s your vision for making the proper method accessible to more people with MS and beyond? 

 

Dr Amy Novonty  22:47 

So I am working on an online course so that people can go through it at their own pace. And it’s more accessible. One on one, you know, is obviously it’s some you know, because some people can do it, some people can’t. But if I can do an online course, I can then launch this to the world. And really my vision is to get people to change a little bit about the way they do health care, so that they learn a skill that they forgot that they even had, and really be able to control some of the symptoms or pain or movements that they used to rely on medications for or an external source for. This allows them to really tap into their internal abilities to change the way their body feels. And I want that accessible to as many people in this world as possible. And including anyone with MS or any other neurological conditions.  

 

Geoff Allix  23:40 

There’s links in the show notes. So have a look. And you’ll find all of the information there. So we’re recording this in early 2021. So it’s obviously a slightly strange time. You’ve mentioned Zoom calls being a method that you need, certainly in the UK where I am, we are not allowed to meet anyone and in the US. I know it’s different in some states to other states and different countries have different restrictions, but it is certainly a different type. So as we’re hopefully emerging from the 2020 COVID time can you see that we are hopefully emerged because there is there are some changes happening there with Vax and so on. Can you see light at the end of the tunnel for COVID epidemic? 

 

Dr Amy Novonty  24:35 

You know, that’s still there’s so much unknown I, you know, excuse a glimmers of this coming towards a different ending, you know, with the vaccine coming out and people are moving about more. I don’t know how long it’s going to take honestly, because there’s still so much unknown. You know, unfortunately with biology and life, there’s mutations there’s variants and So the more time we have, obviously, we have brilliant minds all over the world working on changing, you know, the way that we look at viruses, they examine them, they see how things mutate. So I have confidence that things will start to open up again, in this in the future, I just don’t know when, when that timeframe is, I can already see here in the United States, things are opening up their stops some of the mask mandates in some of the states, and you know, things are shifting, people are more confident now that they have the vaccine in them, that they can go out and interact with others. And I do see the value of social interaction and being out in the community being out in nature, because it’s so healing, we, we respond to each other’s energies. And that’s something that when it’s taken away for a long period of time, it leads to a lot of psychological and mental health issues that you know, it’s a struggle, and we all need help to deal with those. But when we’re dealing with, you know, a physical problem like a virus and a mental problem, it really is overwhelming. So I’m grateful that there are many brilliant minds around the world who are working to find solutions. And I always see the light at the end of the tunnel. I just don’t know when that tunnel how long that tunnel is right now.  

 

Geoff Allix  26:20 

And with that, I’d like to thank you very much for joining us. Dr. Amy Novotny. 

 Dr Amy Novonty  26:25 

I appreciate it. Thank you so much Geoff, for having me on. 

 Geoff Allix  26:27 

Thank you for listening to this episode of Living Well with MS. Please check out this episode’s show notes at overcoming ms.org/podcast You’ll find all sorts of useful links and bonus information there. Do you have questions about this episode or ideas about future ones? Email us at [email protected] We’d love to hear from you. You can also subscribe to the show on your favorite podcast platform so you never miss an episode. Living Well with MS is kindly supported by grant from the happy charitable trust. If you’d like to support the Overcoming MS charity and help keep our podcast advertising free, donate online at overcomingms.org/donate Thank you for your support. Living Well with MS is produced by Overcoming MS, the world’s leading multiple sclerosis healthy lifestyle charity. We are here to help inform, support and empower everyone affected by MS. To find out more and subscribe to our E-newsletter, please visit our website at overcomingms.org

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