Yoga With Chronic Pain
"Yoga has been shown to decrease disability among people with pain, but it is not known how... yoga is a promising means to improving resilience and clinical outcomes for people with chronic pain." In Resilient to pain: A model of how yoga may decrease interference among people experiencing chronic pain,” the authors refer to many embodied correlates of stress: the HPAAxis (hypothalamus pituitary adrenal axis), stress hormones, etc.
Luckily, we don't need to know how yoga works to start practicing and receiving benefits, even when we have pain. According to the National Institute of Health's information page, "Chronic pain persists. Pain signals keep firing in the nervous system for weeks, months, even years."
The Decision to practice is difficult when we're riding the ebbs and flows of chronic pain. Is the pain telling us to keep still? Isn't pain a signal that something is wrong? Will, what I'm about to do make it worse? Will it go away? Why bother if I can't be sure it's going to relieve all the pain?
The obstacles to practice are fierce: pain neurologically and emotionally restricts what we (body and mind) are willing to allow in a protective response. Furthermore, when we're in pain our bodies naturally lower the amounts of certain chemicals that make us feel like doing things, like dopamine, the molecule of motivation. There's wisdom in this: the first step of relief is to remove the source where we can- the heat for a burn, the stinger for a bite, the pressure in a weight bearing extremity.
In chronic pain, the trigger for the nervous system may be long gone. But that doesn't mean it's a good idea to push ahead: the source of pain, signals sent from the nervous system, is real and must be respected. Our body's lower resources of dopamine and other chemicals involved in feeling energetic and focused are real and must factor into our decision of how to move and where to spend our precious resources of attention and effort.
The conundrum about how to proceed when the source appears to be something we cannot remove- the nervous system itself -is also the clue. While scientists continue their work of identifying which neurotransmitters, pathways and receptors are involved, we have a model for how to interact with that nervous system in a way that can change both the message or how we receive it.
Often we think of yoga as a practice of full-blown postures, maybe even all linked together and as exercise. "Exercise" brings associations of effort, pushing past limitations, sweat achievement, and reward.
Instead, Healing Yoga emphasizes the ways that movement, sensation, and awareness form a trinity for transformation. since sensation and awareness are activities of the nervous system that needn't even manifest in a muscular effort, we can use them to begin our conversation with our body and even our pain.
The following principles can guide your experiment of practice with chronic pain.
Begin with the breath, always the breath. Simply feeling where your breathing creates motion and sensation in your body right now, without doing anything else is a transformative act. The areas of motion and sensation are likely to change within the first minute of breathing: paying attention changes things.
Your practice doesn’t have to be long or heroic. Too often we start with an idea of practice that requires an hour - or hours - and assumes ultimate effort and total bliss as the results.
Practice can be a few minutes in bed, 15 minutes on the mat before the hubbub of the day.
Practice is defined in the sutras as finding the place where effort and surrender meet. One corollary of this definition is that very slight effort can be a very big practice. Gentle is often the way to dissolve resistance and therefore pain.
Find a pain free range of motion, or relatively so. Sometimes in group classes (even small ones), the group is doing Warrior I (or any pose) and so we “do” it, too. Spending the first few minutes of practice focused on the subtle motion of just breathing and then adding smaller, component movements to explore a pain free range of motion is the basis for deciding which postures and how to do them are best for each of us. Moving within your pain free range with attention and with your breath almost always increases that range. Respecting that range on a given day is key.
True core can be found with the simple act of breathing. We often think of the core as requiring great effort like that of boat pose, shakti kicks, long plank holds. Those are super helpful when they’re accessible. Synchronizing the motion of the pelvic floor and respiratory diaphragm with the engagement of the throat and mouth are key to moving from the stress response to the relaxation response (i.e. sympathetic to parasympathetic, or fight-or-flight to rest-and-digest).
One way of accessing this is to allow the belly to expand on inhale and feel its fall and gentle, effortless contraction on the exhale.
Try placing your hands or a pillow, blanket or sandbag on your belly and spending time in growing awareness of the rise on inhale, fall on exhale. This is a complete practice.
Use this with cat-dog practice. The reason we inhale into dog (tail and head up) is that it’s a natural expansion and cat is a natural contraction. Inhaling during the expansion and exhaling during the contraction reinforces the way that we breathe when relaxed - the way that babies breathe.
Small, gentle movements, starting with a single joint, from the periphery (hands and feet), coordinated with the breath, held in your attention are the very essence of yoga and practice. Too often we feel that we’re not doing “enough.” Historical texts of yoga famously mention a very few poses - one (Sutras) or 12 (Yoga Yajnavalkya). This is because the components leading up to those were assumed to be imparted by a teacher - not because the authors thought anyone who picked up the book should hop right into lotus (please don’t).
Moving joints in sequence with breath and awareness supports the flow of the lymphatic system - rasa in Ayurvedic terms.
The lymphatic system is a conduit for healing (proteins and building and rebuilding molecules of the immune system), messengers (hormones), and neurotransmitters.
These movements gently dissolve restrictions in the fascia bathed in and on a continuum with the lymphatic system.
Breathing is one of these small, gentle movements. With your attention, you can guide your breath expansion and contraction waves to be felt in body parts that seem distant from your lungs. If you can breathe you can do yoga - in any position.
Your yoga practice may or may not relieve a particular pain. And it will change your relationship with that sensation, body part and its role in your life. Interestingly, recent research suggests that we don’t have to break down pain into body parts and treat knee pain so differently from shoulder pain and so forth. This study has begun the research on addressing pain and movement holistically. While the scientific research into how yoga works is crucial in casting light into our bodies, minds and collective lives, the simple application of breath, practice, awareness, sensation, individuation and rhythm that yoga offers can support us all when we have the opportunity to work with the various manifestations of pain we encounter in our lives.
