Yoga for Pain

My recent experience of nerve pain was illuminating. I follow some of the leading pain researchers locally and internationally and find it a fascinating area of mind-body study. However all the theory in the world doesn’t feel very helpful when you are in so much pain you can barely crawl to the bathroom. So I tried to believe that movement was safe and helpful, even while I was thinking catastrophically about my future in a wheelchair. I knew intellectually that my overactive brain was just trying to protect me, and that having seen the GP and physio and had serious neurological conditions ruled out, that I didn’t need to believe everything my nervous system was telling me. Despite understanding the futility of it, I wanted to know the cause, and if it hadn’t been for the trusting relationship I developed with the local physio (shout out to Godfrey at Drovers Elite Physiotherapy), I would have insisted on scans. Instead, with his support, I explored strengthening exercises like bridge pose (initially any extension at the hip joint was agonising so this was challenging) and standing on one leg. I took his ideas and incorporated them into the yoga therapy I was figuring out for myself, much as I would for a client.

Yoga therapy is an ideal mind body medicine for people living with pain. Chronic pain is the biggest source of suffering in our community, and costs the health system more than the leading cause of death (cardiovascular disease). Pain is human, universal, and tricky in its subjectivity. We were all educated with an image of a hand touching a hot iron, and the subsequent afferent and efferent nerve signals that result in removing our hand from danger. But the old ideas of tissue damage, or dodgy bio mechanical movement patterns, have largely been thrown out in light of modern neuroscience. However that’s little comfort to sufferers, many of whom search for years for a diagnosis that can explain their discomfort.

The latest pain science is well articulated by researchers and educators such as Lorimer Moseley, who entertainingly explains why context and our brains matter so much in his TEDx talk He insists all pain is created in the brain but is careful to convey that doesn’t mean sufferers are malingerers or making it up. Quite the contrary, pain scientists understand that chronic pain is complex, and depends upon the brain evaluating vast amounts of information, some from the sense organs, but also much from the storytelling part of our mind – the storehouse of previous experience, cultural and social expectations, and our beliefs about pain and what it means in the context of our lives. Identifying and de-fusing or uncoupling from the stories we tell ourselves is a key mindfulness skill.Our brains can upregulate or downregulate the sensations we call pain. Pain comes into our consciousness more sharply when we feel imminent danger. Based on all the available sensory info plus our memories and context, our brain turns pain up or down.

Along with a sense of threat, another mechanism for upregulating pain is inflammation. That’s why balancing blood sugars, managing stress, and making lifestyle choices that allow us to sleep well, have meaningful interactions and eat well are important. A key to such a holistic prescription is yoga. Numerous studies show that yoga decreases inflammatory cytokines such as CRP and interleukins. When yoga is delivered in a way that is trauma sensitive, it also works to give people a sense of safety, effectively down regulating pain messages.

Have you heard the expression ‘neurons that fire together, wire together’? It’s a simple explanation for brain plasticity, that is, the way our habits of thinking and behaving, create default patterns for our nervous system. The problem is, these ‘shortcuts’ can wreak havoc on our ability to turn pain down. The better we get at detecting threats, the more we respond to life as if everything is a threat. So once we’ve been in pain for a while, even if there’s no credible source of danger, the experience can easily become a chronic sensation that leaves us primed, at the level of our autonomic nervous system, for more suffering.

One technique in yoga that has been studied as part of MBSR (Mindfulness Based Stress Reduction) is body scanning. This technique is very similar to a body based insight meditation practice, whereby you move your attention throughout the body, scanning from the crown of your head, to the tips of your toes and back again repeatedly, taking in all areas of the body with equal attention, attempting to observe your own sensations (or lack of sensations) with an attitude of equanimity ie taking it all with the same calm poise, neither getting happy about pleasant sensations, or sad about unpleasant sensations. It cultivates a neutral state of awareness that accepts suffering and freedom, pain and pleasure equally. I imagine this body scanning to be like a satellite circumnavigating earth, creating accurate, up to date pictures for Google Earth. Our minds can do this too, feeding information to the corticol humunculus

Touch and movement contribute to this homunculus, so the postures of yoga, and other movement modalities, as well as touch intended to heal not harm, can all help in refining our mindful perception of our embodied experience. Interestingly, in chronic pain, neuroscientists have observed a smudging of the cortex where this information is stored. In lay terms, our GPS is picking up roads that aren’t there, or misinterpreting the data due to the ongoing perception of threat.

As a yoga therapist I don’t surmise to understand all the technicalities and nuances of nociception, interoception or proprioception going on in my clients, however what I do know well is the techniques of yoga and how to adapt them for the person seeking support. Most forms of therapy acknowledge the power of the therapeutic alliance – a trusting relationship sets the foundations for a feeling of safety, and an openness to explore without judgment or defensiveness. From the quiet, calm, connected presence of a yoga therapist, people in pain can draw some sense of being cared for, feeling seen, heard and having their experiences acknowledged. With that rapport, they are usually willing to work with gentle yoga practices, typically including breath awareness, then perhaps extensions of the breath, in particular a longer exhalation which tones the vagal nerve and creates the well known relaxation response – a slowed heart rate, lower blood pressure, lower blood sugar, slowed respiratory rate, improved digestion, and the cultivation of a relaxed frame of mind in which the everyday dramas and inner dialogue can quieter, leaving space for reflection and leading towards a capacity for meditation.
When practiced regularly, people in pain report that due to yoga their tolerance for different positions improves, and their pain experience can be lessened. It’s not a quick fix, a single session may even cause a flare up of symptoms, but when repeated regularly, yoga seems to be an empowering experience, a true mind body medicine, that lowers inflammation, decreases stress responses, improves sleep, and gives the brain an opportunity to rewire some neural pathways to create a more accurate picture of the body in the mind, one that experiences pleasant and neutral sensations without interpreting them as threats to safety.

Victor Frankl’s famous quote captures this idea, “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”. Yoga creates that space, then people are able to choose. In a yoga therapist-client relationship, this can include talking through goals, identifying what matters most, and using the practice of yoga to reinforce helpful self-talk from the body to the brain, as well as from the brain to the body. Slow mindful breathing, coupled with slow mindful movement, guided by a compassionate therapist who embodies an attitude of patient presence, and coaches you to feel increasingly able to move in your pain free range of motion, can be a significant part of your healing journey. In the safe spaces of studios and clinics, yoga therapists are putting into action the latest pain science that tells us that ‘motion is lotion’ and offering a viable, evidence based alternative to painkillers and a sedentary lifestyle.

If you are seeking help for a painful condition, we are more than happy to work with you and your health professionals to get you moving and living life on your own terms again.