Well, much like anything, it depends. The answer is rarely straightforward and definitive.
As mentioned in the last post everyone comes in with their own experience of pain, history, individual, unique life circumstances. What might be helpful for one, will not likely be the same for another.
Below are a few comments made during a recent class, which illustrates this difference, for each person.
“I slept so much better all last week.”
“I’m not really using my cane anymore. My leg feels stronger, and I have no pain.”
“My back went out last week for a couple of days. I was flat on my back, so I used one of the (breath-awareness-distraction) practices and it really helped me get through it.”
And your back now? – Me
“It’s fine, now.”
“I’m so surprised. Normally I cannot walk around without my shoes on.”
Did you feel pain, while we were doing this (walking exploration, practice)? – Me
“No, I had no pain at all.”
I can’t say what will happen for you, or for another. Most often though, people will begin to experience feelings of calm, safety, less or no pain during class. And, some will begin to transition those responses and feelings into their daily lives.
Like most things in life, what we do, what we practice, we get better at. I would say the same, in this case. If you only practice during our class, for an hour a week, you may not see as much progress, notice as much difference. However, if you do a little, each day, I bet your experience will be similar to these others.
What I highlight to people, from both their comments and experiences is that something changed. To get curious about that, and realize they created the change.
It wasn’t something done to them.
From there, they begin to feel some hope. Perhaps a little empowered and more able to start exploring and learn to self-manage or resolve their persistent pain.
The second question people often ask me about Pain Care Yoga classes, after “who is it that comes to these classes” described here, is “what do you do in them”?
Pain is never just about one thing. You want to know what’s wrong. How you’re going to fix it. And how long it’s going to take. And rightly so, as having long-term pain often changes everything for you and how you live your life.
When it comes to pain, however, it is usually not that simple which is why searching for ‘the thing‘ usually doesn’t work in the long-term. Particularly if you’ve had pain for a long time. Which doesn’t mean to say that it can’t change. It can. We know what can help to bring about change, the best practices research points to.
Two key aspects, education … and movement, are important. So that’s what we do in these classes.
Some kind of education piece, usually at the start of the class, is provided. I only spend a few minutes on this, but it’s important to do so. One of the most common things I see with people in pain is the fear of moving. If I can help you to understand why it might be safe to move and why it’s important to do so, that’s a good place to begin.
“Current evidence supports the use of pain neuroscience education (PNE) for chronic musculoskeletal (MSK) disorders in reducing pain and improving patient knowledge of pain, improving function and lowering disability, reducing psychosocial factors, enhancing movement, and minimizing healthcare utilization.” 
Then, you practice. You get to experience how you might move, with guidance and guidelines, to learn what’s right for you. Which often won’t be the same as others in the room.
This is not a typical yoga class with sun salutations, downward dogs, lunges, forward folds, backbends. It is not even what I would call a ‘gentle yoga class’. Yes, we use slow, gentle movements. Yet, sometimes you might begin by just imagining the movement if you don’t yet feel safe to do it. Or you might practice it in your mind, plan out how you might go about it and if it feels right for you. It is always your choice to do or not do anything presented in class. You always get to decide how to move, how far to move, by using a slow, mindful exploration along with guidelines and principles utilized.
Most movements are fairly simple and modifications are always available. You’ll experience a lot of repetition, and rhythmic movements. Movements that cross the midline of the body. Movements that challenge your brain as well as challenging your body. You, anyone, can really begin wherever you’re at. With what’s right for you.
There will always be some kind of breathwork or a breath awareness piece in the practice. Again, it’s not so much about controlling the breath, rather what you might notice about your breath. How breath can be an indicator of your physical and emotional state at any given time. Also, learning how breath can help to bring about change to your nervous system, physiology, which can then change your experience of pain.
Like breath, awareness is key. So often when you are in pain the last thing you want to do is pay more attention to your body. But in fact, this paying attention is your guide to changing pain. It is in this noticing that you can begin to explore what the signals (or sensations) you feel might be indicating, what might be your unique contributors to pain, what might be the reasons for flare-ups. This practice is not only about noticing your body in class but then also paying attention to your whole self in your environment, in the larger world you live in.
There are many reasons, purposes and benefits to practice relaxation techniques. In most yoga classes this is done at the end of class. Though we’ll also do some kind of formal relaxation practice at the end, relaxation or creating a state of calm is facilitated right from the start.
It is when you are in a place of safety, when you are calm and relaxed, that change is likely to occur. It is this place of calm (a parasympathetic state) when you might first experience a change in your pain. Without this, it’s no different than trying to stretch, exercise, push through and strengthen your pain away, which seems not to work out so well.
If you’re interested in learning more, have any questions or would like to sign up for the next series of classes starting at the end of February, please get in touch here. I’d love for you to experience, how you might learn to change your pain. Or, if you prefer a one-to-one session, information can be found here.
 Adriaan Louw, Kory Zimney, Emilio J. Puentedura & Ina Diener(2016)The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature,Physiotherapy Theory and Practice,32:5,332-355,DOI: 10.1080/09593985.2016.1194646
Most people I talk to wonder how yoga might help with their long-term, persistent or chronic pain. So, I thought I might tell you this week a little about who comes to these classes, what we do and why, or the outcomes experienced.
Let’s begin with who attends.
Most people in these classes (or private 1-to-1 sessions) have never done yoga before.
Classes tend to consist of people who don’t turn up in yoga studios, who probably never thought of doing yoga to help with their pain. After all, most of the marketing and imaging around yoga is out of reach for many people, let alone people who have difficulty or experience pain when they move.
Most, are around mid-life; perhaps 45 or older.
The oldest student who’s attended is 78. Most are about 50 – 65 years old. Once in a while someone younger will attend, perhaps in their 30’s. Currently, my youngest client is 13.
What are some of the conditions, or diagnoses they have?
The most common condition is people with persistent back pain and/or those with fibromyalgia. Most often, those with fibromyalgia have had it 20 to 30 years or more. Others have osteoarthritis, rheumatoid arthritis, sciatica, other musculoskeletal pain (hips, shoulders, feet, and neck seem to be the most common). Chronic pelvic pain, is another. Or those who are currently going through cancer treatment, or recovering from it.
What are some of the conditions or diagnoses that often accompany persistent pain?
Most often it’s either (or both) anxiety and depression. Many suffer from irritable bowel syndrome (IBS), chronic fatigue, sleep issues (insomnia, sleep apnea, etc.), incontinence.
You can see there is such a wide variety and it’s not really ‘yoga’ people coming to these particular classes. Again, from what I know about most, they are people who have tried many other things that haven’t worked for them over the long term or are using yoga as complementary to or integrated with other aspects of their personal comprehensive pain management or treatment plan.
Up next on the blog, we’ll dig into what we do in these classes. I hope you’ll join me.
Unhelpful beliefs about LBP are associated with greater levels of pain, disability, work absenteeism, medication use and healthcare seeking. Unhelpful beliefs are common in people with and without LBP, and can be reinforced by the media, industry groups and well-meaning clinicians.”
The purpose of the editorial (made free due to popular demand, read it here) and the infographic is to “identify 10 common unhelpful beliefs about LBP and outline how they may influence behavioral and psychological responses with pain”.
The authors are also “calling on clinicians to incorporate these into their interactions with patients.”
This is so important. It’s why I always include a touch of education and information as part of my Pain Care Yoga classes. When people are in pain, it’s difficult to understand why it might be safe to move, how important it is to move and how movement “doesn’t mean you are doing harm – FACT #5”.
I hope these FACTS will bring some curiosity to your beliefs. I hope you might consider what you believe and how they might influence your experience of pain, either positively or negatively.
Sometimes, however, information is not enough. I, we, can give you all the ‘FACTS’ but often until you experience that you CAN move without pain it’s difficult to change beliefs.
As called for in the editorial, I am personally committed to bringing evidence-informed information and education to the people I work with and hope to provide a new experience to get you moving again, with confidence.
Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet 2018;391:2368-83.
Buchbinder R, van Tulder M, Oberg B, et al. Low back pain: a call for action. The Lancet 2018;391:2384-8.
Like many people my age, we’re not looking so much to get more stuff. Rather, we’re hoping in some small way, we might make a contribution. Help others.
What does this mean for you?
Here’s the thing,
Do you suffer from persistent or chronic pain? Or know someone else who does? Are you tired of finding only short-term relief from pain?
Most people think that pain is inevitable as we age. I used to think so. Now, I know that pain can change. I see it all the time in the people I work with. Science, also tells us this is true. You can learn a bit about my own story of pain and how it changed a little later, but first here’s the deal FOR YOU!
Starting today November 25th until December 2nd,receive 30-40% off my regular pricing.See how you might change what is getting in your way, limiting your life, the contributing factors to your experience of pain. Check this out!
$58 for an initial 90-min session (approx. 40% discount) if you book this week!
$58 for a follow-up 60-min session (approx. 30% discount) if you book this week! (All appointments to be scheduled between Nov 25th, 2019 and Jan 15th, 2020)
Book your first 90-minute session for $58 (regular price is $95)
Book a follow-up 60-minute session for $58 (regular price is $85)
Book a package of 4 sessions, 1-90 min and 3-60 minutes for $280 (regular price is $335)
BONUS:You’ll also receive a FREE audio recording of a slow, guided awareness practice. With the usual busy, stressful holiday season soon upon us, this can be used for relaxation, to help guide you into to sleep or rest or just notice what you feel, what you might need on any given day.
GIVE BACK:I will donate $5 to *Chrysalis House for each session booked, whether a first or follow-up session. Chrysalis House provides a safe and secure shelter to aid in helping and support those affected by domestic violence. Which tends to escalate around the holiday season. Together, helping others.
Email me at firstname.lastname@example.org or you can contact me here to book a session or for further information. To learn more about individual sessions, click here.
NEW LOCATION: I have a new location for my private 1-to-1 sessions. Various opportunities presented themselves but when I heard about this space called “Comfort Corner” it sounded just right. Thanks to my local community for providing all the leads and contacts in/around the West Ottawa area when I went looking for recommendations. People helping people.
Pain is surely complex. Which is why looking for the ‘thing’ to ‘fix it’ usually doesn’t work.
You truly are unique. Each person I work with comes from a unique background with unique experience and their own history, body, circumstances and environment. We’ll work together in partnership to
explore what might be contributors to your pain,
how you might change things up,
create new patterns of moving without pain,
learn to move with more ease,
experience how YOU CAN modulate your pain
My goal is to help you learn to ‘be your own best resource’. So you don’t have to rely forever upon me, or other health care professionals. You’ll have the tools, resources, information and practices to help you through the inevitable journey of life’s ups and downs. To live a meaningful and purposeful life, no matter your situation or condition of health.
I would love to work with you!
Group Classes are helpful for chronic pain but this 1-to-1 work can make all the difference. Why not see if it’s right for you? Or if you have family, friends or colleagues who you think might benefit, please share with them as well.
Email me at email@example.com or you can contact me here to book a session or for further information. To learn more about individual sessions, click here.
*Chrysalis House is a safe and secure 25-bed shelter in Western Ottawa. It is a place where a woman can go to protect herself and her dependants from violence and abuse. In this supportive environment, a woman can focus on her personal needs and choices, as well as on her dependants’ needs.
What if you could learn how to move safely? To live your life again, with more ease.
What if you could learn how to tune into your body’s signals in a way that can best guide you?
Pain is definitely complex and there can be a whole range of contributors to your individual experience of pain. It’s usually not just one thing which is why looking for the ‘thing’ to fix the pain doesn’t usually work. Particularly over the long term.
What if you had a safe place to practice what yoga offers?
gentle movement practice
meditation or mindfulness practices
What if you had a community of others to be with who face similar concerns, uncertainty and questions, while you explore this?
What if you could learn that you are capable of changing or modulating your pain.
What if you could learn a little more to understand pain, what might be contributors, and what might best help to change your experience of pain?
What if you could learn how to work with your breath to help modulate your pain?
What if you could learn to notice stress and muscle tension which may contribute to your pain? Often, these lay just under your current level of awareness.
What if you could learn ways that might help you to sleep, as we do know sleep is often a factor in the experience of pain.
What if you could learn more about your nervous system and your brain and how adaptable these are? What part they play and how this means your pain is adaptable as well.
If any of this is of interest, resonates with you or you’re curious to find out more there is still time to register for the next series of Pain Care Yoga Classes. You can find more information here, or feel free to send a question here or by emailing me at firstname.lastname@example.org
** Tuesdays and Thursday mornings in Stittsville, starting November 5th.
My desire for this update is that in some way it might inspire, be of benefit and most importantly, bring hope to you or someone you know who lives with chronic pain.
Approximately 1 in 5 people in Canada suffer from chronic pain, with costs to the Canadian healthcare system between $47 billion and $60 billion a year – more than HIV, cancer and heart disease combined. One might say that my desire, my passion, is in helping people who feel stuck, in despair and without hope in terms of their lived, unique, experience of chronic or persistent pain.
About 5 years ago, I started studying pain. What pain is (or is not), what might contribute to it and what the current evidence and research tells us. My interest began as a result of my own experience with chronic pain, which dates back a few years prior. Well, actually it began about 2010 or 2011, so almost 9 years ago now.
A year ago I decided to undertake training Neil Pearson offered to various regulated health professionals (doctors, physios, massage therapists, etc.) and yoga teachers, combining pain neuroscience education along with yoga practices and philosophy. The first workshop of the certification process he offered in Ottawa last year, happened to be part of the first module in a certified yoga therapy training program, also here in Ottawa (I subsequently applied to this program as well, and will start the second year of the 2-year IAYT Certified program next week).
Fast forward one year and I’m now certified to teach Pain Care Yoga classes!
WHY DOES THIS MATTER?
Neil trains both medical professionals and others in non-pharmacological pain care in the hopes of bringing knowledge, expertise and evidence-based practices into local communities. He is a physical therapist, a Clinical Assistant Professor at University British Columbia, and a yoga therapist. He has been a consultant with Doctors of British Columbia since 2013, to develop and implement clinical pain management continuing education. He is past Director of Pain BC, and the founding Chair of the Canadian Physiotherapy Pain Science Division.
His goal is “to help people living in pain and to assist others with the same desire to serve. We must shift many paradigms. Our views of pain, the people in pain, and the role and effectiveness of non-pharmacological pain care are mostly outdated.”
My goal is to help serve this purpose as well, by bringing Pain Care Yoga to local communities.
The good news about pain is that it can be modulated, there is hope, and as Professor Lorimer Moseley (probably the most cited pain researcher globally, based in Australia) now says “recovery is back on the table”. We know enough now about chronic pain that we can change lives.
In small group classes (or individual sessions), I hope to play my small part towards helping some of the 20% of our population in Canada who live with persistent pain.
Each time I meet with someone, listen to their experience, offer current explanations about pain, help them learn to move in safety with more awareness, attention and ease, it is clear to me WHY THIS MATTERS.
My classes start mid-April in Stittsville, with private
sessions also available.
When I used to write about yoga for a local magazine, the numbers of Americans practicing yoga was about 20 million. Today, about 6 years later, that number has nearly doubled, edging up towards to 40 million. Globally, the estimate is about 300 million and the number of over 50s practicing yoga has tripled over the last four years.
People often wonder what this thing called yoga actually is. Difficult to answer in just a sentence but to me YOGA is the exploration, awareness, and response that informs how I (might best) relate to the world inside myself and to the larger world around me.
A large part of this doesn’t involve the physical yoga postures or asana practice, but that’s usually where people begin. It is a good way into the wider exploration. Most, practice on a mat and typically in a group class. Certainly, it’s where I began.
Not knowing anything about yoga when starting out, I first practiced Ashtanga yoga and then when I began teaching it was a somewhat modified Vinyasa practice. Both involve strong, physical, almost gymnastic-like movements linked with the breath. Ashtanga, in particular, is meant to be practiced for 1.5hrs each day, 6 days of the week.
My practice today no longer resembles this in the least. Today, my physical yoga practice is interweaved throughout the day, with broader concepts in the background.
Most often it does not take place on my mat.
Most often it is less than 30 minutes at a time.
Most often it’s a response to whatever I feel might best serve me, at any given time.
No special place, clothing, or time.
Which I think might be a helpful way to practice for many who don’t have the time, money, or perhaps ability to get to a studio or gym.
What does this practice look like?
Join me over the next few months and we’ll look at little snippets of yoga, movement, breath practices that can be done in a couple of minutes or combined to make your own personal practice. On your own time, in your own space, that fits into whatever your life demands of you.
Most important to me is to teach people what they can do for themselves. Provide agency. The ability for you to have the tools and the freedom to make choices that enhance your wellbeing and your life.
In October we’ll focus on the feet.
November will be all about the shoulder joint.
In December, we’ll get into the hip joint.
I’ve chosen these particular areas to focus on as they tend to be where problems, pains, issues show up for most people I talk and work with.
People often sit at their desk, laptop, TV, or plugged into a smartphone with their earphones in. Listening to music, podcasts, videos on YouTube, working, or whatever.
As an experiment, the next time you put your earphones on, don’t ‘listen’ to anything except your breath.
It may not be as noticeable if you’re on the bus, driving, in an airport or a similar noisy environment. But, still, I think you’ll find it to be … telling.
How are you breathing?
Are you breathing fluidly?
Is there equanimity on the inhale and exhale. Or is one shorter or longer than the other?
A pause in between may be good. But do you find that you’ve actually stopped breathing? As in not breathing altogether of course, but that your breathing is not fluid. Easy. Continuous. That there is a long pause, perhaps, between the two. That you fail to begin the inhale, until long after the exhale.
Why might that be?
How do your neck muscles feel, while you’re noticing ‘this’ breath?
How does your torso or trunk feel?
How does your abdomen/belly feel?
Do you notice or feel anything at all?
Do you sense anything?
What might this noticing, this awareness tell you?
In the meantime, try this.
Inhale, and exhale, along with the shape below. Expansion, contraction.
I’m curious to hearof your experience.
I can say for sure, I noticed a few things about my own breathing patterns.
When there is quiet, what do I hear?
(Though we’re in the midst of a cold winter, I find I can ‘listen’ more clearly to my breath when swimming or floating in water, similar to listening with earphones in as above. Or if I submerge myself in bathwater. So choose what’s best for you, whatever might be your season.)
Most of the time I’m not sure where I’m at with my practice.
(I tend to substitute ‘my practice’ at any given time with ‘my life’, to get to the bigger picture).
Am I doing enough?
What should I be working on?
Is there enough time in the day?
What comes first?
What’s most important?
I used to get, oh, so bogged down in the details. I would be stuck because there were so many areas I needed to work on, I didn’t know where to start.
What I’ve learned over the past 3-4 years in looking at the research, the evidence about movement, manual therapy, yoga, etc. it’s become clear to me it’s not so much what I choose to do
… but that I choose to DO something.
Today I will go for a skate. Hopefully, I will remember to do a few useful stretches / movements before I begin. I know that doing these will be of benefit to me. Particularly in the cold weather and, well, because I’m getting older.
When I feel the muscles in my back, shoulders, and face tighten from the cold I will try to remember to release some of the tension there. Soften.
I will try to remember that LESS is MORE.
I’ve only been skating once this year, so it probably doesn’t make sense for me to skate the WHOLE canal.
Listen to the whispers that tell me when I’m feeling fatigued.
It is enough.
Sit back down. Unlace my skates. Grab some hot chocolate and call it a day, … well done.