Do you know that you can experience a HUGE amount of pain, yet have no damage or injury in your body?
Have you ever heard of phantom limb pain? It’s when someone experiences pain, yet they don’t even have the body part? Think of someone who’s maybe had their arm amputated but still feels pain there. How can that be?
Or maybe you’re someone who has been diagnosed with fibromyalgia. No obvious damage or injury can be found yet absolutely, you feel pain.
Do you know the reverse is also true? You can have NO pain and yet have ‘damage or injury’ in your body?
Have you ever found a bruise on your body yet had no idea how it got there? Or maybe you broke a bone playing one of your favorite sports but didn’t really feel pain, until you got to the hospital? There was obviously tissue damage, yet no pain. At least at first, perhaps.
Maybe you’re someone who has disk degeneration, yet no pain. According to this study (brinjikji et al 2014) if you’re 60 years old, 88% of people whose back has been imaged will show disk degeneration, yet experience NO pain. If you’re up to 70 years of age, it’s up to 95% who have what looks like damage or injury and yet has NO pain.
When you have a headache, think of a really, really painful headache, … do you think you have something broken or damaged in your head? Likely not.
So why do we think that way about other parts of our body?
Pain is weird, for sure. And complex. And our understanding of it does not always match with what’s going on. Often, we are confused by it, don’t know what to do about it and just live with it.
Don’t get me wrong. You NEED pain. Otherwise you would likely not survive. You need a mechanism to tell you something is up and you need to attend to it.
It’s the persistent chronic pain that seems to be the trouble. In Canada and most places around the world, 1 in 5 people live with it. If it were an easy fix, we would have done so by now. Two areas that the evidence tells us seem to be most helpful are: understanding pain and movement. We’ll cover both.
Well, there is more to it but if you’re curious to know how you might change, how you can influence your own experience of pain, I’d love you to join a new 6-week online program starting July 22, 2020.
Advantages of this being online?
anyone can take it in the privacy of their own home,
at their own pace
all the content is yours to keep forever, and
I’ve made it affordable and accessible so anyone can enroll. $25 week, for 6 weeks (both a payment plan and options are available).
If you or someone you know might benefit, click the link below for all the details.
I could really go on and on about breath, from many different angles and actually have been sent down the rabbit hole for a few days now wondering how I might approach this, in a single blog post.
Our breath, the in-breath and the out-breath happen quite naturally, right? Of course, they do. It is one of the most important things necessary to our survival. We do not have to think about it. It is just one of the many wonderous systems in our body, working behind the scenes.
However, if you look at how a baby breathes, and how many of us older folks breathe, you might notice a difference. How in babies and young children it almost seems like their whole body moves when they breathe. How their big, soft bellies expand with each inhale. For us, often, not so much.
There could be a whole mess of reasons, but the one I’ll explore here is one you’ve perhaps been exploring over the past week.
Muscular tension might be involved when we hold our breath, or when it doesn’t flow so freely.
Generally, muscles and tissues may become strained, fatigued over time if they are recruited, or over-recruited, ‘switched on’ a lot. We may not be aware of this, particularly if ongoing over a long period of time. It often becomes our usual ‘pattern’ rather than what might be a responding or releasing (and relaxing) as required.
There are also some areas of the body where this tension might get in the way of a full, easeful, ‘natural’ breath we see in a baby. I think of the stomach or belly area for one. How many people unconsciously hold or constrict in this area for a multitude of reasons? This, which happens to be the area containing your primary breathing muscle, the respiratory diaphragm. Or might someone hold tension unconsciously in their pelvic floor (diaphragm) muscles, again for a variety of reasons? I think of all those ‘core exercises’ we’ve been told are good for us or how often women socially, culturally, ‘suck in their stomach. Or perhaps you’ve been told to do kegels at one time or another, or hold, strengthen or tighten up your pelvic floor muscles. Which may be useful. Or maybe not.
Both diaphragms are meant to move with each breath yet with tension and tightness in one or both, might this change how we breathe?
Holding tension might not allow for a full, deep breath such as when our respiratory diaphragm moves down, creating the in-breath. Maybe, we hold tension in the pelvic floor, without realizing it and again, not allowing for optimal breath.
Now, think about what is more important to our body, to our brain, but breathing. And how this regular intake of oxygen not only provides nourishment our body needs to survive, but it also forms or influences our physiological state. For instance if we are under threat, or even perceived threat there are immediate changes to our physiology, including our breath, that takes place to aid in our survival.
Which is all great when we’ve broken a bone, need to pull our hand away from fire, stay clear of toxic fumes or something similar. Back in the old days, we would need all our senses, these sensations, to help us stay clear of dangerous predators like tigers and the like.
What happens now though, is often we are unaware of:
1. The threats (real or perceived) that we encounter on a daily basis. These aren’t likely threats like running from tigers, but threats in terms of our relationships, our jobs, our finances, our communities, our environment. How much of the news do you see, threatens your sense of safety? Does this create a sense of tension, stress, holding of your breath perhaps, in your body?
2. The response of your nervous system and subsequent physiology that accompanies this. You may have read that stress is not good for the immune system, for your mental health, etc. but there are also effects on other areas or systems that occur including your pain system. If pain is meant to protect you, yet you ‘feel’ threatened, stressed, and tense might that turn UP the volume of pain? Have you ever noticed a correlation (not saying cause, here) in your stress levels and your pain?
Conversely, how might a sense of safety, turn DOWN the volume of pain? Even a few simple words from a parent to a child such as “you’ll be okay” often turns down a pain response.
Can we learn to notice our breath and what that might tell us about how we feel?
Can we find a breath that is supportive for us, when it’s called upon?
Can we find a breath that is supportive for for us, when we need rest, find calm, sleep?
There is no right or wrong in this.
Rather, can we find a responsive, flexible breath that supports us for whatever it is we’d like to do? To live in an optimal state of health? As a first step, can be begin to notice this at all?
Personally, attention to breath and subsequent practices has had the most influence I find, when working with people who experience persistent pain. Time and time again. Though as Shelly rightly points out “the practices must be individualized to meet the unique needs of the person.” Telling people to take big, deep breaths, may not be ‘the answer’ or ‘the fix’ for everyone which is often what I see out in the main stream media. Suggesting there is some kind of ‘ideal’ breath, for all people, at all times.
I was looking at this tree (pictured above) in my back yard at lunch time today. It sways and flows. Appears strong, yet supple. Not rigid, brittle, tight or constricted. Takes in nourishment, gives back some. Might we be like this tree … A breath in. A breath out. Responding as need be, in any given moment to what life is asking of us.
I’ll be diving into this in more detail with information, a little bit of research and experiential practices in Week 4 of my upcoming online ‘Creating New Pathways‘ course. Want to learn more?
Interested to learn more about this thing called ‘yoga therapy’? Some FAQ’s plus links for ways yoga therapy can help, information for healthcare providers, where we’re at in terms of current research and yoga, yoga therapy.
I look at these flowers and wonder what happens between having a felt sense of freedom and space or that of feeling tightly clenched and constricted. What creates the dance between these two opposites in my my body, my breath, perhaps even my voice?
Recently I find myself rather tongue-tied, influenced each day by current events.
We celebrated Canada Day on Wednesday. Yes we did. Yet, this celebration doesn’t quite feel the same for me these past few years, given what I’m seeing and learning about our county’s history and what Canada Day might (not) mean for our indigenous population or others, unlike me.
I wanted to acknowledge how much I love this country. Having lived abroad for so many years I hold deep appreciation for not only the land, but the culture, society, values, all it’s people. Yet I didn’t want to not also acknowledge it’s dark history and so… I mostly said nothing.
I find uncertainty in knowing what to say, how I might use my voice regarding events unfolding, day by day. How #blacklivesmatter. The need to acknowledge the disparity and racism that exists. Which is not recent, but rather long standing. I still don’t know how to express my thoughts, even here, as I write. I have much to learn and therefore … I mostly, say nothing. Yet, that can’t be right, either.
There’s no way forward in standing still, or silence.
Usually I love to talk, to speak out, as noted in my last blog post. So this not talking does not come easy to me. However, I do notice times, places, situations where I expressly, consciously ‘hold my tongue’ as they say, for a wide variety of reasons.
What happens when there is something you want to say, but you’re afraid to say it? How does this happen in my body, this holding back, this silencing? How do I manage this? Surely, musculature is involved. Therefore my brain, my nervous system play a part. A thought or feeling proceeding it.
I wonder what happens to my breath, when I consciously hold back saying something? When there is a conflict between what I want to express but am unsure how to proceed? Or, perhaps if I don’t believe what I have to say matters. Or maybe this expressing of my self, is not welcomed in a particular environment or social context?
What effect might that have on physiology, my body, my breath? How do I even notice that in my body? What do I feel, how does that feel? Do I even notice when this occurs?
Do you ever notice for yourself, times when you don’t express yourself, hold back on your opinions, aren’t sure what to say? I can say there have been more than enough times when I have done so. In work situations, for sure. But also with family, friends, even strangers I encounter. For me, these are often situations when there is discomfort, conflict or uncertainty already permeating the air, circling into the mix. It is a pattern, I’ve come to recognize.
Today and over the weekend, try this: notice what happens to your breath when you speak with someone. Notice if you pause, give yourself time to think about your response. Notice if you allow others to complete what they’re saying or do you tend to interrupt? Can you feel your breath supporting your voice or does your voice or breath feel held, or tight? Can you notice any of this happening to the person you’re in conversation with? Do you feel comfortable or uncomfortable in what you wish to express? Do you hold back?
Or the opposite. What do you notice about your breath, your voice, when you’re singing your favorite song or in easy conversation with a trusted friend or partner?
What allows one to open up, speak freely? What might not? How might paying attention to your breath be an indicator of this?
I’m interested, to hear how it goes for you. Anything you notice about your breath, your voice. Your thoughts as you begin to speak or decide not to speak. What happens? How does it feel?
Let’s circle back on Monday and consider how our breath might have some influence or relationship to discomfort, and perhaps the experience of pain.
“Your graduation exam for this exercise is to practice breathing during an argument or confrontation”. – Donna Farhi
If you’re interested in diving into this type of exploration or other practices and how they might influence your experience of pain, I offer online 1:1 private sessions.
Such a beautiful tray of food. No wonder eating comes naturally to me. Rather like breathing. But it may not be so for you and I suggest that perhaps our breathing is not always natural either, but is rather responsive and adaptive.
I experience this in other areas of my life, as well. For instance, everything about being a mother did not always come naturally for me. It began with a struggle to breast-feed our first born. I became anxious, stressed and upset when this did not go according to plan. I had to make a call for support and learn from someone. All was well, soon enough.
Next, however, was being home alone all day in the dead of a cold Canadian winter with a baby, requiring so much time and attention. Not only exhausting (compounded by sleepless nights) but the social isolation I experienced was new to me as well, and did not come naturally. Knowing what to do, how to best raise this human being was a challenge. Parenting as being ‘natural’? In some ways, yes, of course. In many ways, not so much. When it didn’t feel natural, I felt like I failed, somehow.
Back to food and eating though. As I said, it does come quite naturally to me. In fact it comes to me far more often than I might need. Hard to resist when images like the one above, presents itself.
Mostly, we don’t pay much attention to these natural things we do until they become a problem, an issue somehow, in how we might like to live our life.
For today’s exploration let’s combine breathing with eating. How might that go?
Much to my family’s dismay I have a tendency to choke, fairly frequently, when eating. Part of it, I’ve noticed, I’m often rushing. Second to that, I’m often talking. Our dinner time is ‘family time’ and usually consists of our coming together prepared for much debate about the events and/or news of the day. When given the opportunity, I do as well, love to talk. Rather similar to the eating thing.
Meanwhile, what’s more important to survival than breathing?
Breathing is going to sneak in ‘as needed’ whether we want it to, whether we make time and space for it, or not. Whether we’re conscious of it or not.
I wonder how eating might go for me if instead of paying attention to what I eat, how much I eat, or when I’m talking, I might just notice how I breathe when I eat.
What might that bring to my awareness?
Perhaps there is something around eating that might be noticeable for you. Maybe instead of choking like me, perhaps you have a tendency to over-eat, or it could be you under-eat. Or perhaps you have some digestive issues.
Try this: Set aside one meal a day in which you do not feel any time constraints. Let yourself breath slowly as you eat. Notice how it feels to allow your belly to release as you chew and swallow your food. Monitor your breathing if you can. Notice what you feel during and after your meal. Again, try not to judge anything. Perhaps there is nothing to notice or perhaps there is.
Curious, isn’t it?
Check back on Friday when we’ll do one more exploration and it is a worthy one, I think. Also, I wonder how the movement and breathing exploration went for you, from earlier this week. You can sign up below to get all these posts.
Also, just to let you know, I’ll soon be announcing a new 6-week online course where breath is one of the things we’ll be exploring and working with. One piece of the puzzle, when we explore various aspects to consider if you experience pain. You can learn more about the ‘Creating New Pathways’ program by clicking the link below.
I was having a discussion with a client this week about the breath and how we breathe. We were talking about the relationship between our body, our breath and how breath moves in relationship to gravity. The forces of gravity, the loads we feel.
Breath awareness is often a focus in yoga. Both in yoga classes and also in a more therapeutic practice of yoga. We spend a lot of time noticing breath, feeling the breath as it moves. Noticing the length of breath, the inhales, the exhales. Where we feel the breath move, in our body.
Taking a different path, perhaps we can explore how breath might not always be moving, or moving so well. As in when you’re holding your breath. Which you might not readily notice throughout the day, unless you pay attention to it.
The basis of this inquiry is from Donna Farhi’s The Breathing Book (highly recommend the book). She states the purpose of the inquiry being:
To identify the situations and activities in which you most commonly engage in breath holding. We don’t usually recognize how much tension we invest in simple activities such as talking or cooking because we don’t recognize the situation as terribly stressful. You may be surprised and disconcerted to discover that you hold your breath in almost every conceivable situation.
Let’s check this out.
Starting today and for the rest of this week, take notice of when you hold your breath.What you’re doing when you hold your breath. Where you are, who you’re with. Make a mental note, or actually write it down so you don’t forget.
You may notice it when you’re speaking on the phone with someone. Perhaps your boss. Or you may notice it when you’re leaning over to make your bed. Or you may notice you hold your breath when your attention is really focused on something, like when driving down busy streets.
Then, you might want to see if you can change it in some way. Just breathe a little more freely if you can. Try not to judge anything, just notice.
I’ve noticed this pattern of breath holding in myself, particularly, in these days. Before I started wearing a mask I would sometimes catch myself holding my breath as I walked by someone. Or when I felt they were standing too near to me. I suspect there was some fear involved in my response. It’s like I didn’t want to take breath in, at that moment.
We’ll do more specific explorations, next week. And maybe get a little curious about how this might affect or influence pain.
Check back with me on Monday (June 29th) for more. In the meantime, keep noticing.
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.
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 email@example.com
** Tuesdays and Thursday mornings in Stittsville, starting November 5th.
Similar to the current biopsychosocial model used in the medical community when working with people suffering from chronic or persistent pain, yoga therapists utilize a comparable framework or philosophy, that being the panca maya kosha model.
The felted model above (by my colleague @meyogalune) beautifully illustrates how we might look at, explore and peel back the many layers of our existence when working with someone therapeutically. We are, after all, more than a body of tissue and matter.
What does this mean, exactly?
Let me provide a very general, simplistic idea of what each represents:
Annamaya kosha. You can think of this generally, as the physical layer.
Pranamaya kosha, or the energetic layer.
Manomaya kosha, or the mental/emotional layer.
Vijnanamaya kosha, or the mind. We might also refer to this as intellect or wisdom.
Anandamaya kosha, or the spiritual, blissful layer. What I prefer to call the meaning and purpose of someone’s self, or life.
What happens sometimes in our current medical system is the person is looked at, evaluated by and treated in terms of the physical layer only or from a biomedical model, rather than a biopsychosocial model. This can be due to a multitude of reasons but I’ll highlight just a couple, below.
One, that may be surprising to you, is how many of our medical professionals are provided little training, specifically, in pain. (1) “In a review of 10 Canadian Universities across 7 provinces… 68% of programs were unable to specify any designated hours for pain educationand veterinary students were shown to receive 2-5 times more pain education than that of health science students (Watt-Watson et.al., 2009). Educational content also typically lacks integration of biological aspects with the psychosocial factors that contribute to the experience of pain (Wideman et. al., 2019b).”
Another reason might also be lack of time that’s allocated to people given our over-burdened system and/or accessibility into “self-management programs that educate people about their condition and build their capacity to take action.” (2)
What is now understood about pain and as stated in the IASP definition, pain is “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. ” You might think of it as an ‘actual, or potential threat to the system’, that system or organism, being YOU. Your whole person.
And often these threats to the system are just under your level of awareness. Or as David Butler says “DIMs and SIMs can hide in hard to find places”. Referencing DIMs as being the Danger in Me, while SIMs as being the Safety in Me. (If you want a brief explanation of this concept, here’s a link.)
We will experience pain when our credible evidence of danger related to our body is greater than our credible evidence of safety related to our body. Equally we won’t have pain when our credible evidence of safety is greater than our credible evidence of danger (Moseley and Butler 2015, pp14).
People sometimes think that their pain problem is, or must be, something physical. Or, sadly, they think or are told, that its all in their head. Pain is complex and by bringing a sense of curiosity to explore many areas, layers or koshas and how they might be affecting you either positively (perhaps a SIM) or negatively (maybe a DIM) we might just change this human experience, we call pain. Your experience of pain.
If you’re interested in exploring this further, I offer both private sessions or group classes utilizing this approach. Along with awareness, exploratory and gentle movement practices, I always add in an educational aspect or some yoga philosophy in line with what we know about pain and how you can learn to be your own best resource. Click here, to see my current schedule.
References above are from ‘A Report by the Canadian Pain Task Force, June 2019’. You can read the full report here, if interested.
(1) “…the current state of pain education in Canada remains inadequate across disciplines, with significant knowledge gaps in both pre- and post-licensure contexts (NASME, 2019; Thompson et. al., 2018).” On page 21 of the report.
(2) “Research in 2005-2006 indicated the median wait time for a first appointment at a MPTC was 6 months….. In a recent update to this work, researchers found little change in the wait times, noting in 2017-2018 the median wait time still hovered around 5.5 months, with some people waiting up to 4 years to access to multidisciplinary pain care (Choinière et. al., 2019).” On page 18 of the report.
When people want help with a problem (like pain) they most
often want to know
How to fix it
How long it will take
My last few Instagram posts were shoulder movements that you
might have found helpful. So, if you came to me asking for help in regards to
shoulder or perhaps neck pain, would I choose to have you do them as thething for you?
Maybe. Maybe not. It
You see, the thing for you is likely not to be the thing that helped me or someone else for that matter.
Which is why looking to find the thing or the fix for chronic pain often leads to frustration. Or further
along the line, a sense of hopelessness.
There are variables between you and I not only in our
physical structure, but also other areas that affect what we might feel or
experience in any moment, on any given day. Particularly when it comes to pain.
And most often, it’s usually not just one thing.
Over the last couple of months, I offered up some movements specific to feet, hips and shoulders that you might have found useful. Whether you’re seeking greater mobility, ease, gaining more awareness or perhaps you’re trying to overcome some issues with regards to chronic or persistent pain that you experience. It can take some time to make progress, or it can actually be rather quick in learning what does, or does not provide relief for you or at least the ability to move with more ease.
I find it most hopeful to know there many things we can try along the way.
And no, it’s not just cherry-picking, or somehow blindly choosing, either. What’s been learned over the years in regards to pain is quite different from our understanding of the past in terms of causation and most important, what might be effective treatments.
It’s now understood that long-term pain is poorly correlated to tissue health and science shows us that it is both complex and often has a multitude of factors. We do feel pain IN our body. However, it is often a nervous system issue… which often increases our sensitivity to pain. We can affect our nervous system. We can affect change. We can affect our physiology. Which is what makes this a hopeful message.
For the most part, any movement you add into your day and into your life will be of benefit. What’s key while moving is for you to build awareness of what works and what doesn’t for you. What feels right and what doesn’t, for you.
If you learn to pay attention to even the most subtle of sensations, you’ll begin to notice and learn all kinds of things about your body and your self which will lead to the other things, that often play a part in your unique experience of pain.
So it’s not just one thing. Or the thing. Or your thing. Or my thing.
What are the other things, that might be contributing to your experience of pain? More to come…
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.