Pain is weird and it can change

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.

Or you can always contact me here, to ask any questions.

Nourishing, Responsive Breath

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.

What’s different?

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.

What might create this tension?

Last week, I suggested you might explore ordinary movements  you do in a day (like making your bed, maybe it’s vacuuming, perhaps while brushing your teeth) and are they perhaps a little beyond what feels easeful for you? It might be the way you feel while doing something, when rushed. When it feels like there’s not enough time and space to do so (maybe when you’re eating, for instance). Tension might have something to do with your thoughts and emotions. The context in which you live, the people you connect with, while talking, using (or not using) your voice.  

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?

If you’d like to read in-depth about the breath, yoga therapy, current findings, and research about breath related to pain care, you might check out Chapter 8 by Shelly Prosko, in Yoga and Science in Pain Care – Treating the Person in Pain.

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.

What might be needed in this moment?

When looking at this picture, I imagine I may have been holding my breath in the moment. Quite a natural response, if I felt I didn’t have quite the stability and balance required to make it to the other side without falling. Perhaps I did feel able, comfortable, and so my breath flowed easefully at the time. For the most part, whatever occurred was probably not something I noticed or was aware of at the time.

It’s interesting to note how our breath might fluctuate throughout the days based on different needs or experiences.

Last week I suggested rather than bringing awareness to how your breath moves, which is often what we’re asked to pay attention to I suggested we might also focus on when it doesn’t. When you might be holding your breath. I wonder how it went for you? Did you notice anything?

This week, let’s explore this a little more.

Today and tomorrow, why not pay attention to your breath while you’re moving or doing an particular activity. It might be during a time or activity from last week, when you noticed this momentary breath-holding.

Choose something where you are not pressured or rushed for time. Maybe it’s when you’re making your bed in the morning, or perhaps brushing your teeth. Another might be when your moving from sitting in a chair to standing up. Practice, allowing your breath to move freely as best you can, as an integral part of the activity. Notice, if the activity or movement is made easier or more difficult when you breathe freely. Try not to judge it as good or bad. Just be curious.

I’d love your feedback about what you notice.

Then on Wednesday, we’ll explore this in another specific activity in our daily life. You might be surprised. Check back then, or sign up below to regularly receive these blog posts.

Dentists, long journeys, work, life. The pause.

sculpture – National Gallery of Canada

A half hour in a dentist chair or a 6 hour drive. Both feel about the same to me.

Why might that be?

Though dentist chairs these days are made to be pretty comfortable, the tension, breath holding that goes on there, remains. At least for me, it does.

A 6 hour drive? Well, though probably not tense I sure can’t move around very much. And for someone with really long legs the cramped space and low seat really does me in.

Now imagine you’re at work, sitting with your laptop in front of you, working on a project that has you so engaged you don’t notice how 4 hours has passed. Or maybe 6 hours. Since you … literally … moved. When you do finally move or stand up your back, neck and shoulders are complaining. A whole lot. You might say to yourself, “ach, this back. Acting up again. When will this pain go away? Probably never. It’s always there, always going to get worse as the years go by.”

Or a similar scenario, but maybe your supervisor is breathing down your back. “Get me those numbers! Why aren’t you finished already? You know how important this is… why is it taking you so long?” I can well imagine those back, neck, shoulder muscles are having a say in how you’re feeling throughout your day, as well.

You might even find it hard to breathe at times. Do you even notice that happening?

What stresses might you have in a day? Why do we call it stress, anyways? Might it be this ‘stresses’ your body, as well as your mind?

What are those little niggly things creating sensations in your body that you’re not really aware of? Not listening to. Paying attention to.

Maybe it’s not the tension, tightness, pucker, hold-your-breath, kind of stress.

It might be more subtle. The slight contraction of your jaw muscles. Shoulders lifting ever so slightly as the minutes are tick, tick, tick, moving along. The gripping of your toes, or perhaps your butt muscles.

What consequences might these create in your body over long – periods – of – time?

This is not to say that all stress is bad. We need to stress the body. That’s why people hit the gym, run for miles on end, love – love – love a sweaty yoga class. Stress can be a good thing. Create a good feeling.

What we don’t want however, is the long – slow – drip by drip – neverending – periods – of – stress.

I bet you notice the BIG periods of stress in your life. Maybe what’s happening right now, for instance. The little, or more subtle ones? Likely not so much.

And if we begin to notice, what might we do to move out of this stress state? Do we have the flexibility, variability to do so?

Pause.

Notice.

Respond.

Repeat. Over and over.

Can we shift, from one state to another? Might we even begin to notice our ‘state of being’?

Difficult. Maybe if we slow down, find some stillness, time or space. Find that pause.

A 4-week Workshop to notice what’s ‘Just Right, For You’.

It might feel good to move it!

Anxiety. Worry. Stress. Fear.

These are uncertain times and so many are feeling vulnerable, whether it’s about health, financial security or so many other concerns.

And yes, there are times when it’s helpful to quiet the mind, tame the thoughts, seek some silence, stillness and perhaps peace in all the chaos.

However, that isn’t always helpful. Doesn’t always work.

I know myself when I am stressed what helps me most is to move. Yes, I start cleaning my house when wound up, upset, feeling anxious, or stressed. There is something about burning off energy that might help to bring some space for quiet, relaxation, peace when you’re done. It might help you sleep. Maybe calm your nervous system. After all, when we are in crisis or feel threatened the nervous system is all about getting your attention, mobilization, preparing for action that might be required.

What might be helpful for you? Below are a few ideas, you might like to try:

  • Put on some loud, upbeat music and move in some way.
  • Dance.
  • Clean. Get at those windows and at the same time get some fresh air when you’re opening them or stepping outside.
  • Practice yoga, tai chi, whatever floats your boat.
  • Lift some weights.
  • Get on that ‘dust collector’ piece of exercise equipment sitting in your house and expend some of that nervous energy.
  • If you’ve got a few extra pantry items that you seemingly stocked up with, bake.
  • Cook.

Let me know how it goes. I know after working at my desk today, I am feeling the need to get up and move it!

Take good care of yourself (and others).

**If you’re feeling distressed, please be sure to reach out to a local resource. For those in Ottawa, call the Ottawa Distress Line

613-238-3311

What outcome, or benefit might you expect from attending Pain Care Yoga classes?

don't lose hope picWell, 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.

If you’re interested in how this might work for you, the next 6-week series of Pain Care Yoga classes begin at the end of February. I’m also available for one-to-one in-person or ‘zoom’ online sessions and would love to hear from you.

 

Who Attends Yoga Classes for Chronic Pain? All kinds.

hearts croppedMost 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.

 

 

Let’s Get You Moving Again

Back facts

The Editorial in the British Journal of Medicine (BJM), begins

“Low back pain (LBP) is the leading cause of disability worldwide, and is often associated with costly, ineffective and sometimes harmful care.[1]

I’ve written about this before, here.

What drives disability and poor care?[2]

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.

  1. 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.
  2. Buchbinder R, van Tulder M, Oberg B, et al. Low back pain: a call for action. The Lancet 2018;391:2384-8.

 

Taming the Beast, that is pain

Professor Lorimer Moseley explains how pain scientists are making amazing discoveries that can help you understand your pain, the first step in taming the beast.

As you’ll see, pain always involves the nervous system and how your nervous system can be retrained.

  • “How do you know if your pain system is being overprotective?”
  • “How do you retrain your pain system to be less protective?”
  • “How do you know if you’re safe to move?”

Learning a little about pain neuroscience education can be helpful. [1]

What complements this is not only learning but experiencing how YOU can change or modulate your nervous system.

Use the tools yoga has to offer; gentle movement, breath and awareness practices… to soothe and calm the system. To ‘Tame the Beast’.

You can find more information and resources at TameTheBeast.org.

[1] Louw, Adriaan & Zimney, Kory & Puentedura, Emilio & Diener, Ina. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice. 32. 1-24. 10.1080/09593985.2016.1194646.

I have chronic pain & you want me to do Yoga? Yes, the two can go together. Learn how.

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
  • breath practices
  • meditation or mindfulness practices
  • awareness 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 info@yogatoolsforlife.com

** Tuesdays and Thursday mornings in Stittsville, starting November 5th.