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.
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.
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.
How might we blend yoga with science to provide pain care to people? A new book just released provides a way forward.
“Our vision is for this book to improve care for people living in pain, whether acute or chronic pain. We believe health care professionals and yoga therapists can enhance care through deeper understanding of pain, science and evidence-informed interventions. We also believe that professionals can enhance their work through integrating yoga concepts, practices and philosophies. As such, this book is meant to bridge yoga, pain science and evidence-informed rehabilitation … and will inform those committed to helping people with this largely undertreated issue that causes so much suffering in the world.” – Preface, Yoga and Science in Pain Care; Edited by Neil Pearson, Shelly Prosko, Marlysa Sullivan
The first chapter by Joletta Belton is about the “Lived Experience of Pain” highlighting to me the need to listen to, acknowledge and consider first, the person and their experience.
“The authors provide an integrated, in-depth understanding of how yoga therapy can be incorporated within a modern understanding of pain as an experience. The book encompasses perspectives from people living with pain, summarises research progress in the field, debates theories of pain and pain management, considers the many different yoga practices, describes pain biology, self-regulation and examines breath, body awareness, nutrition, emotions and response to pain, and above all, integrates concern for practitioners and people in pain as humans sharing an intangible experience together. The authors write about how yoga therapy can provide a uniting and compassionate approach to helping people learn to live well.”
– Bronwyn Lennox Thompson, PhD, MSc, DipOT, Postgraduate Academic Programme Leader, Pain and Pain Management, Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, NZ
There are a lot of yoga books on shelves these days. Yoga for this, yoga for that. You name it; it’s being written about. The trouble with this and certainly when talking about pain is the approach is about the condition, the problem, the illness or disease. What’s often left out is the person. Which may be one of the reasons why we fail in helping people.
After all, your pain is not the same as my pain. Not only is the physical aspect different, my body different, my genetics, my structure. Almost more important is the rest of ‘me’ that’s different from ‘you’.
My life history is different from yours. My environment is different from yours. My stressors are probably not your stressors. My understanding of pain probably differs from yours. My expectations, beliefs and thoughts about my pain will be different from yours. My social structures, friends, family, work-life will all be different. So how might we believe we can just apply this ‘fix’ to everyone who experiences pain? It just doesn’t make sense, when you think about it. Particularly when we understand that pain… is… complex.
We, therefore, should look to explore and be curious about all the things that might be contributing to your particular experience of pain. Similarly, individualize the care, tools, techniques and practices with what research tells us might be useful, to change your pain.
You may have had pain for years. Like 30+ years or more. Still, there is an opportunity for change based on what we know about pain and how it works. There is much still to learn but we can change the nervous system, We can change the brain. We can change physiology and most likely all three of these have been changed if your pain has been ongoing.
Pain can change. There is hope. I will keep saying this over and over and over again …
If you’re the type that likes read and learn about this yourself, order a copy of the book, here.
If you’re the type that would like to learn from me in person or in a class setting with others, check out my updated schedule for the fall, here. New classes starting in September!
Joletta Belton, as noted above, writes a blog “My Cuppa Joe” about the lived experience of pain. Among other things, she is a speaker, educator and advocate for people in pain. You can read her blog, here.
Bronwyn Lennox Thompson also writes a blog “Healthskills: For health professionals supporting chronic pain self management.” An exceptional resource for information, research, and discussion. You can check it out here.
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…
I’m going to challenge you to change things up this week. Whatever you think you should be doing, (in a movement, in your posture) whatever you’ve been told to do… do the opposite.
As an example, while you’re sitting during the day:
If you have a tendency to hold yourself rigid, perhaps with your shoulders pulled back, chest puffed out front, sitting up nice and tall, as some would say ‘good posture’, allow yourself something different. Perhaps slump a little, let the upper back round a little, feel as if you can soften the area between your collar bones, let your belly be soft and full when you breathe. RelaxI’m not saying this is what you need or you should sit this way all day. But try it for a few minutes and notice what you feel.
If you tend to be someone who is generally in a slumped position when sitting, try the opposite. Feel your sitting bones on the bottom of your chair, perhaps even pushing them into your chair slightly. Think about sitting tall, imagining your head feeling light above your shoulders, it lifting towards the ceiling. Collarbones wide, shoulder blades down your back. Notice what you feel.
Though this is only one example. You might try this way of being, or doing, in a multitude of ways.
In yoga, do you always exhale when forward bending and inhale on the reverse? Try changing it up and see what you feel. What do you notice?
Experiment with doing the opposite of what you think is right for you, what you’ve been told is right for you and see how it goes. If you like, comment below so we can take the conversation further.
I’ve also learned it seems we may have been ‘wrong about stretching‘ insofar as we’re not really stretching or lengthening muscles. At least not as much as we once believed. Rather, we’re changing our response to a stimulus via the nervous system.
Our brain is naturally going to respond in a protective manner to anything it perceives as dangerous. If we are trying to re-train flexibility or just movement in the body and do so with strong, forceful pressure or stimulus … the brain/body will react by saying … stop! No! Don’t go there. It will send a (pain) signal to safeguard our movement.
However, if we move in small incremental ways within a safe and pain-free range of motion, the nervous system will react by saying … this feels okay. Safe. I’m happy to explore this.
This is a somewhat simplified way to explain all that’s going on, but it’s a starting point we can work from. We can even begin by just imagining movement and still create changes in the brain and our nervous system. So we can, really, start anywhere.
By learning to pay attention, moving in a way that allows your nervous system to adapt and create new patterns while it feels safe, you will make progress.
This provides HOPE to anyone living with pain, chronic pain, limitation to mobility or perhaps psychological pain (or unease) from the stress, anxiety, depression, insomnia that often accompany physical pain. All of which are common problems affecting a large proportion of our 21st Century population.
The experience of pain doesn’t necessarily correlate with the state of our tissue.
You may see some awful looking images on an x-ray and yet not experience pain. You may experience pain, though not even have the limb that pains you (phantom limb pain).
What I continue to learn is we really can’t be absolutely sure, about any of this. But, stay with me …
As soon as I discover something to share or write about on a blog post, it may soon be out of date. Though research leads us in the most reliable way we know at any one time, it’s only as good as the next study. Knowledge changes, books get re-written.
There is the constant discovery of what we thought we knew, what we’re now learning and what’s yet to come. As in life itself.
As I stated before, pain is indeed very complex. I’m not sure anyone knows with certainty what causes and therefore eliminates back pain, for instance. But I have seen it dissipate almost immediately and over time for those who once believed it cannot, or never will.
For me personally? Today’s x-rays and ultrasounds will likely show arthritis and chronic inflammation / plantar fasciitis still exist in my feet. I do know, however, that my feet (legs and hips) have dramatically changed by working with awareness, changing movements and therefore re-patterning my nervous system over a relatively short period of time. That, and a whole host of other changes to sacroiliac (SI) joint pain which no longer exists, shoulder impingement being resolved and hip bursitis… almost there on it as well.
So where does this lead me, or you, or anyone else?
Are you resigned to thinking it ‘just has to be’ this way?
What is it you REALLY want to be able to do?
Many people I speak with and work alongside are/were just like me and don’t know what information or skills they can learn and use to help them move better, sleep better, feel better.
If you’re someone who’s looking to create better health and wellbeing for yourself or others, you’re in the right place. I provide information, resources and tools that are simple and doable by anyone, anywhere and at any stage in life.
Yoga is unique as it helps to focus your attention. You learn to notice, sense and see what might benefit you in terms moving towards long-term health and healing.
Look at a baby or a young child for a few moments and you’ll notice they make all kinds of movements, in all kinds of ways. I watched a video yesterday and thought back to the crazy, wild, wonderful things we did as kids with no thought or consideration about how to move our bodies.
Look at old or aging people and what do you notice? …
Why is it you sometimes need to visit a doctor, chiro, physical therapist, massage therapist, etc. time and time again for the same problem? They adjust you, work with you in a manner that seems to provide relief but within a few weeks or months, you’re back in their office again. I have been to them all and credit is due in helping with immediate pain or to fix something.
One of the most important changes in the last 14 years or so is the emerging field of neuroplasticity.
Years ago, when our kids were little, I recall speaking with my cousin who has a degree in psychology. We spoke about the development of children and she told me how important it was to interact with them, stimulate them, provide them with challenges. The reason being, that “scientists once thought that the brain stopped developing after the first few years of life. ….
What I also continue to learn is we really can’t be absolutely sure, about any of this. But, stay with me …
As soon as I discover something to share or write about on a blog post, it may soon be out of date. Though research leads us in the most reliable way we know at any one time, it’s only as good as the next study that proves it is slightly different than we first thought (see neuroplasticity).
There is constant change in what we thought we knew, what we’re now learning and what’s yet to come.