Peeling Back the Layers

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:

  1. Annamaya kosha. You can think of this generally, as the physical layer.
  2. Pranamaya kosha, or the energetic layer.
  3. Manomaya kosha, or the mental/emotional layer.
  4. Vijnanamaya kosha, or the mind. We might also refer to this as intellect or wisdom.
  5. 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 education and 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).

categories-of-dimssims

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.

 

Yoga Classes for Pain Care

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.

If you’d like details about my Pain Care Yoga Classes click here, or for more information or to register, contact me here.

If you know others who might be interested, please feel free to share this with them, by clicking on any of the share buttons below.

Yes, we are connected

skeletons

Though I’ve been focusing on the feet these last few weeks, if you’re having problems with your feet you may also want to make some other connections. Yes, similar to what we’ve been exploring there are things you can do physically that will help. But our feet are connected to our leg bones, our leg bones are connected to our hip joint. Our hips are connected to our spine and further it goes, up the whole body.

We tend to look where pain expresses itself… and think we will find the solution there.

Some people may have knee problems and look to ‘fix’ the knee when really what’s happening (or not happening) is at the hips or at the feet. Or elsewhere.

Imagine you have a cast on your ankle and how it might feel when you walk. How your body might compensate. You may end up with a sore back or shoulder muscles as you try to move as best you can with a stiff, unable to bend, ankle. We’re not usually walking around with a cast on, but many people don’t really use a lot of their ankle flexion for a whole host of reasons. Shoes, patterns of movement, previous injury, etc. Pain may be expressed in your back or shoulders when what’s really going on is down at your feet.

People will often say, “yes but I had an x-ray or ultrasound and they found this (insert condition here) is wrong with my feet”. Yes, I’ve been there too. Diagnosed with chronic plantar fasciitis in both feet, osteoarthritis in both big toes. Basically, I was told to wear rocker shoes, orthotics, and live with it.

Orthotics absolutely serve a purpose in many cases but I’m not sure of any other body part we are willing to cast or brace for a lifetime. We might need a collar brace, but not forever. We may need to wear a special boot to help with a foot injury or after surgery. The point is we work hard, physiotherapists and others work hard with us, to remove these external or artificial supports. Our feet and some orthotics, in my opinion, should be no different.

After my own diagnosis and subsequently learning that our body will most often adapt to what’s asked of it, I figured there must be another way. I have put some effort and focus on my feet in many of the ways shown last month but what was happening in my hips (lack of strength and stability) also played a part.

There are often many pieces to the puzzle of long-term, persistent or chronic pain.

For instance, why was it my feet didn’t always hurt? Why only sometimes? Some days?

Paying close attention I came to notice that when under stress, under too much ‘load’, my pain was likely to arise or increase.  If I was out enjoying myself, not a care in the world, doing something fun or even necessary perhaps, I didn’t seem to have pain. But at other times, it most definitely kicked in.

The biggest a-ha for me now is to realize that structural degeneration or tissue damage is likely to show up for me and everyone else at some point (Note: Brinjijki et al 2014 study as shown in the table below). Particularly by the time you’re my age (56). I need not ‘fear’ this, or fear making things worse, but rather utilize all the things I know I can do, that might help with the pain I sometimes experience in my feet.

  • Strengthening
  • Stretching
  • Keeping my feet soft, supple, agile
  • Adding load, good stress, to keep the bones healthy
  • Wearing appropriate footwear; allowing for space, mobility, flexibility
  • Keeping my overall ‘weight’ in a manageable range
  • Knowing that my levels of stress, fatigue, diet and a range of other factors may also play a part.

degenerative spine issues

In the month of November, we’ll explore our HIPS (Yes, I switched my focus this month from shoulders to hips. We’ll get to shoulders in December). This is where load and/or gravitational forces are primarily distributed through the body so how well we manage this, matters.

Along the way, I’ll throw in a few morsels about chronic pain that might help you make sense of your own personal experience with persistent pain in the hips, or elsewhere.

I hope you’ll join me.

 

It’s your life

Consider the ways you need to use and move your body every day.

It's your life

Depending on your life, how much you move throughout the day may be fairly limited or alternatively, you might go through a whole range of movements.

Do you work in an office? Sitting, walking, reaching, writing might be some of the things you do in a day. I suspect sitting, is a primary one. Do you work as a plumber? Your movement needs are different than the office worker. As are what a doctor, teacher, hairstylist, service worker, etc. will be, who are often on their feet much of the day.

What you need to ‘train for’ is different than what anyone else needs to ‘train for’.

What a person needs who sits at a desk all day, is different than what a parent with toddlers needs, versus what a teacher might need.

train for your life

We sometimes get into trouble when we’re doing exercises, that don’t always or altogether correlate so well to what’s actually required in our life. If you’re exercising for basic fitness and enjoyment, that’s fantastic. That in itself is an achievement. But perhaps you might consider adding more to the mix if you’re someone who also experiences pain, fatigue, etc.

This is important:

  • If you’re hitting the gym every day, building strength and stamina but suffer from low back pain because you’re also sitting in a chair for 8 hours a day, perhaps you need to train differently or add something to your training routine.
  • If you are the most amazing yogi but suffer from hip strain or other pain symptoms because during the rest of the day you’re standing on your feet, perhaps you need to look at what you’re training for.
  • If you’re out on the golf course getting your exercise and fresh air daily, but cannot ‘do, or manage’ the rest of your life, perhaps you need to do something else as well.

What happens all too often is the hour of exercise we get at the gym, yoga studio or out on the golf course doesn’t quite support all the rest of what we need to do in our day.

  • If you need to sit, train as best you can so your body can adapt for this.
  • If you need to stand, train what’s required in order to stand a lot.
  • If you are the golfer, train for whatever it is you need to do, besides golf.

But how can you do this and where to find the time?

It’s not always easy, but you can learn to build it into your day. It doesn’t always have to take another hour going to the gym, paying for a babysitter, driving through the snow. There are simple tools, you can use. Anywhere, really. That don’t take up a lot of time.