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.

 

You are not too old. It is never too late, for your pain to change.

Yes, it’s my 58th Birthday today!

Like many people my age, we’re not looking so much to get more stuff. Rather, we’re hoping in some small way, we might make a contribution. Help others.

What does this mean for you?

Here’s the thing,

Do you suffer from persistent or chronic pain? Or know someone else who does? Are you tired of finding only short-term relief from pain?

Most people think that pain is inevitable as we age. I used to think so. Now, I know that pain can change. I see it all the time in the people I work with. Science, also tells us this is true. You can learn a bit about my own story of pain and how it changed a little later, but first here’s the deal FOR YOU!

Starting today November 25th until December 2nd, receive 30-40% off my regular pricing. See how you might change what is getting in your way, limiting your life, the contributing factors to your experience of pain. Check this out!

$58 for an initial 90-min session (approx. 40% discount) if you book this week!

$58 for a follow-up 60-min session (approx. 30% discount) if you book this week!
(All appointments to be scheduled between Nov 25th, 2019 and Jan 15th, 2020)

  • Book your first 90-minute session for $58 (regular price is $95)
  • Book a follow-up 60-minute session for $58 (regular price is $85)
  • Book a package of 4 sessions, 1-90 min and 3-60 minutes for $280 (regular price is $335)

BONUS:  You’ll also receive a FREE audio recording of a slow, guided awareness practice. With the usual busy, stressful holiday season soon upon us, this can be used for relaxation, to help guide you into to sleep or rest or just notice what you feel, what you might need on any given day.

GIVE BACK:  I will donate $5 to *Chrysalis House for each session booked, whether a first or follow-up session. Chrysalis House provides a safe and secure shelter to aid in helping and support those affected by domestic violence. Which tends to escalate around the holiday season. Together, helping others.

Email me at info@yogatoolsforlife.com or you can contact me here to book a session or for further information. To learn more about individual sessions, click here.

NEW LOCATION I have a new location for my private 1-to-1 sessions. Various opportunities presented themselves but when I heard about this space called “Comfort Corner” it sounded just right. Thanks to my local community for providing all the leads and contacts in/around the West Ottawa area when I went looking for recommendations. People helping people.

Pain is surely complex. Which is why looking for the ‘thing’ to ‘fix it’ usually doesn’t work.

You truly are unique. Each person I work with comes from a unique background with unique experience and their own history, body, circumstances and environment. We’ll work together in partnership to

  • explore what might be contributors to your pain,
  • how you might change things up,
  • create new patterns of moving without pain,
  • learn to move with more ease,
  • experience how YOU CAN modulate your pain

My goal is to help you learn to ‘be your own best resource. So you don’t have to rely forever upon me, or other health care professionals. You’ll have the tools, resources, information and practices to help you through the inevitable journey of life’s ups and downs. To live a meaningful and purposeful life, no matter your situation or condition of health.

I would love to work with you!

Group Classes are helpful for chronic pain but this 1-to-1 work can make all the difference. Why not see if it’s right for you? Or if you have family, friends or colleagues who you think might benefit, please share with them as well.

Email me at info@yogatoolsforlife.com or you can contact me here to book a session or for further information. To learn more about individual sessions, click here.

*Chrysalis House is a safe and secure 25-bed shelter in Western Ottawa. It is a place where a woman can go to protect herself and her dependants from violence and abuse. In this supportive environment, a woman can focus on her personal needs and choices, as well as on her dependants’ needs.

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.

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 and Science in Pain Care

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!

Additional notes:

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.

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.

 

The Evolution of a Practice

SimplifyWhen 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.

You can find me talking about this on Facebook, and Instagram, if you want to follow along.

 

“Are we there yet?”

squishedSummer has officially begun and soon many will be on their long-anticipated holidays. Most likely, it will involve some travel. And at some point the dreaded ‘are we there yet?’ You might think it to yourself or maybe your little travel companions repeat the phrase. On the hour. Time seems to drag. on. forever.

Why is it we dread the getting to, and coming back from, our trips?

Sure there can be unexpected delays or surprises that inevitably happen. But typically it’s the thought of sitting in our vehicle driving for 4, 8, or 12 hours to our destination. Or being crammed into the airplane for hours on end. Uncomfortable, to be sure. Not only being seated for so long but also waiting to eat on someone else’s schedule or getting to the bathroom when the need arises.

Most of us sit, for hours, all day long. Why then, does it feel different or more noticeable when we’re traveling? In an airplane, it’s not so easy to move around, to shift in our seats, when discomfort arises. In our cars, perhaps it’s a little easier with more room and not so many eyes watching us.

On most any day, we tend to listen to the hunger and thirst signals our body sends us, while other ‘discomforts’ such as simply moving, tend to be ignored. Why do we respond to some and not to others?

Which discomforts do we choose to tolerate? 

Little kids fidget, move, express themselves all the time. Until they’re told not to.

How might it feel …

to move and shift, and stretch and dance as you like, when you like? As you feel the need or desire to do so? At any time. Any place. Before, the discomfort pretty much commands that you do so?

When you are uncomfortable, how do you respond? Do you respond?

Hmmmmmm……