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.
The second question people often ask me about Pain Care Yoga classes, after “who is it that comes to these classes” described here, is “what do you do in them”?
Pain is never just about one thing. You want to know what’s wrong. How you’re going to fix it. And how long it’s going to take. And rightly so, as having long-term pain often changes everything for you and how you live your life.
When it comes to pain, however, it is usually not that simple which is why searching for ‘the thing‘ usually doesn’t work in the long-term. Particularly if you’ve had pain for a long time. Which doesn’t mean to say that it can’t change. It can. We know what can help to bring about change, the best practices research points to.
Two key aspects, education … and movement, are important. So that’s what we do in these classes.
Some kind of education piece, usually at the start of the class, is provided. I only spend a few minutes on this, but it’s important to do so. One of the most common things I see with people in pain is the fear of moving. If I can help you to understand why it might be safe to move and why it’s important to do so, that’s a good place to begin.
“Current evidence supports the use of pain neuroscience education (PNE) for chronic musculoskeletal (MSK) disorders in reducing pain and improving patient knowledge of pain, improving function and lowering disability, reducing psychosocial factors, enhancing movement, and minimizing healthcare utilization.” 
Then, you practice. You get to experience how you might move, with guidance and guidelines, to learn what’s right for you. Which often won’t be the same as others in the room.
This is not a typical yoga class with sun salutations, downward dogs, lunges, forward folds, backbends. It is not even what I would call a ‘gentle yoga class’. Yes, we use slow, gentle movements. Yet, sometimes you might begin by just imagining the movement if you don’t yet feel safe to do it. Or you might practice it in your mind, plan out how you might go about it and if it feels right for you. It is always your choice to do or not do anything presented in class. You always get to decide how to move, how far to move, by using a slow, mindful exploration along with guidelines and principles utilized.
Most movements are fairly simple and modifications are always available. You’ll experience a lot of repetition, and rhythmic movements. Movements that cross the midline of the body. Movements that challenge your brain as well as challenging your body. You, anyone, can really begin wherever you’re at. With what’s right for you.
There will always be some kind of breathwork or a breath awareness piece in the practice. Again, it’s not so much about controlling the breath, rather what you might notice about your breath. How breath can be an indicator of your physical and emotional state at any given time. Also, learning how breath can help to bring about change to your nervous system, physiology, which can then change your experience of pain.
Like breath, awareness is key. So often when you are in pain the last thing you want to do is pay more attention to your body. But in fact, this paying attention is your guide to changing pain. It is in this noticing that you can begin to explore what the signals (or sensations) you feel might be indicating, what might be your unique contributors to pain, what might be the reasons for flare-ups. This practice is not only about noticing your body in class but then also paying attention to your whole self in your environment, in the larger world you live in.
There are many reasons, purposes and benefits to practice relaxation techniques. In most yoga classes this is done at the end of class. Though we’ll also do some kind of formal relaxation practice at the end, relaxation or creating a state of calm is facilitated right from the start.
It is when you are in a place of safety, when you are calm and relaxed, that change is likely to occur. It is this place of calm (a parasympathetic state) when you might first experience a change in your pain. Without this, it’s no different than trying to stretch, exercise, push through and strengthen your pain away, which seems not to work out so well.
If you’re interested in learning more, have any questions or would like to sign up for the next series of classes starting at the end of February, please get in touch here. I’d love for you to experience, how you might learn to change your pain. Or, if you prefer a one-to-one session, information can be found here.
 Adriaan Louw, Kory Zimney, Emilio J. Puentedura & Ina Diener(2016)The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature,Physiotherapy Theory and Practice,32:5,332-355,DOI: 10.1080/09593985.2016.1194646
Most 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.
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 firstname.lastname@example.org 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 email@example.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.
 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.
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.
Continuing with the second of three papers recently published in The Lancet regarding Low Back Pain. What guidelines are already in place, what’s actually occurring in practice and suggested solutions going forward.
What’s striking to me is the
clear evidence of substantial gaps between evidence and practice, that are pervasive
A few years after delving into this, I am still scratching my head how far behind we are in our medical and clinical practice given the evidence. Yet, I’m hopeful that as more and more of this gets into the public domain, much-needed momentum will begin to close the GAP. Particularly with the crisis we find ourselves in, the growing epidemic of opioid use which is literally, killing people.
What are the treatment guideline GAPS, as outlined in the paper?
study results of clinical practice and highlights the disparity between ten guideline recommendations and the reality of current health care.
Guideline Message: Low back pain should be managed in primary care.
Practice: in high-income, low-income, and middle-income settings, people with low back pain present to emergency departments or to a medical specialist.
Guideline Message: Provide education and advice.
Practice: in high-income, low-income, and middle-income settings this aspect of care is rarely provided.
Guideline Message: Remain active and stay at work.
Practice: in high-income, low-income, and middle-income settings, many clinicians and patients advocate rest and absence from work.
Guideline message: imaging should only occur if the clinician suspects a specific condition that would require different management to non-specific low back pain.
Practice: although such specific causes of low back pain are rare, in high-income, low-income, and middle-income settings, imaging rates are high.
Guideline message: first choice of therapy should be non-pharmacological.
Practice: surveys of care show that this approach is usually not followed.
Guideline message: most guidelines advise against electrical physical modalities (eg, short-wave diathermy, traction).
Practice: worldwide these ineffective treatments are still used by the professionals who administer physical therapies.
Guideline message: due to unclear evidence of efficacy and concerns of harm, the use of opioid analgesic medicines is now discouraged.
Practice: these medicines have been overused in some, but not all, high-income countries; low-income and middle-income countries seem to have very low rates of use.
Guideline message: interventional procedures and surgery have a very limited role, if any, in the management of low back pain.
Practice: these approaches are widely used in high-income countries, little evidence on their use is available for low-income and middle-income settings.
Guideline message: exercise is recommended for chronic low back pain.
Practice: clinician treatment preferences and health-care constraints limit uptake.
Guideline message: a biopsychosocial framework should guide management of low back pain.
Practice: the psychosocial aspects of low back pain are poorly managed in high-income, low-income, and middle-income settings.
As you can see, what’s recommended is not what’s being offered to people for treatment.
Though first line care is meant to be non-pharmacological,
a study from the USA showed that only about half of people with chronic low back pain are prescribed exercise. In Australian primary care and in the emergency department setting in Canada, the most common treatment is prescribed medication.
Then, there are the rates of imaging, even though it has a limited role to play (see previous post).
39% in Norway, 54% in the USA, 56% in Italy as three examples, presenting patients to emergency rooms are given imaging.
Even worse, opioids. Though data for effects of opioids for acute low back pain are sparse,
one study showed that they were prescribed for around 60% of emergency department presentations for low back pain in the USA.
More than half the total number of people taking opioids long-term have low back pain though NO randomized controlled trial evidence is available about long-term effects. Well, we can see some of the short-term effects taking place across our countries at the moment.
In terms of surgery, which has “a limited role for low back pain”,
studies from the USA, Australia and the Netherlands show frequent use of spinal fusion.
So the waste to our healthcare system is apparent, but the bigger cost is what’s happening to the people who are provided these treatments that have shown to have little success. They seem stuck in what seems a never-ending loop of pain.
“Guidelines recommend self-management, physical and psychological therapies, and some forms of complementary medicine, and place less emphasis on pharmacological and surgical treatments, routine use of imaging and investigations is not recommended.
Little prevention research exists, with the only known effective interventions for secondary prevention being exercise, combined with education, and exercise alone.”
Where do we go from here?
“Promising solutions include focused implementation of best practice, the redesign of clinical pathways, integrated health and occupational care, changes to payment systems and legislation, and public health and prevention strategies.”
Current guidelines need to be utilized which we clearly see, they are not. There needs to be better integrated education of health-care professionals including a change to the clinical-care model. Revamping the “current models of health-care reimbursement, which reward volume rather than quality”. Integration of health-care and occupation interventions so we can get people back to work and back to their lives. Changes to compensation and disability policies. Finally, public health interventions to change public’s beliefs and behaviors.
Which brings us to the last of the 3 papers, Low back pain: a call for action, up next on the blog.