All of this noticing, listening in to your body, your feelings and thoughts might provide some direction or suggestions in terms of movement for the day.
We were built to move yet it seems through all our modern conveniences we don’t have to do a lot of it these days. Like who can recall even having to get up to physically change the channel on the TV? Seems so long ago.
We’re told, we all know, we’re supposed to exercise for good health. That word, exercise, seems to have a negative connotation to it for many. These days, I tend to think of movement instead of exercise and try to frame it as something I get to do. And even not so much what I do as long as I DO SOMETHING.
Yet, especially for people who live with pain, even thinking about moving can be daunting. Often it seems to be the thing that aggravates or brings on their pain. I often wonder if people say, “Yoga, for pain? You must be kidding.” I get that. Particularly in the way yoga is portrayed throughout the media.
Yet, you might begin to move slowly. Softly, gently. You might even just imagine movement to begin with. Consider finding that felt sense of safety I spoke of here. If you can begin from your place of safety, it might just change things up for you.
Listening in to what you notice in your body can be a helpful guide. Today, you might feel unwell, fatigued or overwhelmed so choose do less in terms of movement. Or in ways that feel really easeful. If you happen to feel energized, or perhaps are feeling some anxiety it might feel good to move a lot! The important part is noticing the difference and and learning to respond in a way that best suits your needs.
In our culture, there is often just this push to do more. Not to rest. Conversely, that people aren’t trying hard enough. I wonder if we might just listen in and (re)learn what might be useful to each individual in any given moment, rather than what is often the expectations and judgements placed upon them.
What might serve you best in this moment? On this day?
Hard to imagine what it felt like so long ago… sitting through a long-haul flight, train ride or long drive to go visit far off friends, in far off places. I’m sure so many, miss it a lot. Yet at the same time the trip itself may have been uncomfortable. Feeling constrained. Unbearable at times. You might get a sense of a similar feeling sitting through endless zoom meetings, or just cooped-up wherever you find yourself most of the day.
You might feel stiff. Sore. Boxed in. If you’re a little older like me, it may take more time or effort to get moving easefully after a long bout of inactivity.
The same might be said when waking from sleep in the morning. Unless you happen to be a big mover while you sleep, I wonder if you’re rather stationary for the most part? If so, what might be a nourishing way to move your body before getting out of bed?
How might you make the transition from laying in bed to being upright in gravity, a little more easeful?
Come along for this short movement practice. Some of which you may like, some of which you may not. But it might inspire you to move just a little… making the transition from stillness to mobility, ready to begin the day.
I DON’T DO ALL THESE THINGS.
Yet, as a minimum, I do a few movements with my feet. They are where I tend to hold tension so I like to give them some time, space and gentle movement before I step into the day. It seems to be a good thing.
What might you notice, what might feel Just Right, For You?
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.
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.
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
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
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 email@example.com
** Tuesdays and Thursday mornings in Stittsville, starting November 5th.
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…
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.
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.
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.
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.
Summer 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?
Why should all of this matter to you? Why do you need to pay attention?
The median 1-year period prevalence globally in the adult population is around 37%, so chances are you or someone you know is affected.
And, what’s even more important, is
the way we have been treating people isn’t working.
“Low back pain (LBP) is now the number one cause of disability globally.”
There are a LOT of people who experience chronic or persistent low back pain. On a purely personal note, I would say it is the most prevalent ‘problem’ people tell me about when they turn up at my yoga classes.
“Rarely can a specific cause of low back pain be identified; thus, most low back pain is termed non-specific. Low back pain is characterized by a range of biophysical, psychological, and social dimensions that impair function, societal participation, and personal financial prosperity.”
In other words, it’s complex.
Of course, there is always a need to rule out those cases where there is specific causes.
“but, this is for less than 1% of those presenting with LBP. Known causes may include vertebral fracture, axial spondyloarthritis, malignancy, infection, or cauda equine syndrome (very rare).”
So if any of these are suspected by presenting symptoms, a clinician is well advised to do testing, imaging, etc. for what are often referred to as ‘red flags’.
If these are ruled out or if you’re not suspect for these specific causes, what then?
“Most adults will have low back pain at some point. It peaks in mid-life and is more common in women, than in men.”
“Low back pain that is accompanied by activity limitation increases with age.”
“Most episodes of low back pain are short-lasting with little or no consequence…”
“But recurrent episodes are common and low back pain is increasingly understood as a long-lasting condition with a variable course rather than episodes of unrelated occurrences.”
It’s highest in working age groups so the effect to the workforce is impacted. People unable to work, earn income, the possibility of early retirement. “In the USA, LBP accounts for more lost workdays than any other occupational musculoskeletal condition”.
Then there’s a person’s identity. Consequences such as loss of independence, ability to fulfill expected social roles can be impacted. Common themes of worry and fear are identified, along with hopelessness, the strain on families, social withdrawal, job loss, and there’s the navigating through continual healthcare encounters.
Most studies underestimate the total costs of LBP, but the economic impact is comparable to other high-cost conditions like cardiovascular disease, cancer, mental health and autoimmune diseases.
Most cases are resolved within 6 weeks, however, there are risk factors for recurring episodes. For people with other chronic conditions like asthma, headaches, diabetes. Those with poor mental health are at increased risk, etc. As one example, a study of Canada’s population with 9909 participants, found that “pain-free individuals with depression were more likely to develop LBP within 2 years than were those people without depression”.
Lifestyle factors are also at play. Smoking, obesity and low levels of physical activity are associated, although independent associations remain uncertain.
Which brings us back to it being complex. There are multiple contributors, “including psychological factors, social, biophysical, comorbidities and pain processing mechanisms.”
We can see the complexity when there is a continual increase of those affected, an increase in our health care expenditures and by the recent opioid crisis that is literally taking people’s lives.
It also seems whatever we’ve been doing in terms of treatment doesn’t seem to be working.
Why is that and what needs to be changed?
Tune in next week… where we’ll get to the second paper, “Prevention and treatment of low back pain: evidence, challenges, and promising directions.”
Note: For those interested, all references/studies can be found in the Lancet paper, here.