While I love fitness and exercise, yoga is different for me. Yoga is my refuge. Even 20 years ago, when intense yoga totally dominated the landscape, and I was clueless about explaining how what I taught was useful and not some kind of watered down version of “real” yoga, I just couldn’t bring myself to join the sweat fest.
I had started my yoga teaching career in an assisted living facility, working with residents with various disease processes, and also teaching regular mat classes, primarily attended by the wisest element of every culture – middle aged and older women. 😎😍 And while I’ve gone deep into yoga therapeutics and feel comfortable in that realm, yoga for preventing disease and promoting health is what really excites me.
As the population ages and we see upticks in chronic health conditions, I believe we are going to need an increasing number of well-trained yoga teachers and therapists to cross the bridge from fitness to wellness and therapeutics.
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As Dr. Timothy McCall said, “When word gets out about how powerful these practices are, there will not be enough well-trained teachers to meet the demand.” (I’ve often remembered that quote over the years when things felt bleak in the yoga space).
There’s a good chance that some of your students are dealing with chronic pain. Last week, a study was published revealing that there are more new cases of chronic pain among US adults than other chronic health problems like diabetes, depression, or high blood pressure. The study reported that 20 percent of US adults are dealing with chronic (or what I prefer to call “persistent” pain).
A couple of things – if you love teaching slower more mindful versions of yoga practice, that’s good, because it’s the kind of yoga that can help people begin to unravel their chronic pain, it’s the kind of yoga that the world needs right now. And (as I hear myself repeat ad nauseam but feel morally obligated to do so), yoga doesn’t fix everything of course – but it can be a very useful piece of the puzzle.
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Yoga teachers can begin by educating ourselves about chronic/persistent pain. Here are a few tips:
- Persistent pain is not the same thing as acute pain. Acute pain is typically the result of a problem – injury, or a medical issue like a kidney stone. It’s tissue damage. But persistent pain is not the result of a problem. Persistent pain IS the problem. This is the first step in understanding that there are different kinds of pain. It’s such a hard shift to make that many in the medical community still struggle with it. If we are to find lasting solutions to the chronic pain crisis – and the opioid epidemic it has spawned – we must rewire our neural networks that equate pain with injury and start to see things differently.
- Persistent pain is pain that lasts more than 3-6 months.
- Persistent pain is also called “Brain Pain” or “Central Sensitization.” The brain has learned to be sensitive, it has learned to be in pain. It loses its capacity to process sensations appropriately.
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- There are no pain signaling receptors. We have danger receptors. These are called Nociceptors. Nociceptors come in a few varieties including some that sense temperature, movement, and chemicals. Nociceptors are looking out for danger, not pain. Also, you don’t have a specific “pain center” in your brain. Pain is perceived by a complex interaction of different areas of the brain – it’s also influenced by many psychological and social factors. Do you feel safe, loved, cared for, supported, resourced? Answers to these questions contribute to whether or not you feel pain.
- To begin to unravel the wiring of persistent pain, the body needs to feel safe. Movement needs to feel safe, interesting and even fun. Adopting an attitude of curiosity about your body and movement can go a long way towards reducing feelings of fear that perpetuate the cycle of pain.
- Chronic pain is a public health issue – it is as cultural as it is biological. People seek out solutions to their pain via medication, and this has led to an epidemic. COVID increased suicides and death by overdose by a stunning 20%. Chronic pain is not just an individual problem, it is a reflection of deep dysfunction in the culture.
- Research suggest that people who deal with persistent pain and receive Chronic Pain Education along with treatment show better outcomes.
Yoga teachers can be supportive allies in taming this cultural crisis. You can teach your students about persistent pain and point them to resources. I recommend starting with Dr. Lorimer Moseley’s site as a beginning point.
Yoga can be a part of the solution to chronic pain. The more yoga teachers who understand chronic pain interface with health care professionals, the more that we can utilize our skills to support those who are suffering. Has yoga helped you or your students? Please share your thoughts in the comments.
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References:
- Nahin RL, Feinberg T, Kapos FP, Terman GW. Estimated Rates of Incident and Persistent Chronic Pain Among US Adults, 2019-2020. JAMA Netw Open. 2023;6(5):e2313563. doi:10.1001/jamanetworkopen.2023.13563
- Marris D. Theophanous K. Cabezon P. Dunlap Z. & Donaldson M. (2021). The impact of combining pain education strategies with physical therapy interventions for patients with chronic pain: a systematic review and meta-analysis of randomized controlled trials. Physiotherapy Theory and Practice 461–472. https://doi.org/10.1080/09593985.2019.1633714
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I’m not a teacher but a student. Will this be any good for me ?
I think everyone should learn more about chronic pain – whether or not we have it ourselves – because we certainly know others who do.
Excellent article and spot on!
Thanks Tammy!
Thank you for this post, Kristine. I was recently diagnosed with severe bilateral carpal tunnel. I’m told it’s likely inoperable. I’m struggling to identify how to modify my yoga practice to avoid exacerbating my chronic pain. Hand specialists tell me what I can’t do not what I can do. I’m currently not on medication to manage the pain. Any suggestions?
Well, it’s really hard to give any kind of medical advice of course, but you have received good info from your hand specialists. I would “yoga-ify” what they have told you. Bring awareness, slowness, and breath to the movements.
I drink your words like a thirsty comrade.
Thank you for keeping me hydrated in the subtle yoga practices!
Thanks Pamela! xoxo
Thankyou ! Such a tricky area to consider, because people in pain can easily think we are suggesting that pain is in their head, and therefore not real or it is imagined. It’s so important to get the message across that their pain is real, but we need to approach it in a different way.
yes, this is a big part of the issue for sure. People who struggle with chronic pain need to both understand that they have some agency and at the same time that they are taken seriously and believed. They need empathy and compassion.
As a yoga teacher, holistic wellness professional, and 20+ year chronic pain veteran (as well as college student w/in the wellness space), on one hand, I’m so thankful you’re addressing this issue. On the other, you provide some troubling phrasing.
>>>People seek out solutions to their pain via medication, and this has led to an epidemic.
My mom was an RN since the 80s. Pain used to be the fifth vital sign. There are extensive long term studies done on the fate of those of us with untreated pain. We’re not asking to be pain free. (The only time I was occurred in 2016 when I was prescribed T-3 at my insistence on nothing stronger for a snake bite. I do not recommend getting bit by a copperhead to finally have the medical community take your pain seriously.) The epidemic isn’t among chronic pain sufferers. Those of us who have been denied help for decades are lost. The epidemic is due to other socioeconomic systemic issues causing people to seek relief from their lives — not just their chronic pain. Continuing to discuss the “opioid epidemic” damns chronic pain patients to further marginalization and systemic eugenics as we die due to lack of healthcare (because most things including an early COVID infection has been blamed on my “fibromyalgia” and then I’m told “we don’t treat pain” since the “big 3” fibromyalgia drugs don’t work for nearly 60% of the patients per NIH studies.).
>>Chronic pain is not just an individual problem, it is a reflection of deep dysfunction in the culture.
I completely agree, but see a lot of the dysfunction with the medical community and CDC guidelines which terminated a lot of patients’ pain care. I, for one, have lived for 20+ years with severe chronic pain (which now includes severe degenerative spinal arthritis, plus regular osteoarthritis of an almost 50-year-old farmer/horse person), and neither you nor the medical community are talking about the increased stroke, “sudden cardiac event”, cancer, and other rates of illness caused by long term untreated pain.
We cannot CBT and pain acceptance (as much as I’m a fan of MBSR) our way out of this, and I see too many yoga teachers look at this from a purely medical/fitness industry standpoint.
First I would just say that I’m very sorry you have been dealing with this condition for so long and I hope that you have good support.
No one should ever feel shamed for being in pain.
This blog is short and I didn’t get to go into as much depth as I would in my trainings.
Of course opioid have their place in the tx of CP, nevertheless, there is strong evidence connecting CP to opioid abuse. No one should be denied medication and treatment, that’s not what I’m talking about here. But the current medical treatment is incredibly insufficient.
I agree that the lack of appropriate treatment for CP and most other chronic illnesses is the biggest shortfall of western medicine. Western medicine is so very limited in it’s application. As for the dysfunction in the medical community and CDC guidelines -the medical community reflects the dysfunction in the culture.
The CDC was pushed up against the wall. Opioid abuse and ODs were blamed on rampant overprescribing and had to do something. The guidelines were an attempt to both stem the tide, and also, many would say, to take the blame off of the prescribers. Then there’s the whole Sackler family nightmare profiteering rabbit hole.
The point of this blog is that yoga professionals can help to teach people about CP and that there are ways the yoga may be supportive, not to discount standard of care, or to perfectly explain the phenomenon, but most people, including many medical professionals, don’t under the biopsychosocial spiritual etiology of CP. The yoga philosophy/cosmogony/and practice perspective may offer a broader framework than fitness or medical industry that may be helpful in the ongoing search for better treatments.
Well said!!!
Thanks Meg!
Hi Kristine, I have many times the experience that my student is scared to move because she does not trust her pain will get worse or not, or will return.
thank you for the article!
yes this is really common, and there is good reason to be cautious, however, motion is lotion, so you have to find ways to move that are doable.
I started practicing yoga 24 years ago because of persistent headaches and back pain from a car accident and work-related repetitive movement. I found a yoga teacher (friend, mentor, and wonderful lady) who believed in traditional yoga and helped me manage the pain. Chiropractors told me that I would need to have surgery to fuse my back (15 years ago) and in later years a doctor told me I would need a knee replacement (10 years ago). I started to teach yoga 15 years ago to learn more about it, keep a routine, and help others. I also taught traditional yoga to older adults and people with chronic pain. I owned a successful yoga studio and now am semi-retired teaching at The Y. People continue to come to my classes which have grown considerably because of the Subtle Inspired Yoga that I teach to help them with their pain and learn about their bodies. BTW never have had any surgery and I continue to listen to my body when it needs a little extra TLC. Thank you Kristine for your wonderful teachings, guidance, and support over the years. You are a credit to yoga and helping students and teachers be more aware and healthy!
I love to see your referencing and using the language (Motion is Lotion) of Prof Lorimer Moseley. A fellow Australian, and a very entertaining raconteur (no one tells a snake bite story quite as amusingly as Lorimer), he has a dedication to spreading education about chronic pain. As a yoga teacher/therapist, I’ve learned a lot from him. Interestingly, in situations where people are scared to adopt movement – having lived for years (maybe decades) with chronic pain – Lorimer believes that even the tiniest movement or even ‘imagining’ moving the afflicted body part can be beneficial.
yes he’s so wonderful! Thank you for mentioning him and his groundbreaking work!