Yoga and Pain
Neil Pearson, MSc, BScPT, BA-BPHE
Physiotherapist, Certified Yoga Therapist
Co-Chair Canadian Physiotherapy Pain Sciences Group
www.lifeisnow.ca

Unexpected back pain arises during your yoga class! How do you respond?
You might increase the intensity of your ujjayi breath, allowing the sound to distract you from the pain. You might let go of excess tension, listen, accept and inquire into the nature of the sensation. Or maybe you move away from such a deep challenging position to a place of ease and no discomfort because you know that pain means damage. Then again, you might ignore your body while striving for your ideal of the perfect asana. Your choices are endless, and there is not one correct way to respond. However, to respond with wisdom when pain arises during asana practice requires either an understanding of pain science, and/or clear body awareness along with a deep understanding of the first two limbs of Ashtanga yoga- the yamas and niyamas.

Pain is a complex experience. Everything affects the pain you feel: the environment, the meaning of the sensation in relation to your current life situation, your current state of arousal, your past pain experiences, the people around you, your physiology, your beliefs about pain and recovery, …everything! The extent and type of tissue injury also have some influence on your pain experience. However you may be surprised to learn that tissue injury is the least important factor in determination of any pain experience. Like most people receiving an education about pain sciences, it is difficult at first to believe this. “Of course”, we say, “the more pain I feel, the more I am injured”, and “If I still feel pain, then the injury has not healed”. Scientific understanding in the 1600’s believed such statements to be true, however scientific understanding for the past 50 years has proven that such statements are not accurate.

Take a few moments, and consider whether these statements are true or false:

1. You can injure your body without experiencing any pain.
2. You can experience pain without tissue damage.
3. You can feel intense pain in your body without any pain signals arising from the painful body part.
4. The location of your pain may not accurately identify the location of the tissue injury.

The statements are less challenging when you consider asking yourself these questions: Have you ever noticed bruises that you can’t remember getting?; Have you ever had an intense headache or a pain from pulling your finger or wrist back too far?; Have you ever experienced empathy pain when you saw someone else get hurt? Have you ever had brain freeze pain in your forehead or between your eyes?

Pain beliefs in western society are not founded on pain science. As strange as it may seem, they are also not based on our experiences of pain. Our pain beliefs lead many of us to exercise and practice asana in a less than mindful manner. We might laugh about “more pain, more gain” yet this is often the approach we take during yoga classes. We stretch as if the more uncomfortable it is, the greater the increase in flexibility will be. Somehow we miss the incongruence of these actions with the words we hear in class… “Let go of struggle, find a way to stay with your body,…” We disconnect or take our focus externally so that we can survive deeper postures. We relinquish responsibility for how far to push into postures by asking our yoga teachers what we should do when we have pain. We decide that pain is just another obstacle to overcome in our pursuit of asana perfection.

In order to gain more knowledge about your pain beliefs and physiology you may decide to study pain sciences. However, maybe you would prefer a less academic endeavour for challenging your beliefs. If so, then rely on your body. It is an amazing biofeedback machine that tells you exactly what to do during asana practice. You will need to listen carefully though! Your body’s messages may be difficult to hear through the noise of your pain beliefs and attitudes. Ongoing self-study, kindness, non-grasping and contentment will all assist you as you gain deeper body awareness and quiet your mind. Whether you take this body awareness journey or an academic route, either path will provide you with greater knowledge and understanding of pain, as well as deeper understanding of how to respond to pain.

We often search for quick and simple answers. However there is no recipe, pill, or easy technique for how to respond to pain during asana practice. However there are some key ideas you might consider.

• Be mindful of your body, your thoughts, your emotions, and your ability to stay present when you experience pain.
• Neither ignore nor run from the pain.
• Know that pain does not necessarily mean damage.
• Take responsibility for good care of your body, using body awareness and the ten ethical restraints as your guide.

When pain persists…

• Honour and gently challenge the alarms from your body.
• Consult with a health care provider, while not relinquishing all your responsibility for your care and health.
• Be patient, persistent and compassionate with yourself as you recover.
• Listen for the normal messages from your body, instead of only listening to the alarm.
• Become aware of whether you distract yourself or ‘leave’ whenever the pain increases. Sometimes this happens automatically, leading to an experience of pain-free yoga practice but intense pain later when you are no longer distracting yourself.
• Consider that persistent pain can be as much about your physiology as your anatomy. This means there may be nothing in your physical body that needs to be fixed by someone else. All that may be required is for you to approach the sensation, the asana and possibly your life in a new manner.
• Accept that positive changes will happen, and that in time you will learn exactly how you should respond.

Your body will not adapt unless it is challenged. So challenge your body, yourself and your alarms when pain persists. Remember that no one ever overcomes anxiety by avoiding the stressful situation. It is the same for pain. Fear-avoidance will always lead to worsening disability and worsening pain. On the other hand, when you move in a mindful manner and challenge the alarm wisely, your body has the opportunity to adapt. This will lead to improvements in ability, fewer alarms and less pain!

Your pain beliefs may have been challenged by many of the ideas presented here. Then again, maybe your pain experiences have taught you that pain is not so simple. You have nothing to lose by exploring other possibilities about the pain or your body. Dip your toe into the water and see how it feels. Give yourself some time to explore how your body responds the next time you feel pain during yoga class, and be wary of how your thoughts and emotions impact the pain.

Not only is pain a complex experience, it is individual and like most things in life and yoga, you need to find your own path to explore at your own pace.

Enjoy.