Y OGA H ILLSBORO & T HE S TRESS R EDUCTION C LINIC 1 Yoga for Chronic Pain 2 Marie Pielage, PT What is yoga? A “yoking” together of mind and body, especially while doing body movement. So, yoga is “mindful movement.” In a chronic pain state there is often a dysfunctional relationship between mind and body. Yoga can help to normalize this relationship. Pain It is normal for our body to experience pain. Some examples of normal pain are: � Muscle fatigue during vigorous exercise � Muscle stretching pain � Disuse soreness and muscular stiffness � Joint stiffness from inactivity � Post exercise muscle soreness In persons with chronic pain, often there is a hyperawareness of these “normal” pains, and a fear that actual harm is happening to the body. This often leads to less activity, progressing weakness and a cycle of physical dysfunction that begets more pain. The Effects of Yoga for Chronic Pain Sufferers Awareness and Somatic Learning A l earning process occurs in a yoga practice. Persons learn to differentiate the normal pain sensations of the body, from the harmful ones. The perception of all pain sensations as harmful pains begins to change. This process is especially effective in yoga because part of the practice is to pay attention, and to avoid distractions. Most other forms of exercise do not involve this slow, mindful attention to internal sensation. We see evidence of this neuroplasticity in action in almost every yoga class. Musculoskeletal Pain Yoga is a system of movement. Even a gentle yoga practice brings most of the joints of the body through their full range of motion. It asks students to engage their muscles to come into poses, to hold them, to move through cycles of movements. These movement help to move stiff parts, stretch tight ones, and strengthen weak ones. Anecdotally, I have noticed that a lot of people with pain are “motor morons.” Meaning they have low levels of coordination, poor proprioceptive awareness, difficulty grading 232 NE Lincoln Street, Suite O Downtown Hillsboro, OR 97124 503-640-6006 www.yogahillsboro.com
and moderating the physical efforts that they make. In yoga, the body begins to learn healthy movement patterns, better posture, increased coordination and proprioception. All this can help alleviate any pain of a musculoskeletal nature. Breath There are studies that show pain can induce hyperventilation syndrome. Evidence regarding this mild (to a medical model) imbalance can lead to all sorts of secondary effects including many of the symptoms associated with chronic pain (fatigue, dizziness, impaired cognitive function, paresthesias, gastrointestinal distress, anxiety, depression, muscle and joint aches). Once this cycle of pain and hyperventilation is induced, it can become a self-perpetuating and even escalating, leading to more pain and dysfunction, the typical snowball effect. Also, it seems that most people with pain have a habit of breathholding, especially with any physical effort. Breathholding is a strategy for core stabilization that is appropriate for extremely high-load situations such as lifting a very heavy weight. It is not a good strategy for easy and mid level tasks, and can lead to increased muscle tension. One very profound aspect of the breath is that it lives at the intersection of our autonomic nervous system, and our somatic nervous system. This can be a keystone for change!! We can work with the volitional aspect of the breath to affect and help normalize the autonomic processes of the body. The cycle of hyperventilation syndrome can be broken. This keystone begins to reverse the downward spiral of that snowball effect. There are 3 aspects of working with breath that I believe are most effective for the pain patient. ✦ Awareness : This brings the attention away from the pain, and awareness is the first step in changing a pattern. ✦ Decrease Breathholding : In yoga class, we cue the students to release breathholding when making efforts. No efforts in a yoga class are high level enough to warrant a breathholding strategy. ✦ Inverted poses : Inverted poses are when the legs and hips are higher than the chest and head. This profoundly affects the diaphram, basically reversing its orientation in gravity. Consequently, the exhale part of the breath is gravity assisted. This effect is enhanced by the weight of the viscera pressing down on the diaphram. This enhanced exhale is an extremely powerful way to begin deeper, calm breaths that break the hyperventilation cycle. There are modified inverted poses appropriate for almost any student. There are many advanced yoga practices involving different breathing techniques. However, these are NOT appropriate for the pain patient. 232 NE Lincoln Street, Suite O Downtown Hillsboro, OR 97124 503-640-6006 www.yogahillsboro.com
Sleep People with pain do not sleep well. Lack of restorative sleep is another of the snowball effect issues. Non-restorative sleep begets more pain issues, causing poorer sleep. Especially with fibromyalgia, pharmacological intervention is directed toward restoring sleep. As a yoga teacher for many years, the most common thing students say after they are introduced to yoga is “Wow! I slept soooo great after my first yoga class!” Or, “I always sleep great on yoga night!” Conclusion I believe that the movement practice of yoga teaches us to move while maintaining a state of relaxation. This is profoundly different from most other systems of exercise and movement, and I believe is very effective for helping almost any person suffering from chronic pain. “Movement is nutrition for the human body. Yoga, properly adapted, is the best diet.” Lauren Fishman, MD, and Anusara Yoga Teacher. Yoga for Arthritis . “Properly adapted” is the key phrase. Yoga-robics, or McYoga may be harmful. Pain sufferers should seek out an experienced and well-trained yoga teacher who is used to teaching persons with pain issues. 1 This presentation is part of a panel discussion at the Pain Management Options for Chronic Pain Disorders Continuing Education Interprofessional Series at Pacific University’s College of Health Professionals, October 19, 2012. 2 Marie Pielage, PT is a licenses physical therapist practicing at Tuality Healthcare. She teaches adaptive, therapeutic yoga courses and workshops at Yoga Hillsboro. 232 NE Lincoln Street, Suite O Downtown Hillsboro, OR 97124 503-640-6006 www.yogahillsboro.com
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