Chronic pain is often defined as any pain lasting more than 12 weeks. Following a musculoskeletal injury, our bodies do heal, unless we return to an activity/movement that caused the injury – something that is quite common in the fitness world and also in the yoga world.
Pete Blackaby, Intelligent Movement points out that the addiction to stretch into a pain can provide temporary relief because it “..changes the sensory imput but the pain then comes back and if we keep doing this the injury doesn’t have a chance to heal and may even get worse. (Teaching Yoga to People with Chronic Pain).
The challenge that teachers face in teaching yoga to students with chronic pain is how to address the fear of movement that can develop when pain is persistent. Long term pain depletes confidence in the body’s ability to heal. John Kabat-Zinn, Professor of Medicine Emeritus and creator of the Stress Reduction Clinic and Mindfulness in Medicine, Notes that the distress caused by chronic pain:
.. can be compounded by emotional turmoilcaused by knowing that your condition seems to be beyond even your doctor’s control. Full Catastrophe Living
There is now a much greater appreciation by doctors for the unique problem of chronic pain. Pathway Through Pain is a web-based management programme that is run in partnership with 18 NHS services. Here in Buckinghamshire, Bucks Healthcare trust runs community services for pain care management. The service is available to anyone registered with a Buckinghamshire GP.
Research into the effectiveness of Pathway through Pain is underway and interim findings have been published by Bucks new University’s Centre for Telehealth and Assisted Living (CETAL). Initial findings suggest that participants who completed the course (this is key, I think), learnt ways to cope and improve their quality of life. There was a low response from the non-completion group and this may have been due to factors such as motivation to continue with an online programme and relevance to the individual user.
Neuroscience Research Austraila (NeuRA), an independent, not for profit research institute based in Sydney, is conducting research on how …”the sensory system works; how it gives us an accurate map of the external world, allowing us to make accurate movements..”Sensation, Movement, Balance and Falls. I recently came across this research when I welcomed new students to some of my classes and tried to increase my knowledge of chronic pain. I read about Professor Lorimer Mosely and his research into pain and his description of “neuro-tagging”. Pete Blackaby helped me to understand this more fully in the study day that he led for the British Wheel of Yoga, entitled Teaching Yoga to people with Chronic Pain ( 18 March 2017). Pete explained that when people move in a particular way that causes pain and then continue with that movement which again results in pain, …“the brain associates the two things until it becomes impossible to make the movement without pain…”
Helping students in the yoga classroom to move with subtle intelligence around the pain, sometimes frustrates those who would like to “do” the pose. Many can “do” the pose but the pressure to achieve a shape is prevalent and not always helpful. Vanda Scaravelli warned – “Do not kill the instinct of the body for the glory of the pose..” Intelligent, incremental movement can help us to “map”the movement in our sensory cortex , helping us to become more proficient in that movement. This helps to reduce anxieties around movement.
Yoga classes can be so beneficial to those suffering chronic pain. Positives such as improvements in breathing function, relaxation, a non-threatening environment are clear, I believe. Time is given, or should be given, for students to investigate, notice how they move and, importantly, how movement makes them feel. There is access to a teacher who can inform and encourage; the support of class members who can sympathize whilst not invading personal space.
My view is that the greatest help that we, as teachers, can provide is to focus less upon performance/a perfect shape and more upon how the students feels. This will, however, be questioned – as it should.