Teaching yoga to manage pain

GUEST POST: RACHAEL WEST

1 in 5 Australians suffer Persistent Pain!

Learning how pain works can help you keep your clients

A growing body of evidence shows yoga helps with a range of pain conditions, including fibromyalgia, arthritis and lower back pain.

But doctors and physiotherapists are wary of referring pain patients to yoga. They say they don’t know where to find appropriately qualified teachers who understand how pain works and can manage the psychological and social challenges faced by this demographic.

Here’s why it’s important to learn more about pain so you can work with the growing number of people it affects.

Many people with pain have tried yoga that has made their pain worse

Someone with lower back pain may simply need a yoga class that gets them moving. However anyone with fibromyalgia or history of pain flares after small amounts of activity must focus on calming the nervous system before progressing to more challenging practices.

Many people with pain look young and healthy. It’s easy to assume they would prefer a stronger practice. Understand the stages of chronic pain and the best way to approach each one. (It will often be up to you to educate your student.)

You won’t find out if someone with pain has a bad experience in your class

Student don’t tend to tell you why they don’t come back to class. Often it simply wasn’t right for them. But common reasons people with long term pain give up are:

• A pain flare after a class most people would consider gentle
• Frustration at their limited capacity
• Heightened awareness of their pain

Many pain clients try yoga as a last resort. When yoga doesn’t work out for them it is further evidence nothing will ever work, and that yoga is bad for pain. This message gets fed to their health practitioners.

Follow up with pain clients after class. If they did have a pain flare gently educate them about how to manage it in future.

Educate and empower rather than constrict

At worst, the wrong yoga class can make your patient’s pain worse. At best, a less-than-ideal class offers a slower path to recovery.

Educate clients about how to reduce pain while enjoying the benefits of yoga. Refrain from blanket warnings like, “you must not do posture X”. If their physiotherapist has firmly instructed they don’t (for example) practice forward bends, find out why. It will often be to avoid flexion, in which case you may be able to very safely teach Dandasana or Paschimottanasana with a long spine.

It’s important that patient needs are matched with the right style of yoga and teacher so they feel safe and motivated to continue.

Starting slow makes progress faster

As a general rule, yoga for people with pain offers better results if it begins with a gentler practice, and simple teaching that builds body awareness and confidence.

Even those who are more physically capable can benefit from a slow, mindful approach that builds body awareness and correct technique, and keeps them emotionally safe.

Pain is treated in the medical system but the biggest challenges are social and psychological

It’s relatively easy to modify yoga for a painful shoulder. But to keep someone in yoga who hasn’t been able to work due to back pain, who can’t focus because of brain fog, or who feels guilty about not being able to go camping with his family — that is another story.

If you wish to work successfully with the 1 in 5 Australians with persistent pain (and so many of them say they hope you will!) learn how pain works so you can recommend the best class for students. Understand their social and psychological needs to create the class environment that ensures they stick at yoga long enough to receive its wonderful benefits.

References:

1. A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia, Carson JW1, Carson KM, Jones KD, Bennett RM, Wright CL, Mist SD.Pain. 2010 Nov;151(2):530–9
2. Effects of Yoga on Symptoms, Physical Function, and Psychosocial Outcomes in Adults with Osteoarthritis: A Focused Review. Cheung C1, Park J, Wyman JF. Am J Phys Med Rehabil. 2016 Feb;95(2):139–51
3. Yoga as a treatment for chronic low back pain: A systematic review of the literature.Chang DG1, Holt JA1, Sklar M2, Groessl EJ3. J Orthop Rheumatol. 2016 Jan 1;3(1):1–8.
4. Relaxation response and resiliency training and its effect on healthcare resource utilisation, James E. Stahl, Michelle L. Dossett,A. Scott LaJoie, John W. Denninger, Darshan H. Mehta, Roberta Goldman, Gregory L. Fricchione, Herbert Benson, MGH Benson-Henry Institute at Massachusetts General Hospital, Journal PLOS | One (open access online journal) October 13 2015.
5. J Altern Complement Med. 2007 May;13(4):419–26.Yoga Asana sessions increase brain GABA levels: a pilot study.Streeter CC1, Jensen JE, Perlmutter RM, Cabral HJ, Tian H, Terhune DB, Ciraulo DA, Renshaw PF.

Rachael West is learning lead at Yoga for Pain Care Australia which exists to help people with all kinds of pain access the benefits of yoga. She has a degree in Yogic Education from the University of Lille, France.