Physiyoga: physical therapy principles meet mindful movement

How to Approach Chronic Pain From A Physiyoga Perspective
January 26, 2022

I was excited to read this piece in The New York Times about what comes next when modern medicine struggles to treat chronic pain. And after finishing the article I had a few thoughts.

Here’s the thing–the human experience of pain and chronic illness is non-binary: there is no clean drawing of lines. It doesn’t fit into a neat box of research and evidence, nor does it fit into a fixed protocol or guideline. It doesn’t even fit into one provider. We are so much more beautifully complex and layered than that. We are a mix of past, present, and future: our genetic makeup, our diet, movement, emotions, sleep, work, family, community, where we live…and on and on. And the way we care for people who aren’t feeling well should directly reflect these many singular facets.

Integrating a mind, body, and spirit approach to addressing chronic pain is not just words. It’s how we see and explore every patient and student we treat as physiyoga practitioners. What does that person think, feel, believe? Where do they see themselves in the world and society? Do they live in connection to themself and others? The answers to all of these questions and more influence how a person feels, for better or worse.

Pain is an output

It can often be difficult to separate our body’s stories from reality. In many instances of pain, the stories we tell ourselves create and maintain the pain sensations—not the actual pathology or damage.

Pain is a byproduct of inputs that include:

  • What we’ve heard from doctors ⁣
  • How much sleep we get⁣
  • Our diet⁣ and hydration
  • Our coping abilities⁣
  • Whether we have self-efficacy⁣
  • How we breathe⁣, and more ⁣

Pain that lasts longer than tissue healing requirements (six weeks to three months) is considered persistent and chronic, and therefore most likely not due to tissue damage, but rather a brain output. It’s the brain’s way of trying to keep us safe and protected. Pain is created from the above collective inputs: if the inputs are sending signals that we aren’t safe, the brain responds with pain. ⁣

How can we stop the old story cycle and touch upon the true sensations our bodies are wanting us to notice?⁣

For one thing, it isn’t by pushing through the pain. It isn’t by focusing on what we can’t do. ⁣We stop the story by paying attention, finding meaning, using awareness and interoception (our body’s lesser-known sense that helps us understand how we feel internally: tired, hot, hungry, tense, etc.).

Following the story, believing it, and then holding tight to it is actually easier for most people. We are creatures of habit: familiarity leads to comfort. ⁣But getting to the truth—what is really inside us—is where we need to go. It can be uncomfortable work. It starts by going inward and feeling our feelings without judgement–no value placed on them–just observing and accepting with softness and maybe some compassion. ⁣It’s about allowing what’s really there to be given some air time. Otherwise, as the old wise saying goes…what we resist, persists. We can’t fool our bodies into thinking it’s something that it’s not, or into thinking it’s not something that it is. And if that last sentence was confusing (read it again), you can imagine how confusingly this dynamic must play out in our bodies.

We physiyoga practitioners use yoga in one of the most powerful ways: to help people discover and heal. It’s simple (which is not the same as easy), it’s accessible to all, it’s life affirming, and it even makes scientific sense. ⁣

Unpacking chronic pain from a physiyoga perspective

Our experience with movement, pain, and wellness is layered and complex. We lean in with curiosity, attempting to understand how the puzzle pieces fit together. When evaluating factors that may be contributing to a feeling of pain (or decreased movement performance) in our clients, we consider pain science, polyvagal theory, motor control matters, the way(s) they move, kinesiology and joint mechanics (arthrokinematics).

For example, shoulder pain can absolutely be a layered experience, a brain output, based on history, emotions, stress, accompanied by physiological changes in movement, muscle tone, and breath.

Or, it can be purely from dysfunctional mechanics during an overweighted shoulder press. Maybe the shoulder just needs to calm down and get stronger, in which case we need to teach load progressions and sometimes different mechanics.

Remember: How we think, how we perceive, our movement history, the way we move, our trauma–are all a pieces of the movement and experience puzzle.

4 ways to apply physiyoga principles to chronic pain management

As a teacher or practitioner, determining how to use pain science on the spot with a real person is hard. We get it. We’ve been there. Interestingly enough, however, many of the ways you can use pain science are consistent with the ways to being a good human being. ⁣Here are four:

  1. Through your relationship, ask what brings them joy and make it part of their movement practice. Let’s say they love cycling: have them visualize riding a bike while slowly bending their knee toward their chest.
  2. Encourage them to talk about something that makes them happy when reintroducing “scary” movements. This can help them stay present in the moment and prevent overthinking and buying into their pain narrative.
  3. Try a small range of motion and celebrate it like they just won the lottery.
  4. Tie the movement back to their larger goals and explain how this smaller movement gets them one step closer to achieving them. One eye is on the here and now, and the other is on the prize.

Many of these principles are also aligned with what we do in yoga, connecting mind and body, regulating and creating flexible nervous systems: being present. ⁣So don’t get bogged down by a specific plan from which you can’t deviate. Try different tools based upon the person in front of you. ⁣

Most importantly, whether you’re the one dealing with chronic pain, or whether you’re assisting someone suffering from it, the most important thing you can do is disrupt the narrative around pain and start exploring its true sources. Once you do that, a holistic approach to managing it will allow you to move past the fear and into a place of real and sustainable healing.

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