How to practice yoga with chronic pain (without suffering with consequences later)
The year was 2018.
I woke up with the Southern California sun laser-beaming through that small crack between the two panels of our hotel black-out curtains. The clock read 6:30am. Besides me, my friend Anna was yawning and stretching as her alarm went off. It was time to get moving for our 7am yoga class.
But it wasn't just any yoga class -- it was a yoga class to kick off our first day at the Symposium of Yoga Therapy and Research (SYTAR) at Newport Beach, California.
And, boy, were we looking forward to this class! As newly certified yoga therapists, we were excited to observe what other yoga therapists were offering as classes. This one we selected, in particular, was about juicy hips.
I mean, who wouldn't want some juiciness in those hip joints, am I right? Besides, it'd be a great way to start the morning before attending hours of presentations and discussions for the day.
Not even 10 minutes into class, we looked at each other, making faces.
The sequence was poorly designed, the stretches went from deep right off the bat to even deeper. My hips went from bad to worse.
Thirty minutes in, we both decided our poor hips and pelvis had enough destabilizing, and for the rest of the 30 minutes remaining in class, we laid down on the floor and waited until the class was over.
Needless to say, my gait felt off and unstable while walking to breakfast later.
The moral of this story is that not all yoga teachers/therapists and not all yoga classes are created equal.
Fortunately, for me, I can recover fairly quickly. I quickly remedied the instability in my pelvis from the poorly designed yoga class with my own yoga practice, and felt better for the rest of the day.
For my clients and students, however, it may take days or weeks.
Perhaps you have first handedly experience this as well. Your peers, doctors, and family members encourage you to take yoga class to help with the stiffness and mobility issues you’ve been experiencing with chronic pain. And so, you gather yourself, step into a yoga class (pre-COVID, of course), bewildered and uncertain what exactly you are doing there because you feel so out of place amongst the obviously able-bodied and well-dressed students.
Class begins, led by a teacher who is speeding through the class, and all you can do is try to catch up. You’re starting to not feel so hot, and your joints are starting to ache, and yet, you persevere. After all, you don’t want to embarrass yourself, and the teacher tells you to keep going.
Group yoga classes are not designed to be inclusive and accessible for individuals with specific medical conditions.
The class finally ends, and you somehow managed to shuffle your feet home and collapse on your couch. You’re then in pain for days and days, swearing that you’ll never try yoga again.
Unfortunately, this is the experience of many of my clients and students. They were recommended to attend yoga classes to help with muscle stiffness, joint aches, chronic fatigue, and overall chronic pain, only to be severely disappointed and mildly traumatized by their experiences.
Modernized yoga in the West is rarely friendly to those with specific medical conditions, and most often caters to generally able-bodied and relatively healthy individuals.
As a yoga therapist, this breaks my heart because I have studied, and am continuing to do so, yoga as it is supposed to be -- a tool combining the arts and sciences of healing. In my work, I work with individual clients and small groups of students to help them find the appropriate yoga practices from the depths and diversity of this ancient tradition to help them manage, resolve, and overcome what ails them.
While yoga is not a heal-all, cure-all, it can help alleviate some suffering when applied properly.
If you’ve been curious to try yoga again to help with stiffness, tension, and other symptoms associated with your chronic illness, or if you’ve been a yoga practitioner before, and are looking to include yoga back into your life, here are some guidelines to help you get started to avoid the disappointment and pain.
Find the right teacher
Of everything else in this post, this is probably the most important step. The right teacher, with adequate knowledge and experience working with people with specific medical conditions, is an essential catalyst.
As mentioned above, most teachers that you come across in gyms and yoga studios are trained to work with mostly able-bodied individuals. There are a few whose expertise expands beyond just “fitness,” and have the understanding to customize classes and sessions to be more inclusive. Seek them out.
The other approach is to ask your physician, chiropractor, acupuncturist, massage therapist, etc if they know of any yoga teachers of yoga therapists who work individually with private clients rather than in group classes. As a yoga therapist myself, I often collaborate together with other wellness and healthcare practitioners so that their patients and my clients can get the best holistic care.
You can also visit the YogaTherapy.Health website and search for yoga therapists in your local area. Yoga therapists are usually more aggressively trained to work under clinical settings. Many yoga therapists also have other training in medical fields as well.
The right yoga teacher will be able to work with you to create short and long term plans to help you relieve pain, manage symptoms, and create a lifestyle that is more supportive for you.
With many yoga teachers and yoga therapists now online, check out their website and social media for their training and background.. Many will have some type of content --photos or videos -- in one of these platforms: Do they appear accessible and friendly for chronic pain? If the teacher has YouTube videos, try a few out: Do they feel approachable and safe for your body?
In the end, the teacher you resonate the most with will help you create a better relationship and level of trust between you and the teacher, which consequently lead to more effective work in managing and resolving ailments.
Start small
One thing that is hard to remember and put into practice, and yet very critical, is to start small.
It can be incredibly disheartening when you’re unable to do the things you used to do with ease. After chronic pain and/or illness, most of the time all you can think of is how you can return to the life you once had. With that at the top of your mind, you might try to push yourself harder on your activities or exercises on the “good” or low pain days. Then, of course, your body strongly reminds you that you cannot execute tasks the way you once did.
This is the same with your yoga practice and any other activities and exercises you pursue. You need to start small -- as small as 3-5 minutes.
Start with simply breathing, then include some movements with your breathing, then lots of rest afterwards.
If you find the right teacher, s/he will be able to work with you to create customized sessions that incorporate breath, gentle movements, and lots of relaxation to help ease fatigue, depletion, stiffness, and pain.
A few of my clients work with me on 30-minute bases, where we spend about 10 minutes on some guided relaxation and breathing, 10 minutes to slow and restorative movements, and at least 10 minutes for relaxation-based practices to help de-escalate any potential agitations to the body and the nervous system during the session.
Note that it might be tempting to “push” yourself more on your low pain days, but a key strategy in keeping your systems in balance without over aggravating it is to maintain a steady pace, increasing the duration and intensity very, very slowly, without surprising them too much.
It’s very much like trying to approach a scared and nervous dog. You approach slowly, while displaying warmth, affection, and safety. You might pause for a few moments to allow the dog to feel safe enough with you and come closer. Until, at last, the dog senses enough evidence of safety to allow you to touch and pet it.
Similarly, a body with chronic pain and illness is on higher alert for potential danger. Give it lots of evidence of safety. Be patient, be warm, be slow and tender.
Starting small also means that you don’t overextend yourself by over-stretching, especially if you also have hypermobility. While it might feel good in the moment to go into deep stretches and long holds, oftentimes this causes the muscles and tissues to tense up even more afterwards in hypermobile joints. Instead, scale back to about 50-70% of your end range. Use plenty of support such as yoga blocks, bolsters, and cushions to prevent your body from overextending or over-stretching. The right yoga teacher or yoga therapist will be able to help you determine what a safe boundary looks like for you.
You can check out this breathing practice and this gentle movement practice to get started.
Stop when needed
Just as important as it is to start small, you must also know when to stop before your body becomes strained or aggravated.
While the right yoga teacher and yoga therapist may be able to give you some guidelines, ultimately, you know your body best. Communicate with your teacher when you feel like you need to stop and rest, even if that means leaving a class or ending a session early. The right yoga teacher or yoga therapist will understand, and will not judge you for needing to pause or rest. More importantly, keeping an equilibrium in your body is your utmost priority and not pleasing your teacher.
Yoga is not a competition, and it’s definitely not about how many breaths you can hold a pose or how deep you can stretch. Yoga practice is not a display of aesthetically-pleasing structure of the body. Yoga practice, as it is meant to be traditionally, is about realizing ways of living that most support you -- not just physically, but also mentally, emotionally, and spiritually.
Evaluate
Pausing, resting, and giving yourself space during your yoga practice and afterwards are essential components in helping you regain some mobility and strength without crashing into pain. Yoga, after all, emphasizes the stillness and the pauses when you can direct your awareness inwards.
Furthermore, allowing yourself a few minutes to pause often during your yoga practice (for example, between poses) can help you determine whether what you did felt safe and right, whether you need to adjust your time and intensity of your practice, or whether you need to stop your practice altogether for the day and rest.
A good approach is as follows:
Start with 3-5 minutes of your yoga practice.
Evaluate how you feel after your practice. You may feel a bit tired after the practice, but if you recover fairly quickly (minutes to an hour), then you can increase the duration OR the intensity of the yoga practice by about 10% next time. When you increase the duration OR the intensity, stay at that level for about a week or so to observe how your body responds before deciding whether to increase another 10% or scale back.
If you feel tired and worse for hours and days after the practice, then it is an indication that you need to reduce the duration or intensity.
Continue with the appropriate duration and intensity for about a week. Keep evaluating and observing how you feel each time after your practice. Adjust as necessary.
The idea is to slowly go to the edge of your boundary and challenge it just enough rather than crash into it. This strategy helps keep your body and systems feeling safe and supported without the need to send alarm signals.
Have a Plan A, B, and even C
Having a few different strategies in how you’re going to approach your yoga practice that day can be helpful for your high and low pain days, as well as anything in between.
If you’re having a high pain day, have one or two go-to practices that emphasize more on relaxation-based practices and breathing exercises where you can stay in bed.
If you’re having a low pain day, you can have a couple of practices that emphasize more on mobility, strength, and balance (moderately, of course).
If you’re having an in-between day, you can have a blend of practices that focus more on gently mobilizing and releasing tension from your body.
You can also have a few selection of practices ranging from 5 minutes to 30 or even 40 minutes, depending on your pain and energy level that day.
All of these practices, even those on low-pain days, should include a sufficient amount of relaxation at the end to bring the systems back into equilibrium.
The point is to do a little bit of something everyday, even if it looks like a 5 minute breathing practice while you are in bed. These ancient techniques can still impart a sense of calmness that help alleviate the anxiety around your pain or even serve as a buffer in pain sensations.
Your next steps
Whether you decide to do some research to find the right yoga teacher or yoga therapist for you, or take the DIY route, I hope this article provided some good insights in how to create approachable, sustainable, accessible, and safe yoga practices for you.
My hope is that you don’t feel defeated and give up on yoga after a few horrific experiences.
If you would like to experience my approach to yoga therapy for chronic pain, you can Subscribe to my email to receive weekly education and experiential practices for self-nurture and healing.
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