Yoga might be a useful tool in your pain management toolbox. It might not. Let me explain…
“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”*.
This is the International Association for the Study of Pain’s definition of pain. It was revised in 2020 to more clearly convey the nuances and complexity of pain (and you can read more here).
So, pain is nuanced and complex. It is sensory and emotional. And, of course, physical.
We all have a felt sense and personal experience of pain in one form or another. The youngest child in our family fell and grazed her hand this week. It bled a little and she cried. She was frightened and it hurt more when she looked at the injury. It stopped hurting when I covered it with a dressing.
I have had a recurrence of an acute pain in one SI joint this week. No medical professional I have consulted can point to a physical injury in the way that they could with my child’s hand. Yet I can feel a sharp, constant pain which seems to me to resemble the pain you would get from a physical injury. Yet it also gets worse when I am anxious, as if my body is tightening up, and was originally triggered during period of intense personal stress. I find yoga breathing practices help, as do gentle movements where I mobilise my pelvic area. Osteopathic treatment has helped in the past. As have prescription painkillers. No one thing on its own provided a solution.
So, why is it that yoga might be useful when managing pain?
A mind, body, spirit practice
Yoga, particularly when people think about yoga in a class setting, is a physical practice. But it is not only a physical practice.
Yoga is concerned with connection or integration. Personal connection to and between the physical, energetic, emotional, intellectual and spiritual parts of the self. And connection between the individual and the universal (or the divine). A yoga practice includes within it breath awareness, meditation and an exploration of underlying spiritual and philosophical concepts.
Pain affects and is influenced by the physical body but it is also influenced by other factors including but not limited to psychological and social experiences. And so it makes sense that a practice like yoga, which pays attention not only to the physical body but also to other considerations, may be useful in understanding and perhaps managing pain.
It all depends
However, the type of yoga class or elements of a yoga practice which may prove useful will depend on just as many complex factors as those influencing the original experience of pain.
I find that medical professionals often suggest that people do (or don’t) attend a yoga class without any clear understanding of how varied yoga classes can be and how varied the training of yoga teachers can be. Some teachers specialise in philosophy. Others are fascinated by biomechanics and anatomy in action. One class may be entirely breath led, while another may barely refer to the action of breathing at all. Perhaps you will stretch at a class, or do handstands, or chant. Or just lie down and rest (I like those classes best of all).
It may be that this is why (to generalise) people are referred to pilates classes for more obviously physical conditions (particularly musculoskeletal conditions) where there is rehab to be done, and to yoga classes where there is a perception that the individual just needs to relax, or stretch, or destress. But you can certainly undertake physical rehab with the right yoga teacher, and find relaxation and stress relief with the right pilates teacher. It’s all about the approach, experience and training of the person you go to.
Yoga for pain management
I cannot see how a physical yoga class could be helpful for anyone experiencing acute pain. It might be that working one to one with an experienced teacher could support you to mobilise (in the way that I can support myself when I am in a state of acute pain), but a class environment is not appropriate in these circumstances.
However, breath awareness and some pranayama practices may prove to be supportive. This is, in essence, much of what we practice in a pregnancy yoga class. All pregnant people will at some point experience pain, however they birth**. One of the most important things you can do during pregnancy is develop a relationship with your breath so that, when the need arises, you can connect to your breath and utilise it to help you manage your physical, emotional and psychological response to pain. In essence, so that you can calm your nervous system.
The wise and wonderful Uma Dinsmore-Tuli says in her seminal book “Yoga for Pregnancy and Birth” that:
“exhalation is the antidote to pain”.
She goes on to say that:
“to exhale fully releases tension and anxiety and to release tension and anxiety reduces pain”.
This applies to any experience of pain and is not limited to pain experienced during the perinatal period.
A small amount of scientific research has been carried out in this area. A 2022 systemic review of randomized control trials found that there was some evidence that slow deep breathing may help patients with acute pain, although further research was needed to identify which patients may benefit the most, and to determine the best way to deliver the therapy***.
Slow deep breathing
Slow deep breathing was defined and practiced differently in the studies considered in this review. Some of the studies used a counted breaths approach, others simply a combination of “slow”, “deep” and “rhythmic” breathing.
If you would like to practice slow deep breathing now (and explore how it might help you to manage your own pain) I suggest you set aside some time each day to focus on your breath. Perhaps begin with five minutes at a time. Maybe at the beginning or end of the day, when you are resting in bed.
Find a comfortable place to be and position to rest in. You could sit up, supporting yourself. Or perhaps lie down. But make sure wherever you are, you are not aggravating pain by choosing an effortful or triggering position to stay in.
Start by simply noticing your breath as it arises. The breath consists of four parts: inhale, pause, exhale and pause. They arise over and over without any need for you to control them. Notice how your body moves as you breath. Where you feel space arising. Where you experience containment. Notice how fast or slow you breath in this moment.
Notice if paying attention to your breath feels difficult. Perhaps it makes you feel anxious or worried. If this is the case, then this may not be the right practice for you in this moment. You will not be alone in this. It may be that a different anchor is more helpful for you in managing your pain, and allow yourself to detach your attention from your breath and perhaps notice the sounds around you as you rest.
However, if you choose to remain focused on your breath, having noticed the natural rhythm of your breath, begin to see if you can slow it down ever so slightly. A slow inhale, a slow exhale. I like to breath in and out through my nose and find this helps me to slow my breathing down. Perhaps it is the same for you, or perhaps not. Slow the breath without making it more effortful. Soften as you breath.
Some people like to count their breaths. You can do this in lots of ways. Perhaps you count to four as you breath in, and six as you breath out. Or start by counting how long a natural breath is, and add a second or two as you invite it to slow.
And when you are ready to end the practice, simply move your attention away from your breath. Notice the sounds of the room. The feel of the support beneath you. Take some small movements. Become aware of how you feel having practice slow, deep breathing.
And with that knowledge and awareness, consider how helpful (or not) you found it in managing your pain.
**I strongly disagree with any hypnobirthing practitioner who may suggest that any approach to birth can be pain free.