Yoga Therapy & Chronic Pain
Yoga Therapy is a whole-being approach to healing. Rather than treating symptoms in isolation, it looks at a person's physical body, mental body, emotional body, and spiritual body. In yoga, these are called koshas, or layers of the self. An individual's koshas and state of being at the different layers will help inform what practices and techniques a Yoga Therapist offers to their clients.
In this post, we'll look at what pain actually is, why chronic pain behaves differently than acute pain, and how Yoga Therapy works with all layers of the self to help manage it, including some of the specific techniques we use in session.
Oftentimes pain is felt solely as a physical sensation, something felt at the physical body layer, the annamaya kosha. However, yoga believes (and science also believes) that pain impacts and can be impacted by other layers of the self and not just the physical body. This means that we can influence our pain not just from the physical level, and we will get more into this later in the post…but first, let's talk more about pain.
What is Pain?
I studied Pain Care with Neal & Lisa Pearson as part of my Yoga Therapist training, and the first thing that really stuck with me about pain was that "pain is complex". Pain is complex means there is not a simple way to describe or define what pain is and what pain means for each individual person. It also means that the amount of pain does not equal the amount of tissue damage. Pain is bio-psycho-social, it is a multi-dimensional experience and not just a physical happening.
Pain exists to protect us from harm. It is not the only protection mechanism of the body, but it is a major one. The purpose of pain is like a stop or danger signal, a protective mechanism saying, "hey, if you continue doing what you are doing you may cause yourself harm or tissue damage." When you experience a painful sensation, this does not always mean that you are causing tissue damage. Scientists and pain experts believe that oftentimes the initial pain response is that danger or stop sign, the protection mechanism. One of the most surprising things I learned while studying pain is that the brain plays a major role in pain. Nociceptive neurons are stimulated when danger is sensed, and these neurons send signals to the brain, and the brain plays a critical role in interpreting these signals.
Pain that does not go away for three months or longer is chronic. Chronic pain does not necessarily exist to warn us of danger. A study entitled Perspectives on Yoga Inputs in Management of Chronic Pain states that "Chronic pain is no longer a symptom. It lasts beyond natural healing periods, is out of proportion to the causative factor, accompanied by a sensitized nervous system disallowing natural checks; and serves no useful purpose."
Similar to acute pain, chronic pain doesn't just live in the physical body. It moves through every layer of the self. That's exactly why Yoga Therapy, which beautifully explores all five koshas, can be such a powerful tool for managing it. So, what does that actually look like in practice?
Yoga Therapy to Manage Chronic Pain
The Yoga Therapy approach to managing chronic pain begins by observing all five koshas, since, as we have mentioned multiple times already, we do not exist on one layer but instead are multi-layered beings. Each kosha can give us a better understanding of our relationship with the pain that we experience.
Annamaya Kosha (Physical Sheath) – Where do we physically feel pain in our body? What does this pain feel like (sharp, dull)? If the pain was a color, what color would it be?
Pranamaya Kosha (Energetic Sheath) – When I am in pain, what happens to my breath in? What happens to my breath out? Does the pain influence the amount of energy I have throughout the day?
Manomaya Kosha (Mental/mind sheath) – Do I think that the pain will go away one day? What is the 'story' around why this pain exists? Are there repeating thoughts that come up when I think about my pain? What are my past experiences with pain?
Vijnanamaya Kosha (Wisdom/insight sheath) – Can I uncover any subtle beliefs I may have about pain in general or about my pain in particular? Do I believe that I can have an impact over my existing pain? How may my past experiences with pain be influencing my pain now?
Anandamaya Kosha (Bliss sheath) – Am I able to feel connected to my spiritual self? What helps me feel connected to my natural, whole self? Does my pain change or evolve when I am feeling connected to my spiritual self?
By understanding each kosha a bit more, more questions may come up about our relationship with the chronic pain that we are experiencing. These questions are helpful guidance for where a Yoga Therapy for Chronic Pain Session might lead.
One avenue that we often explore in Yoga Therapy for Chronic Pain is nervous system regulation. Oftentimes, when we are experiencing chronic pain, we may be constantly in a fight-or-flight response, aka our sympathetic nervous system is activated. This leaves us in a constant state of stress – body, mind, spirit. In Yoga Therapy, we can use tools like breathwork, guided meditation, gentle movement, and visualization to move us from the sympathetic nervous system to the parasympathetic nervous system. This is where we are able to rest and release tension from body, mind, spirit. Nervous system regulation can have a very meaningful and impactful effect on our experience with chronic pain.
The experience that we have with chronic pain and our relationship with it is really what Yoga Therapy is most effective for when it comes to chronic pain management. Yoga Therapy does not necessarily eliminate chronic pain, but it aims to change one's relationship with it, understand it on a more bio-psycho-social multidimensional level, and learn techniques to reduce the suffering that it brings.
What a Yoga Therapy Session for Chronic Pain Looks Like
Yoga Therapy for Chronic Pain may be offered as a small group class or 1:1. If you are attending a small group class, know that this will feel different than a vinyasa flow yoga class. You may also find that after a few small group therapeutic classes, you would like a more individual and personalized protocol and you may feel called to seek out a 1:1 session.
A 1:1 Yoga Therapy Session could look something like this:
Intake/Consultation: We will begin with an intake/consultation to learn more about your experience (past and present) with chronic pain and set tangible goals for our time together. This intake may include a body and breath assessment and/or a body scan.
Breathwork (Pranayama) – Some breathwork techniques that I often use with my clients experiencing chronic pain are an extended exhale, brahmari or bee buzzing breath, or nadi shodana. Most breathwork techniques will be aimed at nervous system downregulation.
Gentle/restorative movement – This will include pain-informed asana and learning to move within a safe range with the goal of rebuilding trust in the body.
Meditation/Visualization – We will work with the mental and wisdom bodies to uncover some of our 'story' around pain and explore techniques for freeing these stories and thought patterns. This may also include mantra, affirmations, and mudra.
Deep relaxation – This will often be used as a way to round out and incorporate our practice together.
After our Yoga Thereapy session, you will leave with a yoga therapy protocol that you can try out on your own.
Living Well Alongside Chronic Pain
Chronic pain can feel isolating, but you don't have to navigate it from the physical body alone, and you don't have to navigate it alone, period. When we start to understand pain as something that lives across all five koshas, and not just the tissue, we open up so many more doors for healing than the physical body could offer on its own. That's the spirit of Yoga Therapy: meeting you exactly where you are, across every layer of who you are, and helping you build a new relationship with your pain rather than a life defined by it.
If any of this resonates with you, I'd love to support you on that journey. Whether you're brand new to yoga or you've been practicing for years, a Yoga Therapy session can be tailored entirely to you and where you're at right now. Reach out to schedule an intake consultation, and let's talk about what a personalized chronic pain protocol could look like for you.
