Yoga for Pain Management

Here's the deal peeps: The chronic pain bullshit continues. I don't know why I'm all flippy about it right now. It's nothing new. But managing pain takes so much fucking will. There's no pill to fix it. Rather, there's a pill and a potion and supplements and body work and the mindful application heat and cold and exercise and (potentially) diet. Most of all, though, it's about fortitude.

Actually, as of yesterday, it's also about a jaw splint because, on top of everything else, I've been dealing with pretty significant TMJD for most of my life. It's hit a peak of badness lately, unsurprisingly. Life stressors, age and hormonal shifts have contributed to this. But the latest little life glitch to contend with is that my jaw actually dislocates when I open my mouth. (It does click back into the right spot thereafter, but this ain't a good development.)
 
I don't want to dwell on the bad right now. I have enough opportunity to do that in the wee hours of the night. The measure of a person is not in her ability to handle the fun times, of this I am certain. And, since I don't appear to be living a life of constant fun times, I'm going to focus on the gift that is pain. For example, you never have to wonder about the verity of the mind-body connection when you live with pain. It shows itself to you in every moment.

This is actually a relevant segue to a topic I've been meaning to discuss for a while: the specifics of the yin yoga method. I've discussed it briefly before. It's a system that's gained popularity in the last decade - and mostly in the last 5 years - though it's been around since the 70s.

It combines Daoist principles, elemental constructs of Chinese Traditional Medicine with long-held asana (many analagous to yoga postures you'd be familiar with). The objective is to work the body, in these postures, "cold" because you don't want to engage muscle groups - what active yoga practice aims to do. You want to by-pass muscular response so that you can stress (and thereby tone) connective tissue and fascia.

Yin practice works distinctly from active practice. They are complementary but different physical and meditative activities. Often, long-standing practitioners of active styles (Iyengar, Ashtanga) feel that yin yoga isn't "real yoga" because it functions on the plane of the passive. Yes - yin yoga is unapologetically, deliberately passive. The premise is that you do not want to engage regular physiological feedback loops because they're in opposition to those that stress the connective tissue. In this context, stress is a good thing. It implies new growth of healthy tissues and strengthening of existing structures. You cannot stretch connective tissue. That's the purview of the muscles. To stretch ligaments and fascia would be to damage them. So you stress them instead.

Any yoga can be practiced by any person at any stage of ability - but I warn you against embracing the yin style until you have a well-established active practice. The style assumes a certain amount of muscular flexibility and strength. Regardless of the passive intention re: holding postures for upwards of 5 minutes each, it takes strength and pliancy - both physically and mentally - to do so.

Unlike the Iyengar restorative method (and I'll discuss the distinctions between these in a moment), the yin method doesn't dwell on how to prop the poses to allow for long holds. Some teachers address this better than others - but a strong background in Iyengar yoga is the perfect complement to the yin practice. Iyengar yoga is particularly focused on muscular activity in the context of structural stability. Yin yoga focuses on non-muscular activity in the context of structural stability. Skillful application of props is germane to both of these goals.

Here's what I'll say about the yin style (as a person who is very experienced in the ways of the restorative Iyengar method):

• The yin practice is entirely different than restorative practice in its intention. The restorative Iyengar practice focuses on improving health (mental and physical) by taking postures to balance the endocrine system. Those postures, while heavily propped, are not passive. They engage muscles inasmuch as the maintenance of muscular "tone" is inherent to remaining safely in the postures for long periods. The emphasis is on supported back bends and full inversions - which are known for promoting endocrine stability. There is no emphasis on Chinese medical principles. There is an emphasis on the movement of prana.

• By contrast, the yin practice emphasizes complete passivity in the poses. The mantra is: With no expectation, every posture is correct. Time is the only meaningful variable. With long-holdings, comes optimal stress to connective tissues - if you can handle it. These poses focus on the large muscle-groups between the knees and ribcage, particularly the hips and the emphasis is on seated poses, modified standing poses and forward bends. As fascia is interconnected between all muscles in the body, stress on the largest muscles achieves the greatest result. And, as this fascia tones, via stress, one can feel the impact of yin hip openers widely throughout the body. Postures are explored from the vantage point of Chinese medical principles (meridians and elements) and also from the standard yogic vantage point of moving prana.

The last few years of pain management, and near constant meditation on the semi-regular pain-loop I experience, has led me to understand that stretching my muscles does nothing to help my pain. My muscles are pretty stretchy. I mean, I've been stretching them regularly for 25 years. They're also strong and fairly well-aligned. When the pain flares, however, my connective tissue grips like a mass of plastic that just doesn't want to move.

It's taken me years to figure this out. But I was totally shocked to discover that the premise of yin yoga (a method I'd heard about and arrogantly assumed was like "restorative yoga lite") is all about the very thing I cannot contain or work to my will.

Here's another way of looking at things re: yoga as pain management. (Note that yoga is about much more than pain management, of this we are all well aware...)

Iyengar restorative practice seeks to ameliorate pain by balancing neurotransmitters (the hormonal precursors in the brain). Talk about taking things back to the studs. It presumes a non-trivial amount of physical and mental self-awareness - and the ability to stay in some serious poses for a long period of time. When effective, biochemical balance leads to a significant decrease in pain.

Yin yoga doesn't go straight to the brain (well, even as it goes straight to the core :-)). It posits that passive stress to a sheath of tissue (which runs throughout the body) can elicit a change in the pain response. Does that go back to the brain? Yeah. But it's a more accessible vehicle for most peeps.

Is one better than the other? I don't think so. In as much as yin yoga and active yoga are different modalities, so is Iyengar restorative practice distinct from the yin method. One may work better for a particular practitioner at a particular moment. The pain loop is not static. Pain comes from and goes to different places depending on a myriad of factors that are so minute it's sometimes impossible to detangle them. In this respect, knowledge is power.

I often modify my yoga sessions (while in a pain moment) to include elements of active, supported and yin practice. I also modify my intention to suit that of the practice I'm doing. When I work actively, my meditation is on slowing breath and moving that breath to the muscle groups (to improve endurance and flexibility). When I work supportedly, my intention is to use inversions (and pressure points) to restore endocrine balance. When I work in the yin practice, my intention is to be entirely passive - which is almost impossible for me. It's to feel the pain I run from much of the time. To integrate it and to make peace with it.

The value of intention cannot be underestimated. I spent years wondering about whether there's any specific correlation between outcome and intention. Trust me, cuz I've done the work. The correlation is significant. You cannot remove your mind from the pain equation. Nor can you remove it from the yogic one.

Today's questions: Do you practice all three types (active, yin and supported)? What is your experience? Do you manage chronic or semi-regular pain? What are your techniques for managing? How does intention alter your experience of yoga practice (if at all)? Let's talk.