Friday, October 31, 2014

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.

17 comments:

  1. wow, what a great post. I practice Iyengar (active and restorative) and have zero experience in yin. This makes me want to check it out!!

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    1. Jean - give it a try and tell us what you think! You can sign up for a free trial on My Yoga Online (now part of Gaiam TV) and take one of the many yin classes that platform offers. I'm partial to Bernie Clarke and Cameron Gilley.

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    2. And, needless to say, no one's paying me to promote Gaiam TV...

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  2. Hi! It's so nice to hear a perspective on yin yoga from an Iyengar practitioner.

    But I wonder how you can reconcile the two? I'm a yoga teacher currently training in Iyengar (it takes awhile, as you know). Everything I've learned from my Iyengar teachers, my original training which was not Iyengar but in the lineage, and what I understand from reading on anatomy/biomechanics suggests that passive stretching (ie 'hanging in your joints') is bad for the joints. I learned that we TRY to only stretch muscle, that ligaments and tendons inevitably stretch as well but that that should never be the goal as it can destabilize the joints, esp on already-bendy people who may be hypermobile.

    As for the fascia around the muscle, I do believe that it stretches along with the muscle.

    So can you comment on that? I assume from reading your yoga-tagged posts (I'm here from the bra world :) that you were a teacher, but perhaps I'm wrong.

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    1. Hello! I am a long-time Iyengar practitioner and teacher (although I haven't taught classes in a long time). Thanks so much for this comment - I think you raise a really valid question about hanging on the joints.

      Part of the reason that I believe yin practice is not suited to novices is because the novice is apt to be either very flexible or very inflexible without an understanding of how muscular flexibility intersects with appropriate alignment. Newbies also don't tend to have an awareness of what's happening when they experience pain in practice.

      My sense is (and please - other peeps chime in!) that the reason a body-aware practitioner doesn't "hang on the joints" is because her muscles aren't warm and they aren't engaged. One works with a body that only moves as a result of tension to fascia, not because the muscles are warm up and promote more movement than the fascia can withstand. Sure, as part of the muscle, the fascia in that muscle moves when the muscle does. But it moves under different impulse and often out of phase with muscular movement. Please know that this is simply my perspective having practiced both methods and having done yoga for many years. I didn't read this in a book and your teacher may have more to say about this.

      Nonetheless, this is why, I assert, joint damage can happen so easily in active practice. It's also why those who pay careful attention as they lengthen through muscular extension can move deeply without injury.

      Now, having said this - everyone's different, flexible or tight, novice or experienced. One shouldn't stay in these poses past the point of feeling that the joints are hanging. The pain should be diffuse, warm, almost shimmery... When it becomes sharp (or when the mind becomes overly resistant), it's time to come out. Pushing though is not in the nature of the yin practice. It will only sabotage the effort.

      Mind you, this is where awareness of the effective use of props is invaluable. We, as Iyengar practitioners, know how to use a prop so that it protects a joint (on the one hand) and motivates intensity (when appropriate, on the other hand). If the yin teachers knew how to manipulate props in the Iyengar tradition, it would be a phenomenal fusion.

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    2. Also, just want to clarify, though connective tissue doesn't stretch like a muscle, it does lengthen with tone because it releases. That helps to increase muscular flexibility quite remarkably, in my experience.

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    3. Thanks for your reply, and that's the first time I've heard about the distinction between warm and not warm muscles and how that affects stretching of the fascia -- that's interesting!

      Ultimately, though, I still do think the two systems are irreconcilable -- as opposed to vinyasa yoga, for example, which can be done in a way that doesn't conflict with any Iyengar teachings. And even though I'm a tightly woven person, I'd still rather stretch muscle/fascia first and tendons/ligaments/fascia second. Although it's amazing how much we actually don't know in terms of kinesiology and the science of stretching; maybe soon there will be solid scientific recommendations as to how to stretch. Thanks for talking about this!

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  3. Chronic pain stinks, to put it prosaically. As you know, I gave yoga a bit of a spin this fall, but felt that my herniated neck discs weren't appreciating it. I suffered from a tight jaw for a few months while in grad school--it seems that every semester my body still finds a new sort of stress-induced ailment--but haven't been bothered with that particular iteration since. My challenge was finding a physical outlet when I was unable to run for a bit. And whenever I can't run, such as when work gets super busy at this time of year, my body reacts negatively :-( .

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    1. Ha! So true. It's fascinating to me that you refer to the stress-induced ailments that kick in when you begin a new semester. I'm pretty sure, if I led a life of luxury, free of the need to earn money (so I wouldn't have a day job), much of this pain would be more manageable. It's not that I don't like my job (I do!) - and I certainly appreciate what it provides, but living at the pace of the modern multi-tasker can take a toll on a sensitive body.

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  4. I have limited yoga experience (2 years, 1-2 classes a week), and I find your writing on the topic really helpful in understanding what I'm doing. Coincidentally, I've been trying to figure out a way to get back to a Yin class, which my fave studio offers on a Monday evening (a long day in town, staying after work, taking 9 ferry home). For me, these classes are so good for pain relief, for adding flexibility where it counts. My great instructor is really careful to guide us in how to manage the long deep holds. Sleep better the night after these classes than ever!

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    1. Thanks Frances! Strangely, and again, this is not a plug, My Yoga Online does some very adequate yin classes of many different lengths, with different focuses at different levels. You might want to check it out. They may span the gap until you can get back to your fab instructor.

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  5. I didn't know you were a yoga teacher, that is so cool! These types of yoga sound very interesting. I have tried a few different ones (nothing too intense) and even hot yoga. DON'T do this!!!!!!!! Especially with hormone/cortisol problems! (In my defense, I did not know about my hormone/cortisol issues when I was practicing it). But, it sucked. Curious, have you ever tried qigong? I did it once and I can't believe how helpful it was. I am signing up again late November. Hope your pain improves. (well, hope the lack of pain improves)

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    1. Ha! Hot yoga doesn't appeal to me for a variety of reasons - not least of which that I hate sweating! I haven't yet tried qigong but I know it can be phenomenally helpful - those who love it really love it. Here's to pain-management :-)

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  6. I do not have a high tolerance for 'woo' therapies...But when I was having jaw problems (my jaw wouldn't close all the way - had a gap of 3-5mm between my back teeth, my dentist sent me for acupuncture. It worked so well I din't even up needing to get the muscle relaxant/narcotic/whatever it was injected into my face! The other thing - once the acupuncture had worked - was an exercise where you hold your tongue against the roof of your mouth while you open and close your teeth. You do this while keeping your lips loosely together (so you're not opening your whole mouth). I haven't had my jaw act up since I've started doing those 'jaw stretches'!

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    1. My parents are acupuncturists so I am well-versed in the benefits of acupuncture. Thing is, it hasn't helped my TMJD because I have so many other things going on, I've got to drill into those first (I sense). Thanks for the info about that jaw stretch. I'm going to give it a go!

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  7. I've had chronic pain forever, or so it seems. Right now I'm facing spinal surgery and so I'm starting yoga again, with hope it will help me cope and strengthen again. I am mostly bed ridden. I do not work (cannot work) and I can assure you that living a life of leisure is not the answer. Mostly, as I deteriorate, I find my life empty. Of course, my lack of mobility causes a lot of this -- I can't go out for lunch or manicures. Good luck with your chronic pain.

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    1. Anon: I am SO sorry to hear that you have been dealing with pain for so long. Being bed-ridden must be unspeakably hard. Thank you for providing me with another perspective on work - that it helps to keep me grounded and distracted. I wish you peace in this process. xo

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