From Pain to Equilibrium: Resources

I've been working my way up to posting a huge tome about best-practice methods for managing chronic myofascial pain but, truly, it's a massive topic that's so close to home, once I'm done living it, I'm scarcely motivated to continue the conversation.

Having said this, I've written at length about this sort of pain, over many years, so I would recommend - if this post is resonant - that you use the handy search field at the top of this page and type in your subject of note. Chances are high that I've spoken about it (at some length) before...

At the end, this post includes a repository of those methods and mechanisms for peeps who are interested to learn about what works best for me. The potential benefit here, from the perspective of one trying to understand how to manage his or her own chronic pain, is that I've tried just about everything - and many things I'd never be able to come up with on my own - to move the yardstick from pain to "normal". So there's a lot to go through in this blog. If I haven't covered the subject - the internet is vast and I recommend that you put on some good music and get googling :-) because knowledge is power, my friends!

Here's the thing: there is no one definition of chronic pain. What it feels like in my body - and what triggers it - is unique. It's that way for us all, though few practitioners will disclose this (they do need a raison d'etre) - and, statistically, few support practitioners wade through the chaos of chronic pain in their own lives. So the first thing I have to say is that your only way out is YOUR way out. While they may support in many meaningful contexts, it's very unlikely that your sports med doc and your GP and your rheumatologist and your psychiatrist (these peeps do know drugs) and your physiotherapist and your massage therapist and your pain clinic and your cardiologist and your acupuncturist and your yoga therapist and your INSERT NEXT DOCTOR HERE are going to provide you with the answer. Just ask anyone with chronic pain.

To drive this point home again... Put 2 people in a room, both suffering from the after-effects of a concussion, and you will almost certainly find yourself looking at 2 totally different presentations of pain and other symptomology. It's just that way with all chronic pain - myofascial, fibromyalgic, neuropathic and so on. What's the common denominator? A dysregulated central nervous system. As a macro, this intel is very useful. On the micro-level, it's almost meaningless.

I will also disclose, at this juncture, what with my being a fully-formed middle-aged person who can no longer be bothered to hide behind social mores, that I have experienced so many bizarre symptoms and forms of pain at this point, I scarcely know how to quantify them - except to say that I hid many of them from most of my medical practitioners for years because - you heard it here first - those symptoms freaked me out so significantly.

I think you'd agree, I don't come off as the kind of person who hides things cuz they're too scary to think about.

Chronic pain is also, 9/10 times, accompanied or defined by a series of co-morbid conditions that overlap - again, cuz central sensitization occurs at the centre - the CNS - spiraling out in a series of metaphoric floral motifs (what? I need to find some creativity in this topic). We might as well call it "one really nasty outcome of CNS dysregulation" because it never is one thing - it's everything. Which is why you can't fix it like a UTI.

But back to my special format: myofascial. In layperson terms, a swirly vortex of pain likes to inhabit various different zones in my body, almost like a poltergeist. That pain can be extremely intense, coming on like lightning and lasting mere moments to weeks, or dull and systemic, also lasting moments to weeks. It can be notably neuropathic (migraines, "sciatica") to utterly muscular (that phenomenon I refer to as "turtling" where every muscle within a certain zone becomes observably as hard as steel). Sometimes it tangos, elegantly, with SVT, producing an otherworldly sensation. I've also got some joint pain due to that lovely, early-onset osteoarthritis and all of the inflammation it brings to the fore. In some ways, the most problematic sensation isn't full-on pain but mass inflexibility. Though no one would define me as anything other than physically flexible, I feel internally stuck in a way that makes me want to tear at my skin so that I can be liberated from its confines.

For me, right now, fascia - that lovely layer that covers everything in the body, so it's got real estate - isn't functioning "normally". The fibers are unyielding, so replete with nerves that, for the "right" person, alighting the nerve response is like shooting fish in a barrel. Hilariously, I'm hyper mobile in certain ways. For example, in my years of fancy-ass yoga practice, I managed to bypass all of the myofascial triggers that warn me of an impending pain flare. And I suffered. Just cuz something looks pretty doesn't mean it isn't causing harm. And natch, just because it causes harm in one person in one time period, doesn't mean that it will in the next. Note: My yoga practice, in as much as it's brought on pain, is likely the thing that's saved me from the very ebb - so nothing is simple.

Believe it or not, while age has given volume to the pain, my management plan is so utterly sophisticated at this point, I'm faring far better than I did a decade ago. Of course, a decade ago, I wasn't having to manage it as constantly or fervently. And a decade ago my life had not spiraled into the complex landscape that it is today.

As I re-read this post, I imagine that you must be thinking: Lord, Kristin must be freaking out about the unknown end state of all of this. In case that's crossed your mind, let me assure you that I am not. I don't have that luxury and - mercifully - I don't have that mindset. Miraculously, I'm able to view this through the prism of experimentation. I believe absolutely in the power of my mental flexibility. To me, everything is a game, a puzzle. Pain management is how I occupy my time when I'm not doing all of the other things (or in lieu of, on occasion, suboptimally). Say what you will, I am incomparably fortunate to have this natural propensity. Other than money and my awesome husband, this is my strongest protective factor. These three things are a worthy triumvirate.

But other things also help immeasurably (and in no particular order):

• MELT Method (a type of myofascial bodywork done with a special roller)

• Yoga / Bodywork: For me it's traction and therapeutic, for the most part, these days (Note: I'm a teacher with 30 years of experience. Don't try this at home if you don't know what you're doing. Just look up by a couple of paragraphs and you'll see why.)

• Acupressure mats and pillows: I call these my head and bed of nails

• Body scrubbing: for those with fucked up fascia, this is way more useful than you might imagine. It takes a while though and it requires a certain amount of flexibility.

• Massage

• Acupuncture: combined with massage, this is extremely effective in a time-limited fashion

• Nutrition: I follow a Primal Lifestyle diet and avoid all grains, processed foods and sugar. We're all unique but this particular diet-style seems to work for lots when it comes to pain management.

• Supplements: You should talk to your naturopath about which ones are best for you. Magnesium glycinate and vit D are usually good for everyone.

• Sleep: improvement by whatever means necessary. Arguably, this is the most important one of all if you read through the studies.

• Extremely moderate exercise: (Is that even a thing?) Walking, but not as much as you'd like. Yoga or cycling - but not so much that you hit a limit. Managing pain is all about understanding the parameters. This has been my biggest challenge because I'm not moderate. People have been telling me for years to do weight work. Every time I do it, I end up in pain. For me, the optimal weight work is in using my own body in certain modified yoga poses I've spent years honing. Peeps with chronic pain often produce that pain with exercise not because exercise is bad but because those peeps have a dysregulated CNS, symptomologically exacerbated by certain exercise. Remember, everyone is unique.

• Meditation and CBT: At some point, you're going to have to wade into the depths of grief caused by pain that doesn't appear to be going away according to your timeline (or that dictated by your sanity). You're also likely going to be awake for that dark night of the soul. Learn these by whatever means possible. Bonus: Everyone should be doing this so you'll just be extra-sassy and ahead of the curve!

• Any functional neuroplastic method you can find or make up: And yeah, you can totally make it up. Seriously, if you can fake knitting, you can fake neuroplasticity until you get there!

• Pharmaceuticals: Ain't gonna wade into this topic, which is vast and laden with landmines. But if you've had chronic pain, chances are you've gone down this path. For myofascial pain, muscle relaxants that work on the brain (i.e. cyclobenzaprine) can be very helpful, if they work. Drugs can be long-term or short-term. Aim for short-term because the consequences are usually more tolerable.

• Medical cannabis: Another vast topic... One day I'll start a blog on this topic. Note: Most doctors don't know what the hell they're doing on this topic. I have to assume this will change.

• Trigger avoidance: Alas, you need to know what these are in order to utilize this method.
  

• Getting the co-morbid conditions under control: For example: If you have anxiety disorder that's contributing to your CNS dysregulation, consider an SSRI. Or, if you have structural TMJD, get a mouth gizmo. If you can't sleep, you MUST figure that shit out. Nothing will improve till sleep does.

• Learn by books and blogs: I won't lie. There aren't a ton of good pain blogs out there. This cohort isn't at its snappiest much of the time. I only hope that, if we consider mine a pain blog at this juncture, it isn't boring and it is helpful. There are a lot of studies out there to become acquainted with. Painscience.com speaks of them at length. (This blog is sometimes useful but often strident, be warned.) Also, there's a great book that provides tremendous insight and practical support re: the relationship between CNS dysregulation and pain: The Fibro Manual by Ginevra Liptan. You don't need to have fibromyalgia to benefit from this book. It pertains to all pain and sleep disorders. It's also written by an MD who lives with fibromyalgia so it's got some street cred. It's neither allopathically nor "alternatively" focused. It takes a multi-pronged approach, really, the only one works. I also recommend Healing through Trigger Point Theraapy: A Guide to Fibromyalgia, Myofascial Pain and Dysfunction by Starlanyl and Sharkey.

• A collegial relationship with as many of your doctors as possible: Note: When you need them most, that's when your ability to maintain and develop collaboration will be at its weakest. These people need to see you in good times and in bad.

• DNA testing, but not if you aren't one of those peeps who likes to learn about gene-coding and then to figure out science.

• Friends / Family / Pets: (though not if you need to care for these on your own) Don't discount the magic of community. When you can do nothing else, you can accept love and support from those who care about you - and give it when you see pain in your midst. Pain's one optimistic trait is the compassion that it brings to the fore. May we all leverage this to our advantage.

• Knitting: No joke, I am currently sane because of yarn an needles (and not just the acupuncture kind). You can swap in anything that brings you tactile joy, that soothes your soul, that creates beauty and that can be done anywhere. And then do it cuz it doesn't work otherwise.

It's amazing to me that this is just part of the daily regimen that helps me and is by no means an exhaustive list of everything I've tried to date - or will try in the future. Hope it provides a starting off point for anyone who may be able to benefit from my insight thus far.

A Little Bit About A Lot

Yo, Peeps. Much to say, not much time in which to say it. I've got a full day of yoga-doing, naturopath-visiting, window-shopping, friend-meeting, dinner-having and movie-with-subtitles-viewing. This'll be my second in-theatre film in 2 weeks. After 5 years of not seeing one. I average about 1 every 5 years so this is unprecedented. (Mind you, it is a Rohmer film from the 80s.) It's playing at the TIFF Lighthouse (the headquarters of the Film Festival which needs no introduction). I'm feeling rather urban-lady.

Lord, have you ever seen more hyphens than in the paragraph above?

I'm going through a phase of much self-reflection and, frankly, I don't have time to be all existential and bloggy simultaneously. Furthermore, I wonder if my "who am I?" posts freak people out. I mean, I'm eternally freaked out by the vast cavern of my own humanity. Must I inflict that on others? (Answer: Likely yes. But not till I can alchemize the depths of feeling into words.)

Just a few check-in things to say - which are totally disparate in nature - but hopefully include something for everyone:

• For those of you who follow me on Instagram (@kristinm100), you may be pleased to learn I got the job for which I interviewed a couple of weeks ago! It's a promotion and it's going to provide me with new experience and learning opportunities that I'm very excited about. I'm also nervous (but who isn't when she takes a new job??). FWIW, I highly recommend the Kielo Wrap Dress for interviewing.

• Right now, I'm making this sweater and the patter is SO well-written. I love the construction, which is short-row heavy (everywhere), to put it mildly. And yet, while I'm no fan of the short-row, I find myself loving them in this context. I do hope my crazy work-arounds produce a well-fitted end result. I got neither gauge, nor do I fit into 1 specific size (according to the pattern schematic). So I'm going rogue. Mind you, I did so many gauge-swatches for this thing and that should count for something.

• I've been meaning to write about this for years, but honestly, if you experience chronic pain (particularly in the back, for any reasons - but myofascial pain is a good one) you'd really do well to buy an acupressure mat and pillow. This also saved my ass when I was getting those 10-day migraines a couple of years ago. (Thank you God for their abatement). Sometimes this, and sleep, were my only recourse during that time. I affectionately call these gizmos my bed of nails and head of nails. Effectively, they work like a low-fi TENS machine. I have many modalities to manage pain, when it hits, but there is none more useful than this mat and pillow - which are so affordable that you can have one in every room (and in the workplace). They are also very durable in my experience. Those little plastic pokey things do just what you'd imagine - they stick into your back/neck/head (with a pretty good amount of force, esp. if you're not wearing anything between them and you) and they re-route the pain loop. Of course, they also cause pain - pain which you create voluntarily, knowingly - and this rather miraculously re-circuits the neurological response.* I've got a lot to say about this - and neuroplasticity, my latest fascination (and what I imagine is the future for me and pain management). I've recently been referred to a fantastic pain clinic wherein I hope to be able to apply certain neuroplastic techniques to reroute my pain response permanently. I've got new info about what may be reinforcing the pain - arthritic spondylosis, which appears to be throughout my spine and might explain why that pain moves around as it does, and then just as readily disappears. It also explains some other symptoms I've been having. Mind you, I question that the pain is being caused by this, though it certainly may be aggravating it. Many people have spondylosis (although not generally so young) and they do not experience pain. Much has to do with compression of nerves and how degeneration presents itself, but still, I'm not convinced...

• Of course, this has given me much pause for that self-reflection I mentioned above. Arthritis does not run in my family. So what the fuck is going on? Well, I don't think that hormonal change is helping the situation... Has the intensity of my yoga practice, in my teens, 20s and 30s, had anything to do with this? I wouldn't be the first person to cause structural damage with yoga (or any other form of movement). On the flip side, has yoga saved me from much worse damage? What about the miles and miles of walking I've done, almost daily, for most of my life? (I have cut back on this walking only one way to work these days, as my body currently suffers when I walk too far.) The great yoga master, BKS Iyengar always said that you are only as young as your spine - words I have lived by since I was 18. When I've written, in the past, that some mornings I wake up feeling 80, I had no idea that my spine was showing symptoms of age beyond those which my birth certificate would support... No question, I am going to use every known mechanism to reverse this damage and then I'm going to prevent it from recurring.** Even if it means I have to change my diet radically and forever. Cuz this is not taking me down.

• But finally, on a lighter note, presuming you have AC - not sure if you've heard that TO is going through the biggest heat-wave in its history (save one other, many years ago). We're actually in a drought (which somehow I dispute, because I haven't turned the water on in my gardens all summer and they're adequately green). Just want to clarify, since I complain about every weather known to man, that I fucking LOVE this. It's hotter than Hades (or India, more to the point) at 43 degrees. It's sunny constantly (though not today). The patios are actually less full than usual cuz most people can't handle these temps. I may be the only person I know who'll be sorry to see this go (in truth, I prefer 30 degrees but hot is always better than cold) so I'm going to celebrate while the sun shines. Here's to focusing on the positive. Peace out.

*Amusing side note: My husband is a total wuss when it comes to these props - he cannot lie on the mat without screeching like a baby panda. Happily, for him, he doesn't need them.

** For better or worse, you will be reading about all of these mechanisms. Traction, anyone?

Pain in the Ass (Amongst other Places)

I don't know whether to be grateful or grudging that pain returned at the onset of a much needed vacation. It's still here - though shifting (and becoming more malleable with awareness. While the time away brought some awesome moments, it culminated in yet another awful stress. My mother-in-law was in a pretty serious car accident. Miraculously, she's alright (physically, anyway). The car, not so much. It's totaled. But it means more things to worry about. My husband is most definitely having the chance to see aging in action - like, writ large - with all of the responsibility that being one's adult child entails. Really, this fucking age-and-stage shit is not our jam. (Note: Scott really is handling things admirably.)

I realize that I spend a lot of time on this blog complaining or, as I like to call it, being honest. (I like to think that I also spend a lot of time on this blog being positive or an occasional resource for others or a momentary good read.) The fact is that I can only write about where I'm at, and who I am, at any given moment.

Sometimes, I'm the crazy yarn stash-buster. Other times, such as today, I'm the lady who has - in the last 2 weeks - somehow managed to accumulate more stash than she actually busted on her recent, serious stash-busting mission (which was a success). Don't worry - I have a very exciting post about that coming up. If you like to watch rationalization in action, that is.

I'm also that half-mathy / half-half-assed intuitive sewist, who's having a super time refining the Appleton dress - and top - over these past few days. I'm going very slowly because, well, I feel like I'm a hundred and like I've been hit by a bus. Moreover, I don't know what the rush is. I have enough dresses to wear on Monday.

FYI, the osteopath, like the massage therapist, believes I have dislocated my tailbone. If this is the case, it should be a fairly easy (but unpleasant) fix. And while I'm pleased to know that the immediacy of my butt pain will likely be temporary, the metaphor is both hilarious and seemingly eternal (at least these days).

Peeps, I live in this body. I know it very well (even as it evades me with its complexity). My lower back/hip/sacral/coccyx pain may be fixable at the extreme (and thank God for that!), but this is related to my other intermittent chronic pain. I can feel it. And I've spent the last four weeks (often standing for an hour at a time) going through the highs and lows. The low: it's horrid. The high: it's fucking experiential. I feel my structural interrelatedness with increased clarity. Before the pain was a cement block, now it's a series of calibrated layers. My awareness increases with every phase. I'm getting better at this, even if the pain isn't falling away. To feel one's body is a great privilege, even if the sensation is the product of a faulty feedback loop. This sensation is a gift, even as it's a curse. It shows me, viscerally, how everything is just the product of perception.

Here's the thing, I don't know if I'm going to have this issue (on and off as it is) for another year or another 5 years or for the rest of my freakin' life. (Note: I truly do not believe it will last for the rest of my life because I believe I can resolve it with awareness and change. My money's on me. For whatever reason, I really do believe in myself. Moreover, hormones will change.) Alas, I don't appear to be the fastest learner.

I have come up with an interesting practice - approximately 20 minutes of work with the MELT roller (I do my own "poses" which target the trigger points), followed by another 25-30 minutes of gravity-based yoga. What is this? Well, I don't know if it exists, as such, or if it's a technique I've devised from my experience of other schools of yoga. I do a series of poses. They can change but include those wherein I can use a either part of my body or a prop (sometimes elaborate, self-devised) to stabilize and ground another part of my body. I hold these poses for 10-15 minutes, increasing the intensity, very slowly, through various isometric micro-actions. These actions are not taken to extremes - the goal is to activate the pain source SO gently that it tricks the source, which then yields and the pain response diminishes. It's bizarrely subtle work. One mobilizes this action with slow, even breathing and conscious muscular breath control (pranayama).  It think it would be very hard to teach this.

Scott is increasingly of the opinion that I should do some weight-lifting (something that fills me with dread at the best of times and seems insane right now). He feels the issue might be exacerbated by muscle atrophy and that, at very least, the endorphins produced might reroute my pain response. I'm not on this page but, hey, desperate times. And he's lived through the entirety of my experience, if one step removed. We both spend a lot of time hatching plans that might improve crazy Kristin-pain.

Of course, life doesn't go into stasis just because one feels like shit. It's an interesting time in my career right now and I'd be unwise not to leverage it. So I'm using all of my tenacity - which is formidible, thankfully - to plow on.

At any rate, just wanted to check in on this topic. I sincerely hope that, if there are other readers out there who manage pain, that my updates may serve as community newsletter of sorts. We are not alone and we are capable of affecting change. We're also the poster children for goddamn fortitude. Here's to self-awareness. (Def toast with a good wine.)

Transition as Transformation

The last year has been incredibly formative from the perspective of my yoga practice. Since last September (when I hit the nadir of my pain condition - we hope), I've been required to reframe my experience of my body through a variety of different methodologies, some of which I've written about (MELT method, Roll Model, active release chiropractic, yin yoga - amongst others). Really, there's been nothing outside the scope of my exploration. I do mean to write about as-yet-undocumented, life-changing bodywork things I've discovered but really, there are only so many hours in a day. At a certain point, I can research and do it or write about it.

I don't think of myself as one of those silver-lining people. I've been through some dark night of the soul moments vis a vis pain (and acute illness) over the last few years. You know that. I mean, this blog is a litany of fear and complaints (amongst other things). But I'm frankly amazed by the way my completely unpalatable experiences have deepened my awareness of myself and my body-mind.

Before you reach to vomit at that last sentence, let me contextualize. I'm a woman who's deep in the middle of hormonal transition. For better or worse, this has precipitated (or sharpened) many health issues. I'm also a person who contracted an acute illness 3 years ago (right at a critical juncture of hormonal transition, I suspect) who's never really felt the same since. I know there are many who've experienced pertussis in adulthood. Some of them recovered easily. Some of them were unpleasantly ill for a while, but it wasn't decimating. I can't speak for those people.

My own experience of pertussis was life-changing - and not to my physical betterment. It was a premature opportunity to come up against the margins of my mortality. For weeks, in the depth of sickness, I woke (after struggling to sleep) horrified, unable to breathe for what would seem like minutes at a time. I couldn't eat for a month. I couldn't muster the energy to walk down a block, by the end of it (and I have walked a minimum of 8 km a day for my entire adult life). I'm still afraid to touch door handles (not that this is necessarily the way I got sick in the first place). If I watch a TV show wherein someone has a breathing issue, I actually experience extreme anxiety and I must change the channel or leave the room.

Maybe if I'd contracted this illness earlier in my life, I would have had an easier ride. Maybe if I'd been farther along in my transition to midlife there wouldn't have been so much disequilibrium to maneuver around. I will never know. What I can say is that, since that illness, I am existentially fatigued. Since that illness, I have experienced chronic pain to some extent or another. My fingers are always swollen. I've experienced physical injury more frequently. My vision has taken a hit. There are very occasional moments when I revert to my previous body-state, and it's stunning to me. I have always been so young - so lively - in my body. Now when I stand up after periods of sitting, the bones in my feet hurt. I can't eat food as I did before (which is to say, always without issue).*

I realize it doesn't sound like we're moving in a fun direction with this post. Bear with me. It's going to be long because I can't devalue my evolution in sound bites. And really, necessity is the mother of invention.

I went to a rheumatologist recently. I didn't think I had a big-ticket autoimmune condition but, at a certain point, one must rule things out. I'm happy to report that (in the words of the doctor): I can't say what you do have going on, and it's apparent that you're experiencing periods of intense chronic pain, but it's not being caused lupus, scleroderma or rheumatoid arthritis. Intriguingly, he also told me that my flexibility is off the charts (though I've witnessed its regression) and that, while my joints may hurt, there's no evidence of arthritis in my body. How he can know that without an MRI (which I didn't have) is beyond me, but I'll take it.

I don't expect someone to fix this issue for me. I'm on a journey, with my body and we're the only ones in the car. Sometimes it's lonely. I'd really like a map, I think. And then I remember that I have one, in the form of my asana practice.

I've spent so much time in the last 5 years, considering the trajectory of yoga asana. When I became a teacher, I was by far the youngest practitioner in the room - like by 10 years. Generally the Iyengar method won't permit one to train as a teacher before the age of 30 (that's how it was back then). I convinced them that I was up to it. I think of myself as being part of a yogic silent generation - that between the first-generation, Western masters and today, wherein a naturally acrobatic 26-year old learns the Ashtanga 5th series and calls it a teaching and media career.

When I first learned asana (do you sense something about walking barefoot for 3 miles in the snow?), there was no disconnect between the pranic elements of the practice and the movement. I truly can't believe how many people do 2 hours of yoga, 6 times a week as some sort of misguided physical fitness. As an Iyengar practitioner, I have always been exceedingly aware of the relationship between physical movement and potential injury. That's what we do really well in that methodology. I was also excellently taught.

Don't kid yourself. The asana you do healthfully at the age of 26 will hurt you when you're 45 if you're not adapting to the evolutionary landscape of your body (which may include elements of "falling apart" after a certain age - perhaps for a certain reason - or not). We can view yoga as a metaphor for the Self (which I do) but it is also a biomechanical practice. I have no idea why so many people feel that they can do extremely acrobatic postures, simply because they have natural strength and flexibility, without considering their intrinsic biomechanical abilities and potential limiters.

There's a truly ground-breaking series I found recently, written by Toronto yoga teacher, Matthew Remski, called What Are We Actually Doing in Asana (WAWDIA). He's also writing a book on the topic. As an early-adopter, and a practitioner who has broken from the broader Toronto "yoga community" (for various reasons - not what this post is about), this is what I've been waiting on for years. The deliciously, in-depth articles (and I can almost assure you that they will not appeal to the casual yoga-doer), illuminate topics such as prominent, Toronto (former) Ashtangi, Diane Bruni's life-changing injury (which led her to leave Ashtanga altogether). Diane was the teacher I took my first Ashtanga classes with in the Fashion District 20-plus years ago.

Between my own propensity to view the biomechanical element of yoga practice (you know I'm a technician by nature) and my recent physical "set backs", I've come to see my practice in an entirely new light. The joy of youth is in its expansive potential - particularly physical. But as one ages - a slow process of punctuated moments - one's yoga becomes about adapting to the new normal. As one simple example, how do I find the endocrine balance (best provided by inversions), when a headstand may now cause me days of back pain, after the fact? How do I adapt to being someone who could do that headstand with joyful abandon (and no small amount of ego, as I now understand), who knows that what was once healthful is, right now, potentially harmful?

Well, first off, I recognize that what's harmful right now, for certain reasons, may not always be that way. I'm open to the notion that this transition may propel me into a new state that is closer to my former one than the one in which I currently find myself. And then, I adjust. It's not rocket science (though it is some beautiful physics). One day, this body will fail me - I will leave it. Until then, I'll use yoga to maintain it, to find my own deepest awareness with breath and movement. My practice is as beautiful today as it was 25 years ago, for entirely different reasons. For one thing, I don't spend every moment wondering why I cannot move further into a pose. Now I know that the pose is always where I am. Striving is such a waste of energy but only experience and constancy will teach you that. Secondly, one's practice becomes ever more elegant with time. One learns how to transition from pose to pose with subtle efficiency, to be in poses with the appropriate props or un-propped enhancements (increasing awareness of muscular contraction vs length).

Practically, the way I have adapted headstand (cuz that pose is bananas delicious) is with my fancy headstander (scroll down to mid post). I will never regret having spent on this baby and I recommend it for many intermediate / advanced practitioners who want the benefits of headstand without the potential joint compression. (Note: There are some peeps who shouldn't ever do unsupported headstand for any number of reasons. Neck compression is no joking matter.) FWIW, when I use the headstander (and I do lots of variations using it), I do put a block under my head because a) for me that's not an issue - my issue is in my shoulders and upper back and b) yogic perspective is that the endocrine benefits of headstand are augmented by weight on the head. Mind you, by using the prop, I can control the amount of weight on my head without compromising the softness I must maintain in my shoulder area to avoid triggering pain.

I could write a long post about the ways I've adjusted the postural elements of my practice - in fact, I think I might!

But I do want to leave this endless diatribe with one other thought: What I have learned about aging and pain that comes and goes is that this isn't the time to overdo (see above) but it's also not the time to underdo. I know that I must maintain my momentum, my strength, my flexibility and balance - and to increase them, to the best of my ability. For a while, I was afraid of active practice because I knew less about the origin and nature of my pain than I do now (not that I have it all figured out). I may be in pain if I practice. I may be in pain if I don't. I may not be in pain in either scenario. But I must do yoga, not only for my mind and spirit (because it is my connection to my understanding of "God" and universal energy, because it is my second language) - but also because it is a physical practice to encourage biomechanical health. And now that I'm doing it rather actively again, without fear (but with modifications, as necessary), I feel the expansiveness it provides.

So that's today's book. I realize that these yoga posts have limited appeal, especially given their interminable length and subject-matter, but I would so love to hear your perspectives on your own practice. Do you have chronic or frequent pain? How does yoga (or your yoga equivalent) intersect with it? Do you modify? How does your ego muddle through aging as it pertains, not to wrinkles, but to physical ability in your method of fitness? Or to the expansiveness of your mindfulness, more to the point. Let's talk.

*Just want to add, that even though this is how I often feel, people are always shocked if I discuss this with them because I "seem perfectly normal". Just goes to show how you can never tell a book by its cover.

Loose Ends

It's very rare that I'm at a loss for things to do. But today, what with it being -40C with the windchill (that's where Fahrenheit and Celsius merge, btw), I am utterly disinclined to run my errands. Scott and M are off to visit his parents in the suburbs which means I am free! But I'm not particularly motivated to sew or to make potions. Sure, there's going to be some nut-blending experimentation on the agenda, but that won't occupy me for long.

I might opt to cook something - given the sieve-like properties of my century home, it's never a bad idea to run the oven for a few hours. But it's not so fun to cook just for myself. (Mind you, I could bake...)

I know that there will be a robust session of MELT/Yoga Tune Up in my afternoon, if nothing else to undo the damage of recent knitting. What? Knitting in the same sentence as damage? How can this be?

Look, I LOVE knitting. I have been very sad (massive understatement) to forgo this meditative activity, which produces entirely pragmatic, lovely and impressive end results. I've got a half-finished sweater on the needles and I want to wear it. But I've discovered, having knitted now twice in the last week (after a 3 month break), that while it's not causing my pain (neck, head, upper back), it is likely exacerbating it. I've knitted over two, non-consecutive sessions, each lasting as long as it takes to work 12 rows of a sweater. Well, I stopped every 2 rows to MELT my arms and hands and to do stretches of my neck and shoulders so, what would have taken me an hour previously, currently takes me an evening. Not to mention that I spend all of my attention trying to amend my knitting "gait" to be as ergonomic, for my body, as possible. People, this is not efficient.

I don't really know how to proceed. I'm not giving up on knitting. I mean, what else does one do on a trans-Atlantic flight or a train trip to Mtl or while waiting to see the doctor? I feel strangely bereft. I sense that, as my pain resolves with the support of my many treatment methods (more to come), I'll have that much more agency when it comes to this craft. So I guess I'm playing it by ear (and regularly putting the instrument down), a scenario with which I am entirely uncomfortable but then, I've made my peace with discomfort in the last couple of years.

Today's questions: I know that some of you have given up on knitting due to the pain it caused (RSI, for example). I'd love to know how you came to your decision. And for those of you who knit - do you suffer for it? Have you found yourself at this crossroads? But let's not leave the non-knitters out of the equation. Those of you who experience regular or chronic pain, have you given up activities you love in the name of ensuring that your body isn't under undue pressure. Let's talk!

From Pain to Equilibrium: Getting Started

As we all know - if only from reading the last 5 posts I've written on the topic - pain is a sneaky bitch that requires one's masterful manipulation to evict.

Mind you, I love having options, doing research and conducting experiments - so from my vantage point, this aspect of pain management is enjoyable (if one can ally pain and enjoyment in the same sentence).

The more creative you are, the more fun you're going to have. So let's spend this series wearing all the hats: tailor, chef, doctor, healer, critic, carpenter, cheerleader. Let your own needs be your guide.

I think about the methods of pain management and correction (cuz management ain't good enough, IMO, even if complete restoration seems a distant glimmer) into the following categories*:

• Diet and Nutrition
• BodyWork
• Self-Bodywork 
• MindWork 
• Aromatherapy
• "Aversion Therapy", aka avoiding the stuff that hurts
• Structural Correction
• Sleep

*Note: This list isn't exhaustive by a long shot. It's just all I've had time to reckon with so far.

Needless to say, each of these categories breaks down into numerous sub-categories. Some are fairly "universally approved". Who's gonna argue with a diet free of processed foods? Others are less mainstream, more tailored to the niche. Essential oils and potions have always been a huge part of my daily regime and the right concoction can change my state of mind dramatically. Do I hear many people speak of them as floridly as I do? Not so much.

You'll note that I've left out a couple of fairly major categories: Prescription Drugs and Talk Therapy. 

Vis a vis, drugs: I don't want to go there for a variety of reasons, not least of which is that I'm not a doctor and I have very limited experience of pharmaceuticals for pain management. I also truly believe - and this is a construct about which we may need to agree to disagree - that drugs simply mask the issue. They do not fix it. Often, they mess up the body in entirely new ways with unpleasant side effects. Furthermore, one generally sensitizes to pharmaceuticals, eventually - and too many addictions are borne of this methodology. Having said this, there's no reason why you can't take drugs and explore other pathways too. I don't think that those on pharmaceuticals are limited in pursuing all the additional options. Since pain is complicated, many options are indicated, regardless of which of those options provides the greatest relief at any given moment.

In terms of talk therapy: I have more than enough experience of many types of talk therapy to engage in a lively discussion on this topic - it's just never done a damn thing to help me get over pain. Look, I'm nothing if not introspective (about everything, including myself) and I definitely believe that it's critical to be able to unburden oneself of - and give voice to - the fear, anger and other emotions one encounters when dealing with pain (or potential emotional precursors of pain). Thing is, I do that. All the time, with lots of people and by myself. So, this method isn't part of my current trajectory. If you've never gone to counseling, I urge you to consider it. I'm just not going to dwell on it here.

Manage or Cure? My personal goal is to cure my pain by resetting the balance in my body, the loss of which has led to a current state of myofascial unpleasantness in a variety of areas. Pain is simply a response to disequilibrium of many sorts, albeit a whacked out, seriously bad one. I absolutely believe that it is possible to cure this and, really, I'll hazard to say that one must believe it's possible in order to make it a reality. Your brain is extremely powerful. A fucked up autonomic response (fancy term for unconscious brain activity) is likely what's causing it in the first place. In the same way you access pain, you can diminish it. So don't discount that placebo response. It's not a dirty concept - it's the fortuitous outcome of mind over matter and it's just as real as any other kind of fix. 

Cost Benefit Analysis: I've heard from a few people who've expressed an interest in many potential methods for pain relief, followed by the proviso that they can't afford to explore them. Look, we've all got a financial limit. If money were no object, you can bet I'd be at a medical spa in Austria right now. Of course, it's ever trickier if one's budget maxes out before visiting the doctors, not covered by insurance, or trying the acupuncture or buying the vitamins and books. 

All I can say is that we are all enabled, within the limits of our means, to do the best we can to get better. The internet is your friend. So is the library. So are e-books (cheaper than the real thing and easier to store. Read them on your computer if you don't have a Kindle.) Many yoga studios offer free community classes. My Yoga Online offers some awesome Yin yoga (one of the things I've spoken about at length and will continue to discuss in this series) and it's 10 bucks a month. You can't take one live class for that price. Some practitioners will barter (if you have a skill they can benefit from), though I recommend you play that card carefully, after assessment. Sometimes it's a matter of going more slowly than you might appreciate - which, fortuitously, may have  the benefit of maximizing the likelihood that you'll see an emerging solution as a result of one particular avenue taken. Research well and act, first, on the viable methods that resonate. There are lots of options out there that are not expensive.

Next up -  Diet and Nutrition.

It's All About Me

Let me tell you how I got here. (Note: It doesn't really matter if this is actually how I got here, but that it's my belief.)

• When I was 4, I suffered a big loss. (It was 1974. No one cared about the need to ensure grief processing in children. I was in pretty bad shape, to put it mildly...) As a child, I routinely had extreme, super painful "growing pains" that would start in my legs and go to my ears (mainly on the left side). In retrospect, those pains might have been a subdued version of juvenile rheumatoid arthritis (this is one current medical perspective on growing pains). In retrospect, it's also when my TMJ disorder started. It's when my OCD began. These issues persisted to puberty.

• When I was in high school, there were many expectations on me to succeed. Mainly they were my expectations, but let's leave that aside. It was in this time frame that I had my first migraine (with aura). I ignored it. It's also when I met my longest-standing friend, Hilary. She was the one who recognized my OCD and helped me to overcome it (by pointing it out and telling me it was bizarre and needless). She's a doctor now. Teenaged girls, man. You can't beat 'em.

• When I was around 20, I sustained another big loss. (It was the late 80s, people just "dealt with things" and 20-minute-worked-them-out.) I started to experience extreme (and diffuse) left-side hip and leg pain - it was one of the things that brought me to yoga. Walking was a torment, and y'all know how I must walk. This pain went on (either constantly or intermittently) until I was about 25. I tried everything to fix it (acupuncture, massage, diet etc.) When the issue started to recede, I assumed that yoga had done its job. I developed a lot of physical ability in this time and went into a period of relative stasis. Except for the intermittent headaches.

• When I was 29, I had a child. The labour was exceedingly dangerous and stressful. My body was ravaged by it. My mind was in even worse shape. While I appeared to heal very quickly, I was a mess (emotionally) for a good 5 years. My OCD went through the roof. In that 5 years, my reaction to a relentlessly attention-seeking dependent inflicted near constant pain on my torso (left upper back, neck). I was constantly picking her up, carrying her around. Moreover, I was carrying around the stress of parenting, the toll it was taking on my marriage, the generalized stresses of life as they happen. After 5 years, I started seeing my naturopath. I did some hormone panels, went on a variety of supplements to restore balance and to mitigate my anxiety response. The impact was remarkable. 

• When I was 40, I broke my left foot (small fracture) and my ligaments and tendons were affected by the injury. I worked through the acute phase, with a physiotherapist and lots of therapeutic yoga. I do feel that I managed this incident as well as possible, but for a couple of years after the accident (fell down 3 stairs in just the wrong way), I still felt occasional pain in my left ankle and leg.

You'll note I'm not dwelling on the scope of the pain I experienced. Let me assure you, that hip pain was crushing and it filled me with a fear I've rarely encountered. My childhood growing pains were a near-constant distraction. No wonder I was sullen.  OCD, well, let's just say peeps, if you've ever experienced it, it's hell. But I'm a high-functioner. That's what I do. In these times, I got straight As (except for math), advanced in my career, taught myself how to knit and sew, maintained a relationship, raised a kid, built a life. I did not relate to any of the painful times as chronic, simply as bizarre, somewhat structurally motivated and due to bad luck.

But let's leave all this aside.

• When I was 42, I came down with pertussis. No one knows how, just that my immunity to my childhood vaccine had waned (as it does for everyone). This, my friends, was when it all got real. Never in my life have I been so ravaged by illness. Y'all know this story. It's well-documented on this blog. I could barely breathe for 8 weeks (which radically changed my pain response). I was seriously ill for 8 months. It threw me into hormonal chaos. From months of coughing the likes of which I cannot begin to describe, I ended up with sublaxated ribs (a hideously painful kind of rib dislocation) that I didn't deal with until fairly recently (when my chronic pain finally said enough and just refused to leave). I think it's fair to say that, fundamentally, I have not yet recovered from the shock of this sickness. If I'd been 30 years older when I'd got it, I'm pretty sure I would have died. I'm still processing the impacts.

Let me pull out some salient points*:

• I seem to have a predisposition to musculoskeletal body pain from early childhood. It has been systemic, chronic but also intermittent. 

•  I've been really adept at ignoring it - at my peril. But I also live fairly healthfully which has mitigated long-term continuity of symptoms, I suspect.

• Pain recurs in similar ways in different places - the kind of dull-to-searing / acute/diffuse pain I get in my upper back is similar to that I had in my hip and in my head. It tends to stick to the left side.

• My pain (which is felt physiologically, in many ways that modern medicine can quantify) was either catalysed or worsened by serious trauma (emotional or physical).

• The pain has been very amorphous - so much so that yoga was the only thing that ever had any impact on it. Till quite recently, I assumed this was because it built muscular strength, balance, flexibility and structural realignment. And I'm sure this is true. I now realize, it also mitigated the constant feeling of excessive pressure, like shrink-wrapping (which is likely damaged connective tissue). On a weird note: The pain tended to abate at just the moment I couldn't stand it any longer, reinforcing my perspective that my issue wasn't systemic. It never occurred to me (though I was aware, dimly, of the role of connective tissue) that the pain might have been coming from something other than a muscle or a joint. In retrospect, I find this very odd given that my parents are acupuncturists and cranio-sacral therapists. I've been feeling more and more (since the pertussis specifically) like I'm 100 years old. No joke - I have pains consistent with hobbled old people and, on one level, it's freaking me the fuck out. Another weird note: If I push through, I look pretty strong and flexible while being physically active (active yoga, for example). Two hours later, I'm a mess of pain. If I move in (extremely minimal) ways to specifically stretch fascia, pain is dramatically improved and my overall flexibility increases.

• Until I started to manipulate connective tissue with yin yoga (and a zillion other mechanisms I'll discuss in another post) the horrifying pain was largely contained in my left, upper back, neck, jaw and head. As is so often the case, when you tangle with Pandora, you get what you came for. By exploring the pain (again, via many techniques), it's become much less extreme in those areas - but much more evident in MANY areas. 

You may be thinking: Kristin, why the fuck would you go there?? The answer: I had no choice.

The writing was on the wall. You've seen my increasing references to chronic pain over the past 2 years. Each time the pain came, it was more insistent and less pliable. I continued to ignore it with Advil and active yoga and walking through it and swallowing it down. I thought I was doing the work because I exercise actively (lots o' walking, daily), work on body alignment and strength (yoga, many times a week), eat reasonably healthfully (but deliciously - I am myself, after all), take targeted vitamins and supplements, sleep 9 hrs a night (I have to or I can't function), tackling issues with natural practitioners. Also, I'm not 100. I'm fucking young(ish).

At the same time, my predisposition (my nature, if you will) is SO fast-moving that I've leveraged the modern age to become half-robot, it would seem: I haven't read a paper book in years (I read on my computer). Fiction, which sustained me till I was 35, has become a dim memory. For a would-be novelist, that's a hardcore turn of events. I can read 500 plus blog posts a day - and retain a reasonable amount of the information for later consumption. My job is ridiculously fast-paced. I spend upwards of 12 hours a day on a computer. It's a wonder I can think straight at this point.

The last 2 years, specifically the last 5 months, have kicked it into me that I need to return to a more analog existence. This hyper-digital thing is not sustainable. I've got to detach from the hive, to some extent, because the deluge of information is an assault at this point. Nervous system excitability is not something to take lightly. Medical people freak out about that shit and then they tell you it's not fixable. (It's often fixable.)

If you're dealing with some kind of chronic pain, no doubt you've had time to reflect on the triggers in you many dark nights of the soul. May I suggest that you consider whether, when you listen to your quietest voice, the pain is linked intimately to some sort of sub-clinical sensitivity. I'm not calling your cojones into question - or the scientific explanation for your current plight. If you're dealing with chronic pain, trust me, I know you are epically strong. Maybe you're experiencing this pain, in some measure, because you're so strong - because you're masterful at deflection.

Next up, I'll tell you about how I've turned an emerging awareness of my own issue, into a scavenger hunt for books and tools about managing, diffusing and eradicating neuro-sensitivity and its associated pain.

But till then, today's questions: If you have been diagnosed with a connective tissue issue, I'd love to know how you're managing things. Have you got it under control? What are your best techniques? Does it impact your ability to enjoy your daily life (in that you don't do certain things you used to do)? Does it come and go? How do you identify with pain? Please do leave a comment - I wanna know your story!

* Get your ass revaccinated for pertussis, if you're over 35 and you've not had a booster since childhood. Chances are you're no longer immune, which is code for being a walking target. Trust me, you don't want to go through it.

The Forest for the Trees

While the writing has been light, I'm in the midst of one of the most phenomenal phases of my life to date. Let me assure you, it's not cuz times have eased up. In many ways, there's more concrete stress in my life right now than ever there has been. I mention this, not to dwell on it - I mean, I can barely stand to engage with it day after day, I sure as hell am not going to write about it too - but to provide context. I'm not finding answers because the path is clearer. I'm finding them because I'm looking more clearly. That's fucking empowering, gotta say, not that I wouldn't seriously consider going for a clear path if the choice were mine.

My point is - and I'm saying this to any reader who has experienced a period of chronic pain, who continues to experience it now: You can manage this and you will - as soon as you recognize that you are not at the whim of anything. You are an active participant. That doesn't mean you're to blame but it does mean you're specifically implicated in resolution. The sooner you understand this (and I mean deeply, not intellectually) - the sooner you will be able to let go of whatever underpins it.

I'm not so solipsistic as to believe you can successfully manage pain like I'm (increasingly successfully) managing it because my path is the right one - though if the info I provide in the next few posts gives you some clarity or direction, then we both win. I'm saying it because the key to diminishing pain is in understanding, communicating with and (sometimes) engaging deeply with that pain. The path of pain is mind-blowingly complex. It's unique to each of us (although we are all more neurochemically the same than different). Eventually, you will not be able to evade it, to push it down. Trust me, I know. So I have to implore you to meet it head on.

I've frequently thought that if chronic pain were chronic pleasure (and they come from the same neurochemical source), we'd all be so engaged with that sensation that the world would fall apart. I say this as a total hedonist. I'm in the delicious grip of everything beautiful, sensual, aromatic, tactile. I love the way these things make me feel, how they wash over me, how they suck me in - how they bring me to the seat of my very self.

Chances are, if you're experiencing chronic pain, you have something in common with me: you're very sensitive to your environment. The beauty of this, is that sensitivity brings us close to everything. The danger is that it threatens to overwhelm.

Here's my plan for the next few posts on this topic:

• I think it might be useful to explain what I've discovered about pain as it exists in my body - how it's taken years to figure out and how improved recognition has changed my response to it and, more to the point, pain's effect on me. These discussions will centre on myofascial pain disorder (what I'm dealing with) which is a specific expression of a group of connective tissue or fascial disorders, including osteoarthritis, bursitis, repetitive strain injury, fibromyalgia, MS, rheumatoid arthritis, TMJ disorder, chronic fatigue disorder - amongst others. The current belief, and it's profoundly resonant for me, is that connective tissue in the body (a constant web of attachment with more nerves than any other part of you) receives nerve signals autonomically. When that signaling goes rogue, the impacts can be hideous. The new normal your body comes to know - that with pain - is continuously reinforced by large-scale muscular contraction that's stimulated by the connective tissue (on its own pain trajectory). Furthermore, that connective tissue becomes brittle, dehydrated, overly tight. Given all the nerve endings it supports, that causes additional pain that can be diffuse and debilitating. Seriously peeps - a huge part of the solution is biofeedback (which can be accessed in numerous different ways, some of which I'll discuss). This issue is complicated to endure but it's resolvable. And once you figure out what's going on, the resolution can be fairly systematic.

• I will outline the many awesome products, techniques and methods I've utilized, that have had a measurable affect on my own pain response. Yeah, I'm not you (nor your mother nor your kid), but if others hadn't written about these things, I never would have found them - and they have definitely (in complex concert) worked well for me.

• I'm happy to write in detail about any of those techniques or products - if there's interest to hear more. Seriously, I could write a book about these things. I don't want to drill down in ways that may be of little interest to others. So if I mention something and it seems resonant - like you want to know more - please email me or leave a comment.

Let me end this post by saying that I've spent years considering the body-mind connection in one context only - that of my physical practice of yoga. In that practice, I've allowed myself to experience the myriad benefits that the awareness of this connection affords. The minute I got off my mat, I resumed the detente: my body in one corner, my mind in the other. If you've got chronic pain, you can't afford to discount the need for alignment of these states. If broader consciousness is a conceptual challenge for you - and it's certainly not something I've discussed in polite (non-yogic) circles on a regular basis - you're going to have to suspend your disbelief. Sorry, but I can't see any way around it.

On the up-side, if you can philosophically get with the ways in which your mind can change your response to everything, including your physiology, you're in for a wild ride.