Yoga and Myofascial Pain

I should start this post by saying that, in the last month, I've learned enough about "yoga for myofascial pain" to write a book. This is somewhat concerning, if you think about it, as both have been a huge part of my life for 25 years.

I'll also add in the obligatory disclaimer about how the degree of complexity involved in understanding and managing chronic pain is matched only by the degree of complexity when it comes to understanding yoga and how it works to heal and strengthen the body/mind.

This post ain't out to change the world, peeps, but to share some of the more mind blowing things that have influenced me lately. And when I say "influenced" I really mean "deeply experienced" because I've been locked in some cult-like therapy session with my pain lo these past 6 weeks.

On the plus side, we're finally talking.

I don't even know where to begin. In the same way my pain is a huge loop that, when it flares, sucks everything into its grip, my increasing awareness of it is circular, like the ripple produced by a stone skipped into water.

How about starting with the elephant in the room: How does a woman (whose fitness, health and spiritual life paths centre around a practice based on listening to the body) develop debilitating pain - likely produced by years of not listening to her body? I cannot tell you how many classes I've taught over the years wherein I've cautioned my students to listen. I cannot tell you how many more classes I've been to (and personal practices I've done), wherein that's the mantra.

How the fuck did this happen?

Well, the origins of pain are not always clear (and this is the complicated subject of another post) - and one can never discount the nature of the practitioner when it comes to adaptation. I have always been the kind of person who throws herself into things passionately - actually, one might say violently. My mind and body don't really understand moderation. This is no secret - especially on this blog. It's what makes me fun to be around. It gives me scope. It exercises a very fast-moving neuro-chemistry. It makes me incredibly productive. It feeds my ego. I love jumping out of a metaphoric airplane as often as possible (which is strange because, in real life, I'm exceedingly cautious with my actions). Sometimes, all that I can see is the outcome. I'm not naturally adept at interpreting the impact.

I started yoga at a very young age - at a very hard time in my life. My parents were moving to another country. I was in Canada alone. I had just left the fold of my high-school, a small, extremely meaningful place where I'd learned how to relate to everything and to truly be myself. Adulthood had begun, but I wasn't ready. I was, in my mind, cast adrift without family, a crushing emotional experience that I recognized all too keenly: I had lived through it once already, in early childhood. I knew, intuitively (certainly not consciously) that I needed yoga to ground me. I can only say I was very fortunate to have found the Iyengar method right off the bat. It worked for my personality (and against it). It was a "safe" practice focused on structural alignment. It came with a community (albeit one I would eventually eschew).

In retrospect, I remember my teacher constantly smacking me (in the yoga way, to bring awareness to a dull part of the body), telling me not to grip. When I wanted to jump, she made me stand still. When I wanted to go further into a pose, she'd stop me half-way. I had the physical confidence of youth and I felt compelled to move, to achieve. For me, deepening my practice was related to improving my physical ability and form. I could do some fancy poses. Mind you, so can lots of people. Even today, in this ridiculous state, I could warm up my body, move past the pain with some heat and breath work, and do a very active practice in such a way that you wouldn't know - more to the point, neither would I - that I'd distracted myself from dealing with injury produced by chronic pain.

The truth is that you can always work any instruction to suit your unconscious desires.

I realize now, as I meditate, in three different styles - to achieve 3 different states - for about an hour each day (30 min morning, 30 min evening), that my yoga has never been as sincere as it is right now. I do everything with the intention of listening to my body, of incorporating its need for release and extremely precise (almost non-) movement. I learned/practiced these techniques (a pranayama method for quieting the nervous system, a biofeedback method and a method of meditative dialogue) in my late teens. Of course, back then, I thought meditative response was something reserved for the very advanced - or else it was a scam. I was doing it, but I wasn't feeling it.

In one of those fortuitous life-ironies, I turned my attention to yin yoga (to the notion of connective tissue release) at just the time I finally began to understand that my pain is based on its utter restriction. It's possible that my return to active yoga practice in the summer led me, 6 weeks ago, to this particular pain "crisis" - a variation on my semi-regular pain bouts (about which I've written all too often here). This one isn't willing to go, though. It's digging in its heels. And honestly, while I hate the pain, I am so incredibly grateful for its message. As my mother likes to say: You pay now, or you pay later. Really people, I am ready to settle up this bill.

At this point, my methods for working with pain are numerous (again, the zillions of inter-related processes would require a full post of their own). But in terms of yoga, when I wake up in the morning (feeling like I've been hit by a truck, if you must know, and afraid of how my body will last the day in an incredibly stressful job), I meditate. Then I do about 15 minutes of yoga postures that don't look a damn thing like yoga. I prop my body with, say, my dining room table and other furniture. My goal is to stress connective tissue in my left hip, low back and upper thoracic. Gradually, the ridiculous morning stiffness (I've recently developed) abates.

Cut to the evening. I begin by using props very carefully and lying in poses to undo the physical damage of the day. (Note: Yeah, I do realize I've got to find a way not to take it all into my body. But one fucking thing at a time! This is the topic, not of a post, but of a long conversation over dinner and a bottle of wine.) Depending on what's up - and lately it's been pretty fucking hard core - I do very simple, non-weight-bearing poses which I hold for very long periods. These aren't simply yin asanas, though I bring that awareness into the poses via intention. I also do many of the Iyengar supported poses I loathe. Ah, my latent pain (in the early days) knew even then how to avoid things.

Eventually, for the sake of endorphin-release, I may opt to bring some flow (heat) into the work - but not your average vinyasa. My trapezius and related muscles are SO hair-trigger, that one weight-bearing movement can throw everything into a literally nerve-wracking spasm. I use my head stander (have I mentioned how I love this thing) to allow me to get neck and shoulder traction, while also calming my nervous system and regulating my (ever so taxed) endocrine system. Man, I spend a long time hanging upside down.

I can do this because I have the knowledge and the years of technical experience. I own the (expensive) props. I have a yoga studio. I have access to information. I can only imagine how someone without these resources struggles to function. I'm calling on years of mudra - those poses I've done all my life have been saving my ass for decades. The roots of this pain have been in my body for as long as I can remember.

If you are in terrible chronic pain and you haven't done yoga before - please, find yourself a good teacher. When you most need support, don't try to learn something complex on your own. Of course, practice as often as you can in your home, but invest in private classes or a good Iyengar therapeutics class. The teacher, whatever her method, must be knowledgeable, sensitive, able to communicate - and she must be able to see the pain in your body in order to help you to fix it. You wouldn't go to a mediocre chiropractor or physical therapist. Don't take yoga risks when you're managing pain.

When I look at people with my "yoga eyes", I often see their physical (and mental) pain. The very pain I haven't been able to access in myself is writ large in others and it's much less complicated than my own because I see it objectively. I understand how it can leave. When I teach a person in pain, I tell her to listen to her body, to make her actions minute, to hear the feedback of those actions and to face the untenable.

Now onward.

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.

Yin and Yang

I'm having one of those times in life that's relentlessly busy. It's also stressful, in a certain way that hits me hard - my endurance is being tested, and simultaneously my ability to stand at the precipice of change. Yeah, I know we're all being pushed and none of us knows what's coming next. But for me, that confluence of feelings is tough.

Since I haven't got much to say on the craft front - though I do have some knit-sewing, basic projects up my sleeve - why don't I bore you delight you with a little update on the New Regime. It's quickly becoming simply "the regime". The shiny sparkle of novelty has faded. Happily though, my commitment has not.

I cannot tell you how grateful I am to have a practice to support me at this time. That practice isn't always the essence of conscious engagement. It sometimes suffers from my extreme tiredness at the end of the day, or my full-body muscle spasms re: the fun that is hormones. I inevitably follow it up with a glass of wine and, often, a treat. But hey, I'm doing it and I know it's keeping me sane. So let's raise a glass (and eat a bowl of chips) to that.

From the vantage point of shape-evolution, I wouldn't say I've slendered much more in the last month - mind you, I haven't lost any ground. As far as I'm concerned, that's ok. This transformation is a process and I've got time.

Truth is, I've also got a lot of cortisol running through my system lately because my job is flat out. What I do requires the ability to process and analyze large volumes of complex content quickly. Then to provide advice. Thereafter begins the potentially arduous (but worthy) time of negotiation. Simultaneously, I write a lot of documents and brief at a bunch of meetings. There's no acceptable margin of error and the pace is constant.

Those of us prone to the adhesion of fat at the midsection (the apple-shaped for want of a better term) are particularly susceptible to the impacts of cortisol. I can definitely feel, after a week of mega-stress at work, increased puffiness and a decrease in awareness in my abdominal region. No, that's not fat, but it's a warning sign and it's one I'm taking seriously.

As per usual, I walk to and from work daily. Moreover, I'm now practicing yoga 5 times a week. Would it help if I cut back on the nightly glass of wine (and half bottle on weekend days)? Um, sure - from the vantage point of continuing to slim - but I think my mind would be in way worse shape! Wine-drinking is a delicious, sensory experience that improves food and takes me from the stress of the day to the welcome calm of the evening. BTW, I do the yoga first, natch - and while it moves me from the stressed state to one of increasing tranquility, it's no substitute for the mood-alteration technique that is a glass of Chianti. (Note: My bet's on my mother calling me when she reads this post, just to ensure that I'm not descending into alcoholism.)

But let's talk more about the Regime...

• I have stopped doing "gym fitness". I really hate machines and bright lights and weights. I gave it a good try, and I'm sure I'll try it again in the future. But it still doesn't work for me.

• I have also stopped going to yoga classes the gym. Those classes were a means to an end, as I knew from the get go. While they are safe, and social - and while they enforce infrastructure - they are not "taught". They're also not adequately challenging. I sense the need to work more intensively to gain the kind of cardio-fix my body seems to crave. And, truly, my knowledge of yoga asana languishes in those classes. Sure, we're all beginners in the classroom, but I want to explore my body in a wide range of poses - not the 30 one encounters over and over in the average, mid-range vinyasa class.

• So, although the gym is a thing of the past - and thankfully too since it's fucking crowded and you can't swing a dead cat without running into people you know - my practice is happily ever-evolving. I have researched yoga studios that are known for small class sizes and new formats. I've begun to visit a couple of those to take a weekly class.

• I also practice in my home studio on 4 other occasions per week, averaging an hour each time. I either devise my own sequence or, when I'm very tired, and would prefer to be told what to do, I do a My Yoga Online class. This isn't my first foray into My Yoga Online, but the format really has improved dramatically (and it was a good resource to begin with). The site offers hundreds of classes - and new classes are added weekly. (Note: I always try to preview each class I intend to do, once in advance, because I practice without my glasses so I can't see what's happening on the screen. This allows me to weed out the practices that don't suit and to discover new teachers and sequences I prefer). The advanced classes are hardcore. The intermediate ones can be pretty hardcore too. And this platform favours the yin method (in addition to other styles though, alas, Iyengar is not represented). I'm going to do a post on Yin Yoga sometime soon but, in brief it is an excellent adjunct to active practice (which focuses predominantly on the development of muscular strength and balance) to improve flexibility and mindfulness. Especially given the extreme muscle and fascia tension I experience semi-regularly, as a result of hormonal shifts, I find it incredibly useful to practice in this style once or twice a week. Please note: Though it is sometimes classified as "passive", I do not recommend it for beginners. This style is very confrontational and it presumes a baseline of flexibility and structural body awareness. It is also quite distinct - though I didn't realize this before I started practicing the method - from supported practice in the Iyengar style. Both are very useful, btw, but they're not working on the same things in the same ways.

People have asked me lately how I don't get side-lined the minute I walk in my front door. What I'll say is this: I do not make dinner (if Scott doesn't cook, we forage - and that includes my kid). I do not listen to messages. I do not tidy things up. I do not talk to anyone. I wash my face, put on my yoga gear and walk into the yoga room with my computer. If those with whom I live try to talk to me, I answer them monosyllabically. If they ask me to do something, I tell them no. 

The only way to prioritize one's practice - at least if you work full-time - is to put on a shield of selfishness. I can only urge you to become comfortable with that construct if you lead the "modern life" and you don't want to fall apart from stress and/or get fat.

On that topic, you'll notice my blogging is less frequent and it may remain this way until December. I LOVE to write, but it takes time. And the less time I have to do the things I love to write about, the less I have to say when I do have time to write. It's a circular scenario, apparently.

So that's where I'm at right now... I'd love to know if you work-out at home and, if yes, how do you keep yourself on track? (I need pointers! Full-time working mothers, your experience is particularly welcome...) Have you tried the Yin Yoga method? If yes, what are your thoughts on it? Do you find that work stress contributes to abdominal puffiness (wine consumption notwithstanding)? Is this my own personal experience? Let's talk!