I Feel Your Pain

We have all heard people say this, both to physical and emotional painful events.  Said the right way, it is an expression of empathy toward the person experiencing pain.  Most of us probably think that actually feeling their pain is not possible.  You may think that you have to be the one injured in order to actually feel the pain.  I thought so too, until just today.

I follow a pain research group out of Australia: Body in Mind.  The researchers blog about results from their studies and others about acute and chronic pain.  Today I was reading a case study and saw the term "motor empathy".  I have heard of the term empathy, but never in relationship to movement.  So I did some research and found another term "mirror pain" and "vicarious pain".  Both of these terms suggest that getting hurt or sustaining injury is not a requirement to feel pain.

"But how is this possible? The important thing to remember here is that pain is just an experience. It is the end result of a long line of sensory, emotional, cognitive and motivational processes. So we don’t always need to get hurt to experience pain!" - Bernadette Fitzgibbon

Research tested this phenomenon many ways, but mainly by looking at activity in the brain while observing a pain inducing activity.  The brain activity while watching someone get hurt is the same as getting hurt, but only for some people ~ 25%.

In other studies, researchers find the reverse to also be true, i.e. pain inhibition can also be triggered by watching someone get hurt.  The normal response to mitigate pain due to injury, occurs when you watch someone get hurt.  However, this happens when you observe with empathy (that word again).  What is the definition of empathy?  Empathy is taking the perspective of another person and responding in a way that the person would expect.  Researchers compared watching a loved one vs. a stranger experience pain, and the pain inhibition response was greater while watching a loved one.  Because we show greater empathy for someone we love, the pain inhibition was greater.

To follow this research, responding with empathy when someone is hurt can lessen the pain response.  The researchers studied spouses, manipulated the empathetic response of the observing spouse while the other was experiencing pain (hand in cold water), and found this to be true.

I find this line of research amazing!  To me it is further evidence that pain is not just about our muscles, joints, and posture.  Though I still believe and take these factors into consideration, the brain has more power over our pain experiences that sitting too long.

This research also explains how I was taking my patients' pain home with me.  For example, if I treated someone with a headache, I might go home with a headache.  I guess it was proof of providing empathy during patient care!

So instead of just responding with "I feel your pain", an empathetic and therefore, helpful response would be, "How can I help?"

What Should I do at Home?

Most of my students attend class once a week.  And they know (because I have told them) that this is not enough yoga to "correct" what ails you.  I understand the limitation of attending a class one time a week.  Going to class includes schedule coordination, travel to the studio, and cost of the class each week.  So read on to find some ways to start a home practice.  

For those that primarily sit during the day and want to use yoga for postural correction, I believe that once a week may help to prevent the posture from getting worse.  But I don't think that once a week is enough to make changes in the posture that has already become hunched.  Once a week will provide modest strength gains and help to control pain, but change will be slow.

So many of my students ask, "what should I do at home?"  I will always say that "some yoga is better than no yoga" and even 10-20 minutes each day is a great start.  First, look for ways to integrate yoga into your day.  When you are in class, observe what feels good and do some of that at work or at home.  Maybe for you it is 3 part breathing to ease muscle tension, cat/cow in sitting or on hands and knees to mobilize the spine and hips, or some Tummy Time to get you into extension.  Soon, your body will be craving a little more activity and movement.

So if you are new to yoga and/or living with pain, here's a plan to help you:

• Schedule time into each day to do gentle movement.  I am most disciplined when I get up 30 minutes early and start my day with yoga.  It will take at least 21 days to develop the habit, so persevere in those first 21 days.  If you feel stiff in the morning, take a shower first and that will help you with a little more ease.
• Start with the movements that you remember from class then try my free video:  "Core on the Floor".  It is 40 minute in length, but about 30 minutes of physical poses, all performed on the floor.  If you don't have time for all 40 minutes, just do what you have time for and build up to doing it every day.
• As this video gets easier (2 weeks or so), add the "Gentle Yoga, Core on the Floor plus Hips".  This one is about 50 minutes in length and builds on "Core on the Floor".  If you don't have 50 minutes each day, continue to do about 20 minutes of gentle movement on the days you don't do the longer program.  Build to doing the long program 2-3 times a week.
• As you progress (in another 2 weeks), try the "Spine Health" videos.  Each video is slightly different, but I focus on common impairments for people with back pain and stick to basic poses.  If you miss class, these can take the place!
• Keep doing the longer videos (or full class) 2-3 times each week.  Still doing 20-30 minutes of gentle movement on the other days for a total of 5-6 days a week.  Sure, take a day off each week!
• As you begin to feel better, add a 4th day of a long video.

Remember that the more sedentary you are when you start this program, the longer it will take to build up to 2 or 3 days of the longer yoga programs.  That's OK!  Take your time building strength and mobility.  Also recognize that each day may feel different.  Progress doesn't need to take place each day.  If you start, but don't feel like doing the long program, back off.  The key is being aware of how your body feels each day and honoring those feelings.

I believe that yoga is best on your own with guidance on a regular basis from a good teacher.  That way there are fewer reasons to NOT do yoga (i.e. travel, $$, etc.).  Establishing a home practice is about taking care of yourself every day.

If I haven't seen you in a while in class, know that I miss you.  But I get it and I hope you will try my new videos because I made them with you in mind.

Namaste,

Stephanie

Discomfort Should Make You Pause

I frequently remind people in my class that he/she should not be feeling pain or discomfort while performing yoga.  But wouldn’t it be great if we could bring that same sense of ease to daily life.  First we need to determine what discomfort feels like.  I believe that so many of us have accepted pain and discomfort as a way of life.  We live by sayings like: “stay strong”, “live strong”, “don’t let anything get in your way”.  So we ignore our feelings of discomfort and keep going.  But what would happen if we recognized discomfort and pain, took pause, allowed ourselves to be curious about the discomfort, and then took action that led to more comfort?  What would our lives be like?

Now I know that many of you have chronic physical pain.  And you have probably tried many, many things to relieve that pain.  Visited doctors, specialists, massage, acupuncture, etc.  I know because I have heard many of your stories.  But I also hear and see the discomfort beyond the physical.  I see the emotional discomfort, I hear the stress and anxiety in your stories.  I see how consumed you are with trying to find answers.  And I see how your mind and body never stops or takes pause. 

The first step in relieving the discomfort, is to PAUSE when you recognize discomfort.  But you also must realize that this discomfort comes at unexpected times.  It is not just after standing too long or sitting to long or after lifting something heavy. 

You may notice discomfort when you hold back from saying something important about how you really feel to someone you love. 

You may notice discomfort after having a difficult conversation with a work colleague. 

You may notice discomfort from the heavy emotional burden that you are carrying.

You may notice discomfort in a memory.

Maybe some of you can notice discomfort in your mind, but many of us only feel discomfort in our bodies.  Pain is pain whether physical or emotional, we can experience it in the same way.  And the effects can be compounded as the discomfort is ignored rather that given attention.

So today I encourage you to take pause.  Take a few breaths.  Create stillness where you can really pay attention.  Allow yourself to be curious.  Take the path of comfort rather than discomfort.

Namaste,

Stephanie

Taking Care While Going into Extension

Going into Extension Range of Motion of the Spine and Hips doesn't always feel good!  And there are reasons for that.  Most are due to the aging process of the spine and probably what you've done through your life to progress that aging process.  In another Blog, "Educated Assumptions for Teaching Yoga for Spine Health", I talk about the normal aging process of the spine and how I create yoga programs and cue to the general population of folks that attend my classes.  The position that I am most cautious about is extension because I respect the aging spine.  However, I also think that it is the most important position and a motion we are losing due to our epidemic of sitting.  As we age, we are stiffer and these postures are going to lead to permanent change unless we address it NOW.

In trying to describe precautions while going into extension, I will use my own spine.  I have degenerative changes between L5 and the top of the sacrum (aka S1).  This means that I have worn down the disc at that level and I have less height between L5 and S1.  Less height means that I don't extend as much as I used to at that level.  Here are a few pictures to show you what I mean:

Lumbar vertebrae and Sacrum with equal space between each level

Degernative Disc Disease

As I move into extension, that L5/S1 level comes to end range quicker and I feel a twinge of pain.  Does that mean I should never go into extension?  Let me say a resounding HELL NO!!!  All the more reason to learn how to go into extension so that this level does not keep degenerating.

What it means is that I need to get my extension from other areas.  In fact, I think the reason that L5/S1 broke down in the first place is because my years of sitting (thank you PhD and academic life!) stiffened my hips and thoracic spine, i.e. the areas above and below L5/S1.

This follows with the concept of regional interdependence.  The body is going to move, and it is going to get that movement from where ever it can.  If the thoracic spine is tight, then the lumbar spine needs to move more.  If the hips are tight then the sacroiliac joints and lumbar spine must move more.

Pain in that area is my warning sign that I am at end of range for that level.  I need to protect that area with a little flexion provided by my lower abdominal muscles and gluteal muscles, while extending in my hips and thoracic spine.  It takes concentration and muscular control to achieve this.  That is why I give the following cues in standing poses like Warrior 2, Triangle and Side Angle:  "draw the tailbone down", "tighten your bottom", and "draw the lower belly up and in".  All of these instructions are to create a little flexion in the lower lumbar region.  I also instruct to NOT over-correct to flatten out the entire low back.  You want to keep the natural lordosis of the low back if that is comfortable.

For some the excessive amount of extension  in the low back demonstrated here would create pain during Warrior 2

I use similar cues to create hip extension while maintaining a "neutral" position of the low back.  Most people are so tight in the front of the hip, that any pose with hip extension like Warrior 1, Low Lunge, and most poses on the stomach immediately create excessive low back extension.

The goal of these poses is first to NOT feel pain in the low back, feel EFFORT (not strain) in the lower abdominals, gluteus maximus and deep gluteal muscles, and to also feel a GENTLE stretch in the hip flexors and thoracic spine.  Don't push into any pose and PLEASE ask for modifications when you feel pain.

I hope this eases some of that tension in your low back and keeps you moving!  Let me know how it goes.

Namaste,

Stephanie

Big Goal: Break it Down

I start each Yoga Physical Therapy Therapeutic class with self-assessments.  I modify physical therapy assessment techniques, describe "normal" values and what should be felt.  Participants can use this information to determine what he/she needs to work on.  

Since my Big Goal for 2017 is Extension, I am using wheel pose, aka backbend, as my self-assessment.  The picture above is my first attempt just as 2016 was ending.  I was able to hold this pose for all of 2 seconds before crashing down to the floor.  It is a good thing that a yoga certification is not dependent on performance of this pose!  What surprised me was where I felt most limited in this pose: forearms.  Wheel pose is full wrist extension with elbow extension.  You can see that my elbows are not even close to being extended.  I know that my hips are tight, and I feel it in my hips and spine but my forearms were screaming.  

Just trying to wheel pose every day to reach my goal would be frustrating.  So I decided to break this pose down and work on components of this full body extension.  As I describe is a previous post, other yogis suggest other difficult poses in order to progress wheel pose, such as reclined hero.  I decided to make big modifications and use props to help.  

The focus of this pose is wrist extension on blocks at the wall to open the forearms, elbow extension, and upper back extension.  I am pushing into the wall to provide some weight bearing into the hands, just like in wheel pose.  However, I can hold this position much longer than 2 seconds which will help to open the forearms muscles.

I love my therapeutic ball!  This is my version of reclined hero pose.  As the front of my thighs open, I can adjust the ball backward to sit a little deeper into the stretch.  I contract my gluts a little as I am trying to increase hip extension.  You can see the slight flexion of the hips and this is at the end of my range of motion.

Supported wheel on the ball.  I "hang out" in this pose almost every day.  My neck likes the support most of all.  Here, I can work on alignment of my hips (i.e. neutral rotation), engage the gluts and lower belly to take pressure off of my low back, create hip extension, and open in the chest and shoulders.

With any Big Goal, it helps to break it down into smaller parts.  This way I can feel a little progress and success each day.  Small achievements feel better and keep me motivated.

So how are you doing with your goal/s in 2017?  It is OK to readjust and look at the big goals in smaller segments.  Don't beat yourself up if you got off track.  Keep cheering yourself on and stay positive.

Namaste,

Stephanie