Did the Yogis Understand Pain Science centuries ago?! 

The pain came about right after a car crash - we were tucked into the side of the lane waiting for the collision from a car which was out of control & moving fast. I remember after waiting for the tow- truck and thinking my back didn't feel good. A week later- it was still painful to walk, a month later- I had started to avoid longer dog walks. A year later- still there. I have been to the physio, seen the doctor, and been back to the physio. Nothing wrong! Some muscle tightness but nothing major. 

I have done research into pain, causes of pain, into the biomechanics of the Sacroiliac joint- it is much more stable than we often are led to believe. So I am willing to accept the stress of the event seems to have been more of the trigger than the actual damage to the body. Some days it feels sore and others less. But at least it's got me pretty clued up on all sorts of pain science! One thing I do know is that pain education is an important element in recovery from or learning to live with pain.

Has my pain gone - no. Do I still catastrophize that something has gone really wrong? Not often! One of the common reasons folks come to yoga, is to ease pain- whether it’s back pain or the general aches and creaks of our hips and knees. So as yoga teachers, it really helps if we know what we are talking about when it comes to pain. 

It turns out that what we often THINK eases pain - better alignment, or “correcting” our posture is only a small part of the picture. In fact, in emphasizing our power to “see what's wrong” with someone’s posture we might inadvertently become a part of the problem. Because belief is a part of the process of pain. 

It turns out that not only is pain complex, but many factors can cause pain, and they all interact in a multitude of ways, there are also many ways to interrupt pain and to alleviate pain. This Instagram post outlines this in the rather wonderful analogy of a teacup (who doesn't love a cup of tea!). 

In short- we can put lots of things in the cup- exhaustion/stress/muscle strain/ligament tear/death of a loved one/loneliness/poverty etc. but it’s only when the tea reaches the brim that we experience pain. Take one or two things out & the pain will most likely start to ease. 

Sadly the general understanding of pain & how yoga can help alleviate pain is often misconstrued as we learn to move better, to align better, and this fixes the body. But the problem is never all in the body! So this thinking continues the simplistic misperception of the materialist model- where the body is some sort of clever machine to fix. The signals from the body are just saying “pay attention- assess if something is wrong” through the nervous system & to the brain.  Then the brain & nervous system interpret & convey this information which we might experience any amount of pain.

When we are in a life-challenging situation the adrenaline keeps us from feeling some of the pain until we are out of harm's way. When we are afraid we are likely to feel more pain. When we are happy we are likely to feel less pain. 

Traditionally yogis did not perceive the body in this way at all! The more I think about it, the more amazed I am at how much the yogis seem to have understood the complexities of pain - or perhaps more accurately suffering. From one perspective we can see the whole incredibly complex array of yoga practices as aligning with the biopsychosocial model. That is the model of pain that is now understood to best represent the really complex phenomenon of pain.

The yogis believed that ignorance- avidya- lay at the root of our suffering & that we could train the mind to perceive differently and alleviate our pain.  The methodology they came up with involved body, mind and even how we relate to each other. The Patanjali sutras refer to avidya as a klesha- one of the causes of suffering. In fact, it is the foundation of all the kelshas since all our suffering in yoga terms relates to our inability to understand that we are not these time-limited, separate beings that we believe. We are deeply interrelated and our work is realised this so that our whole perception shifts. (More another day on this!)

So back to the biopsychosocial model

The biopsychosocial model dates back to a 1977 paper in which the author, Engels, describes pain as complex and multi-factorial. Pain is not only from damage to the body, but also relates to our emotions and life circumstances. Our current understanding of pain is based on this work- even if in the mainstream it’s slow to catch on. Amazingly - yoga already described the complexity of pain and suffering more than 1000 years ago! 

Let’s have a look at the biopsychosocial model and relate this to what the yogis have said for a LONG time about suffering and pain. 

Bio in Pain Science & Yoga

Bio takes account of the physical body & environment. While tissue damage (like a muscle tear) does have a role to play in our experience of pain- some people have no pain despite damage, and others have pain even when there is no evidence of damage- a torn ligament or obvious cause of back pain for example.

Yoga refers to care of the body through asana as well as a safe & suitable environment and food. The Hatha Yoga Pradipika a 15th century text gives clear direction on where to live- somewhere peaceful; as well as asana (posture) practices, pranayama & how to cleanse the body. Asana is a much earlier invention but not as well documented.

Psycho in pain science

What we believe affects how we feel, pain increases if we are afraid that it’s due to something serious. We also feel worse if we are anxious, depressed or exhausted. One way to imagine our experience of pain is like a teacup - the more we throw into the cup, such as body damage, stress, lack of sleep, trauma, etc. the more likely it is to overflow. This overflow being the amount of pain we experience.

Yoga Psychology

Yoga is a psychological practice- we train the body through asana to steady the mind. We train the mind with meditation & chanting so that we can overcome negative thought patterns & this reduces emotional or physical pain. There are so many practices & teachings on this & we can see the whole web of yoga lineages as different expressions of this desire to outroot suffering in a comprehensive way.

“Yogas citta vritti nirodaha” 1.2 Patanjali yoga sutras describe that yoga exists where the mind is still, where the mind is not disturbed by thoughts, since those thoughts do not always express the truth. Instead, we are offered practices to explore what is true and what is real. One method is called “neti neti” meaning “not this, not this” - whereby we examine thoughts and experiences to see if they are just temporary illusions, or whether they are part of the unchanging fabric of reality. Or to give it one term we often see, Brahman.

Social in Pain Science & Yoga

It is well-documented that health outcomes relate to our social standing. Socio-economic factors, such as poverty, play a huge role. As well as environmental and cultural factors, such as work issues, and whether we are lonely or have a supportive family. And also experiences of racism & discrimination etc.

Community (or Sangha) is considered essential to following the yoga path. Traditionally some yogis lived in distinct communities, often with a guru and distinct social structures. Today the collective experience of yoga practitioners is proven to have mental & physical health benefits.

Conclusion

Yoga philosophy is often presented as irrelevant nowadays or something we humour to not be accused of cultural appropriation. But personally, I think that if we look carefully we can find so many ways in which it is a phenomenal resource of wisdom,  traditional and current, that we can continue to learn from. Because it seeks answers that extend beyond the individual and beyond this lifetime. It continues to keep us motivated during climate breakdown because we can see that life continues beyond this lifetime, beyond this planet. We see that we are only a tiny part of this vast creation and cultivate compassion for all we meet.

The widely accepted biopsychosocial model of pain aligns perfectly with the yoga worldview, one where we accept complexity and change as inevitable and seek to acknowledge all of the mysterious ways in which we and this amazing planet work!

Yoga is spiritual, practical & philosophical. A science of the body & and the mind based on direct observation and wisdom from deep meditation. One which many centuries later has proven itself once again to be relevant. 

6 things we can do to help anyone ease long-term pain- after they have had the OK from a doctor/physiotherapist/PT. 

1. Guided breathwork- can help to reset and regulate the nervous system.
2. Varied movement- can help to reset the nervous system away from patterns of movement that have become linked to pain. When we move in new ways, with different alignments we can retrain the nervous system to form neural pathways that are not associated with pain.
3. Optimism helps to de-escalate the mind from fear and gives us ways to enjoy ourselves right now. Recognising the ability to let go of some fear, to mindfully cultivate a more optimistic outlook is the path to less pain.
4. Acceptance - yoga does not actually preach “positivity” rather it describes that we cannot control situations, but we can learn to manage our responses to the situation so that we do not compound the problem. The Buddha called this the first & second dart. 
5. Strength & stretching- in terms of asana there are benefits to both strength work which have been shown to improve confidence in the body and reduce pain. Stretching also has phenomenal effects from the cellular level upwards. Stimulating a healing response deep in our bodies. A recent interesting paper on strength work & how it helps us live longer is here- this research suggests that it benefits women more than men!
6. Trauma is closely associated with poor health outcomes and increased pain. But trauma-sensitive yoga can help individuals feel empowered and heal from trauma, changing the structure of the brain, improving health and reducing pain.  

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There is so much fantastic research into pain and language so let me know if you’d like me to share more on this soon- I will include it in my Laura Gilmore Yoga newsletter so do sign up here if you’d like to receive it.