StressStop Blog

Yoga and Chronic Pain

Jim Porter, M.A.L.S., President, StressStop.comFriday, July 13th, 2012

When I miss yoga for more than a week, a long running bout with chronic pain (which may have to do with an old case of Lyme disease) rears its ugly head. When this chronic pain first hits me I feel a low level ache that runs up and down the backs of my legs. Sometimes, if I let things go long enough, it radiates out into other areas of my body, like my hips. It's hard to describe exactly, except to say, that if I bend down with my legs straight and try to touch my toes the pain is often excruciating.

Ironically, it's when I come back to yoga (after missing a few classes) and do the forward bends and downward facing dogs that the pain is the most intense. But what I've discovered is, if I force myself to do whatever versions of forward bend or downward facing dog that I can do, things usually get better by the end of class; and they continue to get better on successive days until about the fourth or fifth day when the pain completely disappears. After the pain goes away completely, I can switch back to doing yoga every other day without experiencing any relapses in pain.

A Yoga Class Doing Forward Bends.
Forward bends are incredibly painful when I'm dealing with this chronic pain.

So how does yoga work to relieve pain? According to Stanford University Professor, Dr. Robert Sapolsky, who wrote the book on stress "Why Zebras Don't Get Ulcers," when you experience short bouts of intense pain - like if you hold your hand too close to the flames - there are pain sensor neurons that fire in the area where you FEEL the pain and there are also neurons in the spine that receive these messages. There's also an entirely separate neural circuit that turns OFF the pain when you pull your hand away.

So one neuron receives the pain message and another neuron shuts it off. The only trouble is low level pain (like my arthritis pain) has NO shut off switch. That's why slow (chronic) pain continues unabated the way it does.

But in the case of itching at least, you can easily fool your pain receptors into shutting off. Here's how it works: The next time you have an itch from a mosquito bite on your hand run it under a stream of hot water. Slowly turn up the temperature on the spigot until it's as hot as you can stand: And then shut it off. (You don't need to burn yourself.)

When you shut off the water you'll notice: the itching almost immediately subsides and doesn't come back for hours.

Here's why: Low level pain, like itching (with no off switch) shares the same pathway (in other words the same wiring) as would a sudden burst of intense pain from the same area (like the hot water on the same piece of skin as the itch). But this time the ON/OFF circuit is activated by the sudden pain. Turn off the hot water and the OFF button on the circuit is now activated. No pain whatsoever (either intense heat OR low level itch) is experienced from this area of skin. You fooled your nervous system into turning off the pain receptor for the itch by sending an intense wave of pain up the same nerve highway as your low level pain was traveling.

A Yoga Class Doing The Downward Facing Dog Position.
Downward facing dogs are difficult too.

So what does all this have to do with chronic pain and yoga? During the various stretches I do in yoga class, I very carefully find the position in the stretch (typically in forward bend and downward facing dog) where I can endure a short blast of intense pain. I know I can vary the intensity of the pain by lengthening or shortening the stretch. So I'm totally in control of the pain, but I deliberately go to the edge where I can turn it ON with some intensity. As Dr. Sapolsky confirmed when he read this blog, I'm probably activating the on-off circuit for this pain in the same way that I turn the itch off with hot water.

Thus my yoga practice may be helping me manage my chronic pain by allowing me to turn off the pain circuits that normally couldn't be turned off.

There are other possible explanations for why Yoga may be helping me reduce pain. Here are some of the reasons offered up by other experts in the field:

1. It could be helping me to relieve chronic pain by simply helping me relieve stress.

Here's a quote from Tim McCall, M.D. a writer for Yoga Journal on the relationship between yoga, stress and chronic pain:

Stress can exacerbate pain, whatever its cause. When you are feeling overwhelmed by stress, your pain tolerance may be lower. And, of course, a vicious cycle often ensues, since being in pain can be stressful. Yoga, as perhaps the best overall system of stress reduction ever invented, can help interrupt this cycle.

2. Yoga helps you see the pain in a more accepting way.

Kelly McGonigal, PhD, Author of Yoga for Pain Relief was interviewed on About.com. Here's what she had to say about Yoga and pain:

Yoga teaches you how to befriend your body. People with pain often feel betrayed by their body. Yoga can help you restore trust and learn how to listen to your body and develop intuition about what it needs. By taking care of your body in a gentle way, yoga can help you make peace with your body and overcome the anger, sadness, and frustration that are common responses to chronic pain.

3. Yoga teaches you relaxation techniques that help you let go of tension.

Kelly McGonigal, PhD, continues:

Deep relaxation and meditation (aspects of yoga practice) are the key to unlearning chronic muscle tension, pain sensitivity, stress, and anxiety. Relaxation and meditation have also both been shown to tap into the body's natural healing and pain-reducing responses.

There are so many reasons why yoga is helpful in reducing chronic pain - from lowering your stress about the pain, to turning off pain receptors, to getting you more in touch with your body - that it's difficult to pinpoint the exact reason why it works. But I can tell you from my own personal experience that it really DOES work: As long as I don't miss too many days in a row. And the takeaway here, is, it's as important as a preventative against pain as it is as a cure.

A Yoga Class Doing A Stretch.
Always tell your teacher ahead of class if you have any injuries or chronic pain and he or she will help you make adjustments to your practice that keep you safe.

If you do decide to take a yoga class, always tell your instructor if your chronic pain limits your movement in any way, or if your chronic pain is the result of an injury. Usually the teacher will ask ALL the students at the beginning of class about any injuries or restrictions, but it never hurts to go in five minutes early and have a conversation with your instructor ahead of time, especially if you are doing yoga for the first time. Your teacher, will then modify any poses that might overly stress the parts of the body that are most affected by your injury, so that you won't further injure yourself in any way.

(For example, after I had knee surgery, there were many adjustments the teacher helped me make to accommodate my limited range of motion in the affected area. Eventually my range of motion returned, and I could go back to the normal version of the pose.)

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