As Yoga teachers, we will often have students who struggle with pain. It is not our job to diagnose or treat. However, it is our role to support, nurture and protect the student from suffering. As well as facilitate a place for growth of the physical, psychosocial and spiritual being. This can feel like an impossible task when pain is a complaint. Especially when the pain is one that is persistent, irritable and sensitive. We all know students with these pains the ones that are made worse by “everything” and made better by “nothing”. My purpose with this article is to shed just a little light on the topic of pain and the neurobiology behind it.
Neurobiology of Pain
The human body and brain are directly connected through the nervous system. Containing 400 different nerves that if stretched end to end would extend 45 miles. These nerves sit at a resting level of excitement, ready at every moment to communicate necessary information from the peripheral (body) to the central system (brain). Each nerve contains a series of receptor sites. These sites are specifically sensitive to changes in the internal environment such as mechanical, chemical, temperature and touch.
To the surprise of many, no nerve in the body or brain contain receptors specific for pain. Instead, the nerves are armed with something called Nociceptors directly translated these are danger receptors. Nociceptors will fire along with the other receptors if any of the changes detected are severe enough that the body has a potential of harm. The nerves will send the messages of sensation to the brain via the spinal cord. The brain receives the messages and interprets it with a series of complex events involving multiple cortical regions to determine if said event is indeed dangerous.
If the brain believes that danger is imminent, then a painful experience will be expressed. If the brain decides this is not a place that requires action, pain will not be produced. This might sound confusing but it is really no different than the process used by all of our senses. For example, you do not have vision receptors in your eyes. You have light receptors. It is the brain that produces the visual experience. Evidence has shown us that nociception is neither required nor enough for pain to occur.
Have a look at this simplified case example. A 48-year-old female student comes to you for a private session with the report of shoulder pain.
Her pain has been present for multiple months and she cannot recall a mechanism of injury. She has seen doctors and therapists and they have all told her nothing is actually wrong with the shoulder. Maybe bursitis or tendonitis but her MRI is clear. She has been offered injections and medications but has declined. She is choosing an alternative path.
You applaud her for this and begin your yoga medicine intake. Her range of motion and strength appear normal. Her resting posture is quite good. The mechanics during standing asanas are good. Chatarunga alignment is good. Hmm, but she is in pain and many of the motions you ask her to perform are done with a grimace and apprehension.
At this stage, you might begin to wonder if you can actually help her. You can, with just a little bit of knowledge. I would recommend requesting permission to discuss her case with her primary care provider to know you have all the necessary medical facts.
Reminders About Pain
All individuals with pain can benefit from these bits of knowledge.
- Pain Is Normal
- Pain is simply the body’s alarm system
- The role of pain is to communicate actual or perception of threat
- Pain commands action in order to promote survival
- Pain, regardless of how long it has been present, how severe it is or if an injury has occurred or not, is always an output of the brain or central nervous system
- Tissue damage is neither sufficient nor necessary for pain to be experienced
- Hurt and harm are not the same.
You then as a yoga teacher are not protecting the shoulder in this scenario but rather the central and peripheral nervous systems. In medical terms, this individual could most likely be classified as someone who has central sensitivity, not mechanical dysfunction.
You might be thinking, great, but what do I do with that??
Energy goes where attention is given. You need to facilitate a place of safety for the nervous system. Knowledge of the human pain system comes first (see the 7 points above) then you put it into practice.
How’s this for a practice starter?
Have her place one hand on the belly and one hand on the heart and begin to breathe a little deeper.
This simple act can be like a self-hug, assuring the nervous system you got this, and there is no need to suffer or protect. After creating a greater sense of awareness and connection to her breath, you could begin a gentle seated meditation. Bringing in the ability to be aware of a variety of sensations without the need to react to them. Visualization of movements or positions of the arm that tend to elicit pain can be utilized to practice this idea of observing the sensation without reaction and with the security of mind that harm is absolutely not present even if hurt is.
Once these steps are mastered, transition your client into a moving meditation or asana practice. Remember to keep the conscious presence on the breath and let the body naturally begin to take shapes. If sensations of discomfort present themselves, challenge her to come back to the practice of observation, awareness of safety and letting go of the need to overprotect.
Following these 3 simple steps can begin to desensitize the nervous system:
- Return to the breath
- Awareness of safety
- Movement without the need to protect,
It should not take too long to see a shift in the student’s pain patterns and complaints. It may take a long time for the pain itself to completely resolve but the functional ability and movement tolerance will progress with gentle facilitation.
For further reading I recommend, Explain Pain, Butler and Moseley. And Therapeutic Neuroscience Education, Louw and Puentedura.
by Marnie Hartman, PT, DPT, CSCS, RYT.