This picture above is me practicing at my teacher’s (Kales) house today. In the context of writing about pain experience, evidence and yoga, I should point out that when I first met Kale, in 2009, I could barely move. 2 years of chronic pain, and what I now recognise as sensitisation, fear avoidance and textbook chronicity markers, I could barely even sit on the ground (hip and knee pain), my squatting ability was non existent (too stiff, too sore).
Additionally, I was too restricted to do many daily activities one takes for granted- more enjoyable recreational activities were certianaly out of reach (surfing, exercising more generally), even socialising comfortably was frustratingly difficult. For over 2 years my physical capacity was extremely curtailed.
A corollary of this was an understandable disillusionment with my profession. In spite of personally receiving months and ultimately years of physiotherapy treatments and advice for my condition, its ineffectiveness for persistent pain and notably its subservience to the biomedical model was alarmingly obvious. So, after being a patient for over 2 years of fruitless perseverance with the conventional private practice physio/biomedical model, (which for the record included unnecessary and expensive scans, dubious diagnoses, inflammatory inaccurate language, multiple injections, scripts for medications, passive treatment, referrals to surgeons- all of which is devoid of evidence incidentally, with additional good evidence that actually causes harm), I dumped it to learn yoga.
Along the way, I found an innovative, intriguing and captivating approach to movement, exercise and well-being.
Concurrently, I also noticed that actual scientific research into pain and movement dysfunction was beginning to converge more and more with what I was doing. Graduated, mindful movement based approaches that emphasise decreasing fear about movement, increasing self-efficacy, self-understanding and self-empowerment began to emerge in the literature as effective evidenced based treatments.
Carefully tailored and individually instructed yoga can, if taught correctly, cover all these bases (see Appendix I and II). The problem is that this evidence has still not shifted clinical practice and clinical business models in many cases. Many practitioners are simply at a loss to know how to integrate this information and pragmatically utilize the biopsychosocial model.
What yoga does (when of course instructed properly, correctly and knowledgeably, with a teacher who has subjective empirical experience in the art, and combines this with good evidence) is that it offers a great avenue for this clinical paradigm shift.
More than that though, it offers interested people a lifetime of study, & a tangible practice that maximises physical and mental potential, rather than merely removing symptoms.
Properly instructed yoga, combined with evidence based principles and good pain management education can break the cycle of pain, and can allow neuroplastic changes to occur to reverse the “dark side of neuroplasticity”.
APPENDIX I
Factors that increase sensitisation (open the pain gate)
Biomedical Model and Treatment
Catastrophising
Pain-related anxiety and fear
Stress
Helplessness
Factors that decrease sensitisation (close the pain gate)
Biopsychosocial Model and Yoga
Self-efficacy
Pain coping strategies
Readiness to change
Acceptance
APPENDIX II
References:
Vlaeyen, J. W., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85(3), 317-332.