A continuation of Dr. Lisa Holland PT, DPT, ERYT-200, PRYT first article on this topic.
Last week I explained the science of the brain when in pain. To recap, pain nerve tracts bring info from the body to the brain and then relay information to several other center of the brain at a site that is responsible for analyzing threat against survival. The neurotransmission can direct a thought or consciousness to the CEO of the brain, the prefrontal cortex, as well as the regions of the brain set up to construct a multi-systemic nervous system response. How you will react in the body and the mind is somewhat dependent upon the perceived threat of the information being analyzed.
With the above logic, how does the brain not perceive physical activity as a physical threat even once it is connected with a certain exercise related event? The key is our ability to move on or heal. The perception of how threatening is the painful stimuli depends on the relationship you have with the region you’re feeling the pain. Can your body send the right information to the brain or is that region damaged and unable to send the real information? If a region in your body has fully healed then why is the brain not dulling the sensation of pain as would normally be the case?
There is a connection between the activity and how your brain has processed information of discomfort in past experiences, and continues to do so even now that you’ve healed. We (physical therapists) now have evidence based rationale for why a prescriptive mindset of surrender, acceptance, persistence and courage may be the perfect lens from which to view a bridge between inability (to perform an activity) and tolerance (of pain).
How To Add in the Concept of Dysfunctional Motion.
When dealing with chronic pain, movement that hurts indicates a dysfunction in the information transmission process and it can be difficult to ascertain what level of the process has gone astray. Layers of protective actions cause new levels of dysfunction and so although tissues have healed and are no longer broken, the body continues to act as if it were inflamed. I believe nature values action but the action is not synonymous with overreaction.
Through prescriptive yoga you can witness the dysfunction and miscommunication that happens along your information transmission process. Prescriptive yoga helps you better understand your tendency to overreact or underreact, and this learned behavior empowers you to cope with a dysfunction or threatening state of being. Self-reflection shows that pain is also tied to lack of sleep, lack of proper nourishment to heal, demands upon your time and/or social threats that you may feel.
It seems insane but sometimes having pain becomes the protection. The mud in which the lotus flower forms values the security in knowing the muddy muck verses experiencing a new reality. Staying stuck in habits that foster more pain like the consumption of sugar or inactivity can become a subconscious prison. For those who want out of chronic pain, practicing prescriptive yoga with a guide or guru can help create the feeling of support, safety and freedom to experience the work outside of the subconscious prison -- the known.
This is where the biopsychosocial model really benefits from prescribed yoga. Since movement ties into the physics, anatomy and physiology, we can manipulate the natural sciences that state every action requires some level of energy exchange. When the body has an abnormal inflammatory response, we now know that the brain (or the cells) perceives a false threat or gets stuck on a part of that process and either puts too much or too little energy into the right action. If we can cognitively conceive another reaction then we may be able to facilitate that new reaction occurring.
For example, in pain disorders, many movement dysfunctions are influenced by compensatory or avoidance techniques. To break free of avoidance techniques, body awareness is applied through something as safe as visualized motion, and therefore can bring awareness to a non-painful action and focus on a more truthful reaction of the non-threatening movement. The target then becomes the mind where you can deplete your energy worrying about “what if” or you can use that same mental energy to see what is and visualize what can become in an empowered way.
I developed my teaching system out of a real need to get the message across that yoga therapy does not require the yoga to be about postures -- that is only one of the 8 limbs of the science. Therefore, one can practice the other 7 and be guided by the wisdom of the entire science to experience valuable movement by staying still and placing focus simply on the air moving in and out of the lungs. It is not the perfection of the structure or complexity of the posture that makes yoga valuable to chronic pain patients. It is the training of the awareness of the potential experience and then, being present in a difficult step forward.
Self-Realization by Earning Your OMs.
Learn all the limbs of the practice to influence the receptivity and acceptance of a manual or physical experience in physical therapy. The innate wisdom of the practice has the potential to establish a discipline through a peaceful experience amongst the chaos. You earn points in pranayama, self- reflection, meditation or asana by being human, not by doing human. When I would teach this to the elementary school kids, I would inspire the fire to do the hard work of being by rewarding the students with an Om symbol marked on their mat for the day. So here are 5 ways to earn your OM:
Realize that you may have already spent all your Oms from the past. Accept that it will require constant diligence to earn more points doing little things.
Stop assuming you will always feel pain. As I cited in part one of this article, science is documenting how our mind will physiologically evoke pain just by anticipating it in the future. Ask yourself if the pain you are feeling is attached to an emotional or social threat to your happiness, more than a physical one.
Visualize yourself engaged in the activity you blame ‘pain’ for not doing anymore and when using your imagination, focus on how you would feel doing that task while being present and happy. You do not need to be pain-free to be present and happy, or do you? When you open your eyes, realize that you have not lost the ability to experience anything as long as you have your imagination.
Prioritize an 8 second breath cycle for 3 minutes every day. Close your eyes and visualize the space within the center of the mind, focus both eyes on the center of the forehead, deep behind the brow, between the eyes. Seated upright and tall with hips heavy in a firm chair, take note of placing your feet on the floor. Inhale for a count of 8, no more and no less. Hold for 2 seconds while focusing on an imaginary flame at the central space in the brain. Smoothly exhale for 8 seconds. Repeat for 3 minutes. Do not gulp air or collapse the body on the exhale. Why create a threat when the reality is that there is non? In the least, this cyclic breathing can evoke a more comfortable relay into the rest of the brain that you are calm with a nerve response.
Try on some postures and mix them with physical therapies that are built from a point of neuromuscular stability and safety for the insular cortex’s benefit. Then proceed using the sensory response for the courage to move and release. I teach patients in a very systematic way because that gives them the control they seek and helps quiet the anticipation of pain.
I Dare You to Be Happily in Pain
I dare you to make this the year to focus on the now. I dare you to make yoga a discipline in your life now. I dare you not to worry about what you have lost in the past or in the future by your pain. Let that go. Place that energy into deciding how you desire to feel now and what building blocks for contentment are under your control now in your present state? Take a series of long , slow and grounding breaths before , during and after you move into the now and become present to the dare of being happy.
About the Author:
Dr. Lisa Holland PT, DPT, ERYT-200, PRYT has been a licensed Physical Therapist for close to two decades with a personal yoga practice since 2000. An active member of the International Association of Yoga Therapists, The American Physical Therapy Association and the Charlotte coordinator for the Yoga Alliance community initiative, Lisa’s main objective is to foster safe and effective public well care models by bridging yoga with healthcare. Since 2009 she has studied yoga as a lifestyle with her beloved teacher Sri Dharma Mittra and is working towards her 500 hour Dharma Yoga certification.
Originally from the NYC area, Lisa obtained her bachelor in Athletic Training at Hofstra University and practiced in the field of sports medicine and orthopedics for over a decade before moving to Charlotte in 2004. She is a licensed therapist in both North and South Carolina and has completed thousands of hours of post professional clinical trainings including a clinical doctorate in Physical Therapy, women’s health, pediatric development and integrative orthopedic care. To learn more about her wellness mentorships and integrative courses visit @ www.OmHealing.net and www.Bellyguru.com