Yoga for Chronic Pain, Part I

Yogic tools including asana, breathwork, and meditation can help ease the burden of chronic pain.

By Timothy McCall, M.D.

Millions of people live with chronic pain. Arthritis and back pain are probably the two most common forms, but others include everything from fibromyalgia to cancer. As yoga therapy grows in visibility, many of these people are likely to come looking for relief—and fortunately, yoga has much to offer.

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.

Asana

The physical postures of yoga can help relieve pain in a number of ways. The most obvious is the ability of a well-rounded yoga practice to lower stress levels. Stress makes muscles more likely to go into spasm, and muscle spasms are an underappreciated contributor to both acute and chronic pain. Indeed, in the case of back pain, it's tight, aching muscles (which can grip in response to even minor injuries to tendons, ligaments, or other connective tissue) that experts now believe cause most of the pain. The practice of asana, beyond its ability to induce relaxation, can be an effective way to relieve muscle tightness. In contrast to many other forms of exercise, yoga promotes both strength and flexibility in muscles.

Asana can also be very helpful in conditions such as back pain and degenerative arthritis, where poor anatomical alignment and dysfunctional movement patterns are usually contributing to the problem. By teaching your students to engage muscles that aren't working properly, and relax ones that don't let go when they should, you can help them bring their bones into better alignment, relieving compression of joints and soft tissues.

Unconscious muscular gripping can be a problem in a host of conditions ranging from headaches to carpal tunnel syndrome. By offering feedback to your students as they practice, you can slowly help them bring awareness to areas where they currently have little. In some areas, such as in the muscles of the face, simply pointing out the gripping may be enough to allow the students to let go. For other areas, such as in the hips or quadriceps, it can take years of steady asana practice to find significant muscular release.

A regular asana practice can also improve sleep. Poor sleep can worsen pain and is thought to be a major contributor to the pain in such conditions as chronic fatigue syndrome and fibromyalgia. Be sure, however, to advise your students to avoid activating practices, such as backbends or vigorous pranayamas, too close to bedtime. Sensitivity varies among individuals, but generally it's a good idea to put a few hours between vigorous asana and sleep, and to balance active practices with a good dose of restorative and relaxing ones, especially when practicing later in the day.

Posture and Pain

Posture can play a huge role in back pain, neck aches, carpal tunnel syndrome, and a variety of other conditions, and here again asana can be very helpful. In the modern world, where people spend a large percentage of their days sitting at desks or staring at computer screens or TVs, it's common to round the back and hold the head well in front of the spine. This C-shaped slump can compromise nerve conduction and blood flow to the arms, potentially worsening the pain of such conditions as carpal tunnel and thoracic outlet syndrome. This misalignment is commonly accompanied by an unhealthy internal rotation of the upper arms, further exacerbating the problem.

When the head is poised directly above the spine, it takes relatively little effort to maintain its position. But when you hold your head well in front of the spine, the muscles in the back of the neck and upper back get stretched and can become painful, which is one reason why neck, back, and shoulder tightness and pain are so common. Having to hold up a weight equivalent to a bowling ball all day can also contribute to fatigue, another common complaint, and another factor that can worsen the perception of pain.

The particular asanas that improve posture will depend on precisely what you see when you examine the student. For those with the classic C-shaped slump—"Slumpasana," as it's sometimes called—gentle backbends are often therapeutic, though these students may find them particularly difficult. Slumpers often fail to engage their rhomboid muscles between the shoulder blades and their back extensors in the thoracic region.

Take care that when these students do backbends, they aren't overly arching their lumbar spines or their necks. Doing so allows them to give the outward appearance of bending backward without actually engaging those muscles that they either don't know how to use or prefer not to use. Without your guidance, they may be doing these poses in a way that not only won't help their problems but could end up causing pain in new places.

You might have such students try Bhujangasana (Cobra Pose) or Salabhasana (Locust Pose), keeping the backs of their necks long and their gazes directed down at the floor to encourage them not to compress their cervical vertebrae. Also advise them not to strive to get as high as they can in these poses, which often happens at the risk of compressing the lumbar spine. Instead, have them stay closer to the ground while focusing on bringing movement into the area between their shoulder blades. While it may not look like much, your students are likely to report that doing the poses in this manner makes them work in a way to which they aren't accustomed—and that's the key to their benefit.

In Part 2, we'll explore using breathwork and meditation to bring pain relief.

Dr. Timothy McCall is a board-certified specialist in internal medicine, Yoga Journal's Medical Editor, and the author of book Yoga as Medicine: The Yogic Prescription for Health and Healing (Bantam). He can be found on the Web at www.DrMcCall.com.

See All Yoga as Medicine Articles »