Restoryoga a system of self-care for managing chronic pain

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1 Restoryoga a system of self-care for managing chronic pain Kathy Felkai On February 26th, I had the honour of presenting the practice of yoga for managing chronic pain at The Canadian Pain Society s 4th Annual Chronic Pain Refresher course. As I hear about and experience the frustration and despair of many of my yoga students, I feel that there is a great need for improving treatments and care. In many cases, in some communities, due to the lack of availability and public coverage for alternative pain treatments, the only available tool is the prescription pad. We need to do our best to develop a new strategy for treating chronic pain. I hope that in the future, hopefully soon, treatment plans will include yoga as well. In this way passive management will move toward active management, i.e. taking charge and taking control. I have been teaching yoga for about 10 years. I can say with full confidence that treatments will be, and are more successful when integrating the whole person: body, mind and spirit. Healing is a continual movement away from fragmentation toward wholeness and connection. ~ Dawna Markova This quote sounds like a prescription for yoga. The word yoga means union of body, mind and spirit, which has been the focus of yoga teachings for about 4000 years. We should not ignore that we cannot fully restore the body without restoring the spirit, which might be giving up and giving in already. Yoga is a way to reach the spirit and the mind. It is a way to tap into the body s natural healing ability, that tremendous internal power which we all possess. Yoga is available for everyone, the young and old, the healthy and ill; it has a lot to offer to those who are willing to start their journey. Yoga is a process, not a destination. It is a journey, which is not always easy, but has great discoveries and rewards along the way, e.g. better overall health, more vitality, a clearer mind, an improved sense of wellbeing, just to mention a few of the benefits. The style of yoga that I teach and practice originates from Vanda Scaravelli and Esther Myers. They created a therapeutic style of Hatha yoga -- gentle, yet highly effective. As Vanda stated:

2 the stress-free new yoga that works with the body to restore health, vitality and energy. I have now been teaching this style of yoga at the Wasser Pain Clinic/Mount Sinai Hospital/CBT program for seven years. As the focus is on integrating the whole person, I find that this program is very helpful and effective. I make sure, in every class, besides the physical practice, that I take time to explain and educate students about the body, e.g. movements of the spine and joints, like neutral position, flexion, extension, and help them understand which poses are helpful for their condition, and which are not. To ensure that everybody benefits from their yoga practice, I am always eager to find ways of adapting and modifying poses. Educating and imparting knowledge are important components of treatment. Properly trained yoga teachers are able to contribute, and can work together with the CBT program s leading physician. I wish that CBT programs, including yoga, were more available without cost to patients. It would be more beneficial to offer CBT programs for longer terms as an integral part of regular treatments, starting right at the beginning when patients are meeting with their physicians to set up a plan for management. Hopefully, use/overuse of various medications could be reduced or prevented if we offered alternative ways of coping with pain, anxiety and despair. I feel that it is important for me to share my yoga experience, as my own recovery gave me the motivation to become a yoga teacher. I started my practice about 12 years ago when I was diagnosed with CFS/FM. I felt that I was in a deep black hole: in pain, feeling depressed, scared. Yoga simply felt good for my aching body and eased my mind. Gradually, I was able to restore my health and my spirit. These are very meaningful words: yoga gave me my life back and gave me a new purpose. I know that the practice is always there for me, as it is for all of us, and is even more important at difficult times of flare-ups or other physical or emotional challenges. I found my yoga home at the Esther Myers Studio, and I was very fortunate to learn from Esther herself. She passed away from breast cancer in I am proud and honoured to continue in her footsteps. Her teachings her words are etched in my mind. My passion is helping my students find their own path, their own yoga, to manage pain, fear, discomfort, but more importantly to help them find joy: the joy of

3 movement, the joy of breathing deeply, the joy of relaxation. I know that the regular practice of yoga can provide these joys, as I myself have experienced. The yogic tools for managing chronic pain are: Pranayama / loosely translated as breathing practice Asana / practice of poses Mediation / focused mind, focused attention Generally speaking, over time, a well-rounded yoga practice should include all three of these components. Pranayama is the essence of yoga, as the breath is the connecting link between body and mind. It is a way to quiet the mind, to balance and strengthen the nervous system, and to shift the focus to the more restorative parasympathetic division. Breath practice can be done anytime, in any position. The breath is readily available to us we can always come to our breath when we feel stressed, tense, or in pain. Due to pain and anxiety, our breathing becomes shorter and shallower, moving up higher in the chest. We usually start our practice with simple conscious breathing, to reconnect with the breath and body, by feeling and observing the breath cycle, gradually moving on to other practices. Pranayama should always be done gently, without any strain or force. Some practices are helpful for relaxation, for calming the racing mind; others help with easing pain, or even generate energy. Our suggested breath for Asana practice is deep belly breathing. Generally speaking, the exhalation creates space, sets muscles free, breaks knots, and relieves discomfort and pain. Deep inhalation brings renewed energy, life and support. The next yogic tool for managing chronic pain is Asana, or the physical practice of poses. The goal of Asana practice should not be the Asana itself, but developing the necessary strength and flexibility over time to do the poses with ease. What makes Asana practice different from any other form of exercise is moving with grounding and breath. Our basic and most important principle of practice is The Ground-The Breath- The Spine. There is a definite interaction and connection amongst these three elements, which are always present. This principle makes sense for everyone, both beginner and advanced student alike. Practicing from this principle provides us with a strong and stable foundation, anchoring the body and the mind, keeping us safe,

4 secure, aligned, even when the physical practice is limited or challenging. As we establish a strong and stable foundation on the ground, as we visualize growing roots deep into the earth, our body releases. Poses become steady without effort, and muscles tone through release and extension. The breath brings us to the state of quiet attention, the essence of yoga. As we follow the breath, the release of the exhalation balances the receptivity of the inhalation. The spine lengthens with a gentle wave-like release, bringing energy, vitality and movement to poses without force and strain. This release divides the body at the waist. The lower half is pulled into the ground, and the upper half is released toward the sky, giving lightness and freedom to the upper body. This wave-like movement can be felt throughout the entire body, gradually freeing up tight and tense parts of the body. The third yogic tool is Meditation, meaning focusing the mind and the attention. The focus could be the breath, body image, awareness, sounds, visualization for health and wellbeing, pain relief, restoring energy, and many more as are widely practiced. Meditation is highly effective for decreasing anxiety, improving pain tolerance by changing perception of pain, and uplifting the mood, counteracting the harmful effects of stress. Long-term meditation appears to change the wiring of the brain and can help reduce the transmission of pain signals. As well, meditation can be freely practiced without Asana and Pranayama. There are hundreds of Asana and Pranayama practices available. Some students find benefits from breathing or from relaxation, while others enjoy practicing a variety of poses. I have a folder filled with testimonials received from my students. I feel that their words actually tell us what yoga is all about. Besides testimonials, there are numerous studies done about yoga for chronic pain. The most extensive study was done in 2010, including FM, chronic low back pain, Carpal Tunnel, chronic back pain, and cancerrelated pain. According to the studies, in all study groups the main benefits were reduction of pain and functional disability, lessening of pain medications, a change in attitude toward pain and a person s condition, and more confidence handling daily tasks. I consider that the most important benefit of all is the improved quality of life, as indicated in the studies and described in my students testimonials. One of my students, who have been practicing with me for five years, said it best: What a great pleasure it is to be able to sit through a family dinner or a movie more comfortably.

5 At the end of my conference presentation, I showed a video -- a few minutes of a short class for managing chronic pain, with students who have different chronic pain issues. During the video, I emphasized some useful tips for practicing and making modifications to suit different issues. I would be glad to send a copy to anyone who is interested in sampling a taste of yoga. I would like to offer my experience, my knowledge, and my expertise in this field to integrate the practice of yoga with treatment plans. I am available for consultations, private and group lessons, and would gladly advise on setting up yoga programs as part of treatments. I believe in the process of yoga. I reiterate that yoga is a journey, not a destination. I am personal proof that regular practice of therapeutic Hatha yoga is an effective way for managing chronic pain. Yoga is the rhythm of the body, the melody of the mind, the symphony of the soul, creating the harmony of life. ~ B.K.S. Iyengar Bio Kathy Felkai is certified by the Esther Myers Yoga studio, has been teaching yoga for 10 years. She has been teaching at the MK Centre for 8 years and at the wasser Pain clinic CBT program for 7 years. She has been providing employee wellness classes and private lessons as well at the Rehab and Wellbeing Clinic. In February 2012 she presented yoga for managing chronic pain at the CPS 4th annual refresher course. She started her journey when she was diagnosed with CFS/ FM. She is committed and passionate about sharing her experience with yoga as a way of restoring her health, regaining her life.