Know your Pain, Know your Relief Event
On Wednesday May 31st, I was invited to teach a yoga class and participate in a panel discussion on holistic approaches to pain. The event was to encourage a more holistic approach to pain management on the launch the Global Pain Index, based on market research conducted for GSK to find out patterns of pain around the world, including in Australia.
This was a wonderful opportunity. I love sharing health-related information, I am sure everyone can benefit from yoga or other mindful exercise once they find the best style for themselves. I was excited to share my knowledge and to share yoga with everyone there. I have been teaching yoga and TESOL for years so would be fine presenting. Surely...
For those of you who know me with my performance and social anxiety, you can imagine how I actually felt. The yoga class was mostly nerve free until the camera was in my face. lol For the panel discussion, I was nervous but ok until I was the first to answer, then the information I'd practiced saying clearly and logically fell out of my head. The white noise inside my head and memory fail was quite spectacular (from the inside) but I managed to remember more and become more comfortable as the discussion went on (from the outside). Apparently I managed to get some of my key points across, but here I'd like to cover them again and add any I may have missed in my bunny-in-the-headlight moment.
While the yoga class was lucky enough to get onto Sunrise that morning, the key information from the panel was not. I would like to share that information below:
The causes of pain are numerous: muscular tension, lack of muscular tension, damage to tissues, nerve compression or damage, inflammation both local and systemic, for example. Muscular tension can lead to headaches, cramps, joint pain and muscular tears. A lack of muscular tension in some areas can cause joint pain and tension in other areas. If you have had sciatica or other nerve compression injuries you understand the burn of the compressed nerve. Inflammation can cause non-specific pain that you cannot seem to make go away not matter how you stretch.
Dietitian Wendy Stevens from Nourish & Nurture nutrition counselling spoke on the importance of an anti-inflammatory diet in pain management. The need for whole foods - vegetables, nuts, seeds, herb & spices and Omega-3s, those good fats, was also reinforced. Omega-3s being especially important for their role in reducing inflammation, promoting recovering and healing as they are so nutrient rich. Moderation through having a little of everything. The anti-inflammatory breakfast provided at the event was described and was definitely delicious - thank you to the chefs at Suttons Beach Pavillion for the awesome spread created with Wendy's input.
Pharmacist Raymond Napper from the local Terry White Chemist explained the need for people to have a relationship with their pharmacist. If your pharmacist knows what medicines you take regularly they would be better able to provide advice both on pain relief but also on regular medications that may not agree with you. It was explained that they can provide suggestions for you to take to your GP about different medications in the same class which can help reduce side effects which can include pain.
Psychologist Melissa Day, Director of Pain Research and the Brisbane Pain and Rehabilitation Service at the University of Queensland, suggested psychological approaches that overlap with yoga. She suggested belly breathing and mindfulness to help with pain management. She also covered the psychological aspect of lack of movement that comes in when people are in pain due to fear of having the pain again or making it worse.
There are four ways yoga can assist in pain management:
The breath: The breathe can be used to fake-it-til-you-make-it with your nervous system. When you are stressed, you naturally start to breathe more shallowly, just in the top of the chest. This chest breathing can become a habit if you are under long term stress. Under long-term stress, our levels of inflammation within the body increase. By breathing down to the bottom of the lungs so your belly rises and falls, using all of your lungs to breathe, you can convince your nervous system that you are no longer stressed and this will bring down inflammatory markers in the blood stream. A 2010 study showed that experienced yogis had lower levels of inflammatory markers (IL-6 41% higher; CRP 4.75x higher in novices) in their blood than beginners. This was achieved with just 6-months of regular practice - not one for those who just want a pill to fix it, but really quite short considering how long we've been stressing ourselves out through our lives.
Stretching: If pain is caused by muscle tension then stretching the muscles out can help to reduce that pain. You may need to stretch the muscles - 6-10 deep breaths for each comfortably uncomfortable hold, or you may need to stretch the fascia which can be 3-5 minute holds at a milder level of stretch in a Yin Yoga class. If you have never done Yin Yoga before I strongly recommend you attend some Yin classes before trying these fascial stretches on your own.
Strengthening: If muscles are too loose or weak, the joints can move beyond regular range of motion leading to possible pain and injury. Strengthening the muscles in a safe, controlled, functional movement can help build joint stability and allow other muscles to relax when they are not needed for the movement. A classic example of a weak muscle issue that affects a large number of people is the core. The core consists of the pelvic floor and the muscles that wrap horizontally and diagonally in both directions around the abdomen. The core DOES NOT include the six-pack. When the core is weak, other muscles will do the work of stabilising the body. For example, when the core is weak, a sway will build up through the body as we walk and move. In order to keep vision comfortable we engage the muscles of the neck and shoulder to hold the head in place leading to neck and shoulder pain and tightness in those muscles. This can be reduced by building the core muscles back up to levels where they are covering their workload.
Mindfulness: By focusing on how we move in yoga, on the breath, or on the guidance given during a mindful meditation we take our mind off the thousands of thoughts running through our minds. We allow our mind time and space to slow down. We allow our nervous systems to move away from that fight/flight/freeze mode and into rest and digest. In rest and digest we allow our bodies to run background functions such as digestion, cellular repair, immune boosting, that get turned off when we are running away from the sabre-toothed tiger that our body imagines when we are in our everyday high stress mode.
Following this event, teaching my two regular yoga classes was the best way for me to wind my freeze/flight response that kicked in during the panel discussion back down to a rest and digest. The mindful focus on my breath and modulating my voice so others could relax helped return my system to relaxed. Think about what works for you. It may be yoga, tai chi, painting, gardening... Whatever it is, find what makes you feel better and do it regularly.
A 2012 review of the literature found that although some studies had limitations, there is evidence that yoga can be used to help those experiencing pain. More and better research is required, but it is a promising start for a modality that does not generate enough money to fund its own supporting research (not that I'm very cynical, hehe). I have always promoted my yoga as yoga for every body. With smaller classes it is easier to offer different options and keep an eye on each individual. Those in pain are also catered for. One of my yogis who was at the breakfast stated that with just 2-3months of yoga practice twice a week she has much more mobility and less pain from her Rheumatoid Arthritis.
One question from the audience asked why Australians were found to have more pain than other countries. Without knowing the exact answer, I wonder if it's not those two very Aussie traits that come out of 'she'll be right'. The easy-going, 'yeah it hurts but whatever' approach meaning that people don't address their pain; or the possibly more uptight, 'it'll be fine, I don't want to cause any problems for anyone else by asking for help'. Both of these approaches can cause more pain in the long term as stiffness sets in. When people have pain they stop moving that area to avoid the pain itself or fear of making it worse, as discussed by Melissa.
Another issue that should be considered when discussing national pain levels, is the lack of work-life balance Aussies have compared to other OECD countries. Australia ranks 32nd of the 38 OECD countries for number of hours spent in personal care (sleep, leisure, etc). It is likely that this could lead to higher stress levels, more hours spent seated and less time doing the things we love that can help reduce pain.
And if you think 'No Pain, No Gain' is the way to train, then think again. A 2017 study on stretching to just the point of discomfort or beyond that to the point of pain showed no added benefit to stretching beyond comfortable limits. There was a slight increase in flexibility which was put down to increased pain tolerance. Increased pain tolerance is dangerous as it means you can move closer to the point of damaging or snapping a muscle or tendon without feeling as many warning signs. Awareness of what you feel as you move is vital to keeping yourself safe as you move. Being mindful of the signals your body sends as you stretch, strengthen and play will help keep you pain free, or reduce the incidence of new pain if you already have pain.