Wednesday, July 24, 2013

Thoughts on pain in yoga: 4 types of pain and how to practice with them

 
Last week there was some lively discussion in the yoga blogosphere about pain in yoga practice. As you can imagine, commentators had a wide range of opinions, ranging from: "if there's no pain you're not practicing hard enough" and "injury is inevitable in yoga, just get on with it", to, on the other side of the spectrum "if your practice injures you, you are letting your ego dominate" and "if it hurts, you're doing it wrong," and of course everything in between.

I remember my early yoga teachers talking on occasion about "good pain" versus "bad pain", which is pretty vague and therefore not very helpful. In addition, pain is highly subjective and each individual has a very different tolerance to pain depending on their individual physiology and their past experience (just imagine if a full-grown woman began screaming and wailing in public over a skinned knee; yet it's perfectly understandable that a 4-year old would).

From my perspective, it's not very useful to make generalisations about pain except to say that we will all experience it at some point or another. You really cannot know what another person's individual experience is, or judge whether their pain is "transformative" or just really, really annoying.

I do think it's useful to reflect on a few different types of physical pain and how these might affect our yoga practice. Here are four main types that I can think of:

1) Muscular pain: It is perfectly normal when you are working the body in new ways and pushing your limits to experience some soreness afterwards. This kind of muscular pain is usually isolated in areas of the body that you've been working hard, and might feel like tightness, stiffness, achiness or soreness, and is a sign of a normal, healthy body that is getting stronger and more flexible. Especially if you are practicing on a day-to-day basis, you are going to feel the residue of yesterday's practice when you first step on the mat. Generally with muscular pain of this kind, you can take a few deep breaths, observe the sensations, and keep going through your practice.

There is a big difference between observing pain and ignoring pain. In yoga, we never ignore any sensations. Observation is critical: if you have muscular pain that gets steadily worse, or the area where you feel pain starts to become inflamed, you may have an injury.

2) Joint pain: Joint pain is probably the most important type of pain to recognise in yoga. Joint pain can be dull or acute, but generally it's pain that you feel deep within your body around your critical joints: ankles, knees, hips, shoulders, or anywhere along your spine. It might feel like pressure building up against something solid. Other symptoms of unhappy joints include swelling, unusual stiffness or soreness in these critical joints, and continued discomfort when you use the joint throughout your day.

Joint pain is a serious sign telling you that you are doing something that is wrong for your body. If you try to "push through" joint pain you may end up with a very severe injury - the kind that will be with you for the rest of your life. In my experience, joint pain in yoga often occurs when people try to force their way into a pose that their body is not fully ready for: for instance, injuring your knees while trying to force your body into full lotus position. Joint pain is the type of pain that you work around in your yoga practice, never through. Often this might mean refining your technique or changing your alignment to reduce stress on joint, or modifying a pose.

3) Acute pain / injury: Acute pain is a sharp, intense pain that can't - and shouldn't - be ignored. Pain from an injury is not necessarily acute - it may vary in intensity, but it will usually be accompanied by other symptoms include feelings of heat, swelling, or redness over the affected area.

Unfortunately, injuries can occur suddenly and there may not be any warning signs. In yoga, especially if we are pushing our physical limits, injuries can occur in any number of ways. They can happen to you in your very first class or your thousandth, while trying a new pose or doing a pose you've done a dozen times. Often injuries occur when we push ourselves too hard or try things we are not quite ready for, trying to run before our muscles have really got the hang of walking. Sometimes we don't fully realise that we've injured ourselves until after our practice is over. The first few hours after an injury are critical, so it's important if you do injure yourself to immediately stop and look after yourself, whether that means applying an icepack or seeing a doctor. This can make the difference between a speedy recovery and a long, slow one.

When you're dealing with an injury (whether it happened in yoga or off the mat), the only yogic thing to do is to practice ahimsa (non-harming) and to let the injured area rest, so it can heal.

4) Chronic pain / recovering injury pain: Many people come to yoga because of pain. This is a totally different type of pain than the previous three, which we are assuming occurred during your practice, because this is pain that you are living with everyday, and bringing to your yoga mat.

Chronic pain or the pain of a recovering injury is different for everyone, so there's not a lot of use generalising here. The best advice I can give is to work with an experienced teacher or a yoga therapist to find the right mix of practicing with, through and around your pain, and devising practices that will help you feel better, and not make your pain worse.


So to sum up:

Type of Pain Feels like Practice recommendations?
Muscular Soreness, tightness Breathe through it and observe how it changes.
Joint Pressure, swelling, stiffness, inflammation Practice around it, never push through!
Injury Acute pain, swelling, redness, heat Rest and heal! Practice around it.
Chronic Constant, of varying intensity Practice with, through or around, depending on the individual case.


Readers, what are your thoughts and experience? Would you group things differently or could you add to this summary from your experience?

9 comments:

  1. i love this post and the table you made!

    Certain postures cause pain for me now (depending on the day): savasana always always always results in acute, sharp lower back pains for the remainder of the day. So I don't practice savasana (or supta badhakonasana or even legs up against the wall... anything where i lay with my lower back against the ground for any length of time isn't good).

    I have had an instructor (ashtangi) tell me to push through upward dog (instead of doing baby cobra) even though I told her I have to limit my upward dogs due to lower back pain. It was frustrating because a yoga class is not really the best place to have a discussion and argument. :S

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    1. I can totally relate to what you say about savasana! Actually, lying on the floor is not comfortable for a LOT of people. Personally I need a rolled up blanket under my neck and one under my knees to be able to really relax (in restorative yoga this is called "rolling brook" pose). In my classes I always encourage people to modify savasana to suit them: by putting a bolster under their knees to take the pressure off the lower back, or rolling on their side, whatever will allow them to relax their bodies and their minds.

      It's awful to hear 'bad instructor' stories like that one - especially with backbends! I have known Ashtanga teachers to teach a highly modified version of the sequence, with almost every pose modified, to people with injuries. There's just no reason to believe that every person should do every pose exactly the same.

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  2. Distinguishing between types of pain highlights the importance of listening to our bodies. I am currently doing physio for severe disc degeneration and pinched nerves and the first thing my PT asks me is what is my pain level; is it muscular, spinal ie. joint, or nerve pain. Knowing your body and your type of pain is critical for knowing how to proceed.

    Eco yogini, have you tried savasana with bent knees to take the stress off your lower back? I would be very wary of an instructor who does not respect your limits.

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    1. Hi prairiechick, thanks for commenting! I think that gift of discerning different types of sensations is a big part of what we learn through yoga - connecting with ourselves and learning to know our bodies, and our pain if it's there. Without that self-knowledge, how would we know how to proceed with our practice? An instructor can guide us but they can't feel what it feels like to BE in our bodies - that is our opportunity and our responsibility.

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  3. YES!
    Agree, Agree, Agree. Thank you for posting!

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    1. So glad this resonated with you. :)

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  5. Thank-you for using your time and knowledge to address such a critical and misunderstood issue.

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