Sam (not her real name) was a 36-year-old woman with four children, the youngest just 14 months old. She had a history of childhood trauma and grew up caring for her alcoholic mother.
Now a mother herself, Sam’s husband frequently traveled for work, leaving her to manage the demands of a busy household alone. Her own needs—sleep, nourishment, self-care—were constantly pushed aside. She was exhausted, under-slept, and struggling with low mood, energy, and motivation.
Sam also felt deeply unhappy about her body. After years of breastfeeding and pregnancies, her self-esteem had plummeted. During a consultation for possible breast augmentation, doctors discovered a lump. It was malignant.
What followed was a whirlwind: surgery, chemotherapy, and radiotherapy. The side effects made it impossible for her to care for the children. Her husband adjusted his work schedule, and her sister moved in to help.
When I first met Sam, she was underweight and fragile, her beautiful blue eyes brimming with held-back tears. She quietly confessed that receiving the cancer diagnosis had come as a relief—finally, she said, she had a reason to rest.
What is TOTAL PAIN?
The concept of “Total Pain” was first developed by Cicely Saunders, a pioneering nurse in modern palliative care in the UK, who introduced the concept of “Total Pain” in the 1960s. This groundbreaking idea transformed the understanding and treatment of pain in patients with terminal illnesses.
Total Pain is understood from four interconnected dimensions of a patient's suffering:
1.Physical Pain – Body pain caused by illness, injury, medication and treatment.
2.Emotional Pain – Psychological distress such as anxiety, depression, fear, or anger.
3.Social Pain – Struggles related to relationships, roles in family or society, financial pressures, or social isolation.
4.Spiritual Pain – Existential distress, such as questioning the meaning of life, suffering, or fear of death.
Total Pain in Yoga Therapy
I was first introduced to the concept of Total Pain over two decades ago during my yoga therapy training. It came from a Clinical Nurse Specialist (CNS) in the UK who integrated yoga principles into her work with terminal patients. Her wisdom not only transformed my approach as a therapist—it also changed my life as a human being. 🌿
It was through this understanding of Total Pain that the idea of Total Care emerged—now one of the most essential tools I use in Yoga Therapy, especially in complex cases like Sam’s.
Although Sam wasn’t a terminal patient—she is now healthy and thriving 10 years later—her condition at the time was incredibly fragile and required a sensitive approach.
We live in a culture that constantly pushes us to “do more” in the name of growth:
Take ice baths to strengthen your immune system. ❄️
Face your deepest fears with exposure therapy. 💥
Risk everything to become a millionaire. 💰
Become an athlete in your 70’s!! 🏋️
But this oversimplified view ignores a vital truth:
Sometimes, just surviving requires all our energy.
In those moments, what we truly need is not more challenge—
We need Total Care..
What does Total Care look like in Yoga Therapy?
Physical Care
Gentle, fully supported postures using cushions (not bricks), with the upper body slightly elevated. Slow, mindful joint movements, and breath awareness with soft abdominal breathing.
Psychological Care
A brief, supportive conversation rooted in trauma-informed language. Active listening, short guided Yoga Nidra or relaxation practices.
Social Care
A warm welcome, genuine smile, shared laughter, comforting tea, and nourishing food. A person-centered, nurturing approach—care that feels like pampering.
Spiritual Care
Respect for the individual's cultural and spiritual background. Thoughtful use of sound, visualisation, and meditative practices, always guided by discernment and sensitivity.
In Sam’s case, I took care to make the space welcoming, quiet, warm and gently lit for her arrival. We started each session in a fully supported sitting form, where I listened to Sam’s needs-which also offered me an assessment of her energy levels-.
I had already prepared the bolsters and props for her to lie down in a Restorative “Business Class” (a real treat), and I invited her to do the following movements very slowly from the feet upwards:
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Wriggling the toes
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Rotating the ankles
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Flexing and pointing the feet
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Lying down cat & cow
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Shoulder rolls
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Wrists rotations
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Opening and closing of the hands
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Releasing the jaw with yawns
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Turning the head left and right
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Eye circles.
Followed by:
-Gentle abdominal breathing
-Foot massage 🦶
-15-20 mins Yoga Nidra
-Slow return and awakening
-Final reflection
-Home made soup with freshly baked bread. 🍲
Your share: situations when we can apply Total Care
It’s easy to understand why someone going through a cancer diagnosis and treatment would need a Total Care approach.
But there are many other moments in life when a person needs to be gently cared for in the same way.
Have you ever found yourself in a state where Total Care felt like the only possible path to healing?
Can you think of a time when one of your students, clients, friends, or family members might have benefited from this kind of care?
I hope that this approach opens a door to new possibilities of working with your students experiencing Total Pain, free of ambitious physical practices, challenging breath work or mental exertion. Because sometimes, life is already challenging enough and all we need is rest, recovery, and Total Care.
