I often tell my students that the majority of their new clients will come to Yoga Therapy with a musculoskeletal injury complaint: lower back, shoulder, knee and neck pain being the most common.
I also like to remind them that we, as Yoga Therapists, are not physiotherapists, even if our clients come to us to find solutions for these issues.
We should not try to take on that role or pretend that we can treat specific physical injuries, in the way a physiotherapist would do. On the contrary, the Yoga Therapy approach is totally different – we look at what Dame Cicely Saunders once described as “Total Pain” or what we now refer to as Bio- Psycho- Social- Spiritual-Pain (BPSS).
Cicely Saunders was born in England in 1918 and trained as a nurse, a medical worker and a physician and she was involved in the care of terminal patients. In 1967, she founded the first hospice dedicated to the understanding of pain, compassionate care and clinical research.
She defined the concept of Total Pain as “The suffering that encompasses all of a person’s physical, psychological, social, spiritual and practical struggles”.
When confronted with pain, whatever the origin might be, a Yoga Therapist will look at the individual’s physical symptoms, psychological factors, social environment, belief system and day-to-day limitations.
This process involves a detailed pain assessment in which we find out more about the pain patterns, with questions such as: “When does the pain occur?”, “Is it worse in the morning or at the end of the day?”, “Which activities aggravate it and which ones relieve it” and “What kind of pain is it?”
This assessment includes pain scales (from bearable to unbearable), medication side-effects and any other physical symptoms that might accompany the pain (trembling, nausea or dizziness).
The Yoga Therapist will also enquire about the psychological and emotional effects of pain, exploring what we would describe in the yoga tradition as the Manomaya Kosha (thoughts and emotions) and the Vynanamaya Kosha (the wisdom body).
“How does this pain make you feel?” Angry, frustrated, tired, defeated, sad or anxious? “What do you think about this pain?” or “Where do you think it comes from?”
More than physical pain
It is always surprising how accurately your client will answer these questions, especially about the origin of their pain. Given the right time and safe space, your client will respond from a place of self-understanding and wisdom, such as “Maybe it started when I was pushing myself really hard at work”, or “Maybe it was when I was playing tennis with my son”.
Those ‘maybes’ are really important for our work as Yoga Therapists and we should always listen to these responses, when our client’s tap into their own inner wisdom, with care and attention.
In the same way, it is also essential to understand how their physical injury affects their relationship with their external environment. Human beings, by nature, are meant to connect with others. Feelings of disconnection caused by an injury, can perpetuate pain and delay the recovery process.
At some point in our lives, most of us have experienced pain that has curtailed our work and social activities, perhaps having had to take sick leave or miss a friend’s birthday celebration. Added to the physical pain that we suffer, is the feeling of disconnection from others and of being left out, not to mention the worries about financial issues such as “Will I be able to pay my mortgage or rent?” and “How long can I survive without going to work?”
As the levels of pain grow, it might filter through the layers of your client’s belief system, or as we call it, the “Why me?” effect. This results in questioning one’s faith, the human condition and the universe and often manifests as skepticism, sarcasm or fatalism.
Statements such as “I give up”, “The medical system is a sham”, “What’s the point anyway” or “No-one cares” should give us an insight into our client’s spiritual pain, whether they are religious or not.
Equally important, are the day-to-day limitations – simple things such as being able to do your own grocery shopping, cook your own food, dress yourself and go to the bathroom, without assistance. Not being able to do these things ourselves is possibly the most impactful pain of all, as it takes away our ability to meet our most basic human needs.
The Yoga Therapy Approach
Yoga Therapy’s approach to muscular skeletal pain from an injury follows the same path in our treatment.
We find out all the different aspects that make up the full extent of our client’s pain and start from that point, building up through the layers of the human condition. This involves pain-free physical practices and movements – no matter how small and simple – breathing techniques, relaxation, guided meditation and sharing of experiences through trauma-sensitive conversations.
The good thing is, Yoga Therapy treatments can take place in parallel with conventional medical care and physiotherapy, and can be really effective for the relief of symptoms, changing destructive patterns and introducing new beneficial habits.
It offers tools for better quality sleep – hence facilitating healing – and skills for pain management, in the form of mindfulness and self-regulating breathing practices.
Yoga Therapy gives us an all-round approach to what might seem like a simple musculoskeletal injury, by treating it from a wider, more complex perspective, inclusive of all the different human dimensions.
…..as I like to remind my students, “Attached to a shoulder injury, there is whole human being”.