A man came to me a few months ago whose physician is a Yoga student of mine. James, the 31-year-old man, came at her suggestion because he was in chronic pain. He was an athlete, and within the past 15 years had suffered an eye injury, Carpal Tunnel Syndrome (CTS), and spinal injuries. He was also in several traffic accidents, the last one in August 1997. As a result of these injuries he underwent two spinal surgeries, the last of which left him in a neck-to-hip body cast for six months afterward.
Dr. Ann Mick, James’ physician (and my Yoga student), reported that James was unable to stay in any position for more than a few minutes without experiencing discomfort. He had limited range of motion in his neck, chronic left shoulder and neck pain, and an extensive myofascial pain syndrome.
Ann is also a certified massage and Trager therapist and she wanted him to receive both traditional and complementary medical care. James received acupuncture, training in Yoga and meditation, physical therapy, and massage therapy in addition to CTS release surgery. After a year, however, he still had chronic pain in his neck, shoulders, and wrists.
James had done some Yoga prior to our meeting. He found that in trying to follow the instructions and stay up with the class, he only irritated his injuries. My goal with him was Yoga education: how to heighten awareness of himself in order to develop internal guidance, inner strength, and softness in his body. Patanjali in his classic scripture the Yoga Sutras (sutra 2.46 sthira-sukham asanam) describes this as a balance of steadiness, or sthira, and comfort, or sukha.
During the first session I was able to help James access sthira and sukha through the release of some of the chronic tension in the foundation of his body. He learned to find, feel, and relax his pelvic floor, buttocks, belly, anal, and genital areas. He next learned to isolate and lift the center of his pelvic floor, the perineum, while relaxing the surrounding muscles. With patient coaching he was even able to continue the lift through the center of his body, connecting the perineal lift to a subtle lift in his abdomen, sternum, and the crown of his head. This “core lift” gave him an internal strength that his body could relax into.
To further enhance the benefits, this practice of core lift was always coordinated with dirgha and ujjayi pranayama-deep, three-part sounding breaths. Finally he practiced how to breathe into the pain, experience it as sensation, and release some of the emotional armoring that added stress to his mind and body. This practice was enhanced by learning to “talk” and “listen” to his body. This helped him discover underlying negative attitudes, which he was able to transform into compassionate intentions for healing.
After the first session he practiced at home. He was able to go deeper into the hurt without clenching, and became familiar enough with his body to find and sustain the core lift without my assistance. James experienced an increase in awareness, confidence, and muscle tone in the core of his body.
Midway through his second session we combined a review of core lift with pelvic mobility. Learning to level his pelvis, at the same time as he brought both muscular and energetic lift through the center of his body gave him the power to find and maintain his own axis of alignment while standing, sitting, and walking.
Finally this was combined with spontaneous, prana-directed movements. This allowed his body, now supported by an inner strength, to intuitively unwind some of its chronic tensions and holding patterns. After a time he was able to move his head from left to right, up and down, and ear to shoulder.
By the end of the session James could sit on a meditation pillow on the floor for a short time without fatigue. After years of limited, painful movement, these dramatic developments lifted his spirits and gave him inspiration to continue practicing.
At the heart of James’ improvements was his willingness to create a new relationship with his painful body. The key I gave him was a method of awareness that allowed his body to be so steady, so comfortable, and so safe that it could release its old, painful holding patterns. By practicing the core lift he learned to hold himself from a stable and mobile center, rather than chronically clench from fear and weakness.
When you are injured the muscles and tissue that protect the moving parts of your body-the joints-try to stabilize you by tightening in spasm. Most treatments focus on releasing the spasm, but if there’s no core strength to rest on, the spasm may return. As James learned to develop core strength, parts of his body that were chronically contracted could finally relax into an internal support. For the first time he was able to breathe into his pain as sensation and release some of the emotional armor he was wearing.
It is clear that Yoga can effectively release chronic pain. But like James one must have a willingness to be in a new relationship with the body and its pain, hold a compassionate and supportive intention, and develop core strength. The following exercise is based on the flow of work that James and I did together.
Preparing the body with conscious breathing
(Note: The following was prepared for Yoga teachers working with students with chronic pain.)
The first step is to establish full, deep breathing. Use ujjayi (the sounding breath) and dirgha (the three-part breath) pranayama in combination.
When you have chronic pain breathing tends to be shallow and you frequently hold your breath. With restricted breathing you’re not exhaling fully and can’t remove from the lungs stale air and the residual buildup of toxins. With chronic pain the muscles are cold and contracted from poor circulation, so even less oxygen comes in and fewer toxins are removed. When you breathe fully and deeply, the lungs work more, the diaphragm moves, the intercostal, back, and abdominal muscles work. This generates heat into the core of the body.
Another positive result of conscious breathing is its calming effect on the emotions, reducing fear and anxiety in the nervous system. You feel safer emotionally as well as more at ease and relaxed physically. Conscious breathing also helps diminish tension before it accumulates around the areas where chronic pain exists.
Establishing a supportive mental attitude
The next step in releasing chronic pain involves changing the person’s attitude toward the part of the body in pain. Invite the person you are working with (the student) to observe not only what the pain feels like, but how they feel about the pain. The intention is for your student to feel the emotions connected with the part of the body that hurts. This important step connects emotional pain with physical pain, and enables your student to recognize the continuity between his or her body, mind, and feelings.
There are many attitudes associated with chronic pain: suffering, anger, despair, depression, loss, and helplessness, to name a few. These attitudes exist when we hate, fear, or deny parts of our body that hurt. Because we cannot remove the hurt, we shield ourselves from it, denying it the very attention and love it needs to heal. This of course adds to the stress because of the negative self-directed energy required to deny parts of ourselves.
The first step in changing the negative attitude is to create a feeling of comfort and safety. Have your student come into a comfortable, relaxed position, lying on the floor in the relaxation pose, or perhaps in a restorative posture. Direct the student to communicate with the pain by placing a hand on the part of the body that hurts. Depending on what is appropriate, either the student can put his or her hands on, or the teacher can, or both.
Putting hands on the painful part of the body is soothing. It opens a relationship to this part and brings a message of affection to it: “I’m willing to make a different choice in my relationship with you.” It starts to send energy, heat, and fluid to this part of the body, creating an overall feeling of well-being and nurturance. It invites the traumatized part of the body to rejoin the rest of the organism and helps move the student from denial to interest.
Then ask the student to breathe into the part of the body being touched, feel what is going on, and ask if it has a voice. If so ask the body to speak. I had asked this of James. He felt anger, despair, and judged what was going on negatively. His whole self was in denial physically, mentally, and emotionally. Negative statements leaked through in his language: “My body betrayed me; I’m angry with it”, “I don’t know why this happened to me ,” and “I feel like a failure because I cant figure it out and fix it.”
At this point in the process, there’s often a release: the student comes out of denial. There is a wide range of emotional releases, from full expression to silence. Now is the time to use affirmations because the student’s habitual critical language keeps the pain intact longer. I asked James to restate how he felt after the release: “I am getting to know this part of my body”, “I feel safer in this part of the body”, “I feel more loving toward this part of the body,”etc., were the responses, indicating a shift in relationship between mind and body.
Increasing Intimacy and Awareness of the Body
Once the student has released some of the emotional armor and moved beyond denial, the next step is to release chronic tension substantially using specific Yoga movements combined with breath.
Our culture tends to strengthen on top of unrecognized vulnerability and helplessness; we go in quickly, name the pain, and get out. But true strength runs deep and can only take root in the center of vulnerability — it is crucial that the student go to the center of what is inside if he or she is truly going to heal. To do this you need to help the student create a balance of steadiness and comfort with core stability and strength.
To build core strength a strong and mobile pelvic floor, a softly engaged abdomen, an open, lifted heart, and an aligned spine are essential. Pelvic floor work provides the foundation anatomically, neurologically, structurally, and energetically.
The pelvic floor relates to the muladhara or root chakra where basic issues of survival and safety reside. If this part of the body is frozen then the foundation of safety is locked and movement is based in fear. When the student begins to stretch open the pelvic floor, energy can move through and up this chakra, and she or he can consciously act on issues of survival and fear, thus building a strong foundation for living.
Stretching open, moving, and strengthening the pelvic floor is followed by a unique movement, which I call the core lift, by which the center of the pelvic floor, the perineum, is subtly lifted up into the core of the body. In various yogic texts this is termed mulabandha. (There are different schools of thought as to what does and does not constitute mulabandha. For the purposes of this study, mulabandha does not include the lifting and contraction of the genitals, vajroli mudra, or the lifting and contracting of the anus, ashvini mudra. It also is not the form of mulabandha that is only practiced in a meditative sitting posture, such as siddhasana, with retention of the breath, kumbhaka, and application of the throat lock, jalandhara bandha. I refer to the variation of mulabandha I use in this approach as core lift to avoid confusion.)
It is important to note that the pelvic floor is not an easy part of the body to access because our culture associates it with pain, shame, inappropriateness, and sin. And for some of us there is trauma in this area from surgery and/or sexual abuse. These issues make it more difficult to bring to this part of the body an unfettered curiosity. Most Yoga teachers are not experienced or trained to relate in depth with this type of trauma, so as a Yoga teacher you have to know your limits and be capable and confident, because once you go there you’d better be prepared to stay with it and bring in a professional or suggest professional therapy if appropriate.
The core lift is accomplished by a subtle lifting or arching of the pelvic floor into the core of the body. This is done by contracting the muscles surrounding the perineum, the area between the genitals and the anus. It’s not difficult to do, yet because the lift is subtle it requires as much attention and focus as any technique in Yoga. The ability to focus, however, is of great benefit because when our mind is strongly focused, we can begin to relax and feel safe.
About the Author
Christopher Ken Baxter is a founding member of Kripalu Center for Yoga and Health and is one of the original developers of Kripalu Yoga. Out of his 30 years of experience with Yoga, he has developed AtmaYoga, a form of Yoga that has its origin in core strength of body and spirit. For more information on AtmaYoga and the many offerings of AtmaYoga Educational Services, visit atmaYoga.com, call 413-528-6408, or E-mail atmaYoga[at]bellsouth.net. Many thanks to Moe Clancy for her help with this article.