Reflection: Pain, breath and trust

I’ve just finished reading Hell Bent by Benjamin Lorr.  The subtitle reads ‘obsession, pain and the search for something like transcendence in competitive yoga’.  It’s a compelling read detailing the author’s journey and relationship with ‘hot yoga’ or Bikram yoga.  I found myself both intrigued and challenged.

Bikram yoga follows a set sequence of postures, 26 in this beginning sequence, leading to 91 postures.  Performed in high temperatures.  If you become hooked, you will end up body beautiful with a high level of fitness.  And you might suffer a stroke along the way, faint and work through extreme pain in the body.  There are some amazing success stories that seem impossible but I trust the author who has researched ideas, talked with experts outside of the yoga community and literally bent over backwards to ask questions and find answers for his experience and others’ experience of this approach to yoga.

The reasearch on how we interpret pain got me thinking about my experiences of working with clients in pain.  A clinic in Minnesota conducted a study of sixty patients waiting for back surgery.  They took part in a ten week programme focused on strengthening key muscles that support the spine.  Forty six participants completed the study and only three of those went on to have surgery.

The clinic questioned conventional medical wisdom in four ways:

1. Avoiding surgery: Dr Nelson, the clinic founder and director’ is quoted as saying that 85% of the time the exact cause of pain in the study group could not be determined.  CT scans showed abnormalities in patients but it was discovered that people with no back pain have similar abnormalities on CT scans.  The abnormalities could not be confirmed as the source of pain and questioned surgery as an option.
2. Intensive rehab: exercise programmes were used to overload the muscle until it failed to work.  At failure, nerve/muscle pathways are activated and the muscle adapts.  The muscles are sore but healing is promoted.  Pain did not need to be avoided.
3. Specific attention: weakened muscles were isolated for strength work using exercise machines, whilst ignoring the muscles guarding the area.  Often painful areas become weaker due to underuse and the person finds ways to compensate.  This can lead to further weakness and a complicated tangle of pain and issues.
4. To complete the exercise programme, the patients would experience pain and they needed to accept this was part of the rehab.  Our understanding of pain is incomplete.  The study attempted to educate the patients to understand that ‘Pain actually changes the pain’.  They needed to understand that pain does not mean the same as harm.  Often where the pain is perceived to be, is not where the problem originated.  The pain being felt is in another part of the nervous system.  In addition, surgery on the area of concern will not change the pain because this is not where the pain is being experienced.

The same doctor talks about the positive effects of forward bending and backbending on vertebral discs.  Discs have negligible blood supply which means a limited supply of nutrients to the disc and removal of waste products from the disc via the process of diffusion.  In a compressed disc diffusion is even more limited.  Forward bends and backbends encourage the diffusion of nutrients from the blood into the discs and ‘are probably the only ways we know of to increase diffusion to the disc’.

This particularly resonated with the author, being a member of the Backbending club.  Lorr describes backbending as awesome: ‘training for the mind: both the deep primitive areas governing pain and the more socially important limbic channels responsible for emotions and fear.  I found this interesting too.  I am often told by clients that they are told not to do forward or backward bending.  This advice needs to be individualised, not  everyone needs to avoid this movement neither should that everyone should do it.

Lorr goes on to describe the effects of his extreme backbending practice: hallucinations, waves of tears, anger, and pulsing headaches are just a few of the many releases that occur as you work.’  Also, ‘To really backbend you have to become intimate with pain, not as an informational entity that raises awareness, not as a warning, but as a phenomenon every time it comes up, and ultimately move through it while it screams in your face.’

This is very different to my experience of yoga and I am not tempted to try it.  The idea of understanding and exploring uncomfortable sensations to see if they are harmful or informative has to be a good thing.  This is a regular practice in talking therapies where clients are given a space to process painful experiences to come to a new understanding or level of acceptance.  Often after bodywork, the client feels more uncomfortable but it has a different quality and a positive aspect.  Tension is often released but the communication between the muscles and the brain is more accurate and clear.

In my role as a bodywork practitioner I regularly listen to people’s stories and watch them sit with physical and emotional pain. Different parts of the person ask for attention; those parts may seem unrelated to the original trauma or perceived thread of related issues.  We are often hijacked by the loudest player of the piece but it can be a distraction as described in the study where a part of the nervous system away from the compromised area is in protest.  Often the first step when working with pain is to be in it and to listen.

I listen to the words.  I listen to the body in my hands.  I listen to the space in the room.  What I am told does not always correlate to what I feel and hear in my hands.  Most of all I listen to the breath.  When the breath disappears, we wait.  The moment a deeper breath is taken there is a change.  The breath mediates and in its honesty leads the way to a healing experience.  That healing comes from the person and their relationship to their place in the world; I am a facilitator sometimes a bystander.  It might be a complete release or just the start of a new journey.  It takes time and trust.  But there is change.

When the body is heard it is often ready to receive touch and movement.  And when the body is ready, how the mind experiences the pain changes.  The relationship between the mind and body may be recalibrated and clarified and then we can begin to understand what is harmful and what is healing.  The mind and body is an important relationship and when separated from one another there is miscommunication and confusion, as in any relationship.  Their mediator is the breath.  Bring the breath to the front of bodywork practices and magic really does occur.

© Yvonne Cattermole