kristy manuel a3l therapeutic yoga for chronic pain · 2/15/18 1 therapeutic yoga for chronic pain...

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Therapeutic Yoga for Chronic PainFILEX 2018, SYDNEY, AUSTRALIA

KRISTY MANUEL, MS, C-IAYT, ERYT-500, YACEP

ACSM CERTIFIED EXERCISE PHYSIOLOGIST,

ACE CERTIFIED PERSONAL TRAINER

DIRECTOR, YOGAFIT FOR HEALTHCARE

Kristy Manuel A3L Therapeutic Yoga for Chronic Pain

What are some things we know (or think we know) about pain?


More Americans suffer from Chronic Pain than diabetes, cancer and heart disease combined

126 million Adults report some type of pain

>40 million adults report severe pain

25.3 million Adults report pain every day

23.4 million adults experience “a lot” of pain


Pain is the most common reason Australians seek medical help and is Australia’s third most costly health condition.

1 in 5 Australians live with chronic pain; increases to 1 in 3 over age 65.

1 in 5 GP consultations involves pain with 5% of those severe pain.

Arthritis and back pain account for 40% of forced retirement from Australia’s work force.

The total cost of pain is estimated at over 34 billion dollars in Australia.


Opioid Epidemic• Initial guidelines funded by Pharma were published encouraging doctors to

expand their use of prescription narcotics to relieve pain.

• Doctors were taught that OxyContin was time-released, and that it would not

cause addiction.

• Purdue Pharma and 3 top executives pleaded guilty of criminally misleading

the FDA, clinicians and patients about the risks of OxyContin


Opioids efficacy for Chronic Pain• “there has been a 423% increase

in expenditures for opioids for back pain but that dramatic increase has

not led to any population-level improvements in clinical outcomes

or disability rates.”

• -Deyo RA, Overtreating chronic back pain: time to back off? J AM

Board Fam Med. 2009


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“Narcotic medications are the most important impediment to recovery from chronic pain”.

AMERICAN COLLEGE OF OCCUPATIONAL MEDICINE GUIDELINES, 2ND EDITION, 2004

Studies show patients who receive narcotics for chronic pain are less likely to recover function, and are less likely to go back to work.


Chronic Pain

“Pain that persists 3 months after and injury and beyond the usual course of an acute disease or a

reasonable amount of time for a comparable injury to heal, that is associated with chronic

process that continuous or intermittent pain for months or years, that may continue in the

presence or absence of demonstrable pathologies; may not be amenable to routine pain control methods; and healing may never

occur.” -ASIPP

“ An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such

damage...pain is always subjective… It is unquestionably a sensation in part or parts of the body, but it is also always unpleasant and

therefore also an emotional experience.”


Chronic Pain is complex

• NOT an indicator of tissue damage

• A LEARNED maladaptive mind-body response that results in changes to the physical body and the nervous system.

• Cartesian model: (old paradigm) 1:1 relationship between tissue damage

and pain


NeuroMatrix Model of Pain• Pain is an output of the brain!

• Influenced by input from cognitive perception, sensory information and emotions.


Responses to Input of CSE

Reflex Action (fastest)

Functional Nociceptive Pain (stops us from doing something to further damage): first step in

normal healing process.

Stress Response:

Hormonal Response: HPA Axis; fight or flight helps us mobilize

our resources to respond.

Motor Reactions: the limbic system connects to the basal

ganglia and cerebellum for the translation into behavioral

response. Our state of mind and emotions influence every nuance

of our motor behavior.


Image source: Wikipedia commons


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Yoga & Chronic Pain Healing Model: The 5 Koshas

• Physical Body• Vital Body• Emotional/Ment

al• Discernment• Bliss Body

Chronic pain has been associated with changes in all the koshas


Chronic pain #1 reason people seek out CAM• Published studies of yoga effectiveness in treating chronic pain are growing in

the last few years.

• 2017 review of yoga and low back pain found improvements after 3-6 months of yoga practice when compared to non-exercisers.

• A study published in Spine, two 90 minute yoga sessions a week for 24 weeks resulted in 56% reduction of pain along with reduced depression and less disability, compared to pain medications.

• A 2014 study showed women who practiced yoga once a week in a class in addition to some home practice reduced knee pain 38% after 8 weeks.


How Yoga Works

• Yoga practice regulates the nervous system and the release of neurotransmitters associated with the autonomic nervous system.

• Increases in GABA, serotonin and dopamine along with increased tone of the Parasympathetic NS and the vagus nerve along with downregulation of the Sympathetic NS.

• Brain activity is also affected showing down regulation of the limbic brain and more blood flow to the frontal lobe along with increased gray matter.


Yoga as an important tool for chronic pain

Individual process!

The breath come first!

Movement is essential!


Individual Process

• No two plans will look the same.

• Must consider attitudes about pain from the client and his/her loved ones and what they have been told by the medical team.

• What have they tried so far including yoga and exercise as well as medications.

• Individual goals and needs (assessment)


Pranayama• Breath awareness: hands on rib cage, belly

chest for increased awareness.

• Breath techniques (some examples)

• Equal ratio breath

• Box breath

• Alternate nostril Breath• Directed Breath

• Ujayi Breath

• Bee’s Breath (Brahmari)


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Movement (not necessarily poses)

• Important to start with pain free movement. Important to feel safe!

• Slowly begin to incorporate movement into pain (remember pain doesn’t mean tissue damage but a sensitization).

• Neuroplasticity: Changes in the brain and nervous system are possible.


Starting point• Constructive rest pose (CRP); a passive

psoas release pose ideal for teaching

breath and beginning the process of

release.

• Always ask what makes it feel better?

(do more of that!)


The YogaFit Essence

Breathing

Feeling

Listening to the body

Letting go of expectations, judgments, competition

Staying in the present moment


Thank you!Let’s practice!

CONTACT: KRISTY MANUEL, MS, C-IAYT, ERYT

[email protected]

WWW.YOGAFIT.COM


kristy manuel a3l therapeutic yoga for chronic pain · 2/15/18 1 therapeutic yoga for chronic pain...

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