October 25, 2023 • 46 mins
Are you ready to unlock the power of evidence-informed Yin Yoga in managing chronic pain? This fascinating episode wraps up our four-part series, illuminating how Yin Yoga can help regulate the nervous system and promote mindfulness. We journey through the meditative stages of a typical Yin class, revealing the transformative impact it can have on those grappling with persistent pain. A captivating discussion awaits you, exploring the role of Yin Yoga in overcoming pain and fostering a positive relationship with the body.
Imagine if there was a way to untangle the knot of chronic pain from our self-identity. A groundbreaking study from 2003 used fMRI imaging to gain insights into this, revealing a compelling method known as a 30-second interoceptive exposure task. The process decouples pain from the self, leading to a remarkable reduction in pain intensity, duration, and associated anxiety. We delve into the fascinating findings of this study, shedding light on how it employs strategies that Yinsters are already using. Though perhaps with this information we can support those with persisting pain even better.
We also dissect the influence of kinesiophobia or the fear of movement in managing chronic musculoskeletal pain. Drawing from a systematic review in 2018, we highlight the correlation between kinesiophobia, escalated pain intensity, and disability. The critical role of yoga teachers in shaping a positive environment and nurturing a supportive relationship with the body is emphatically discussed.
Join our vibrant Facebook community where we continue this enlightening conversation, sharing evidence, asking questions, and growing together. Engage in the exploration of Yin Yoga's benefits, especially for special populations like those dealing with chronic pain. Tune in to this episode – a treasure trove of knowledge for teachers and students alike!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Yin Yoga Podcast.
I'm your host, mandy Ryle.
Today we are wrapping up ourfour-part series Becoming an
Evidence-Informed Yin Teacher orStudent.
I have to tell you that I havebeen excited about this episode
and the papers that I'm going totell you about since I started
(00:22):
putting this series together acouple of months ago, and here's
why the papers that we're goingto talk about have been
extremely important, evenformative, for me in developing
my own personal teaching valuesand my personal teaching
strategy.
As many of you know, I workmostly with people who live with
(00:42):
chronic pain, providingholistic pain care coaching.
To me, these papers will revealto you as a Yin student, as a
Yin teacher, how things that weare already doing in this
practice can be applied to helpto manage chronic pain and even
(01:05):
prevent chronic pain, if you'resuffering from chronic pain.
I think that you're going tofind this information extremely
refreshing.
So, as you know, these last fewweeks, my intent was to help
you to become Evidence-Informed.
I wanted to help you learn howto access evidence, how to read
(01:27):
and process evidence and,finally, how to employ evidence
in your own practice andteaching.
So, to that end, I haveprovided the links to every
single study that we talkedabout in episode three and four.
You can find those links in myfree, private Facebook group,
movement for Healing.
I'm going to put a link to theshow notes there.
(01:48):
I really hope you'll join andat least check out a couple of
these articles and just start towork out your research literacy
muscle that you've been workingthese last few weeks.
The other thing about thatgroup is that I am very
accessible there, so if you haveany questions about anything
that you've heard or any of theresearch, you can just ask me
(02:10):
there.
So thank you so much for yourcontinued support of the Yin
Yoga podcast and forEvidence-Informed Yoga.
Please enjoy this lastinstallment.
Here we are.
It is the final episode in ourseries Becoming an
(02:33):
Evidence-Informed Yin Teacher orStudent.
I have to say that the processof putting these four episodes
together has been prettychallenging.
I sort of feel like I've beenwriting a term paper every week
for the last month or so, butit's also been really edifying.
I have read so many studies,I've gone down so many rabbit
(02:57):
holes and, as a consequence,I've really actually learned
quite a bit.
So thank you for being on boardwith me throughout this journey
and I hope you're finding asmuch value and is learning and
learning as much from it as Ihave been.
So today we're actually goingto be looking at some evidence
that is related to Yin Yogapractices, but the evidence is
(03:19):
not specifically about Yin Yoga.
On a personal note, I will tellyou that the information that I
will share with you today hasbeen absolutely essential in
forming my values as a teacher,in forming my technique and my
strategies in working with myclasses, my students, but also
(03:42):
with my clients in my pain carecoaching practice.
Last week, we discussed tissuescience.
We just had a tiny, tiny,little, bite-size nibble of
tissue science, but we all knowright.
If you're listening to thispodcast, I feel like you're on
(04:02):
board with me.
We all know what makes Yin sucha healing practice.
It has less to do with thephysical and more to do with the
less tangible aspects ofpractice, so that would be
things like mindfulness,non-judgmental awareness,
equanimity and breathingpractices.
For me personally, when I findevidence that is related to our
(04:28):
practice but comes from outsidethe yoga world, I find it even
more valuable.
Since number one, I trust thatthere is less risk of bias,
because often in yoga research,the subjects know that they are
getting a yoga intervention, andso that might skew the results.
(04:48):
The other part of that is, if aresearcher is studying yoga,
the chances are they alreadyhave sort of bought into yoga,
and so their bias might in someways corrupt the results as well
.
The other thing is that when Ifind evidence that is related to
the practice but doesn'tdirectly involve yoga practice,
(05:11):
it gives me some fresh ideasabout how I can apply techniques
in my practice or teachingThings that may not necessarily
be part of the tradition but area beautiful addition, and so
when I read this evidence, itreally opens up my thinking
processes, and it's a greatmental exercise to consider how
(05:34):
evidence might or might not beuseful to our practice or to my
work specifically.
So all yinsters know that yinis a beautiful way to practice
mindfulness.
You might recall that the YogaSutra state that in yogic
(05:55):
meditation one should firstcultivate attention to the inner
landscape through Prachahara,and then select a focal point
for maintaining attentionthrough Dharana, and then
finally become absorbed into theobject of meditation through
Dhyana.
It is said that the object ofmeditation should be close to
(06:19):
one's heart, and what is closerto us, to our own heart, than
our own embodied experience,which is why I think yin is such
a wonderful opportunity topractice mindfulness.
It could be a standalonemindfulness practice or it could
just be an adjunct to a moreformalized seated practice.
(06:40):
So a typical yin classnaturally and unobtrusively
leads the practitioner througheach of these stages of
meditation.
There is a centering practice,which is analogous to Prachahara
, a focus on a body part orsensation, which would be the
(07:01):
Dharana, the choosing of thatfocal point.
And then there is a whole selfattending to the ripening of the
pose or, in some cases, thesomatic drill.
That would be the Dhyana, theabsorption into the experience.
(07:21):
So meditation is really bakedinto the yin practice and I know
that all of you I know formyself.
We have ample anecdotalevidence that we or our students
feel calmer before and afterpractice right.
So we know that there is somenervous system regulation that
happens naturally in practice.
(07:43):
We know that we feel lessreactive to stressors in our
lives over time right with a lotof practice, and that we have
the ability to attend to ourbodies better and to be more
present generally.
Now, not all teachers, not allclasses, not all styles are
really emphasizing these things,but these are absolutely
(08:06):
essential In my personalpractice and in my teaching.
And while these benefits can beattributed to the more esoteric
or spiritual drivers, there arereal physiological changes that
underpin these states.
(08:28):
As a curious yogi, this is thestuff, personally, that I want
to know.
It is, to me, a harmonizing ofthe traditional and the modern
and, in my opinion, it doesn'ttake away from the spiritual
aspect.
Rather, to me, in my thinking,it reinforces it.
But how can we harness thisinnate quality of practice, for
(08:54):
example, to serve specialpopulations, as I do with
chronic pain, or how can wedirect our practice toward
healing ourselves and ourcommunities?
I would argue that evidence isa really good place to start.
We know that these things work,so what I'm suggesting is that
(09:16):
maybe now it's time to try tounderstand why it works, so that
we can do what we do evenbetter.
For my part, I love the scienceof tissues, but I feel very
strongly that the benefits ofyin yoga and movement in general
come from improving our skilland being embodied, and being
(09:42):
embodied and intending to alldomains of self, and not
segregating them into discretecategories that we address
separately, right?
So then, maybe we have onediscipline for our muscles and
we have one discipline for ourconnective tissues, and we have
one for our mental health, andone for our trauma, and one for
(10:02):
our social health, one for ourfinancial health.
Right, like all of thesedomains of self are happening in
each and every whole self, andso what I am suggesting here is
that we can address all of thesetogether rather than
segregating them as we havehistorically done.
(10:25):
So let's discuss some reallyinteresting evidence that can
help us to understand how toimprove our embodied awareness,
and the second study, I think,is going to be particularly
applicable to those of you whoteach yoga.
(10:45):
The first study is valuable topeople who practice and teach.
I also refer to this study alot with my clients who are
healing chronic pain.
So the first paper is titledquote immediate and lasting
chronic pain reduction followinga brief, self-implemented,
(11:11):
mindfulness-based interoceptiveexposure task a pilot study.
That's end quote.
That's just the name of thestudy, in case you want to try
to look it up.
The author, the lead author,his name, is Kiyun and it was
published in 2017.
This is the only paper that I'mtalking about which is not open
(11:33):
access, but I find it sovaluable that I wanted to tell
you about it here.
I do have the complete paperfrom my pain science mentor, so
I have read a few times the fullstudy.
So when I first read this paperin 2021, I was like completely
bowled over, and I have to admitthat it has informed pretty
(11:56):
much every class or client Ihave taught since.
That's how powerful I thinkthis information is.
So even though this was only apilot study that is, a pilot
study is really a study to seeis this even a viable research
topic and then maybe todetermine what information might
(12:17):
be useful in follow-up studies.
This paper is extremely welldone and it piggybacks off of a
lot of other research thatdemonstrates how certain brain
regions are associated with thechronicity of pain.
What they're going to betalking about in particular is
(12:41):
the default mode network, whichI will explain to you.
So here is a quote from arelated paper that was actually
cited in the pilot study thatwe're discussing.
Quote chronic pain patientssuffer from more than just pain.
Depression and anxiety, sleepdisturbances and decision making
(13:03):
abnormalities alsosignificantly diminish their
quality of life.
Recent studies havedemonstrated that chronic pain
harms cortical areas unrelatedto pain.
Here we propose that long-termpain alters the functional
connectivity of cortical regionsknown to be active at rest, ie
(13:28):
the components of the defaultmode network.
End quote.
So lots of other studies haveshown these brain changes.
Many other studies have alsoshown how incredibly beneficial
(13:49):
mindfulness-based stressreduction is for chronic pain,
specifically low back pain.
So this paper is kind of takingall of that information.
But it's especially interestingbecause it did not require the
subjects to learn a lengthymeditation technique like
mindfulness-based stressreduction.
(14:10):
I mean, that's like aneight-week course you have to
take to learn how to do thistechnique.
This study is interestingbecause it simply taught the
subjects in this study to use a30-second interoceptive exposure
task, which was extracted frommindfulness-integrated cognitive
behavioral therapy.
So I'm going to again quotethis study.
(14:32):
This is directly from theabstract Quote.
Recent imaging research showsthat approximately 80% of people
who transit from acute tochronic pain produce
neuroplasticity-linking painpathways to learning areas of
the brain, thus showingphysiological evidence that
(14:55):
chronic pain is largely learned.
Religious meditation programshave been used successfully to
teach people a way of decreasingpain-related distress and
unlearning their unhelpfulrelationship to pain.
However, not all chronic painpatients are amenable to undergo
(15:16):
a full mindfulness program andthen maintain daily practice.
End quote.
So perhaps some of theinformation that I've just
shared with you about this ideaof chronic pain being learned is
new for you.
If this is new information foryou, or if it's just something
(15:39):
that you would like to learnmore about, I would very much
recommend that you enroll in myfree email course Introduction
to Pain Care Yoga.
You'll get a little bit of, alittle bit more in-depth
education about this in thatfree course, and that is always
linked in the show notes.
(16:00):
So that was just a little note,because I think that that's
kind of like a little bomb todrop on you and then not to
offer a continuing resource justdidn't feel right to me.
So definitely access thatcourse if that's something
you're interested in learningmore about.
So, in other words, theperception of pain is highly
influenced by cognitive andaffective factors, which have
(16:23):
been increasingly associatedwith the transition from acute
to chronic pain.
That's a quote from Thorn 2004.
So let's talk about what, then,is happening to the brain in
people who are suffering fromchronic pain or transitioning
(16:43):
from acute to chronic pain.
The changes appear to be in apart of the brain known, as I
said before, as the default modenetwork.
The default mode network isalso referred to as the me
network.
It is the place in your brainwhere you create me and mine.
(17:05):
It's the place in the brainwhich is activated when you're
daydreaming, when you'reremembering autobiographical
information and telling storiesabout yourself and your
experiences, and it's alsoassociated with all of the other
self preoccupations that didn'ttend to take up our attention
when we're not otherwiseoccupied.
(17:27):
So, in other words, it usuallyspins up when you're task-free,
when you're just sitting there,okay and when you're performing
an attention-demanding task,usually the default mode network
activity decreases in favor ofactivation in the brain areas
associated with the task.
So if you go for a run, forexample, the brain areas that
(17:49):
are associated with running andthat whole experience, those are
going to be activated andtypically the default mode
network would take a backseat.
However, in other studies usingfMRI imaging by the way, this
study did not use fMRI imaging,which is fine because they had
(18:10):
plenty of evidence from otherresearch here's a quotation from
a study that did use fMRIimaging specifically on
individuals with low back pain.
This study is grecious at all,from 2003.
Pain patients, despiteperforming the task as well as
controls, displayed reduceddeactivation in several key
(18:34):
regions of the default modenetwork.
In other words,self-referential processing
remains significantly greater inpain patients, and so for
anyone who has had a pain issue,this is a familiar feeling.
I bet Pain is such a powerfulprotective response because it
(18:56):
literally crowds everything elseout.
The pain or the fear of thepain, even when it's not
terrible, right, it's alwaysjust kind of there that's what
my people tell me all the timeLike it doesn't really hurt,
it's just there.
That's kind of the experienceof being in pain, and to some
(19:17):
extent that is attributed tothis autobiographical network
never being able to really shutoff.
In the grecious study, they hadthe subjects in the fMRI machine
perform a visual task.
As they were performing avisual task, the control
subjects, their default modenetwork activity decreased, as
(19:40):
you would expect to see.
And individuals who suffer fromchronic pain in this case it
was low back pain thoseindividuals performed the task
just as well as the controls,but their default mode network
was just going, going, goinggoing, which really explains why
people who have chronic painare often so distractible and,
quite honestly, they getirritable.
(20:01):
You would get irritable too ifsomething was constantly
demanding half of your attention, right?
So this is the experience thatyou're having To some extent, I
hope to validate this for you.
You're not crazy, and to someextent I also want for us to
understand how powerful thesenetworks really are.
So, as I said, in the greciousstudy, it was a visual task, but
(20:25):
let's imagine that they wereable to perform this fMRI.
They were able to do this brainimaging on people who were
moving.
Obviously that would beimpossible, but I would imagine,
based on my experience, thatthe default mode network would
be even more active, since whenyou're moving and you have fear
of hurting yourself, you're justgoing through a litany of
(20:46):
memories, predictions, fears,beliefs, in an attempt to
protect yourself from potentialharm.
And what we see in thisresearch is that that behavior
is no longer adaptive.
It no longer serves afunctional or physiological
process to have this constantspinning of autobiographical
(21:10):
information.
This incessant activation of themean network is part of the
learned experience of pain andit is unrelated to your tissues.
It has nothing to do withwhat's going on in the body at
all.
It is a learned response in thebrain due to neuroplasticity.
(21:32):
So you might be wondering howcan we unlearn?
So this study, the Kayun et al,designed a 32nd interoceptive
exposure task and assigned it to15 subjects.
Their prediction was that theinteroceptive awareness would
(21:52):
activate a quote functionaldecoupling of the cognitive,
evaluative and sensorydiscriminative dimensions of
pain end quote which can help usto not react to pain, which can
then help us to reduce centralsensitization.
So this paper has lots of greatneuroscience.
(22:13):
There's more to it than whatI'm revealing here, but I don't
really want to spend our wholeepisode on it, so I will stop
there.
But let's just say that theidea here was can we help people
to decouple their experience ofpain from themselves through
(22:37):
this 32nd interoceptive exposuretask?
So what was the task?
The subjects were asked to focustheir attention on the most
intense body sensation, as oftenas it intruded into their
awareness, for 30 seconds only,and they were specifically asked
to evaluate four physicalcharacteristics of the pain or
(22:59):
discomfort.
Those characteristics were mass, so how big was it basically?
The motion Was it moving around?
Was it still?
The temperature Was it hot,cold, warm, freezing, scalding?
And the cohesiveness Did itstay together?
Was it solid or was it moreephemeral, like a cloud?
(23:21):
And they were asked to assesseach of these characteristics
while remaining objective or notgetting caught up in the story
of reacting to it.
So, in other words, they weretraining their default mode
network to stand down while theyattended to their pain.
They used this practice in dailylife for 10 weeks.
(23:42):
So of the 15 subjects, two ofthem had to drop out of the
study, but the remainingsubjects experienced a reduction
in pain, anxiety, pain durationand pain intensity.
The participants alsonormalized anxiety, depression
(24:04):
and stress severity.
And here's what's really reallycool the results were even
maintained or, in some cases,improved upon at a two-month
follow-up.
So after the 10 weeks theywaited two months and then they
checked in on the subjects againand the results that the
(24:25):
subjects had experienced weremaintained or, in some cases,
improved upon, which means thatmany of the subjects continued
practicing the 30-second taskeven after the study, which
tells you just how simple andeasy it is.
So my clients often come to mewith a lot of distress about
(24:50):
their pain, and some people aresuffering 24-7.
Some people don't suffer everysingle day, but it's still a
chronic pain issue and theystill have a lot of fear and the
default mode is still extremelyactive, right.
So it's a very, verydistracting and disruptive force
in their lives.
I can tell you for sure thatthey would take gladly a 10 or
(25:13):
20% reduction in anxietyduration, intensity of pain.
Well, guess what?
The subjects in this study hadreally, really amazing results,
in many cases, way more than 30%, 50% or even 70%.
Some of the subjects evenreported that they didn't use
the interoceptive task very muchbecause, after using it for a
(25:37):
short time, the pain wasn'tintruding into their awareness
very often.
Okay, so you're thinking, well,I have, like this pain issue.
My student has thismusculoskeletal issue.
They have arthritis in theirknee.
How will this help them, right?
So what I am suggesting is thatsomething that is very much in
(26:00):
the wheelhouse of a Yin teacherand certainly within the
wheelhouse of a Yin student, isto learn to pay attention to our
discomfort and pain withequanimity, to be objective.
And the reason I love this taskis that it gives you a
checklist okay, mass,temperature, cohesiveness,
movement done.
(26:21):
Okay, it helps you to remainobjective.
Yin is absolutely the perfectcanvas for interoceptive
awareness.
You may have noticed inyourself or in your students
that at first, when you firststart practicing, it can be very
, very, very difficult to payattention to the body without
(26:43):
spinning up a story or becomingdistracted.
But, by the way, both of thosethings do to the default mode
network, right.
But over time, the attentionmuscle can be strengthened.
We have seen this in researchand, with an educated teacher
who is emphasizing this capacityof Yin, a student can learn to
(27:07):
disengage from the story andobserve something that is more
accurate.
Speaking of observing thingsmore accurately, let's move on
to our next topic, our nextstudy, which is related to fear,
or specifically fear ofmovement.
(27:28):
This is known as kinesiophobia.
I'm going to quote thedefinition of kinesiophobia
directly from the study thatwe're going to look at.
Kinesiophobia, also known asfear of movement, is defined as
an excessive, irrational anddebilitating fear to carry out
(27:50):
physical movement due to afeeling of vulnerability to a
painful injury or re-injury.
This also comes directly fromthe study I'm quoting.
The prevalence of kinesiophobiaand persistent pain ranges from
50 to 70%.
It can be acquired through twoforms.
(28:11):
One would be a direct aversiveexperience, so that would be a
pain or a trauma, and the otherwould be social learning.
So kinesiophobia can also beacquired through observation and
instruction.
If you instruct bodies inmotion moving bodies please perk
(28:35):
your ears up.
I'm still quoting here.
Kinesiophobia may be associatedwith pain and associated
outcomes, disability and qualityof life, in several ways.
First, kinesiophobia alters howpeople move, possibly with the
initial goal to avoid pain.
It causes adjustments of motorbehavior, which affects the
(28:56):
performance of actions relatedto the management and control of
pain and pain relateddisability.
And here's the final thing fromthis quote that I really would
like for you to pay attention toA greater degree of
kinesiophobia predicts greaterlevels of pain.
(29:18):
End quote.
So this may fly in the face ofeverything that you know about
pain, especially as a Yinteacher, right?
So we are told often, and webelieve strongly, that if you
hurt yourself, that you shouldrest, you should not move that
body apart, you shouldn't dothings that would aggravate the
(29:39):
injury and you should doeverything in your power to
avoid the movement that causedthe injury in the first place,
because you're very, veryfearful that it will happen
again.
And what I'm telling you is theresearch shows that that
actually will potentiallyincrease your pain, increase
(30:03):
disability, decrease quality oflife.
The evidence is pretty clear.
So all of this information thatI just shared with you comes
from a study called role ofkinesiophobia on pain,
disability and quality of lifein people suffering from chronic
musculoskeletal pain asystematic review by Suarez at
(30:26):
all in 2018.
So let's talk about the paper.
This random excuse mesystematic review included 63
articles.
So that was the.
They went through a ton ofdifferent papers and they
eliminated all.
Eliminated all the ones thatweren't going to fit perfectly
(30:46):
into their study design, andthey ended up with 63 papers.
And here were the findings.
They say we found strongevidence for an association
between a greater degree ofkinesiophobia and greater levels
of pain intensity anddisability, and moderate
evidence between a greaterdegree of kinesiophobia and
(31:07):
higher levels of pain severityand low quality of life.
A greater degree ofkinesiophobia predicts the
progression of disability overtime.
That's with moderate evidence.
And a greater degree ofkinesiophobia also predicts
greater levels of pain severityand low levels of quality of
(31:27):
life at six months.
That's with limited evidence,however.
So maybe it's hard tounderstand this moderate
evidence, this high evidence,this low evidence.
Basically, what that means isthat the effect size was low,
moderate or high.
So let's talk about this ideaof kinesiophobia and the really
(31:52):
horrible outcomes that happen asa result of fear of movement.
It is absolutely normal to wantto protect yourself when you're
injured.
Okay, pain is an extremelycompelling experience, which
absolutely forces us to protectourselves, but let's talk about
(32:12):
chronic pain as opposed to acutepain, right?
So when you injure yourself,you twist your ankle.
That's acute pain, right, weshould protect ourselves.
But chronic pain is defined aspain that persists past normal
tissue healing time, which isgenerally considered to be about
(32:34):
three months.
The pain issue is no longerbecause of the tissues and more
because of a learned response topain.
So fear, which is a reaction tothreat, is now maladaptive.
It no longer serves a purpose.
Right, this fear isn't helpingyou anymore.
(32:56):
It's not helping you to protectyourself.
Your tissues are healed.
The problem with fear is thatit activates this sympathetic
nervous system and defensivebehaviors which can increase
pain, even in the absence oftissue damage.
So why do I think this study isreally important for yin
teachers?
Why did I choose, of the twostudies I wanted to talk about,
(33:19):
to talk to you about this one?
How often, as yin teachers oryoga teachers in general, do we
refer to a pose, position ortransition, or even a body part,
as safe?
How often do we do that?
What kind of message do we sendabout that pose or transition
(33:46):
or that body part?
When we say that, are weindicating that some are not
safe, ie dangerous?
How often in our teaching do wecaution students in subtle or
very explicit ways to protectthemselves.
Let me give you an example.
(34:07):
Years ago, we auditioned aninstructor for a potential spot
on the class schedule at mystudio, sound Method Yoga in
Omaha.
The teacher had been teachingfor quite some time and she had
us on our backs and she had astar knees into our chest in a
(34:27):
pose that we often callapanasana.
Sometimes we call it windreleasing pose.
Essentially, your knees arehugged into your chest right,
you're laying on your back, andshe cautioned us strongly from
holding our knees or pressing onthem directly in the pose, as
it could cause knee injury.
(34:49):
That's what she told us.
What really alarms me about thisis that she's really, really
giving the wrong idea about thebody, indicating that it could
potentially be so incrediblydelicate that just your hands
resting on your knees could harmthem.
Now I'm saying that Iunderstand that a lot of older
(35:11):
people do have knee pain, butthere is absolutely no possible
possible way that you couldinjure your knees by touching
them in apanasana.
So what does this potentiallydo?
It encourages fear of movement,fear of a body part, fear of a
(35:32):
pose.
How else do we potentiallycause some fear of movement in
our students?
It could be as simple astelling a student that if it
hurts, just come out of the pose.
If it hurts, don't do it.
Right, and this seems likegreat advice.
(35:52):
Right, you don't want people toquote injure themselves, but it
can be incredibly harmfulbecause it equates pain with
injury.
And you, my evidence-basedlovelies, know that pain and
injury or tissue damage are verypoorly correlated.
And since we understand thatsocialization is a major cause
(36:16):
of kinesiophobia, what I amtelling you is that you, as a
yoga teacher, have the capacityto do a great deal of good.
You can be a force for good inthis world.
You can reinforce that bodiesare strong and stable and
adaptable, or you can do a lotof harm.
(36:37):
You can encourage people tobelieve that their bodies are
delicate, that their bodies arebreaking down, that injury is
inevitable, that aging is aone-way ticket to decline, and
then we just have to bubble wrapourselves against potential
(36:57):
injury.
This is the difference betweenbeing evidence-informed or not.
In my opinion, this is the mostcompelling reason.
So let's look at the evidence.
If you're still on the fenceabout this, right.
If you're like, well, somestuff is just dangerous, okay.
So let's go back to what youlearned last week about how
(37:20):
tissues become stronger andbigger.
In some cases, performanceimproves as a result of the very
most extreme stretchingprotocols that we talked about
in that first study.
It is highly unlikely that themild stretches that we teach our
students or that we practicefor three to five minutes could
(37:42):
cause trauma to tissues, so theconcerns of damaging tissues are
probably unfounded.
The fact is, your body isreally freaking strong.
If your body could get injuredby holding your knees or by
holding an uncomfortable posefor three minutes, it would be
kind of a shitty body.
It doesn't make sense that thebody could be harmed with such
(38:05):
low forces.
So does that mean that I'mencouraging you to ignore pain?
No, I'm definitely notencouraging that.
However, in our own practice oras teachers, I'm encouraging
you to invite an exploration ofpain, as in the first study that
(38:28):
we discussed, right?
So rather than immediatelycoming out of that thing that
hurts, perhaps we could try toin a slightly different way and
just examine not just thesensation but also our response
to it, not just physiologically,but mentally and emotionally as
well.
(38:50):
For my part, if my studentexperience is pain in a group
class setting, one of thereasons I love Yin is because I
can go over there and we canjust have a conversation.
There have been many times onthe podcast where I was teaching
a live class and you heard mehave a conversation with my
students.
Right, by finding a slightlydifferent way to still do the
(39:12):
pose, we are opening the door tocurious awareness, to
interoception, a more accuratesensing of what's actually
happening in the body.
The other thing about finding aslightly different way to do
(39:32):
the pose is that it will buildconfidence in the student that
this movement is in fact, safe.
For me, it encourages autonomyin the student and it reduces
fear.
But if we just go oh my gosh,don't do that pose, it hurts,
come out.
Right, that is going toincrease fear.
(39:53):
Right, and understanding howpowerful fear is to the
chronicity of pain or thetransition from acute to chronic
pain, that is something thatshould absolutely be on our
radar as teachers or students ofYin.
This is the number one reasonthat I am so passionate about
(40:19):
helping movement professionalsbecome research literate.
So I want you to know that, asI was preparing these
discussions for these last fourepisodes, I read and discarded
dozens of other studies.
I wanted to expose to you howimportant it is to be evidence,
informed, by dispelling myths,but by also encouraging you to
(40:42):
think bigger about our practiceand its value, way beyond
flexibility, way beyond range ofmotion.
Yoga, and Yin Yoga especially,are so much more than just
stretching.
Yin Yoga, with its emphasis onpresent moment, non-judgmental
awareness, slow breathing andgentle movement, can potentially
(41:05):
reduce systemic inflammation.
So last week we talked about astudy that showed how stretching
might help to modulateinflammation.
We also see studies aboutmeditation and how they could
reduce systemic inflammation.
There is some preliminaryevidence as well that Yin can
(41:27):
improve health span and immunitythrough mindfulness practice.
So one of those studies that Iconsidered very strongly for
this episode demonstrated anincrease in telomerase activity
after mindfulness meditation.
So what is telomerase activity?
So your immune cell telomeresprotect and stabilize the ends
(41:49):
of eukaryotic chromosomes.
Shortened telomeres are amarker of immune cell aging and
vulnerability to apoptosis,which is essentially cell death,
and are associated with poorerclinical outcomes and premature
death in various age-relateddiseases.
So we want to preserve ourtelomeres.
(42:09):
Telomerase protects telomeres.
So the evidence is stillpreliminary, but promising right
that potentially, mindfulnesspractice could help us to age
better, to maintain our strongimmune system.
(42:37):
It can play a role in calmingchronic pain.
Yin can reduce anxiety andstress.
And, yes, yin can improve rangeof motion, although, for me,
what the major benefit I see ofthe postures themselves is
improved proprioception, which Ithink then contributes to range
(42:59):
of motion.
So it is very clear, guys, thatlifestyle has a huge impact on
human health.
Yin yoga and yoga in generalare already well-accepted
strategies for improving health.
I believe that, with enhancedresearch literacy, yoga teachers
and students can make a hugeimpact.
(43:22):
Right, each and every Yinteacher out there is seeing
dozens of students a week.
What if we could help people toreduce their fear of movement?
What if we could help people touse their mindfulness skill
toward greater interoception,perhaps even preventing chronic
(43:44):
pain, preventing age-relateddiseases and improving health
span?
What I'm saying, guys, is thatour power in this practice and
in this profession is immense ifwe use it.
So, if you have enjoyed theseepisodes, I would say that you
(44:04):
are a perfect candidate for myYin teacher training.
The first module is primarilythe science of Yin.
So, even if you have noaspirations to teach Yin yoga, I
think that you would really,really enjoy this self-paced
online training.
I invite you to learn more onmy website if you're interested,
(44:24):
and I will include a link inthe show notes.
If you would be interested inaccessing links to all of the
research which I have discussedin this episode, please join my
free, private Facebook group.
It's called Movement forHealing and that is where I will
be posting all of the links andthe research cited in this
(44:48):
episode and also in the previousepisode.
It's also where you could bringup some questions that you
might have, or if you have someother evidence that you would
like to share with the group, Iwould love to see it and we can
have a discussion about it there.
Thank you so so much for yourinterest in evidence-informed
(45:09):
practice.
Welcome to the Yin Yoga Podcast.
I'm your host, mandy Ryle.
Today we are wrapping up ourfour-part series Becoming an
Evidence-Informed Yin Teacher orStudent.
I have to tell you that I havebeen excited about this episode
and the papers that I'm going totell you about since I started
(00:22):
putting this series together acouple of months ago, and here's
why the papers that we're goingto talk about have been
extremely important, evenformative, for me in developing
my own personal teaching valuesand my personal teaching
strategy.
As many of you know, I workmostly with people who live with
(00:42):
chronic pain, providingholistic pain care coaching.
To me, these papers will revealto you as a Yin student, as a
Yin teacher, how things that weare already doing in this
practice can be applied to helpto manage chronic pain and even
(01:05):
prevent chronic pain, if you'resuffering from chronic pain.
I think that you're going tofind this information extremely
refreshing.
So, as you know, these last fewweeks, my intent was to help
you to become Evidence-Informed.
I wanted to help you learn howto access evidence, how to read
(01:27):
and process evidence and,finally, how to employ evidence
in your own practice andteaching.
So, to that end, I haveprovided the links to every
single study that we talkedabout in episode three and four.
You can find those links in myfree, private Facebook group,
movement for Healing.
I'm going to put a link to theshow notes there.
(01:48):
I really hope you'll join andat least check out a couple of
these articles and just start towork out your research literacy
muscle that you've been workingthese last few weeks.
The other thing about thatgroup is that I am very
accessible there, so if you haveany questions about anything
that you've heard or any of theresearch, you can just ask me
(02:10):
there.
So thank you so much for yourcontinued support of the Yin
Yoga podcast and forEvidence-Informed Yoga.
Please enjoy this lastinstallment.
Here we are.
It is the final episode in ourseries Becoming an
(02:33):
Evidence-Informed Yin Teacher orStudent.
I have to say that the processof putting these four episodes
together has been prettychallenging.
I sort of feel like I've beenwriting a term paper every week
for the last month or so, butit's also been really edifying.
I have read so many studies,I've gone down so many rabbit
(02:57):
holes and, as a consequence,I've really actually learned
quite a bit.
So thank you for being on boardwith me throughout this journey
and I hope you're finding asmuch value and is learning and
learning as much from it as Ihave been.
So today we're actually goingto be looking at some evidence
that is related to Yin Yogapractices, but the evidence is
(03:19):
not specifically about Yin Yoga.
On a personal note, I will tellyou that the information that I
will share with you today hasbeen absolutely essential in
forming my values as a teacher,in forming my technique and my
strategies in working with myclasses, my students, but also
(03:42):
with my clients in my pain carecoaching practice.
Last week, we discussed tissuescience.
We just had a tiny, tiny,little, bite-size nibble of
tissue science, but we all knowright.
If you're listening to thispodcast, I feel like you're on
(04:02):
board with me.
We all know what makes Yin sucha healing practice.
It has less to do with thephysical and more to do with the
less tangible aspects ofpractice, so that would be
things like mindfulness,non-judgmental awareness,
equanimity and breathingpractices.
For me personally, when I findevidence that is related to our
(04:28):
practice but comes from outsidethe yoga world, I find it even
more valuable.
Since number one, I trust thatthere is less risk of bias,
because often in yoga research,the subjects know that they are
getting a yoga intervention, andso that might skew the results.
(04:48):
The other part of that is, if aresearcher is studying yoga,
the chances are they alreadyhave sort of bought into yoga,
and so their bias might in someways corrupt the results as well
.
The other thing is that when Ifind evidence that is related to
the practice but doesn'tdirectly involve yoga practice,
(05:11):
it gives me some fresh ideasabout how I can apply techniques
in my practice or teachingThings that may not necessarily
be part of the tradition but area beautiful addition, and so
when I read this evidence, itreally opens up my thinking
processes, and it's a greatmental exercise to consider how
(05:34):
evidence might or might not beuseful to our practice or to my
work specifically.
So all yinsters know that yinis a beautiful way to practice
mindfulness.
You might recall that the YogaSutra state that in yogic
(05:55):
meditation one should firstcultivate attention to the inner
landscape through Prachahara,and then select a focal point
for maintaining attentionthrough Dharana, and then
finally become absorbed into theobject of meditation through
Dhyana.
It is said that the object ofmeditation should be close to
(06:19):
one's heart, and what is closerto us, to our own heart, than
our own embodied experience,which is why I think yin is such
a wonderful opportunity topractice mindfulness.
It could be a standalonemindfulness practice or it could
just be an adjunct to a moreformalized seated practice.
(06:40):
So a typical yin classnaturally and unobtrusively
leads the practitioner througheach of these stages of
meditation.
There is a centering practice,which is analogous to Prachahara
, a focus on a body part orsensation, which would be the
(07:01):
Dharana, the choosing of thatfocal point.
And then there is a whole selfattending to the ripening of the
pose or, in some cases, thesomatic drill.
That would be the Dhyana, theabsorption into the experience.
(07:21):
So meditation is really bakedinto the yin practice and I know
that all of you I know formyself.
We have ample anecdotalevidence that we or our students
feel calmer before and afterpractice right.
So we know that there is somenervous system regulation that
happens naturally in practice.
(07:43):
We know that we feel lessreactive to stressors in our
lives over time right with a lotof practice, and that we have
the ability to attend to ourbodies better and to be more
present generally.
Now, not all teachers, not allclasses, not all styles are
really emphasizing these things,but these are absolutely
(08:06):
essential In my personalpractice and in my teaching.
And while these benefits can beattributed to the more esoteric
or spiritual drivers, there arereal physiological changes that
underpin these states.
(08:28):
As a curious yogi, this is thestuff, personally, that I want
to know.
It is, to me, a harmonizing ofthe traditional and the modern
and, in my opinion, it doesn'ttake away from the spiritual
aspect.
Rather, to me, in my thinking,it reinforces it.
But how can we harness thisinnate quality of practice, for
(08:54):
example, to serve specialpopulations, as I do with
chronic pain, or how can wedirect our practice toward
healing ourselves and ourcommunities?
I would argue that evidence isa really good place to start.
We know that these things work,so what I'm suggesting is that
(09:16):
maybe now it's time to try tounderstand why it works, so that
we can do what we do evenbetter.
For my part, I love the scienceof tissues, but I feel very
strongly that the benefits ofyin yoga and movement in general
come from improving our skilland being embodied, and being
(09:42):
embodied and intending to alldomains of self, and not
segregating them into discretecategories that we address
separately, right?
So then, maybe we have onediscipline for our muscles and
we have one discipline for ourconnective tissues, and we have
one for our mental health, andone for our trauma, and one for
(10:02):
our social health, one for ourfinancial health.
Right, like all of thesedomains of self are happening in
each and every whole self, andso what I am suggesting here is
that we can address all of thesetogether rather than
segregating them as we havehistorically done.
(10:25):
So let's discuss some reallyinteresting evidence that can
help us to understand how toimprove our embodied awareness,
and the second study, I think,is going to be particularly
applicable to those of you whoteach yoga.
(10:45):
The first study is valuable topeople who practice and teach.
I also refer to this study alot with my clients who are
healing chronic pain.
So the first paper is titledquote immediate and lasting
chronic pain reduction followinga brief, self-implemented,
(11:11):
mindfulness-based interoceptiveexposure task a pilot study.
That's end quote.
That's just the name of thestudy, in case you want to try
to look it up.
The author, the lead author,his name, is Kiyun and it was
published in 2017.
This is the only paper that I'mtalking about which is not open
(11:33):
access, but I find it sovaluable that I wanted to tell
you about it here.
I do have the complete paperfrom my pain science mentor, so
I have read a few times the fullstudy.
So when I first read this paperin 2021, I was like completely
bowled over, and I have to admitthat it has informed pretty
(11:56):
much every class or client Ihave taught since.
That's how powerful I thinkthis information is.
So even though this was only apilot study that is, a pilot
study is really a study to seeis this even a viable research
topic and then maybe todetermine what information might
(12:17):
be useful in follow-up studies.
This paper is extremely welldone and it piggybacks off of a
lot of other research thatdemonstrates how certain brain
regions are associated with thechronicity of pain.
What they're going to betalking about in particular is
(12:41):
the default mode network, whichI will explain to you.
So here is a quote from arelated paper that was actually
cited in the pilot study thatwe're discussing.
Quote chronic pain patientssuffer from more than just pain.
Depression and anxiety, sleepdisturbances and decision making
(13:03):
abnormalities alsosignificantly diminish their
quality of life.
Recent studies havedemonstrated that chronic pain
harms cortical areas unrelatedto pain.
Here we propose that long-termpain alters the functional
connectivity of cortical regionsknown to be active at rest, ie
(13:28):
the components of the defaultmode network.
End quote.
So lots of other studies haveshown these brain changes.
Many other studies have alsoshown how incredibly beneficial
(13:49):
mindfulness-based stressreduction is for chronic pain,
specifically low back pain.
So this paper is kind of takingall of that information.
But it's especially interestingbecause it did not require the
subjects to learn a lengthymeditation technique like
mindfulness-based stressreduction.
(14:10):
I mean, that's like aneight-week course you have to
take to learn how to do thistechnique.
This study is interestingbecause it simply taught the
subjects in this study to use a30-second interoceptive exposure
task, which was extracted frommindfulness-integrated cognitive
behavioral therapy.
So I'm going to again quotethis study.
(14:32):
This is directly from theabstract Quote.
Recent imaging research showsthat approximately 80% of people
who transit from acute tochronic pain produce
neuroplasticity-linking painpathways to learning areas of
the brain, thus showingphysiological evidence that
(14:55):
chronic pain is largely learned.
Religious meditation programshave been used successfully to
teach people a way of decreasingpain-related distress and
unlearning their unhelpfulrelationship to pain.
However, not all chronic painpatients are amenable to undergo
(15:16):
a full mindfulness program andthen maintain daily practice.
End quote.
So perhaps some of theinformation that I've just
shared with you about this ideaof chronic pain being learned is
new for you.
If this is new information foryou, or if it's just something
(15:39):
that you would like to learnmore about, I would very much
recommend that you enroll in myfree email course Introduction
to Pain Care Yoga.
You'll get a little bit of, alittle bit more in-depth
education about this in thatfree course, and that is always
linked in the show notes.
(16:00):
So that was just a little note,because I think that that's
kind of like a little bomb todrop on you and then not to
offer a continuing resource justdidn't feel right to me.
So definitely access thatcourse if that's something
you're interested in learningmore about.
So, in other words, theperception of pain is highly
influenced by cognitive andaffective factors, which have
(16:23):
been increasingly associatedwith the transition from acute
to chronic pain.
That's a quote from Thorn 2004.
So let's talk about what, then,is happening to the brain in
people who are suffering fromchronic pain or transitioning
(16:43):
from acute to chronic pain.
The changes appear to be in apart of the brain known, as I
said before, as the default modenetwork.
The default mode network isalso referred to as the me
network.
It is the place in your brainwhere you create me and mine.
(17:05):
It's the place in the brainwhich is activated when you're
daydreaming, when you'reremembering autobiographical
information and telling storiesabout yourself and your
experiences, and it's alsoassociated with all of the other
self preoccupations that didn'ttend to take up our attention
when we're not otherwiseoccupied.
(17:27):
So, in other words, it usuallyspins up when you're task-free,
when you're just sitting there,okay and when you're performing
an attention-demanding task,usually the default mode network
activity decreases in favor ofactivation in the brain areas
associated with the task.
So if you go for a run, forexample, the brain areas that
(17:49):
are associated with running andthat whole experience, those are
going to be activated andtypically the default mode
network would take a backseat.
However, in other studies usingfMRI imaging by the way, this
study did not use fMRI imaging,which is fine because they had
(18:10):
plenty of evidence from otherresearch here's a quotation from
a study that did use fMRIimaging specifically on
individuals with low back pain.
This study is grecious at all,from 2003.
Pain patients, despiteperforming the task as well as
controls, displayed reduceddeactivation in several key
(18:34):
regions of the default modenetwork.
In other words,self-referential processing
remains significantly greater inpain patients, and so for
anyone who has had a pain issue,this is a familiar feeling.
I bet Pain is such a powerfulprotective response because it
(18:56):
literally crowds everything elseout.
The pain or the fear of thepain, even when it's not
terrible, right, it's alwaysjust kind of there that's what
my people tell me all the timeLike it doesn't really hurt,
it's just there.
That's kind of the experienceof being in pain, and to some
(19:17):
extent that is attributed tothis autobiographical network
never being able to really shutoff.
In the grecious study, they hadthe subjects in the fMRI machine
perform a visual task.
As they were performing avisual task, the control
subjects, their default modenetwork activity decreased, as
(19:40):
you would expect to see.
And individuals who suffer fromchronic pain in this case it
was low back pain thoseindividuals performed the task
just as well as the controls,but their default mode network
was just going, going, goinggoing, which really explains why
people who have chronic painare often so distractible and,
quite honestly, they getirritable.
(20:01):
You would get irritable too ifsomething was constantly
demanding half of your attention, right?
So this is the experience thatyou're having To some extent, I
hope to validate this for you.
You're not crazy, and to someextent I also want for us to
understand how powerful thesenetworks really are.
So, as I said, in the greciousstudy, it was a visual task, but
(20:25):
let's imagine that they wereable to perform this fMRI.
They were able to do this brainimaging on people who were
moving.
Obviously that would beimpossible, but I would imagine,
based on my experience, thatthe default mode network would
be even more active, since whenyou're moving and you have fear
of hurting yourself, you're justgoing through a litany of
(20:46):
memories, predictions, fears,beliefs, in an attempt to
protect yourself from potentialharm.
And what we see in thisresearch is that that behavior
is no longer adaptive.
It no longer serves afunctional or physiological
process to have this constantspinning of autobiographical
(21:10):
information.
This incessant activation of themean network is part of the
learned experience of pain andit is unrelated to your tissues.
It has nothing to do withwhat's going on in the body at
all.
It is a learned response in thebrain due to neuroplasticity.
(21:32):
So you might be wondering howcan we unlearn?
So this study, the Kayun et al,designed a 32nd interoceptive
exposure task and assigned it to15 subjects.
Their prediction was that theinteroceptive awareness would
(21:52):
activate a quote functionaldecoupling of the cognitive,
evaluative and sensorydiscriminative dimensions of
pain end quote which can help usto not react to pain, which can
then help us to reduce centralsensitization.
So this paper has lots of greatneuroscience.
(22:13):
There's more to it than whatI'm revealing here, but I don't
really want to spend our wholeepisode on it, so I will stop
there.
But let's just say that theidea here was can we help people
to decouple their experience ofpain from themselves through
(22:37):
this 32nd interoceptive exposuretask?
So what was the task?
The subjects were asked to focustheir attention on the most
intense body sensation, as oftenas it intruded into their
awareness, for 30 seconds only,and they were specifically asked
to evaluate four physicalcharacteristics of the pain or
(22:59):
discomfort.
Those characteristics were mass, so how big was it basically?
The motion Was it moving around?
Was it still?
The temperature Was it hot,cold, warm, freezing, scalding?
And the cohesiveness Did itstay together?
Was it solid or was it moreephemeral, like a cloud?
(23:21):
And they were asked to assesseach of these characteristics
while remaining objective or notgetting caught up in the story
of reacting to it.
So, in other words, they weretraining their default mode
network to stand down while theyattended to their pain.
They used this practice in dailylife for 10 weeks.
(23:42):
So of the 15 subjects, two ofthem had to drop out of the
study, but the remainingsubjects experienced a reduction
in pain, anxiety, pain durationand pain intensity.
The participants alsonormalized anxiety, depression
(24:04):
and stress severity.
And here's what's really reallycool the results were even
maintained or, in some cases,improved upon at a two-month
follow-up.
So after the 10 weeks theywaited two months and then they
checked in on the subjects againand the results that the
(24:25):
subjects had experienced weremaintained or, in some cases,
improved upon, which means thatmany of the subjects continued
practicing the 30-second taskeven after the study, which
tells you just how simple andeasy it is.
So my clients often come to mewith a lot of distress about
(24:50):
their pain, and some people aresuffering 24-7.
Some people don't suffer everysingle day, but it's still a
chronic pain issue and theystill have a lot of fear and the
default mode is still extremelyactive, right.
So it's a very, verydistracting and disruptive force
in their lives.
I can tell you for sure thatthey would take gladly a 10 or
(25:13):
20% reduction in anxietyduration, intensity of pain.
Well, guess what?
The subjects in this study hadreally, really amazing results,
in many cases, way more than 30%, 50% or even 70%.
Some of the subjects evenreported that they didn't use
the interoceptive task very muchbecause, after using it for a
(25:37):
short time, the pain wasn'tintruding into their awareness
very often.
Okay, so you're thinking, well,I have, like this pain issue.
My student has thismusculoskeletal issue.
They have arthritis in theirknee.
How will this help them, right?
So what I am suggesting is thatsomething that is very much in
(26:00):
the wheelhouse of a Yin teacherand certainly within the
wheelhouse of a Yin student, isto learn to pay attention to our
discomfort and pain withequanimity, to be objective.
And the reason I love this taskis that it gives you a
checklist okay, mass,temperature, cohesiveness,
movement done.
(26:21):
Okay, it helps you to remainobjective.
Yin is absolutely the perfectcanvas for interoceptive
awareness.
You may have noticed inyourself or in your students
that at first, when you firststart practicing, it can be very
, very, very difficult to payattention to the body without
(26:43):
spinning up a story or becomingdistracted.
But, by the way, both of thosethings do to the default mode
network, right.
But over time, the attentionmuscle can be strengthened.
We have seen this in researchand, with an educated teacher
who is emphasizing this capacityof Yin, a student can learn to
(27:07):
disengage from the story andobserve something that is more
accurate.
Speaking of observing thingsmore accurately, let's move on
to our next topic, our nextstudy, which is related to fear,
or specifically fear ofmovement.
(27:28):
This is known as kinesiophobia.
I'm going to quote thedefinition of kinesiophobia
directly from the study thatwe're going to look at.
Kinesiophobia, also known asfear of movement, is defined as
an excessive, irrational anddebilitating fear to carry out
(27:50):
physical movement due to afeeling of vulnerability to a
painful injury or re-injury.
This also comes directly fromthe study I'm quoting.
The prevalence of kinesiophobiaand persistent pain ranges from
50 to 70%.
It can be acquired through twoforms.
(28:11):
One would be a direct aversiveexperience, so that would be a
pain or a trauma, and the otherwould be social learning.
So kinesiophobia can also beacquired through observation and
instruction.
If you instruct bodies inmotion moving bodies please perk
(28:35):
your ears up.
I'm still quoting here.
Kinesiophobia may be associatedwith pain and associated
outcomes, disability and qualityof life, in several ways.
First, kinesiophobia alters howpeople move, possibly with the
initial goal to avoid pain.
It causes adjustments of motorbehavior, which affects the
(28:56):
performance of actions relatedto the management and control of
pain and pain relateddisability.
And here's the final thing fromthis quote that I really would
like for you to pay attention toA greater degree of
kinesiophobia predicts greaterlevels of pain.
(29:18):
End quote.
So this may fly in the face ofeverything that you know about
pain, especially as a Yinteacher, right?
So we are told often, and webelieve strongly, that if you
hurt yourself, that you shouldrest, you should not move that
body apart, you shouldn't dothings that would aggravate the
(29:39):
injury and you should doeverything in your power to
avoid the movement that causedthe injury in the first place,
because you're very, veryfearful that it will happen
again.
And what I'm telling you is theresearch shows that that
actually will potentiallyincrease your pain, increase
(30:03):
disability, decrease quality oflife.
The evidence is pretty clear.
So all of this information thatI just shared with you comes
from a study called role ofkinesiophobia on pain,
disability and quality of lifein people suffering from chronic
musculoskeletal pain asystematic review by Suarez at
(30:26):
all in 2018.
So let's talk about the paper.
This random excuse mesystematic review included 63
articles.
So that was the.
They went through a ton ofdifferent papers and they
eliminated all.
Eliminated all the ones thatweren't going to fit perfectly
(30:46):
into their study design, andthey ended up with 63 papers.
And here were the findings.
They say we found strongevidence for an association
between a greater degree ofkinesiophobia and greater levels
of pain intensity anddisability, and moderate
evidence between a greaterdegree of kinesiophobia and
(31:07):
higher levels of pain severityand low quality of life.
A greater degree ofkinesiophobia predicts the
progression of disability overtime.
That's with moderate evidence.
And a greater degree ofkinesiophobia also predicts
greater levels of pain severityand low levels of quality of
(31:27):
life at six months.
That's with limited evidence,however.
So maybe it's hard tounderstand this moderate
evidence, this high evidence,this low evidence.
Basically, what that means isthat the effect size was low,
moderate or high.
So let's talk about this ideaof kinesiophobia and the really
(31:52):
horrible outcomes that happen asa result of fear of movement.
It is absolutely normal to wantto protect yourself when you're
injured.
Okay, pain is an extremelycompelling experience, which
absolutely forces us to protectourselves, but let's talk about
(32:12):
chronic pain as opposed to acutepain, right?
So when you injure yourself,you twist your ankle.
That's acute pain, right, weshould protect ourselves.
But chronic pain is defined aspain that persists past normal
tissue healing time, which isgenerally considered to be about
(32:34):
three months.
The pain issue is no longerbecause of the tissues and more
because of a learned response topain.
So fear, which is a reaction tothreat, is now maladaptive.
It no longer serves a purpose.
Right, this fear isn't helpingyou anymore.
(32:56):
It's not helping you to protectyourself.
Your tissues are healed.
The problem with fear is thatit activates this sympathetic
nervous system and defensivebehaviors which can increase
pain, even in the absence oftissue damage.
So why do I think this study isreally important for yin
teachers?
Why did I choose, of the twostudies I wanted to talk about,
(33:19):
to talk to you about this one?
How often, as yin teachers oryoga teachers in general, do we
refer to a pose, position ortransition, or even a body part,
as safe?
How often do we do that?
What kind of message do we sendabout that pose or transition
(33:46):
or that body part?
When we say that, are weindicating that some are not
safe, ie dangerous?
How often in our teaching do wecaution students in subtle or
very explicit ways to protectthemselves.
Let me give you an example.
(34:07):
Years ago, we auditioned aninstructor for a potential spot
on the class schedule at mystudio, sound Method Yoga in
Omaha.
The teacher had been teachingfor quite some time and she had
us on our backs and she had astar knees into our chest in a
(34:27):
pose that we often callapanasana.
Sometimes we call it windreleasing pose.
Essentially, your knees arehugged into your chest right,
you're laying on your back, andshe cautioned us strongly from
holding our knees or pressing onthem directly in the pose, as
it could cause knee injury.
(34:49):
That's what she told us.
What really alarms me about thisis that she's really, really
giving the wrong idea about thebody, indicating that it could
potentially be so incrediblydelicate that just your hands
resting on your knees could harmthem.
Now I'm saying that Iunderstand that a lot of older
(35:11):
people do have knee pain, butthere is absolutely no possible
possible way that you couldinjure your knees by touching
them in apanasana.
So what does this potentiallydo?
It encourages fear of movement,fear of a body part, fear of a
(35:32):
pose.
How else do we potentiallycause some fear of movement in
our students?
It could be as simple astelling a student that if it
hurts, just come out of the pose.
If it hurts, don't do it.
Right, and this seems likegreat advice.
(35:52):
Right, you don't want people toquote injure themselves, but it
can be incredibly harmfulbecause it equates pain with
injury.
And you, my evidence-basedlovelies, know that pain and
injury or tissue damage are verypoorly correlated.
And since we understand thatsocialization is a major cause
(36:16):
of kinesiophobia, what I amtelling you is that you, as a
yoga teacher, have the capacityto do a great deal of good.
You can be a force for good inthis world.
You can reinforce that bodiesare strong and stable and
adaptable, or you can do a lotof harm.
(36:37):
You can encourage people tobelieve that their bodies are
delicate, that their bodies arebreaking down, that injury is
inevitable, that aging is aone-way ticket to decline, and
then we just have to bubble wrapourselves against potential
(36:57):
injury.
This is the difference betweenbeing evidence-informed or not.
In my opinion, this is the mostcompelling reason.
So let's look at the evidence.
If you're still on the fenceabout this, right.
If you're like, well, somestuff is just dangerous, okay.
So let's go back to what youlearned last week about how
(37:20):
tissues become stronger andbigger.
In some cases, performanceimproves as a result of the very
most extreme stretchingprotocols that we talked about
in that first study.
It is highly unlikely that themild stretches that we teach our
students or that we practicefor three to five minutes could
(37:42):
cause trauma to tissues, so theconcerns of damaging tissues are
probably unfounded.
The fact is, your body isreally freaking strong.
If your body could get injuredby holding your knees or by
holding an uncomfortable posefor three minutes, it would be
kind of a shitty body.
It doesn't make sense that thebody could be harmed with such
(38:05):
low forces.
So does that mean that I'mencouraging you to ignore pain?
No, I'm definitely notencouraging that.
However, in our own practice oras teachers, I'm encouraging
you to invite an exploration ofpain, as in the first study that
(38:28):
we discussed, right?
So rather than immediatelycoming out of that thing that
hurts, perhaps we could try toin a slightly different way and
just examine not just thesensation but also our response
to it, not just physiologically,but mentally and emotionally as
well.
(38:50):
For my part, if my studentexperience is pain in a group
class setting, one of thereasons I love Yin is because I
can go over there and we canjust have a conversation.
There have been many times onthe podcast where I was teaching
a live class and you heard mehave a conversation with my
students.
Right, by finding a slightlydifferent way to still do the
(39:12):
pose, we are opening the door tocurious awareness, to
interoception, a more accuratesensing of what's actually
happening in the body.
The other thing about finding aslightly different way to do
(39:32):
the pose is that it will buildconfidence in the student that
this movement is in fact, safe.
For me, it encourages autonomyin the student and it reduces
fear.
But if we just go oh my gosh,don't do that pose, it hurts,
come out.
Right, that is going toincrease fear.
(39:53):
Right, and understanding howpowerful fear is to the
chronicity of pain or thetransition from acute to chronic
pain, that is something thatshould absolutely be on our
radar as teachers or students ofYin.
This is the number one reasonthat I am so passionate about
(40:19):
helping movement professionalsbecome research literate.
So I want you to know that, asI was preparing these
discussions for these last fourepisodes, I read and discarded
dozens of other studies.
I wanted to expose to you howimportant it is to be evidence,
informed, by dispelling myths,but by also encouraging you to
(40:42):
think bigger about our practiceand its value, way beyond
flexibility, way beyond range ofmotion.
Yoga, and Yin Yoga especially,are so much more than just
stretching.
Yin Yoga, with its emphasis onpresent moment, non-judgmental
awareness, slow breathing andgentle movement, can potentially
(41:05):
reduce systemic inflammation.
So last week we talked about astudy that showed how stretching
might help to modulateinflammation.
We also see studies aboutmeditation and how they could
reduce systemic inflammation.
There is some preliminaryevidence as well that Yin can
(41:27):
improve health span and immunitythrough mindfulness practice.
So one of those studies that Iconsidered very strongly for
this episode demonstrated anincrease in telomerase activity
after mindfulness meditation.
So what is telomerase activity?
So your immune cell telomeresprotect and stabilize the ends
(41:49):
of eukaryotic chromosomes.
Shortened telomeres are amarker of immune cell aging and
vulnerability to apoptosis,which is essentially cell death,
and are associated with poorerclinical outcomes and premature
death in various age-relateddiseases.
So we want to preserve ourtelomeres.
(42:09):
Telomerase protects telomeres.
So the evidence is stillpreliminary, but promising right
that potentially, mindfulnesspractice could help us to age
better, to maintain our strongimmune system.
(42:37):
It can play a role in calmingchronic pain.
Yin can reduce anxiety andstress.
And, yes, yin can improve rangeof motion, although, for me,
what the major benefit I see ofthe postures themselves is
improved proprioception, which Ithink then contributes to range
(42:59):
of motion.
So it is very clear, guys, thatlifestyle has a huge impact on
human health.
Yin yoga and yoga in generalare already well-accepted
strategies for improving health.
I believe that, with enhancedresearch literacy, yoga teachers
and students can make a hugeimpact.
(43:22):
Right, each and every Yinteacher out there is seeing
dozens of students a week.
What if we could help people toreduce their fear of movement?
What if we could help people touse their mindfulness skill
toward greater interoception,perhaps even preventing chronic
(43:44):
pain, preventing age-relateddiseases and improving health
span?
What I'm saying, guys, is thatour power in this practice and
in this profession is immense ifwe use it.
So, if you have enjoyed theseepisodes, I would say that you
(44:04):
are a perfect candidate for myYin teacher training.
The first module is primarilythe science of Yin.
So, even if you have noaspirations to teach Yin yoga, I
think that you would really,really enjoy this self-paced
online training.
I invite you to learn more onmy website if you're interested,
(44:24):
and I will include a link inthe show notes.
If you would be interested inaccessing links to all of the
research which I have discussedin this episode, please join my
free, private Facebook group.
It's called Movement forHealing and that is where I will
be posting all of the links andthe research cited in this
(44:48):
episode and also in the previousepisode.
It's also where you could bringup some questions that you
might have, or if you have someother evidence that you would
like to share with the group, Iwould love to see it and we can
have a discussion about it there.
Thank you so so much for yourinterest in evidence-informed
(45:09):
practice.
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