Yoga For Chronic Pain

Chronic pain can lead to physical and mental consequences beyond the pain. Up to 50% of patients with long-term chronic pain can experience mood issues including anxiety and depression. Chronic pain can also impair concentration, attention, and memory, even after controlling for mood symptoms, which suggests that pain impacts cognition.

Chronic pain has been associated with structural changes in the brain. Structural magnetic resonance imaging studies (MRIs) of chronic pain patients have shown a decrease in gray matter in areas of the prefrontal cortex, insula, and anterior and midcingulate cortices-- areas associated with pain processing, regulation of mood, and cognition. It is unclear whether these brain differences are the cause or effect of chronic pain.

A recent review in Pain (April 2015) discusses the growing literature to support that mind-body practices like meditation and yoga can improve chronic pain and its negative impact on the body and mind. Several studies have shown that both experienced and beginner mind-body practitioners experience less pain when exposed to painful stimuli-- both during and outside of meditative states. Experienced yoga practitioners as well as short-term mindfulness practices have been shown to have increased ability to tolerate cold pain. Yoga has also been shown to improve conditions associated with chronic pain, including depression, anxiety, and fatigue.

 

 

There is also growing evidence that suggests the protective effects of yoga on the brain (both gray and white matter).

Yoga and meditation have also been associated with changes in the brain that appear to counter age-related decline in gray matter volume. Experienced yogis and meditators have more gray matter volume and cortical thickness in brain regions that are involved in pain processing, attention, autonomic control, and emotion regulation (including primary and secondary somatosensory cortices, insula, anterior and posterior cingulate cortices, superior and inferior parietal cortices, hippocampus, and medial prefrontal and orbitofrontal cortices). Yoga and meditation practitioners have also been found to have increased white matter connectivity throughout the entire brain (in contrast, chronic pain is associated with disrupted white matter connectivity). Even a short term intervention of 11 hours of meditation has been associated with white matter changes in areas associated with self-regulation (i.e., changes to the corona radiata, a white matter tract).

Chronic pain is challenging both because of the pain itself as well as the long-term impairment of mood and cognition. Yoga and meditation-- even short-term beginner practices-- can be effective non-pharmacological interventions to counter the long-term negative effects of chronic pain on the body, brain, and mind.

Reference
Bushnell MC, Case LK, Ceko M, Cotton VA, Gracely JL, Low LA, Pitcher MH, Villemure C. Effect of environment on the long-term consequences of chronic pain.  Pain. 2015 Apr;156 Suppl 1:S42-9. doi: 10.1097/01.j.pain.0000460347.77341.bd.

Yoga for Depression During Pregnancy

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Yoga & Pregnancy

A recent study published in Women's Health Issues found that a 10-week gentle prenatal yoga program for 34 pregnant women with depression significantly improved the severity of depression. Yoga helped improve depression severity in both observed measures as well as subjective self-report. No injuries or safety issues were reported during the program. This study adds to the existing literature that gentle prenatal yoga can help treat depression and has advantages especially for women who prefer to minimize medications during pregnancy.

Reference

Battle CL, Uebelacker LA, Magee SR, Sutton KA, Miller IW. Potential for prenatal yoga to serve as an intervention to treat depression during pregnancy. Womens Health Issues. 2015 Mar-Apr;25(2):134-41. doi: 10.1016/j.whi.2014.12.003.

Yoga & Flexibility

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Yoga & Body

Yoga has also been shown to improve joint range of motion in people with osteoarthritis. A randomized controlled trial of 250 people with osteoarthritis of the knees compared 40 minutes of daily Hatha yoga exercises to therapeutic exercises over 3 months and found that yoga significantly improved range of knee flexion more than non-yoga therapeutic exercises at both the Day 15 and Day 90.

So don’t let your fear of being “inflexible” stop you from trying a safe, supervised yoga practice. Yoga is not a competition or a quest to find the “perfect” pose, but the union of the body and mind to find a centering practice that is safe and healthy for your unique and individual body and mind. There is no one-size-fits-all yoga pose sequence. Many poses and sequences can be modified safely with the support of blocks, blankets, or alternative positions. The key is talk openly to your yoga teacher about concerning areas of tightness or injury ahead of class and not to push yourself past your own limit.

If you have injuries or medical conditions, please check with your physician first to ensure a safe yoga practice. Pregnant women should practice sequences modified for prenatal yoga and should consult with their physician.

People often say, “I can’t do yoga because I’m not flexible enough.” This is like saying “I don’t lift weights because I’m not strong enough.” A safe practice of yoga can actually increase flexibility.

A February 2015 study in Journal of Physical Therapy Science found that 90 minutes of Hatha Yoga per week for 20 weeks increased spinal flexibility in women over 50 years old. The study found that yoga practice increased spinal mobility, hamstring flexibility, and joint range of motion in all age groups. Previous studies have similarly shown an increase in muscular strength, endurance, and joint range of motion even from 8 weeks of twice a week yoga practice of 10 minutes of pranayamas (breath-control exercises), 15 minutes of dynamic warm-up exercises, 50 minutes of asanas (yoga postures), and 10 minutes of supine relaxation in savasana (corpse pose).

Note: People with a history of medical conditions such as osteopenia or osteoporosis (low bone mineral density), bone or cartilage disorders, should speak to their physicians first as well as yoga teachers to find out guidelines for a safe practice to prevent any injuries from excessive force or pressures on the body during practice. Depending on the individual, certain poses should be modified or avoided.

References

Grabara M, Szopa J. Effects of hatha yoga exercises on spine flexibility in women over 50 years old. J Phys Ther Sci. 2015 Feb;27(2):361-5. doi: 10.1589/jpts.27.361. Epub 2015 Feb 17.
Tran MD, Holly RG, Lashbrook J, Amsterdam EA. Effects of Hatha Yoga Practice on the Health-Related Aspects of Physical Fitness. Prev Cardiol. 2001 Autumn;4(4):165-170.
Ebnezar J, Nagarathna R, Yogitha B, Nagendra HR. Effects of an integrated approach of hatha yoga therapy on functional disability, pain, and flexibility in osteoarthritis of the knee joint: a randomized controlled study. J Altern Complement Med. 2012 May;18(5):463-72. doi: 10.1089/acm.2010.0320. Epub 2012 Apr 26.