Adapting Yoga for Chronic Pain

Yoga can be a great tool for those living with chronic pain, both because of its physical effects and the effects that it can have on our mood. I lived with chronic pain and chronic fatigue syndrome for nine years, and starting a yoga and meditation practice was hugely beneficial. I am now mostly pain and fatigue free. I’m not the only one who has found relief through yoga. While asana and mindfulness meditation can sometimes reduce physical pain, most studies have found that these tools are most effective in reducing the secondary suffering that often accompanies chronic pain. What is “secondary” suffering, you may wonder, and if there is such a thing, what, then, is “primary” suffering?

Primary suffering is physical pain experienced as a result of illness, injury, or tissue damage. While asana can sometimes help (and certainly medication, prescribed by your primary physician, can also help), depending on the cause of the pain, there may or may not be anything you can do to reduce it.

Secondary suffering is the emotional pain that’s a reaction to primary suffering. If you feel (rightfully) angry, sad, depressed, anxious, or hopeless because of illness, you are experiencing secondary suffering. These kinds of feelings are an instinctual response to living with constant pain, so naturally, they are common among those who do.

Thankfully, yoga and meditation are two tools that I’ve found extremely useful in reducing my own secondary pain and that of chronically ill students in my work as a yoga therapist.

If you’re a yoga therapist or an experienced yoga instructor who would like to work with students with chronic pain, or already have some students in your classes who live with chronic pain, here are some ways you can adapt any style of yoga to make your class more accessible.

Research

Before working with students who have chronic pain, understand that you're not an expert on their pain, they are, so listen carefully and be open to learning what you don't (and may never personally) know about their pain. Researching how yoga can alleviate, or at least not exacerbate, chronic pain can help you find alternative postures, adjustments, and meditations to make your class welcoming to those living with chronic pain.

Before working with students who have chronic pain, understand that you're not an expert on their pain, they are.

For example, offering yoga nidra can be a way to create inclusivity in your class—everyone can participate, regardless of physical ability, and it can be adapted for those who have experienced physical and emotional trauma. Check out this recording for some ideas on how to customize your yoga nidra session for students with chronic pain. If you’d like to learn more about training in pain- or trauma-informed yoga nidra, check out iRest yoga nidra.

Language

Stay away from words like “advanced” and “beginner” or “harder” and “easier.” Using this language can reinforce the idea that some bodies (usually young, thin, and fit) and practices are better than others. Instead, use language that encourages students to check in with their body and their practice.

Phrases like “what works for your body,” “what feels good for you today,” and “find a place in the pose that feels comfortable” can keep students in their own bodies and their own experience. It can train them to stop comparing themselves with others.

Adaptations and Adjustments

I encourage you to let go of what you think a pose is “supposed” to look like and focus on finding ways to help students feel comfortable and supported in the pose. If you have access to props (such as bolsters, straps, blocks, and blankets), use them to adapt poses so they’re more accessible to your students.

Apply the same mindset when it comes to hands-on adjustments: Always ask/obtain consent before adjusting, and don’t push students to go to a place you think they should be in (of course, this is important advice for adjusting any student!); ask the student about their experience and use that feedback to make sure you’re not doing anything to cause more pain. Another way of adjusting is to use your language to encourage them to find their limit in the pose. Often, people can get competitive with themselves in a yoga class and push too far.

Go Beyond Asana

Use the vast array of yogic tools in your toolbox. Sometimes, showing up for class is all a person with chronic pain is going to be able to do. Some students will have limited movement and weak muscles because of inactivity from pain. If they’re not able to take part in the asana practice, even an adapted one, you can offer options like meditation, pranayama, supported resting postures, and visualizations to help them participate. Guided meditations, like yoga nidra, or visualizations can often help the student move their focus away from their pain onto the breath, a posture, or a visual cue, and just shifting their focus can sometimes provide relief.

Offering them something they can do can provide people living with chronic pain, who may have been forced to abandon activities they once enjoyed, with a sense of joy and relief from feelings of hopelessness.

Class Environment

Many people living with chronic pain aren’t getting adequate help from their healthcare providers. Chronic pain conditions are not well understood by the medical community, and so while many doctors do want to help their patients, there is no standard treatment for chronic pain. Further, even friends and family may not be able to understand what they’re going through.

The environment you create in your class can sometimes be more important than the sequence you teach.

In these circumstances, sometimes just going to a yoga class, being surrounded by people taking care of themselves and focusing on their health, can be beneficial. Accepting where they are on their journey with chronic pain—and being supported in that journey by a health-conscious community—can be a tonic for people living with chronic pain. Therefore, the environment you create in your class can sometimes be more important than the sequence you teach: Aim to create a welcoming atmosphere of inclusivity, one that embraces all ability levels and is focused on each person being free to listen to and express their needs.

Attending a yoga class can be transformational for anyone living with chronic pain. If you’d like to work with these students, remember that teaching yoga is about more than just offering asana. It’s about creating a safe, supportive environment in which students are encouraged to understand their bodies, explore their limits, and tap into their potential.