Several types of persistent pain exist. Some pain is caused by tissue damage or inflammation (e.g., tumor, infection, osteoarthritis) or nerve damage/dysfunction. These types of pain can usually be treated or managed with medical intervention. Mind-body practices like yoga can help reduce inflammation, calm the nervous system, improve mobility, and enhance quality of life for these individuals.

The type of persistent pain I want to describe here is the most common and called ‘centralized’ (neuroplastic) pain or 'mind body syndrome'.

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“This study showed that yoga practitioners had a low frequency and intensity of climacteric symptoms, which may justify their better quality of life. Other studies have shown that yoga can decrease menopausal symptoms and improve quality of life during the menopausal transition and postmenopause. Thus, women should be encouraged to consider yoga as an option for managing climacteric symptoms and improving quality of life” (Cota e Souza, Reis, & Lima, 2020, p.5)

This new Brazilian study concluded that a regular yoga practice before menopause may be helpful in decreasing menopausal symptoms. The researchers studied women in the ‘climacteric’ stage. “Climacteric is a phase in a women’s life that comprises the gradual transition from the reproductive phase to the non-reproductive one. It begins around age 40 and ends around age 65” (Cota e Souza, Reis, & Lima, 2020, p. 1). Common symptoms related to hormonal changes in this period include: hot flashes, memory/concentration disorders, sleep problems, urinary and genital changes, headaches, fatigue, and depression (not a complete list). The nature and severity of climacteric symptoms can vary widely, resulting in a different impact on quality of life.

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The vagus nerve is a part of the body that has been historically under-appreciated. Interestingly, ancient yogis understood the nervous system and ways to regulate it, even though they did not have the modern scientific method or technology to dissect, measure and manipulate it! Fortunately, the vagus nerve is now gaining the recognition it deserves; inspiring research and offering hope for trauma recovery as well as treatment of many diseases and disorders.

What happens in vagus doesn’t stay in vagus!

The vagus nerve is the longest of our 12 cranial nerves, travelling from the brain stem to all the major organs. Its name comes from the Latin word for “wandering”. Its role is to monitor and communicate sensory and motor information between the body and the brain. In recent years, the vagus nerve has attracted a lot of attention. Dr. Stephen Porges developed the Polyvagal Theory to help explain how the two branches of the vagus nerve determine the state of our autonomic nervous system. In a threatening situation, the vagus nerve activates the sympathetic nervous system to generate adrenaline and cortisol so we can fight or flee. If we are unable to fight or flee the situation, the parasympathetic nervous system can create an immobilization or freeze response as a last resort and effort to mentally escape from the situation. It’s important to note that this process is automatic and unconscious. The vagus nerve also detects when we are safe to engage in relaxation, play, sleep and connecting with others.

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In university, I had a housemate who was incapacitated for two days out of every month while she was menstruating. Lorna* would be in bed during this time, and I recall the four young women and myself who lived with her sympathized, but accepted that this was something some women had to endure. At that time, I was not familiar with yoga and its benefits for treating a range of pelvic pain conditions.

Dysmenorrhea is characterized by cramping in the lower abdominal area during menstruation. Primary dysmenorrhea (not caused by other diseases) affects 60% to 93% of women under the age of 25. Risk factors include: onset of menstruation before age 12, low body mass index, anxiety (increases pain perception), and psychosocial stress. One study showed 66% of young women with dysmenorrhea had limitations in their daily activities due to pain. Another study estimated school absence to be 80 to 93%. Menstrual pain has a tremendous impact on quality of life for otherwise healthy, young women.

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Please click on the image above to see the full article as published on the The Happy Pelvis website, including its creator Michelle's personal introduction. 

Pelvic pain and trauma. Three words that typically aren’t used together. However, the more I delve into and think about the topic of pelvic pain, the more I am convinced that we need to be aware of its connection with trauma. Why? So those with pelvic pain can feel understood and treated in a sensitive way, and so those who care for and about them will understand and treat them with sensitivity.  Trauma is a word that’s being used more frequently, which unfortunately, doesn’t mean that it’s always used appropriately. Let’s start by defining the term. Dr. Pat Ogden¹ defined trauma as “Any experience that is stressful enough to leave us feeling helpless, frightened, overwhelmed or profoundly unsafe” (p.66). A trauma response can occur after a single event or in prolonged situations of overwhelming stress. Prior to the COVID-19 pandemic, an estimated 90% of the population had experienced at least one traumatic event.² This percentage would surely be higher now.  

What’s traumatic to one person is not necessarily traumatic to another, or to the same extent.

For example, hospitalization in childhood, a car accident, death of a loved one, assault, or surviving a natural disaster or war, can have very different effects on two different people, even if they’re siblings. The Adverse Childhood Events (ACEs) Study established that certain events experienced in childhood can have a negative and lasting impact on mental and physical health, life opportunities and relationships.³ Multiple research studies have found that experiencing abuse in childhood is a significant risk factor for developing a pelvic pain condition.⁴ In addition, the trauma of discrimination, oppression or exclusion combined with childhood trauma and persistent pain can compound and magnify its effects.

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I attended a live interview with Dr. Sinead Dufour, Pelvic Floor Physiotherapist and co-author of the April 2020 Society of Obstetricians and Gynecologists of Canada (SOGC) updated guidelines for the treatment of urinary incontinence in women. She was accompanied by Dr. Carolyn Best, a Urogynecologist. These new guidelines are ground breaking because they emphasize conservative care, as opposed to non-conservative and more invasive interventions such as testing, surgery and medications. The guidelines address the treatment of the three most common types of incontinence: stress incontinence (leaking urine with exertion, sneezing or coughing), urge incontinence (leakage occurs with the urgent need to urinate), and mixed incontinence (a combination of stress and urge incontinence). 

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I have been learning a lot about the nervous system, which I find fascinating! The nervous system consists of the brain, spinal cord and nerves that carry messages back and forth between the brain and body. The nervous system is exquisitely well-designed, However, it can make or break our health and well-being. The nervous system is a major factor in determining sensitivity to stress, pain, and other stimuli, such as lights, scents, sounds, and skin irritants. 

Central Sensitization (CS) (also known as Central Sensitivity Syndrome (CSS)) occurs when the neural signalling in the nervous system is amplified, resulting in hypersensitivity to pain, and sometimes other stimuli. Central sensitization is about how the nervous system can develop and adapt in response to injury, such as a stroke or spinal cord injury. It is often related to physical or emotional trauma and can result from certain infections including Lyme disease, Hepatitis C or Epstein Barr Virus.

I became interested in this topic after reading a study finding that pelvic floor floor muscle tenderness is associated with CS. CS is identified with a wide range of conditions where there is no evidence of tissue trauma or disease, including: fibromyalgia, chronic fatigue syndrome, restless legs syndrome, Temporomandibular Joint Disorder (TMJ), migraine/tension headaches, irritable bowel syndrome (IBS), some chronic pelvic pain syndromes, multiple chemical sensitivities, post-traumatic stress disorder (PTSD), over-active bladder and chronic hives. In studies, CS has been identified in some people who have tissue trauma or diseases such as multiple sclerosis (MS), rheumatoid arthritis, or post-surgical breast cancer. 

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These sources were referred to in my May 2022 presentation. 

Ballou, S., Gray, S., & Palsson, O. S. (2020). Validation of the Pandemic Emotional Impact Scale. Brain, behavior, & immunity - health, 9, 100161. https://doi.org/10.1016/j.bbih.2020.100161

Blackburn, E. Lin, J., Dhabhar, F., Adler, N., Morrow, J. & Cawthon, R. (2005). Accelerated Telomere Shortening in Response to Life Stress. Proceedings of the National Academy of Sciences of the United States of America. 101. https://doi.org/10.1073/pnas.0407162101

Brown, J. & Wong, J. (2017, June 6) How gratitude changes you and your brain. Greater Good Magazine.

Buric, I., Farias, M., Jong, J., Mee, C., Brazil, I. (2017). What is the Molecular Signature of Mind–Body Interventions? A Systematic Review of Gene Expression Changes Induced by Meditation and Related Practices. Frontiers in Immunology, 8  https://doi.org/10.3389/fimmu.2017.00670

Gratitude is good medicine: Practicing gratitude boosts emotional and physical well being

Goliszek, A. (2014, November 12). How stress affects the immune system: Using mind-body therapies to keep stress from making us sick. Psychology Today.

Greenberg, M. (2012, August 12). How to prevent stress from shrinking your brain: Learn how to preserve brain power when you’re stressed. Psychology Today. 

Mitchell, M. (2013, March 29). Dr. Herbert Benson’s relaxation response: Learn to counteract the physiological effects of stress. Psychology Today. 

Taylor, S. Landry, C.A., Paluszek, M.M., Fergus, T.A.,  McKay, D. & Asmundson, G.J.G. (2020). Development and initial validation of the COVID Stress Scales, Journal of Anxiety Disorders, 72  https://doi.org/10.1016/j.janxdis.2020.102232

www.selfcompassion.org

Yaribeygi, H. Panahi, Y., Sahraei, H. , Johnston, T.P. & Sahebkar, A. (2017). The impact of stress on body function: A review. Experimental & Clinical Sciences Journal, 16  doi: 10.17179/excli2017-480

Nurturing our mental health during the COVID-19 pandemic with Dr. Bessel van der Kolk

Mental Health Resources from the Ontario Association of Social Workers

Wellness Together: Virtual mental health and substance use support for people in Canada and Canadians abroad. Options include phone counselling. 

NeuroNova Centre's Mindful Movements Thursdays 7:00 pm to 8:00 pm EST on Zoom - pre-registration required.

Weekly guided imagery with Belleruth Naparsteck

Guided meditations by Tara Brach

Mindfulness-Based Fitness Training: Free sample modules and complimentary course access for members of the armed forces, healthcare providers, educators, law enforcement, first responders, and other public servants through The Sounds True Foundation.

Pause4Providers: Drop-in mindfulness sessions for health care providers

This list of articles is updated regularly! Video resources are posted on my YouTube channel.

Yoga as an Integrative Therapy for Mental Health Concerns: An Overview of Current Research Evidence

Yoga and mental health: A review

Yoga: What you need to know (NIH National Center for Complementary and Integrative Health)

Treating major depression with yoga: A prospective, randomized, controlled pilot trial

Exploring the therapeutic effects of yoga and its ability to increase quality of life

Yoga for Anxiety and Depression (Harvard Mental Health Letter)

Just what the doctor ordered: Take a yoga class and depression, anxiety improve

An Exercise to Boost the Brain’s Natural Anti-Anxiety Drug?

Emotions in motion

Trauma-Sensitive Yoga and Mindfulness

Trauma-Informed yoga: A guide

Trauma-informed mindfulness: A guide

Embodied Healing in the Aftermath of Trauma with Jenn Turner (podcast)

Healing Trauma and PTSD through Yoga

Trauma-Sensitive Yoga (Social Work Today)

The Power of Trauma Sensitive Yoga

Yoga as an Adjunctive Treatment for Post-traumatic Stress Disorder: A Randomized Controlled Trial

How Yoga Helps Survivors of Trauma

Transcending Trauma: How Yoga Heals (reader advisory: discusses childhood sexual trauma)

Yoga as a Treatment for Grief?

Most Yoga is Not Trauma-Sensitive. Here's Why it Should Be

Trauma Informed Yoga is People Informed Yoga

How Yoga Helps Heal Trauma: A Q&A with Bessel van der Kolk

Healing Body and Mind with Gentle Hatha Yoga (The Narcissist in Your Life Podcast)

Treating Trauma Through the Lens of Yoga and the Yamas by David Emerson

Trauma-Informed Yoga: When the Breath acts as a Trigger

Could Yoga Hold the Key to Healing a Patient’s Trauma?

Trauma Centre Trauma-Sensitive Yoga Research and Studies

Yoga for Chronic Pain by Dr. Arielle Schwartz

Studies show the benefits of yoga for mental health - Articles from Psychology Today 

13 Real Benefits of Yoga

How Yoga and Breathing Help the Brain Unwind: Research shows normalization of neurotransmitters in anxiety and depression

5 Ways Yoga Can Benefit Your Mental Health: Why a "prescription" for yoga may be as effective as psychiatric medication

How Can Yoga Make Your Life Better? Discover 6 reasons why yoga is more popular than ever

Can Yoga Improve Self-Image? New research shows increased body appreciation among people who practice yoga

Meditation and Yoga Can Reduce Symptoms of PTSD: Different meditation and mind-body practices may be equally effective

Mind-body practices downregulate inflammation-related genes

Dr. Herbert Benson's relaxation response: Learn to counteract the physiological effects of stress 

Yoga as a complementary approach in conventional medicine

Yoga in the VA - Fact Sheet (U.S. Dept. of Veterans Affairs)

Do you know someone who suffers from migraine headaches? Maybe this someone is you. The symptoms can vary. Some describe it like a vice tightening around the head, stabbing pain in one or both eyes. It can be accompanied with severe nausea and hypersensitivity to light and sound. They are unfortunately common and difficult to treat. The good news is that migraines are one of the neurological conditions that can be helped by yoga. 

For Brain Awareness Week, I reviewed: "Therapeutic role of yoga in neuropsychological disorders”, a peer-reviewed, open access article published in the World Journal of Psychiatry in October 2021. This article was a collaboration between university researchers in Iran & Germany. There were an amazing 228 references!

The authors referred to yoga as ”an ancient Indian non-religious mind-body method, considered a philosophical and spiritual discipline that alleviates suffering and promotes human health” (p.755). Yoga has been practiced as a healing method for over 4000 years and includes postures, breath work and meditation.

The authors looked at the role of yoga in the treatment of a number of neuropsychological conditions. These included: tension & migraine headaches, Azheimer's disease, multiple sclerosis, epilepsy, neuropathy, Parkinson's disease, stress and anxiety, depression, bipolar disorder & schizophrenia.

Modern neuroscientific methods have opened a new and exciting chapter on the study of yoga’s effects on  brain structure and function.Yoga and meditation affect brain waves and increase brain activity; enhancing cognition and decreasing anxiety.

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There is no end of group yoga classes to choose from – from Ashtanga to Bikram to Restorative for all levels. If you can’t find a class that suits you, even more choices exist on-line. With all these options, why, might you ask, would someone want a private yoga class? After all, it’s also more economical to attend a group class! For sure, group classes have many benefits. If you want to be somewhat anonymous, you’re seeking community or you just want to come and go without any commitment, group classes are great.  

On the other hand, if you want to address your individual needs, accelerate your learning, and have one-on-one time with a teacher who is interested in and can help you work towards your personal goals, private classes are recommended. I was not convinced of the benefits of private classes until I started teaching myself and was able to compare what I can do in a group versus what I can do with one of those students in a private session. 

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Things have got worse for many people with pelvic health issues during this pandemic. STRESS is a big factor. The pelvic floor muscles and our gut are barometers for stress. If you've noticed more pelvic pain, bladder issues or digestive problems, you're not alone. Difficulties in accessing health care, treatments, and support services have not helped. Compounding this is social isolation and other factors that have forced a change in the way we want to live our lives.

Here are a few examples of pelvic health struggles people are dealing with: 

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“You should try meditation.” Chances are you’ve heard this suggestion at some point – either from yourself or someone else. Meditation, mindfulness meditation, in particular, has become a mainstream recommendation for everything from chronic pain to anxiety to cancer. Viewed as safe, relatively harmless and accessible, many health care providers are practising, teaching and recommending mindfulness meditation to their patients. Meditations are easily found online and public classes in yoga and meditation abound.

Most of us want people to be empowered to take charge of their health and well-being and it is great that there is such an effective tool that is free, readily available and simple to use. However, since reading Dr. David Treleaven’s (2018) book: “Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing,” I have realized that meditation practices should come with a caution: “May cause distress in people with a history of trauma.” Treleaven was motivated to research this topic and write a book based on his personal experience. A seasoned meditator, he had traumatic symptoms arise during mindfulness meditation as a result of vicarious trauma from working as a therapist with sex offenders. As a result of finding many people who had similar experiences in meditation, he described the tendency to regard mindfulness as a cure-all for all difficulties as the ‘panacea problem’ (Treleaven, 2018).

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Who isn't impacted by boundaries? You may be aware of them or not, and impacted if they're your own or someone else's boundaries. When you feel frustrated or resentful, it might be worth pausing to consider if your boundaries are involved. 

- Did someone take advantage of your generosity?
- Did someone exploit your time? 
- Did someone invade your personal space? 
- Did someone persuade you to do something you really didn't want to? 

What happens if you change the statements above?
- Did I allow someone to take advantage of my generosity?
- Did I allow someone to exploit my time?
- Did I allow someone to invade my personal space?
- Did I allow someone to persuade me to do something I really didn't want to?

Boundaries are within our control. Even if we didn't learn about healthy boundaries growing up, it's never too late to establish them for our own happiness and well-being. 

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Since taking a course in Trauma-Sensitive Yoga^₁ in November 2018, I have adopted a trauma-sensitive approach in all my group and private classes. I am continuing to explore how trauma affects the brain, how it is held in the body, and how mindful movement is so effective in helping people move beyond their trauma.

My perspective is that each one of us has trauma. Major traumas, such as a serious accident, assault, or surviving a natural disaster, are widely accepted as long-lasting and may require specialized therapy for recovery. However, other less obvious traumas can have lasting, serious effects. These traumas might be difficult to talk about because they seem insignificant or common. If you did talk about them, you might get the response “that happens to a lot of people” or “you just need to get over it”. Consider the following potential traumatizing events: the death of a pet, betrayal by someone you trusted, witnessing an accident or death, reading/watching a graphic news story, or caring for a loved one with dementia. Any of these events can cause real trauma.

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We're heading into a full year of COVID-19 turning our lives inside out. Have you had yourself a pity party yet? Have you thrown what felt like an adult temper tantrum lately? I confess, I've done both! We're affected by grief and loss in ways we might not recognize. If we have loved ones who have been ill or died, the grief is tangible. You don't have to look far to grasp the immense suffering that surrounds us. Just being exposed to trauma of those we know or from the media can cause vicarious loss and trauma. Grieving has been made more difficult by the restrictions on public gatherings, social isolation and limited access to support services.

I do not want to minimize the momentous losses and grief that many people are experiencing. I do want to draw attention to the many intangible losses that we may be experiencing and can elicit a grief response. They may seem small and even insignificant, especially when held up against the suffering that surrounds us. However, I think it's important to recognize what is happening so we can respond to our personal and very real grief.

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Revised July 2020

Did you know?

• 50% of women who have had children have some degree of prolapse¹; and some are not aware of it.
• 95% of lower back pain is caused by pelvic floor dysfunction (PFD)².
• 1/3 of women experience urinary incontinence³ .

These are sobering statistics (and I stopped myself at listing only three types of PFD!). If pelvic floor dysfunction is so common, why aren’t women and their doctors more well-informed? My intent in sharing these numbers is not to scare people. It is to offer hope. The pelvic floor is like any other part of the body – if something is out of whack, it speaks to us through symptoms. The body is a healing machine & given the right treatment and conditions, many people can experience relief from pain, leakage and other symptoms that have a huge impact on quality of life.

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Where there is trauma, there is grief.
Trauma always involves loss. A person's life changes after trauma. It's not an option to just go back to life as it was before the trauma. Some people describe their life in two parts: life before the trauma and life after the trauma.

Where there is grief, there can be trauma.
Many, but not all losses involve trauma. People respond differently to similar events, thus some will experience trauma with grief and others will not.Psychologists Pat Ogden and Janina Fisher identify trauma as any stressful experience that leaves us feeling helpless, frightened, overwhelmed or profoundly unsafe.

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Yoga for Grief & Loss 

© Kathleen Pratt, 2018, Kingston, Ontario

Introduction

Grief is a universal response to loss of something important in our lives. Grief affects us emotionally, physically, psychologically, spiritually and socially. Most people think of bereavement as a cause of grief, but grief occurs in response to a multitude of losses such as natural disasters, unemployment, divorce, serious health diagnosis, and sexual assault. ‘Disenfranchised grief’ is grief that is not acknowledged by society , such as family estrangement and dementia. Bereavement is associated with excess risk of mortality, particularly in the first weeks and months after a loss. It is also related to increased physical symptoms, illness and use of medical services . Due to a variety of factors, some bereaved individuals are at risk for complicated grief, depression and stress disorders. In normal bereavement, a range of fluctuating emotions (including depression, regret, guilt and anger) and feelings of repressed or unresolved grief can take years to resolve (Philbin, 2009).

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