About Neil Pearson
Neil Pearson is a physiotherapist and Clinical Assistant Professor at the University of British Columbia. He is an experienced yoga teacher, a yoga therapist, and creator of the Pain Care Yoga training programs for health professionals and yoga therapists. Neil is founding chair of the Physiotherapy Pain Science Division in Canada, recipient of the Canadian Pain Society’s Excellence in Interprofessional Pain Education award, faculty in yoga therapist training programs, and an author.
Neil develops innovative resources, collaborates in research, and serves as a mentor for health professionals and yoga practitioners seeking to enhance their therapeutic expertise. He is co-editor of ‘Yoga and Science in Pain Care: Treating the Person in Pain,’ available Aug 2019.
To learn more about Neil click here.
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182 Neil Pearson: Pain Science and Yoga | Repost
“And what we really need to do around this is to understand that yes pain is something that is part of life. We all get pain now and then and some of us are going to have a whole bunch of pain and we need to have resources and community-based assistance and programs to help us because pain management should not end when you stop seeing a health care professional. It should continue in your community.”
About This Episode
In this conversation Neil Pearson and Kathryn Bruni-Young talk about the dynamic and complex nature of pain. Neil begins by defining pain and talking about some misconceptions we have when it comes to pain. From there they talk about the purpose of pain and how we can learn to move and teach in a way that doesn’t over catastrophize pain. Neil teaches us that pain and tissue damage are poorly correlated, except for when we have tissue damage in the skin, which really changes the way we experience pain.
Kathryn Bruni-Young: 00:00:28
Hi everyone. Welcome back.
Today on the podcast we are reposting Episode 110 with my mentor Neil Pearson. So this interview was done before I took Neil’s mentorship. I had just taken a weekend course with him I was so excited about his work and pain science and so I invited him on the podcast.
We had such a wonderful conversation. Neil is really one of my all-time favorite people to work with and learn from. I just appreciate his teaching so much and his attitude about movement and just his personality, such a wonderful teacher.
So we are reposting this episode in case you missed it. And even if you didn’t miss it, I highly recommend you listen to it again because there’s just so much in here. Neil Pearson is also one of our guest faculty members for the 300-hour online teacher training that I am co-facilitating with my friend Carly stong.
So Neil is going to be leading us through the pain science module and I find… I mean I’ve interviewed a ton of people on pain science, a number of physiotherapists, and researchers, and I really do find that there is always a little bit something different to take.
Yes, I’ve heard these ideas so many times now over the course of the years. But there is always just getting a better understanding of all the bits and pieces and then figuring out how to actually put it into practice.
I think oftentimes we get really used to hearing about pain science, the nervous system, the biopsychosocial model, all that stuff. But then we easily kind of revert back to our old ways of thinking and old biases old habitual cues that we say during our classes stuff like that.
So that’s why we want to repost this episode today. Such incredible and important information. I feel like we can never get enough of this stuff and that is also why Neil is teaching on the faculty of our training.
If you want to learn more about that training early bird pricing ends December 31st. So you’ve got to get your application in before that day. You also have to pay your deposit before that day and then we have individualized payment plans so everyone is gonna be on their own kind of payment plan. You can chat about that with Carly after you apply.
All of that information is on my Web site mindfulstrength.ca, it’s on the home page you can just scroll down, click the link you’ll see it all there. We have the dates, the pricing, all the other incredible guest instructors, and the application. Really everything you need.
Alright everyone, here is my conversation episode 110 with Neil Pearson.
Kathryn Bruni-Young: 00:03:06
Alright. Neil Pearson welcome to the podcast!
Neil Pearson: 00:03:09
Thanks a lot. Kathryn, it’s great to be here.
Kathryn Bruni-Young: 00:03:11
I am really looking forward to this. I’ve been looking forward to it for a while now. I got to take your workshop. I don’t know when it was maybe like a month and a half ago two months ago in Montreal?
And since then I’ve just been really inspired by all of these things that I’ve heard you talk about so I’m super excited that we’re doing this. Do you want to take a couple of minutes and tell people a little bit about who you are and the work that you do just in case they haven’t heard of you?
Neil Pearson: 00:03:37
Okay, that’s great. Thanks.
So I’m a physical therapist and I’m a certified yoga therapist and I’m a clinical assistant professor at the University of British Columbia. So I’ve been a physical therapist since 1985 and spent probably about two-thirds of my career working with people with complex chronic pain problems.
That mostly got me interested in this area really because I was running into patients, the story of the pain or what had happened to them in relation to their pain and disability didn’t really match with what I learned in school.
So that really made me wonder whether what I learned in school was very accurate and unfortunate at the time, in the 1980s and 90’s there weren’t really any or very many books on pain so I just started to search, and the more I searched more interested I got in the area and the more inspired I got that there were actually things that we could do when pain persists.
Kathryn Bruni-Young: 00:04:31
So what are some of the things that you learned at school that then you realized just maybe like you weren’t working for you in your practice?
Neil Pearson: 00:04:38
Well I think the main idea was this link between when there is damage to the body there will be pain, and when there’s more damage there’ll be more pain and that if there’s a lot of pain the only way to help a person get better was to fix the tissue damage.
And I think that’s one of the striking things because I got to work in a trauma intensive care unit working in a hospital with people who are recovering from trauma afterward. Seeing that some people had such horrific injury to their body yet were able to recover not only just recover more ease of movement but in some people, the pain didn’t end up being a big ongoing problem.
This didn’t make sense at all from what I learned in school about that if there was tissue damage or you know poor posture or scar tissue that those things had to hurt and potentially hurt a lot.
Kathryn Bruni-Young: 00:05:30
Yeah, it’s so interesting in your course that I took in Montreal, you just told so many great stories and gave so many examples of people who you had met who had had these very traumatic incidents happen and who recovered quite well and it was just so interesting to hear all those things.
I think that more and more people are starting to talk about this pain stuff but for us to really get it into our minds I feel like we need to hear it so many times even if we’re not physical therapists. I just think we’re so programmed to see the body through this only biomechanical machine-like lens of “if you do this, this pain will occur”. It’s so hard to not think about it that way.
Neil Pearson: 00:06:10
Right. I mean that’s one of the beauties of what we do in yoga is that we start with the understanding that the first thing we need to do is: become aware of thoughts like that and then we start to try to shift them.
What you say is a big issue. We need to start to recognize that there’s another way to look at our existence or our ability to recover. Yet, the first thing we often need to do is start to… every time we have a thought that links tissue damage and pain as directly related to each other, completely related, and only related to each other, we need to notice that and then start to think of “well does that match with what I’ve experienced in life?”.
I can go through lots of evidence or information to say that there’s lots of scientific evidence that it doesn’t. But that’s probably not the important thing. It’s that we’ve all heard stories and we all probably know people who’ve had relatively small injuries that gave them a lot of pain and other people who’ve had particularly nasty injuries and they’ve been able to get back to life.
You just want to say to the person like “that must hurt so much!”. And you know you know the person you may look back and smile and say “well you know that’s the weird thing is it doesn’t”. So it’s probably the stories as you said that I talk about, are really stories to remind people that they’ve heard these stories before.
But we haven’t actually taken the time to think about what we think about that experience in a relationship to what we’re having now. Because when the pain’s really really bad it feels like, you know it feels like there must be a really really horrible tissue problem going on there and we don’t put any thought into that sort of logic that we have. Or we don’t compare that to other times in life when we’ve had pain or when others we know that pain.
Kathryn Bruni-Young: 00:07:59
So if someone, maybe like a layperson asks you “what is pain?”. How do you usually describe it?
Neil Pearson: 00:08:07
Wow. Yeah, the answer may have to do with a whole lot of things like how much time we have? How well I know them? You know, what kind of scenario we are in? But I think if I were to start describing it for everyone I would start with the idea that pain is complex.
To really understand pain, we need to be able to look at it from many points of view, from many perspectives. That’s part of the complexity of it because we can say things like “pain has to do with protection, and that pain has to do with perception and our pain as humans is a human experience”. It’s all these different things. Not just this one thing that we can define and say you know this is what it is.
It’s got the complexity of like love. Like the love we experience as humans is so complex there’s no real one way that I can tell you what it is in a sentence or two. Actually, I would do horrible at trying to tell you what that part is. But in terms of pain, it’s the same idea. If I try to explain it to you really briefly then that’s so incomplete that we can’t really understand it.
Kathryn Bruni-Young: 00:09:17
What do you think the average person thinks pain is.
Neil Pearson: 00:09:21
Oh well, it’s a great question. Actually when I do a lot of public education and I always ask people “what’s the purpose of pain?” and what you’ll get is people say “well it’s an alarm system” or “it’s a warning” or “it’s a message that says that your body’s been damaged”.
So unfortunately what happens is the person’s view is “that’s what pain is, that’s all it is”. So all of those answers would have an amount of correctness to them but they’re all incomplete because it’s never as simple as that.
I mean something as simple as a paper cut tells you that right? Here’s a relatively small tissue injury that can cause an extraordinary amount of pain given how small it is. So there’s gonna be other things that influence pain or other things that pain is.
Kathryn Bruni-Young: 00:10:13
I’ve heard you say that pain is a moving target and then it doesn’t necessarily tell us what the problem is, where the problem is, or how bad the problem is. So I’m wondering if you could talk a little bit about this.
Neil Pearson: 00:10:26
OK, so the moving target bit is that it has a lot to do with when we’re helping people to do pain management or a movement or exercise as part of their recovery. A lot of times the words that come out of health care provider’s mouths suggest to the person in pain that “this is the way you do this, this is the way you move, this is a way you exercise”.
To the person on the other end, of course, they may be thinking “well but my pain is not the same all the time”. You know it changes from morning to noon to night and it changes from day-to-day. Why should I have the same plan all the time?
The person in pain knows that their pain is a moving target and therefore what we need to do is find a way to help the person to morph their plan based on all the things that the person needs to get done today but also how they’re feeling today.
At the same time what we want to do, if we go to the second point you made about pain not being fully accurate is that if we only use pain as our guide for how much to move that’s often problematic because pain is not an accurate indication of how much you should move to get better and it’s not an accurate indication of tissue health.
It tells you some information about that but it’s not fully accurate. It’ll be a little bit like in my yoga teaching world if I were to tell you to just use your breath as your guide. As long as you can breathe calmly you know that your body is safe. We’d say “Okay, that’s a good idea but it’s not really complete enough”. So that sort of goes into this idea that pain is not fully accurate.
I guess to go there to talk about that, it’s to think we normally do think that the purpose of pain is to tell you where you’ve been injured, what kind of injury it is, and how bad the injury is to your body. But we’ve all had experiences where that’s not true. With brain freezes, one experiences often I ask people to consider is that the intensity of pain in brain freeze has nothing to do with tissue damage. And the location of pain in brain freeze usually has nothing to do with where the problem is because it’s usually a soft pallet getting so cold is usually what the problem is.
So the pain in this situation, the purpose of it, is around protection where the purpose of it would be to get you to stop or change your behavior rather than to accurately tell you where the problem is, what the problem is, and how bad it is.
That sort of leads into this other idea that if the pain isn’t fully accurate at guiding you for how much to move well what would you do? And so what we have to say is that it doesn’t seem like there’s any guide or any one alarm system or protective mechanism that is fully accurate.
What we’ve done is… and actually listening to patients who figured this out for us and then it made sense, is that some patients were saying “you know they’ve told me to pay attention my pain but that doesn’t really work. So what I actually do is pay attention to how tense my body is and how much I’m holding my breath and if my mind gets really racing I start to get anxious or we start to get angry when I’m doing this. I try to control those things.”.
People are saying that what they do is they use their ability to breathe calmly, their ability to keep their body tension low, and their ability to calm their mind and the pain. As a group of things that together give them a better guide for how much to move when they’re trying to recover function or ease of movement.
Kathryn Bruni-Young: 00:14:07
So it’s kind of interesting like when I think about this whole thing and think “OK well if pain isn’t always accurate” why does the body have this response?
Because I think logically we think “OK I do the thing and it hurts, so that must be bad” but if that’s not always the truth then what is the purpose of this whole system?
Neil Pearson: 00:14:31
I wish I could answer definitively for you to say “well this is where it is” but it certainly seems to be that it has the most to do with the idea that… in this particular case the purpose of pain is to try to get you to stop or change your behavior.
If the pain was more intense, that means there’s, even more, need to stop or change your behavior, right? Or if it feels scarier, that’s a mechanism that could get you to pay more attention you know? If a painting you have doesn’t feel all that scary then you might not react. Yet, if the protective mechanisms inside us are in a place where they’re trying to get you to change your behavior right?
So the idea that these automatic mechanisms inside us that function to keep us safe and sometimes when they’re running automatically their purpose is to just get us to change behavior not particularly to tell us what’s really going on right now.
Which by the way gets really confusing too in that there is one aspect of our physical body that is better at telling us where the problem is, what the problem is, how bad it is and that’s our skin.
If you injure your skin, you’re much more likely to be able to say exactly what kind of the injury and what the injury was whether it was a cut or a pincher or a tear or a burn. You can most likely actually tell us what it is and you most likely could actually say where it’s happening in your body and they probably have a good idea of the severity of it.
That makes it even more complex for us because your skin’s pretty good at that but most of the things that are below your skin are really horrible at being able to tell you or be able to send signals that you can interpret as telling you exactly what’s wrong where it’s wrong and how bad it is.
Kathryn Bruni-Young: 00:16:23
Yeah. So interesting.
Neil Pearson: 00:16:26
Kathryn Bruni-Young: 00:16:27
Because we have this experience of our skin that is so accurate and that makes us believe that everything we’re feeling is accurate.
Neil Pearson: 00:16:34
Well, I think that’s really well said I think so.
Kathryn Bruni-Young: 00:16:36
I have had this experience before and like you know lots of people I know who have told me also about their experiences. I used to have an experience where I would go into a twist and I would have a sensation around my lower back or around my S.I. joint and I used to think like “oh no I must be like tearing this apart, I must be just like doing this like serious damage in there”.
And I think in yoga there is oftentimes this like “really listen to your body and just be really aware and feel all your feelings and”. When I hear people speak about pain sometimes I’m like, I definitely see the value in paying attention to your body and not just blowing through everything and not paying attention.
But at the same time is it possible that sometimes we’re like getting a little bit too sensitized to all these little feelings that we’re having and then catastrophizing certain parts of our body?
Neil Pearson: 00:17:30
Oh, I think the answer is most definitely yes.
The process that we hope people get through yoga is to not just be aware but to be discerning and to be curious. You know you go there into that twist and you feel that sensation what we’d want you to do is… you feel that sensation and the sensation is one of it feels like something dangerous is going on. And what we’d want you to be able to do is to say “could I actually stay here and explore this” like what happens to that. Right? if I stay and I just watch that pain that feels dangerous or if maybe I back off or doesn’t feel quite so dangerous.
So I feel calm enough that I can explore this. What happens if I just keep on watching it. What happens if I breathe in a different way or maybe as I feel this sensation on my back I’m also…there’s a thought that’s coming up or emotion is coming up and we start to explore that. I think you’re right with the idea that there’s potential in awareness practices for people to become, as you say catastrophic, and end up having catastrophic thinking and end up having anxiety around the sensations.
Yet what we want people to do is to practice discernment, right, and see if you can get to that place of equanimity. But all those things are so hard. Because when we first go there you know, the logic is “It feels like it’s ripping. It must be ripping. This is dangerous, I shouldn’t do this, I should move my body”.
Hopefully over time through a practice of yoga people can go to that spot or close to that spot and instead of running away from it or just cutting their teeth and using their strength and will to push through because they’re tough. But to stay in that place where you can’t explore and be curious and, in the end, be more discerning.
Kathryn Bruni-Young: 00:19:14
How did you get into yoga, and what about yoga do you like?
Neil Pearson: 00:19:20
I’ve sort of informally meditated for a long time, although I tried to when I was in university at some meditation sort of. I would say I dabbled in meditation. Then about the same time that I started to do a lot more work in multidisciplinary pain management programs, I met a passionate meditation teacher and started to learn more from him.
What was interesting is that at one point he said to me something like “You know you’re never going to be able to sit still unless you can get your hips and back more flexible, so you should really go do yoga”. I’m starting from a place of I really really love being quiet and sitting still and meditating. That’s something that I think has just always been like this natural thing.
Even as a teenager I used to go to a lake and just you know turn my focus to the sound of the waves and sit there. It just feels good. But then I went to this yoga class that I went to. I think I really got lucky with my first yoga teachers.
It was so obvious that this was a way to meditate and move at the same time. And I love movement. I trained to be a PhysEd teacher before I went into physiotherapy so movement is something I love. This idea of being able to meditate and move together really really worked for me.
I think that’s what keeps me going with my own personal practice is I really enjoy continuing to challenge my body because I think like most people with age, I’m getting close to 60 now, and with age, things start to change in your body so you have to sort of challenger your physical practice a little bit differently.
But I guess for me the big motivator is that by doing the physical practice it is easier to sit and be silent and just experience that introspective space.
Kathryn Bruni-Young: 00:21:19
Do you do like yoga practice as your main form of movement? Do you do other practices as well?
Neil Pearson: 00:21:29
Well, I cycle and I’ve been sort of a lifelong runner although I had a pretty substantial disc injury a few years ago and so I’m just trying to get back into running now without… because I ended up pinching a nerve and having some neuropathic leg pain.
That’s interesting the way I said that like it’s really not a big deal. I have really really intense leg pain and weakness in my leg from this and it’s taken a long time to get better. But anyways.
So I really enjoy that as well. I mean so I guess in the winter I do cross-country skiing and snowboarding so there’s lots of movement practice that I do but I don’t do any other contemplative movement practice. Although I got to say that I would really really love to learn Taichi. I watch people doing it and I’m just mesmerized. I think that would be another really fascinating contemplative movement practice to explore.
Kathryn Bruni-Young: 00:22:26
Cool. What’s it like recovering from a significant injury where there’s a lot of pain when you know all this stuff about pain?
Neil Pearson: 00:22:34
There’s a whole bunch of experiences I’ve had around this. One of course is almost the shame at the beginning of not telling people about it because it’s like you know there’s almost this feeling like this is purely inside me right? This feeling that other people would think you know “well obviously what you’re teaching people doesn’t work if you’ve got this problem”.
But then there’s also I think probably the most extraordinary experience I had was that the pain was so intense and felt so dangerous. It affected my sleep so much and the visual image that I was always coming up with about this horrible thing that was going on inside my body; thinking like “all those things are happening in me”. Me who’s teaching people about this all the time. And I kept on thinking if I didn’t know what I know I think this would potentially disable me because it was so intense and it affected every aspect of me.
You know it created some social isolation even. Plus we know that all of those kinds of effects of horrible pain can feedback into the person and make it so much harder for the person to get better. I really kept on. It really drove home a whole lot of things that I knew but I got to learn them at an even deeper experience with the idea of how it is that this pain thing really can destroy us because it’s so powerful.
Kathryn Bruni-Young: 00:24:12
I want to take a moment in the middle of this episode to tell you about Building Resilience, our 30-day practice progression. If you want to get started with strengthening in a mindful way and you’re not quite sure where to begin or there are just so many options out there. Go over to mindfulstrength.ca and get started.
Each day you get a new class. Every class is 30 minutes or less so it’s super manageable and classes range from strengthening with weights and bands and your body weight, all the way to self-massage and restorative practices. So you get a little bit of everything which will help you build your resilience.
To sign up go to mindfulstrength.ca. All. Right everyone. Back to the show.
Kathryn Bruni-Young: 00:25:00
Yes. It’s so interesting. I thought what you said about this maybe a little bit of feeling of shame around having an injury and being a professional is so interesting because my mom was a yoga teacher for a long time and had a studio in Toronto. She experienced a very traumatic, very acute injury. It was really hard for her to talk about that initially; this was almost 10 years ago.
When not a lot of people in our community were talking about cross-training and doing different things and whatever. All the yoga stuff that we’re talking about now. And it was really difficult for her to like say “I have this injury and this is what I’m learning and these are the things that maybe I’m starting to rethink”.
I just think that it’s so interesting there’s like this little feeling inside of us that when we are a professional we know everything and of course nothing bad is ever going to happen.
Neil Pearson: 00:26:04
I think as well as a yoga teacher because you know the language that we use around yoga really has to do with it. It helps people to suffer less. Then if we are then in pain or if we are then talking about suffering there’s still this… sometimes people will say things to you like “well obviously it doesn’t work, right? If you practiced this all the time, if it is not working for you maybe it’s not so effective as you’re saying”.
This is really unfortunate because it’s you know it’s called confirmation bias; a person who believes that pain management doesn’t really work. Or a person that believes that yoga therapy wouldn’t help or that yoga wouldn’t help. Then they see a person in one of these areas with pain, it’s just going to confirm their bias. And unfortunately, when that bias comes verbally back at us it can feel really embarrassing and will keep us quiet.
Kathryn Bruni-Young: 00:26:59
I think also… I’ve interviewed Greg Lehman a couple of times and he talks quite a lot about pain and in our last interview he said something about how he actually experiences pain sometimes, and that experiencing pain sometimes is normal. But we’ve kind of put it in this category of like abnormal or pathological. I’m wondering what you think about that. Is having pain a normal human experience?
Neil Pearson: 00:27:26
Right. That’s a great question and I actually want to tackle it a little bit of a different approach in that what we’ve tended to do in the last, I don’t know 50 to 100 years, is medicalize pain.
When a person has pain that is ongoing our approach is to go to a medical person which obviously there are times when we want to do that. Imagine you go to the medical personnel with this pain and the medical person says “hey there are some things that we can do with the medical interventions or short-term pharmacological things to help you”. Unfortunately what happens is that then that medical intervention ends and the person is back in their community and they’ve got nothing.
What we really need to do around this is to understand: yes pain is something that is part of life. We all get pain now and then and some of us are going to have a whole bunch of pain and we need to have resources and community-based assistance and programs to help us because pain management should not end when you stop seeing a health care professional. It should continue in your community.
We know this is highly, highly important. One other way to go at this is to say: if you walked into me with a persisting pain problem, I think I can be confident that I can help you to change it but I don’t know how much I can help you to change. It sort of depends on you and everything else you’ve done.
I had to hold in my heart at that time and my mind the idea: maybe you’re going to be the person who at the end of what we do working together and you’re off considering doing things on your own in the community, you might be saying “you know the pain is pretty much gone. I’ve got most of my function back again”.
You might be the person who says the pain hasn’t changed. They’re still there. It’s better but it’s still there and there are still some things that I can’t do anymore. But I’ve got my life back. Or you might be that the person who says “I know what you’ve done has really helped me to be able to move some more years. I’ve found my purpose in life again. I’ve gotten back to life again. But you know that pain really has not changed very much”.
That’s the complexity of pain. We don’t know where the person in front of us, which one they’re going to get to. That person who continues to have pain; in two of those groups that people are continuing to have fairly consistent ongoing pain, that sometimes the way it’s going to be for that person through life. We need to not fully medicalized that that try to show the person what they can do and create community-based services to help them to manage this thing.
Kathryn Bruni-Young: 00:30:11
How much do you think the relationship with the practitioner or the clinician or the teacher matters in their recovery or that feeling better of the client or the student?
I was going to be flippant and say 64 percent. I think the reason why to say something like that is: it’s laughable that’s the training that I’ve got in school told me that it wasn’t about me it was about my expertise with the stuff that I did. It was about knowing the right stuff to do. Yet if you look anywhere in the research literature it will say that therapeutic alliance or the connection that you are able to make with the person that you’re with is vastly important.
There are some research studies that say that the connection we feel with the person who’s helping us out may actually give the effect. More than 50 percent of the positive outcome is from that kind of an alliance or a relationship that’s built. I stumbled a month ago on some research that’s really fascinating they’re talking about some Autonomic Synchrony.
It was specifically in people who are already connected, they’re already partners. It was really amazing that when one person experienced pain they actually were watching synchrony between these two people in terms of their heart rates and the respiratory rate. One study looked at skin conductance. Another one looked at heart rate variability. One even looked at brainwaves that EEG waves and saw this synchrony, which is really fascinating.
We talk that way. Qe talk about being in sync with somebody. I think when we are in sync there probably is our autonomic nervous systems are sinking up. But also when we’re there we seem to be able to learn better, we feel safe. We may be able to, in that point where we feel in sync with the teacher, we may be able to learn the things that teachers teaching better.
There’s a whole lot of that that still needs to be researched but that makes sense from life. You know there are times that the only way you’re really going to learn this well is if you trust the person you’re with a lot and you feel safe with them. Even so much sometimes is that the person that is teaching us needs to be a role model of what we need to attain. If the person we’re working with is having a hard time calming their mind or calming them breath or their body attention and the student is feeling, that it’s gonna be hard for the student to learn that.
I think so the more we look at this the more we realize that is essential. You got to find the right person.
Kathryn Bruni-Young: 00:33:02
Yeah. It’s so interesting. I’ve been to a number of different clinicians. I’ve had a number of different experiences. Some very positive and some very negative. I don’t think that this is a thing that every clinician is thinking about. And sometimes I like baffles my mind a little bit.
Neil Pearson: 00:33:24
I agree so much. I think it’s really fascinating from the coaching world. I run a mentorship program for health professionals and movement practitioners and one of the women who’s in the program right now she’s a longstanding coach. She’s actually coaching at the Olympic level for long long years. As we’re talking about some of these pain management things, she’s a reaction sort of like you just said it’s like “people don’t get that”. Because to her it just makes sense, the only way that you’re going to be able to help the person you’re with is if you morph yourself to them.
The recognition of the really really good coach, which is what we really are as yoga teachers or yoga therapists, is able to morph themselves based on the person to get the better result.
Kathryn Bruni-Young: 00:34:18
A teaching question that I have. You said something in your workshop that really really got me thinking. It was something and maybe I misunderstood this, so if I did you can just correct me. I thought you said something about “when you teach somebody a movement and they say: ‘Oh this hurts’. If we as the teachers always say: ‘oh if that hurts, then don’t do that or stay away from it’, we almost like catastrophize that pain more, and potentially make that worse.
Neil Pearson: 00:34:52
Yes. We’re doing that behavior, we are guiding the person that way in an attempt to keep the person safe, which is really really important. At the same time what we haven’t thought about it is: if you do a movement and it increases the pain, then I say “well change it” and then if I do that every single time, I’m actually teaching you is that the only way to change the pain is to change the body. That doesn’t really match up with what we understand from yoga.
For some people, the implicit message s that pain is bad. Pain is dangerous. That if there’s pain I’m damaging my body. And What we want to do is find ways to give people experiences of going back to that exploring and being curious and discerning. The person says it hurts; well, how about this time what I say is “what would happen if you breathe this way or how about if you did something in a different part of your body? Or we got you two from yoga we thought about something that would change a person’s prana. Or we got the person to consider a different thought or different emotion.
By playing with these things we start to be able to see that we can modify it in many ways. We start to realize that pain is not just only related to the body and that starts to break down. Hopefully, break down that idea that pain means damage.
Kathryn Bruni-Young: 00:36:21
OK. How often, if at all, do you think that the pain we’re experiencing is directly related to the tissues?
Neil Pearson: 00:36:32
Kathryn Bruni-Young: 00:36:34
I’ve heard another pain physio person say that about 10 percent of the time we can really like nail down the pain somebody is experiencing right down to their tissue. There’s not a lot of other factors. Only 10 percent of the time. But I’m wondering what other people say about this.
Neil Pearson: 00:36:52
Wow. I’m struggling with answering the way you form the question. My belief is: if you have persistent pain, let’s talk of persistent pain for now. If you have pain is persisting, I really really believe that what we need to do is understand that…this is after an injury…right?. There’s been a physical injury or there’s something going on in the physical body.
When the pain persists there is still something going on with the body. We’ve also got these protective mechanisms acting in a different way. Normally the protective mechanisms after awhile will calm down and stop giving you pain, stop being so wound up and cranky. Sometimes the message that people hear around pain science like education is this idea that “if you’ve got pain persisting, the problem in your body is healed up by now. The reason you’re having the ongoing pain is from the nervous system”.
I’d like to consider it in a different way. I know that if you tore ligaments or overstretched a tendon or bulged a disc or had sore joints and you have not been able to move that part of your body for a period of time, there’s no way that that tissue is as healthy as you wanted to be. I would say there still is something going on in the body. Even though yes there’s stuff going on with the nervous systems in the neuroimmune stuff that’s that has to do with protection. But we need to work on both.
This is why I’m having a hard time answering the question. I think the question is pushing people towards the ideas well what do I do about this then? Really the ideas that have pains persisting, we do best when we work on getting the body healthier again, and when we work on trying to wind down sensitive or sensitized nervous systems. Do them together.
A lot of people who have been injured are hearing this message of “you know by now the tissues heal they don’t need to worry about your tissue anymore”. I think the added thing is the person can’t believe that. It is like: “what do you mean the tissues heal”. To fully disconnect pain from the tissue sounds so alien and like you really don’t understand. Also for a lot of people, I think what it sounds like is “you’re just telling me it’s all in my head. That there’s nothing wrong it’s my. The only reason I have pain is because of some psychological flaw”.
That is not the intention of that language but I think it’s an outcome that becomes a barrier for the person getting better.
Kathryn Bruni-Young: 00:39:38
Yeah, that’s really good. That’s very good. I have a client who is approaching 70. She’s very active. She plays tennis every day. In tennis, there’s running, there’s running sideways and there’s a fair bit of impact going on there in the lower body. She’s definitely very mobile.
Sometimes she comes to see me and we’ll do a couple of really simple exercises like lying down on the back hip bridge. So simple, so low load, low impact. I feel like low everything. Sometimes she’s really bothered by this exercise because she knows that she has a little meniscus tear in one of her knees but I don’t think it really bothers her when she plays tennis.
When she does the hip bridge it seems like a problem. She doesn’t want to do the movement. I’m like “OK well let’s do let’s do a different movement”. I think about this case all the time and I find it very confusing because in my mind I’m like “OK well if you can run around on a tennis court where your knees and your whole body is going into all these like funky positions, but then lying down on the floor and doing a hit bridge feels like it’s aggravating. What is that? How do I work with this person?” Other than just saying “OK well let’s just try something different”.
Neil Pearson: 00:41:00
Right. I think that’s a really fascinating one. I think we run into these things a lot. It shows you that if pain were only to do with the tissue and the force applied to the tissue then do what she’s experiencing wouldn’t make any sense.
In the one she’s a this is putting a lot more load on the tissue and a lot more different loads on the tissue of the knee when she’s playing tennis. It gets the idea that sometimes people say well pain is influenced by context. If we said that in a different way we’d say: “pain is changed by everything”. It comes back to that idea of where the pain’s there because of the load that’s being applied to abnormal tissue. Well that’s part of it.
Pain can also be influenced by the setting in which you are. We know through experience and science that it can be changed by color, by how much you sleep, by noxious smell, by past experience, by parts of our genetic system you. You sort of go on and on and on. There are all these different things that would alter or all these factors that could change this.
In that particular case, I would guess that there’s probably a bunch of different factors that are different between those two scenarios that are becoming more powerful than the actual mechanical load. It’s really really tempting to say she’s playing tennis. She’s doing something that’s social. Social engagement really really changes the chemistry of the body.
She’s probably getting endorphins and probably adrenaline as well as she’s moving. Adrenaline, at least in the short term, is a good pain reliever. There’s probably this chemistry stuff and there’s also the psycho-emotional stuff of playing tennis. We could say is those factors can be so big that even if there were signals coming from our knee that the system isn’t interpreting it as a dangerous problem.
Whereas over here you’ve taken all those factors out that would help to down-regulate the system. But now you’ve got this low mechanical load and the system and now she experiences pain. Did that make some sense?
Kathryn Bruni-Young: 00:43:20
Yeah for sure. For sure.
Neil Pearson: 00:43:22
That doesn’t really tell us what we’re going to do, though. That was the second part of what you asked. Right. I guess what I would do is say “so I really want to know is what she wants from me”. Right. Here’s the person who’s who is playing tennis and doing this stuff and not having much of a problem there.
I guess she must be having a problem with that knee in other aspects of her life. I’d want to know what are her goals around this. What does she want us to try to change? Then to me, if we’re going to have her do the bridge it would be: can I see getting her to do the bridge would help her towards the goals that she wants to attain?
If that particular exercise wasn’t getting her towards that goal, then what I would probably do is just…if I thought “well I can do that in another way”, I’d just do it another way. But if I thought I was really really important to meet her goals, then I would start to think of “well what else could I do to modulate the pain here?”.
Maybe I could get her to do some breathing technique or a pranayam or a pratyahara technique or Yoga Nidra or use some other technique before and maybe even after she does it. That could change the chemistry of the body and change the descending modulation from the brain, and maybe by doing that she could do it with less or no pain.
Kathryn Bruni-Young: 00:44:56
Yeah, it’s very interesting. My initial thought was like “OK well well why am I doing the bridge in the first place”. Then I’m like “OK. Well because of glutes and hamstrings strength. I might try to strengthen the posterior chain”. And then I realized that I could also do not like all these other ways. That’s great. But yeah I think that what you just said is really interesting. It just shows people that like there still are so many options of what we can do. If something isn’t working for somebody, there are so many things to do.
Neil Pearson: 00:45:25
Kathryn Bruni-Young: 00:45:28
Last question I want to talk a little bit about teaching and if you have any specific advice for people who teach yoga or movement when they’re working with people who have pain. I know that we’re not really trained to work with people who have pain, but that’s kind of just what happens.
Neil Pearson: 00:45:48
Kathryn Bruni-Young: 00:45:48
People show up to class because they have pain.
Neil Pearson: 00:45:50
Wow. I guess my very first thought is: as a yoga teacher I think it’s really important (because of what you just said) is that actually take it upon ourselves to learn more about pain. The trouble is that within most yoga teacher training programs there’s not a focus on or not a point when you actually sit down and just talk about pain itself.
I would say is that that that’s really really important. To be able to teach somebody that there is some knowledge of the topic. I think unfortunately that the flip the other way is a lot of times in yoga teacher training the message we get is we need to keep people safe. We need to keep their body aligned this way or we’ll damage the body. Or when there is pathology in the body, if there’s not really good alignment that’s going to cause more damage.
Those are good things to understand but if that’s your only understanding of pain then you’re only understanding “is if it hurts there must be damage”. Once again that’s not a very yogic idea and that’s not the best way to keep people safe. We need to learn more. That’s the first step.
I think as yoga teachers we’re sort of well-positioned around this because we can go learn that information, but then what we can do is actually use it in our daily practice. We can start to play around with it for ourselves and see how it fits for us. Obviously recognizing that everyone’s different. But at least if you bring it in your own personal practice it becomes easier to bring it into teaching other people.
Then what I would say is: if a person comes up to you and says that when they do this it hurts. I think what we need to do is recognize that from a yoga perspective, we need to start with: “All right, in my mind, I know that pain is influenced by everything. I know that every aspect of this person’s existence can be an influencer on this. Not just physical body”; however, what I’d want to do is I want the person to feel safer.
I would be thinking if I’m going to ask this person to modify the posture or to do it in a different physical way, I would want to use language that doesn’t create that link between tissue damage and pain. More language around curiosity: “hey what would I want to happen if you tried doing this. Let’s see what happens when you do this”. Rather than you know this directive language well if it hurts you shouldn’t do it. Be more exploratory. But if you use the physical body first, the person in front of you probably already holds that idea. Pain has to do with my physical body.
It’s possible that if you even within a yoga class if you start by saying to the person “let’s explore your thoughts or your emotions or your prana here”, the person might get the eye-rolling business going on and not really thinking what you’re doing. Or not feel that what you’re doing was making them feel safe. We certainly can start with modifying the alignments of the body or the person’s body tension or movements to change it.
But then what I would say is we’d also want to hold in our mind: can I come back to this person and ask them to explore it in different ways? I’ve given the person some guidance so the person feels more safe right. They can do the asana practice that they want to do and not feel worse. Then I’m a yoga teacher because I want to teach yoga not just asana. That person cues me to think maybe next class I’ll bring in something that could explore this. Right.
There are certain postures that we do where we know the body starts to send pretty strong messages. You could actually get people to start to explore changing their breath in a certain way or working with prana in a certain way in the next class. Everybody, and that person who’s there, gets to explore that.
To sum that up as a yoga teacher: learn more about pain. Start to practice for yourself and then find ways to get the students who tell you about their to feel safe. Then start to be curious and explored in different ways.
Kathryn Bruni-Young: 00:50:08
Awesome. Neil, this has been such a pleasure. I’m so glad that we got to have this conversation. Thank you so much for coming on the podcast.
Neil Pearson: 00:50:15
Oh, you’re welcome. This is great. It was such a pleasure meeting you. I hope we meet a bunch of times again.
Kathryn Bruni-Young: 00:50:21
For people who want to learn more about your work or learn about your mentorship or anything like that, where do they go to see all that information?
Neil Pearson: 00:50:28
The current website I have is Pain Care U so p a i n c a r e u, the letter U dot com. www.paincareu.com. It has the Pain Care Yoga Certificate Training which is more of a therapeutic side. We are going to be coming out with a new system for yoga teachers rather than yoga therapists. What we just talked about. Helping yoga teachers to bring in this knowledge and help with their students more.
If people want a little bit the mentorship that’s all that’s is on the Pain Care U website. The information about Pain Care Aware, which is the new program, isn’t on there yet. We’re just finalizing bringing that together. If people really want to dive into it, there’s a book that’s being released this summer Yoga and Science and Pain Care. It’s sixteen different chapters written by different people who are both health care professionals and yoga teachers or yoga therapists. Sort of diving even deeper into this vast topic.
Kathryn Bruni-Young: 00:51:39
Amazing. I’m looking forward to the book. I also interviewed Shelley Prosko, so I’m like a double looking for it.
Neil Pearson: 00:51:46
Well, hopefully, you’ll get Marlysa on there, too.
Kathryn Bruni-Young: 00:51:49
OK. Thank you so much.
Neil Pearson: 00:51:51
Oh, you’re welcome. It’s been a pleasure.
Kathryn Bruni-Young: 00:51:55
So that’s our show. Thank you, everyone, so much for listening.
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