Yoga for back pain

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One of the most common problems my yoga students complain about is chronic pain around the shoulder blades and in the upper back and neck. This kind of pain plagues those of us who work with our arms extended in front of us, whether we’re typing on the computer, cooking, carrying children, lifting heavy objects, or washing dishes. Let’s face it: that includes just about all of us. Because these activities are especially demanding on the arms, shoulders, and upper back, it’s not surprising that back pain is so widespread, even among the most dedicated yoga students.

Upper back pain commonly stems from the tendency to slump in the spine and round the shoulders. Slumping causes the shoulder blades to slide away from the spine, chronically overstretching and weakening the muscles around them. Eventually these muscles harden into tough bands to protect themselves from this constant strain. As they tire, these weakened fibrous muscles go into spasm, creating hot, persistent pains along the edges of the shoulder blades and the sides of the neck. Shoulder work is a foundation for nearly all hatha yoga poses. 

Common shoulder stretches reduce the upper back pain only marginally, and some can even make the problem worse. That’s because stretching often focuses on the pain without addressing its deeper causes. The cause of the slumping, paradoxically, lies in the front of the body, deep within the shoulder area of the upper chest. Tightness in the upper chest muscles pulls the shoulders forward and down, while rotating the upper arms inward. By releasing the tension in these muscles, we can undo the most persistent cause of chronic upper back pain.

Challenges in Your Yoga Practice

Tightness in the upper chest makes it difficult—and sometimes even harmful—to perform basic asanas. Tense muscles draw the shoulders forward and rotate the upper arm bones inward, straining the shoulder joints in a number of common poses. For example, if you tend to hunch your shoulders while extending your arms to the sides in poses such as virabhadrasana II (warrior II), the deepest part of the shoulder joint can be harmed where the misaligned bones pinch the rotator cuff muscles. Moreover, hunched shoulders cause the upper back to round and the shoulder blades to “wing out” to the sides, weakening the muscles of the upper back.

The tightness also shows up in poses in which the arms are extended overhead, such as virabhadrasana I (warrior I) and adho mukha shvanasana (downward-facing dog). The same tightness that causes shoulder problems in warrior II will make it difficult for you to fully extend your arms overhead or open your chest in these poses. In warrior I, your elbows may bend out to the sides as the upper arm bones rotate inward, again causing the bones of the shoulder joints to pinch the rotator cuff muscles deep in the shoulder sockets. Tenderness in the muscles of your chest indicates that problems will persist until the muscles are relieved of their chronic tension through focused stretching.

The same is true in downward-facing dog. Though it is generally easier to straighten the arms in this pose, the upper arm bones still tend to rotate inward toward the ears. The weight-bearing nature of the pose makes this inward rotation all the more dangerous if you (like many students) push your chest toward the floor, straining your shoulders at their weakest point.

Finally, when you extend your upper arms behind your body in poses such as sarvangasana (shoulderstand), the same tightness in the fronts of the shoulder joints turns the shoulders strongly inward and causes the elbows to slide out laterally. This misalignment severely compromises the shoulders and causes the chest to collapse, putting harmful weight on the bones of the neck.

The Root of the Problem

What’s the common denominator in these poses? In each case, the upper arms rotate inward as the shoulders roll forward and down, bringing the shoulder blades with them. The cause of these problems is tightness in a trio of muscles that run from the inner arm through the armpit to the chest.

Two of these muscles run along the inner edge of the upper arm: the brachialis, which (along with the biceps) bends the elbow, and the corachobrachialis, which adducts the upper arm, bringing it closer to the body. A third muscle, the pectoralis minor, attaches at one end to the coracoid process, a thumb-like forward extension of the shoulder blade, and at the other end to the ribs of the upper chest. The role of this muscle is to draw the shoulder forward and down. When we reach forward to move or manipulate objects—an action we perform frequently—the pectoralis minor, corachobrachialis, and brachialis muscles all contract.

Among the three, the pectoralis minor is most responsible for postural problems. Although it is a relatively small muscle, its attachment to the coracoid process allows it to exert a good deal of leverage on the shoulder. As we reach for something, contractions of the pectoralis minor draw the shoulder forward, in turn pullling the shoulder blade away from the spine and rounding the upper back. Chronic tightness in the pectoralis minor, then, promotes forward-slumping shoulders, while tightness in the muscles along the inner arms further aggravates problems by causing the arms to rotate inwardly.

Although the muscles responsible for causing our discomfort are in the front of the body, the pain we feel is in the upper back. It is caused by a misalignment of the shoulder blade that has been persistently pulled away from the spine by the slumping in our shoulders. This pull causes painful muscle spasms along the edges of the shoulder blades. The muscles that are most affected are:

The rhomboids, muscles that con-nect the shoulder blades to the spine. The upper rhomboids are particularly strained by their effort to pull the shoulder blades back into place, countering the pull of the pectoralis minor.

The levator scapulae, which extends from the top edges of the shoulder blades to the upper vertebrae of the neck. These muscles elevate the shoulder blades and are strained by the pull of the shoulders as they slump forward and down.

Tension in the rhomboids causes chronic pain along the edges of the shoulder blades nearest the spine, while tension in the levator scapulae creates pain in the sides of the neck, which can make it difficult to turn the head. If, for instance, your right shoulder is hunched forward, tension in the levator scapula on the right side of your neck will make it more difficult to turn your head to the right. This pain may also shoot down through the inner edge of your shoulder blade.

Skillful body work concentrating on these upper back muscles will help ease your pain, but it will not eliminate the cause, which is tension in the front of the chest, in the pectoralis minor. If you suffer from upper back pain, try massaging just beneath your collarbones, especially between the third and fifth ribs, which will likely be quite tender. (You may be surprised to feel a corresponding twinge under your shoulder blade, a hint of the neurological link between these areas.) It is just as important for you to massage the muscles in the front of your upper chest as it is to have your upper back massaged. Tenderness in the muscles of your chest indicates that problems will persist until the muscles are relieved of their chronic tension through focused stretching.

How to Stretch and Open the Chest (Correctly)

Hatha yoga poses are powerful tools to stretch and open the chest. However, we must be attentive to some simple details to ensure that these hatha yoga poses properly target the problem. One of the most common stretches for the upper chest, for example, is often performed incorrectly. In this stretch the hands are clasped behind the body, and the arms are drawn away from the back to stretch the fronts of the shoulders. But if you are not careful, the very muscles you are trying to stretch can cause the arms to become misaligned, further straining the shoulders.

To perform the stretch correctly, bend your elbows and interlace your fingers behind you, separating the palms of your hands. Keeping the elbows bent, lift and square your shoulders; then draw your shoulders back, moving your elbows toward each other so that your upper arms are parallel. Flexible people will be tempted to straighten the arms and hyperextend the elbows, but this is a temptation to resist, since it reduces the effectiveness of the stretch. The proper action of squaring the shoulders, bending the elbows, and bringing the upper arms parallel will rotate the upper arms outward, opening the space between your upper chest and the fronts of your shoulder joints. Moreover, the arm bones will “hug” the shoulder joints, protecting your rotator cuff muscles.

To increase the stretch, keep your chest elevated as you draw your hands away from your back. Ultimately, you can straighten the arms, but only if this does not make the shoulders rotate in and downward. Since many of us are too quick to straighten the arms, it’s better to keep the elbows slightly bent.

Seated Stretch

Purvottanasana (upward-facing plank) is a posture that stretches the brachialis (inner arm muscles) as well as the chest. To begin, sit on the floor with your knees bent and your feet a comfortable distance in front of you. Place your hands on the floor 12 to 16 inches behind you, wider than your hips and (ideally) with your fingers pointing forward. (If you feel wrist pain in this position, place a support such as a folded towel under the heels of your hands or turn your hands outward.) Bend your elbows slightly, and, as you exhale, soften your chest downward, bowing your head. As you inhale, draw your shoulders back, keeping your elbows bent and your upper arms parallel. Lift and open your upper chest, feeling the stretch just below the lines of your collarbones. Keep your hips on the floor.

Next, with each inhalation, lift your chest and straighten your arms, maintaining the open space between your chest and the fronts of your shoulder joints. The more you straighten the arms while pressing downward through the mounds of your index fingers, the more you feel the stretch along the inner edges of your biceps and forearms.

Progress in the pose by raising your hips. Don’t take your head back at first—keep it lifted, looking toward your knees. Continue to lift your chest. Ultimately you can take your head back by lengthening through the crown of your head.

Avoid throwing your head back in a way that collapses your chest and hyperextends your neck. Do not lift your hips if your arms turn in, if you feel a sharp pulling deep inside your shoulder, or again, if your chest collapses.

In the full pose, the legs are extended straight out in front of you. Isometrically draw your heels toward your hands to activate your hamstrings. Extend through your toes, lift your hips, and open your chest.

Standing Stretch

This stretch addresses some of the deepest levels of tightness in the arm, shoulder, and chest. Stand next to a wall with your feet parallel and comfortably separated. Place the fingertips of one hand on the wall at shoulder height with your arm fully extended. Place your other hand on your hip. Cup your fingers so that only the fingertips touch the wall, and rotate your arm outward slightly so that your thumb (rather than your index finger) points upward. Keep your shoulder aligned with your hand and begin to lift and open your chest with your breath, rolling your collarbones back.

Now, twisting from the waist, turn just your upper body, extending through your arm to the fingertips, as if the wall were moving away from you. This stretch extends from the chest and the armpit down through the entire length of the inner arm to the thumb. You may feel the stretch at any point along this line. It is a deep fascial stretch that feels unlike most muscle stretches—it may tingle, which indicates a lengthening of the tougher fascial tissue. Breathe. The tingling is normal and fine, as long as it does not become a sharp localized pain. This stretch reaches some of the deepest levels of tension in the arm and shoulder, and opens the flow of circulation to the entire area.

How to Get the Best Results

Shoulder work is a foundation for nearly all hatha yoga poses. Lengthening the chronically short muscles in the inner arm and chest establishes better alignment in the shoulders and frees you of fatigue and painful spasms in your upper back. When your shoulder joints are aligned, they enjoy their fullest range of motion. Your chest feels broad and open, and the lower tips of your shoulder blades stay firmly and comfortably in place on your back.

If you take a quick inventory of your body as you progress with these three easy stretches—the chest opener with the arms clasped behind the back, the upward-facing plank, and the standing stretch near a wall—you’ll notice that the muscles between the shoulder blades and the spine feel broad and lightly toned. Your arms hang easily at your sides with a slight outward rotation, maintaining the feeling of breadth across your upper chest. Your head turns from side to side without difficulty, and you experience greater freedom when you extend your arms to the side and overhead. When your arms are stretched overhead in warrior I, for example, you will feel the inner edges of your shoulder blades release downward as your chest opens. There will be no bunching up of the muscles at the base of your neck. These are all signs of progress, signs that you are dissolving the chronic pain in your upper back and creating space for a more fruitful asana practice.

Written by Doug Keller -  

Doug Keller has a master’s degree in philosophy from Fordham University. His yoga journey includes 14 years of practicing in Siddha Yoga ashrams, intensive training in the Iyengar and Anusara methods, and nearly a decade of teaching in the U.S. and abroad. Asana instruction, essays, and other enlightening information are available on his website. 

HEAL YOUR NECK & SHOULDER PAIN 

Find out how postural awareness and a targeted yoga practice can bring you long-lasting relief from neck and upper back pain.

Like many yoga teachers, I often begin my classes by asking students if there are particular places in their bodies where they feel tension, tightness, or discomfort that they’d like our session to address. The single most common reply is “neck and shoulders.” In fact, neck pain and its associated disorders are much more common than previously believed, according to a task force established by the World Health Organization (WHO). Most people will suffer from neck pain at some point in their lives, the task force reported in the journal Spine in 2008, with some evidence indicating that 10 to 20 percent of adults suffer from chronic or persistent neck pain.

While neck pain sometimes results from trauma—such as an injury from playing sports or whiplash from a car accident—by far the most common cause is stress on muscles and ligaments stemming from poor postural habits, typically related to our computerized, stressful, sedentary lifestyle. One of the most widespread postural problems is forward head posture, a misaligned relationship between the head and the shoulder girdle, where the head protrudes in front of the shoulders and the upper back rounds. This causes the muscles of the neck, shoulders, upper back, and chest to alter their length and efficiency as they struggle to counterbalance the weight of the heavy head against the pull of gravity—with the muscles in the neck and front body becoming tight and short and those in the mid back and the back of the shoulders becoming weak and overstretched.

Typically the muscles complaining in pain in forward head posture are the overworked posterior muscles of the neck, which serve to extend, rotate, and laterally bend the head. These include the suboccipital muscles at the base of the skull; the deep neck extensors, located alongside the cervical vertebral column; and the upper trapezius, which extends down from the base of the skull and the cervical vertebrae, and also serves to move the scapulae (shoulder blades).

The most common cause of neck pain is stress on muscles and ligaments stemming from poor postural habits, which are often related to our computerized, stressful, sedentary lifestyle.

Prolonged postural distortion pulls the scapulae up toward the ears and causes the muscles in the front of the neck and chest—including the sternocleidomastoids, anterior and medial scalenes, and pectoralis major and minor—to tighten and shorten, drawing the head even farther forward and rounding the shoulders. As the chest collapses, the chin juts out to keep the gaze forward, creating further compression in the neck.

Forward head posture can have a number of adverse effects throughout the body. The shortening of muscles in the front of the chest puts pressure on nerves and blood vessels in the arms, which can increase the risk of repetitive stress injuries, such as carpal tunnel syndrome. The elevation and forward movement of the scapula, combined with a weakening of the lower trapezius and supraspinatus, can compromise the shoulder joint, leading to pain and inflammation in the rotator cuff. Forward head posture can also compromise your lower back, because the curve in your lumbar spine may change to offset the shift in your cervical spine. In addition, continual “slumping” compresses the lungs and internal organs, so it’s not surprising that this rounded posture can interfere with proper breathing, circulation, and digestion. Healthy diaphragmatic breathing is difficult if you’re in a slumped position, and shallow “chest breathing” can lead to or exacerbate neck pain because it uses accessory respiratory muscles, especially those around the neck, to lift the chest, which creates compression on the cervical spine.

One of the most pain-producing postural problems is forward head posture, where the head protrudes in front of the shoulders and the upper back rounds.

To determine whether you have forward head posture, try a simple self-test: stand with your back and heels against a wall; if the back of your head doesn’t easily touch the wall, you may have this misalignment and be at increased risk for neck pain. The WHO task force reported that for most people struggling with neck pain, the best strategy is self-care. That’s where yoga comes in. Yoga asks us to pay attention to the many factors that can influence neck and shoulder pain—including our postural habits, body mechanics, thoughts, and emotions—and move with diligence and compassion in the direction of health.

For lasting relief of neck and shoulder pain, it’s essential to bring your postural awareness and yoga practice into daily life. The following set of postures includes three chair-based yoga practices that you can weave into your workday to cultivate proper sitting posture and enhance circulation in the neck, shoulders, and supporting muscles. Two gentle on-the-floor backbends help counteract the effects of forward head posture on the muscles of the back, neck, shoulders, and chest.

3 Poses in a Chair - Seated Mountain Pose

In this well-aligned sitting posture, the head is balanced directly over the shoulder girdle, relieving supporting muscles of the extra burden of holding it up against gravity. Sit tall, with your feet planted firmly on the ground and your sit bones dropping down into the seat of the chair. From this place of grounding, extend the crown of your head up toward the sky, lengthening your spine. Soften your shoulders away from your ears and rest your hands on your thighs. Be sure your chin is parallel to the ground, neither poking up nor tucked in. Imagine that you have a headlight in the center of your chest at your sternum, and shine that light directly forward. Relax your face. With a soft gaze and smiling eyes, look toward the horizon. You might visualize yourself resting your head back against a supportive headrest. If someone looked at you from the side, they’d see your ear directly over your shoulder, and your shoulder directly over your hip.

Angel Wings with Circles

Geared toward enhancing circulation in the shoulders and upper back, this posture helps free the scapulae, which are suspended by a network of muscles and ligaments that attach to the neck and upper spine.

From seated mountain pose, extend your arms forward; then bend your elbows and place your fingertips on your shoulders. On an inhalation, open your elbows out to the sides as you draw your shoulder blades together in the back of your body; imagine that you have a nut on your spine and your shoulder blades are moving together like a nutcracker to squeeze it. On an exhalation, bring your elbows forward and together, as you feel your shoulder blades sliding apart in back of your body. Continue for 3 to 6 breaths.

Then, keeping your fingers resting lightly on your shoulders, imagine that your elbows are felt-tipped markers, and draw large ovals in the air with them. Keep the breath slow and easy as you circle in one direction for 3 to 5 breaths and then reverse direction for 3 to 5 more breaths.

Ear to Shoulder

This posture helps stretch muscles that are involved in rotating and tilting your head, including the scalenes and upper trapezius, which often become extremely painful and sore in people who sit at a desk for long periods.

From seated mountain pose, reach your arms behind you and clasp your elbows with your opposite hands. Then release your right hand and place it on your right thigh, with your left hand holding your right arm just above the inside of the elbow. Inhale as you lengthen the crown of your head toward the sky; then exhale and release your right ear down toward your right shoulder, trying not to lift the shoulder toward the ear. Drop your left shoulder down and breathe into the left side of your neck. Stay here for several breaths, then exhale and gently rotate your head so that your nose moves toward your right shoulder.

Inhale and rotate your head the other way so that your nose moves toward the sky.

Continue for a few breaths, synchronizing your movement with your breath. Then relax, release your arms, and let your head float back over the shoulder girdle, crown lifting to the sky. Repeat on the other side.

2 Poses On the Floor - Baby Cobra

Unlike other variations of bhujangasana, in which the arms can help raise the back, this version requires the back muscles to do all the work. As a result, this pose helps strengthen many of the muscles that tend to be weakened and stretched by forward head position, including the middle and lower trapezius, latissimus dorsi, rhomboids, and serratus posterior.

Lying on your belly, bring your arms down by your sides, palms facing down, and your chin or your forehead to the floor (you can place a small folded towel under your forehead if you like). Root down through your pubic bone, and press your legs and the tops of your feet down into the earth, lengthening back through your feet. Find your breath. On an inhalation, lift your head, neck, shoulders, and upper back as high as you comfortably can, keeping the hands on the floor. The goal is to create a slight backbend in the upper spine without stressing the low back. On an exhalation, relax everything back down. Continue with this practice, inhaling up and exhaling down for 3 to 6 breaths. For an extra challenge, stay in the lifted pose for several slow, deep breath cycles. Be sure to keep your neck long so that you’re not just cranking your neck up and down but using your back muscles to lift the back and shoulders; imagine that you have an eye in the back of your neck, and try to keep that imaginary eye wide open.

Arm Variation

Clasp your hands behind your back, keeping the elbows soft. On an inhalation—as you lift your back, shoulders, and head—also lift your clasped hands up away from the tailbone and extend your arms back. Allow this action to help draw the shoulders back, and invite the arms to straighten without locking the elbows.

Neck Turn Variation

Each time you relax down on an exhalation, turn your head to one side, being sure to alternate sides.

Restorative Backbend

This pose can be particularly soothing after a day behind the desk since it stretches the muscles in the front of the shoulders and chest that tend to get short and tight in forward head posture—particularly the front of the deltoids, subclavius, and pectoralis major and minor.

Place a block underneath one end of a bolster so that the bolster rests at a slant. Sitting on the floor with bent knees, bring your sacrum against the lower portion of the bolster and ease yourself back into a comfortable reclining position, arms resting at your sides, palms up. Feel free to cover your eyes with a cloth or a small pillow and use additional blankets, if necessary, to support your head. Set a timer for 5 to 15 minutes, then turn your attention inward, allowing your breath and gravity to help the pose deepen and unfold.

Bringing Your Yoga into Daily Life

The best strategy for people struggling with neck pain is self-care.

Remember, good posture is not just something reserved for yoga class; it can offer profound healing when practiced off the mat, too. Try integrating yoga into your daily life by noticing what’s happening physically, energetically, mentally, and emotionally throughout your day. While you’re at your desk, plan to take a 30-second break every hour to check your posture and watch your breath. After a restroom break, try a few rounds of angel wings and ear-to-shoulder stretches. With awareness and practice, you can find profound relief from neck and shoulder pain, cultivating lasting balance.

This article was written in consultation with Matthew J. Taylor, PT, PhD, immediate past president of the International Association of Yoga Therapists. Portions adapted from Healing Yoga for Neck and Shoulder Pain: Easy, Effective Practices for Releasing Tension and Relieving Pain by Carol Krucoff (New Harbinger, 2010). Carol Krucoff, E-RYT 500, is a yoga therapist at Duke Integrative Medicine in Durham, North Carolina, co-director of the Therapeutic Yoga for Seniors teacher training, and author of Healing Yoga for Neck and Shoulder Pain. 

YOGA FOR PAIN RELIEF

There are few things more frustrating to a person with chronic pain than hearing someone say, “Your pain is all in your mind.” But if you’re one of the estimated 50 to 75 million Americans living with chronic pain, these words might actually be the key to relieving your suffering. Chronic pain is in the mind—but this does not mean what you think it means. The experience of pain is real. Pain has a biological basis. It’s just that the source of pain isn’t limited to where one feels it or thinks it is coming from.

Modern science and yoga agree: our present pain and suffering have their roots in our past pain, trauma, stress, loss, and illness.

For decades, scientists and doctors thought that pain could be caused only by damage to the structure of the body. They looked for the source of chronic pain in bulging spinal discs, muscle injuries, and infections. More recent research, however, points to a second source of chronic pain: the very real biology of your thoughts, emotions, expectations, and memories. Most chronic pain has its roots in a physical injury or illness, but it is sustained by how that initial trauma changes not just the body but also the mind-body relationship.

The complexity of chronic pain is actually good news. It means that trying to fix the body with surgeries, pain medications, or physical therapy is not your only hope. By first understanding chronic pain as a mind-body experience and then using yoga’s toolbox of healing practices—including breathing exercises and restorative poses—you can find true relief from pain and begin to reclaim your life.

The Protective Pain Response

Understanding the difference between acute pain and chronic pain will be critical to your ability to reduce and manage your pain. Let’s begin by examining the basic steps of the pain response: sensation, stress, and suffering.

The protective pain response begins when the body experiences some physical threat, such as a cut, a burn, or an inflamed muscle. This threat is detected by specialized nerves and sent through the spinal cord and up to the brain where, among other things, the threat signals are transformed into pain sensations. Emotion-processing areas of the brain also get the message, triggering a wide range of reactions, from fear to anger. Combined, your thoughts and emotions about the physical sensations of pain make up the suffering component of the full pain experience.

To help you take action, the threat signals have been simultaneously routed to the areas of your brain that help the body launch an emergency stress response, coordinating the actions of the nervous system, endocrine system, and immune system. The emergency stress response triggers a cascade of physiological changes that give you the energy and focus to protect yourself from life-threatening danger.

Even after the threat is gone, the pain response is not over. The mind and body are very interested in making sure you know how to protect yourself from this threat in the future. So the nervous system begins the process of learning from this experience. Any kind of injury or illness, even one that is short-lived or appears to be fully healed, can change the way the nervous system processes pain.

Understanding Chronic Pain

Chronic pain differs from acute pain in three important ways. First, the body can become more sensitive to threat, sending threat signals to the brain even when the threat is minor or non-existent. Second, the brain can become more likely to interpret situations as threatening and sensations as painful, producing pain responses that are out of proportion to any real danger. Finally, with repeated pain experiences, the boundaries between the many aspects of the pain response—sensation, suffering, and stress—get blurred. In most cases of chronic pain, the mind and body have learned all too well how to detect the slightest hint of a threat and mount a full protective response in all its glory.

So the things that make pain so effective at helping us survive acute emergencies and handling short-term pain are the very things that make chronic pain so complex and persistent. The pain you feel may reflect a protective mind-body response that has become overprotective.

Pain Again

Why does past pain make you more sensitive to future pain? You can thank one of the great wonders of our nervous system: its ability to learn in response to experience. This ability is called neuroplasticity. Through the repeated experience of pain, the nervous system gets better at detecting threat and producing the protective pain response. So unfortunately, in the case of chronic pain, learning from experience and getting “better” at pain paradoxically means more pain, not less.

Both modern science and yoga share this idea: present pain and suffering have their roots in past pain, trauma, stress, loss, and illness. Modern science uses words like neuroplasticity to describe the process of learning from past experiences; yoga uses the word samskara. Samskaras are the memories of the body and mind that influence how we experience the present moment. Samskaras keep you stuck, feeling the same emotions, thinking the same thoughts, and even experiencing the same pain.

The best way to unlearn chronic stress and pain responses is to give the mind and body healthier responses to practice.

Samskaras do not always lead to suffering—they also lead to positive change. Just as trauma, illness, pain, and stress leave traces on the body and mind, so do positive experiences. What you practice, you become.

Learning is lifelong, and none of the changes you’ve learned have to be permanent. Neuroplasticity can be harnessed for healing. Your mind and body have learned how to “do” chronic pain, and your job is to teach it something new.

Unlearning Pain Through Relaxation

The best way to unlearn chronic stress and pain responses is to give the mind and body healthier responses to practice.

By helping you transform chronic pain-and-stress responses into “chronic healing” responses of mind and body, yoga helps reduce your suffering of chronic pain. Your mind and body have built-in healing responses that are just as powerful as their protective pain-and-stress responses. Whether it’s a meditation on gratitude, a relaxation pose that puts the body and mind at ease, or a breathing exercise that strengthens the flow of energy in your body—they all share the benefit of bringing you back home to your natural sense of well-being.

Relaxation specifically has been shown to be healing for chronic pain. It turns off the stress response and directs the body’s energy to growth, repair, immune function, digestion, and other self-nurturing processes. The relaxation response unravels the mind-body samskaras that contribute to pain and provides the foundation for healing habits. Consistent relaxation practice teaches the mind and body how to rest in a sense of safety rather than chronic emergency. Below, we will look at a breathing practice and several restorative yoga poses that promote the relaxation response.

Breathing the Whole Body

Breathing the body is a visualization practice adapted from the traditional practice of yoga nidra (yogic sleep) and the body-scan practice taught in Jon Kabat-Zinn’s mindfulness-based stress reduction program for people with chronic pain. Start in any comfortable relaxation pose such as savasana (corpse pose). Place your hands on your belly and feel the movement of the breath. Notice the belly rising and falling, and notice the breath moving in and out of your body. Direct the breath right at the sensations of discomfort. Imagine that the breath is dissolving the tension and pain.

In this practice, you will imagine that you can inhale and exhale through different parts of your body—as if your nostrils were moved to that part of the body. Start with your feet. Imagine the breath entering your body through the soles of your feet, and exiting your body through the soles of your feet. Notice any sensations there. Feel, or imagine, that flow of energy in the feet as you breathe. Now repeat this visualization for other parts of your body: Your lower legs, knees, and upper legs. Your hips, lower back, middle back, and upper back. Your belly and chest. Your shoulders, upper arms, elbows, lower arms, hands. Your neck. Your forehead and the crown of your head.

When you get to an area that feels tense, uncomfortable, or painful, don’t skip it. There are several things you can try that may make you feel more comfortable. First, stay with the visualization and direct the breath right at the sensations of discomfort or pain. Imagine that the breath is dissolving or massaging the tension and pain. Imagine the solidity of the tension or pain softening. Find the space inside the pain. Second, try moving your attention back and forth between the uncomfortable area and a more comfortable area. For a few breaths, breathe into the painful area; for the next few breaths, breathe into another area. Switching back and forth like this can teach the mind how to give the uncomfortable sensations less priority. You are practicing a healthy kind of distraction: intentionally shifting your focus while still being present in your body.

When you have worked your way through the whole body, let yourself feel the breath enter the body through your nose, mouth, and throat. Imagine the sensation of breathing through your whole body, as if the body were gently expanding as you inhale and contracting as you exhale. Feel, or imagine, the flow of energy through your whole body.

A Restorative Yoga Routine for Chronic Pain

Restorative yoga turns on the healing relaxation response by combining gentle yoga poses with conscious breathing. Below you will learn four restorative yoga poses that may be practiced on their own or in a sequence.

There are several factors that make restorative yoga so relaxing. First, each pose is meant to be held for longer than a few breaths. You can stay in a restorative pose for 10 minutes or even longer. The stillness allows the body to drop even the deepest layers of tension. Second, restorative poses use props to support your body. Props can include the wall, a chair, a couch, pillows, blankets, towels, or bolsters designed especially for restorative yoga practice. The right support in a pose will make it feel effortless, so your body can fully let go.

You shouldn’t feel strong sensations of stretch or strength the way you might in a more active yoga pose. Stretching and strengthening, although healthy, are both forms of tension in the body. They are a kind of good stress on the body, asking the body to adapt to the challenges of a pose. But restorative yoga is all about letting go of tension and stress.

Although these poses may look as though you are doing nothing, this is far from the truth. Restorative yoga rests the body but engages the mind. The breathing elements of each pose make restorative yoga an active process of focusing the mind on healing thoughts, sensations, and emotions.

The order of poses presented here is just one possible sequence. As you explore the poses, you may find that your body prefers a different sequence or that you would rather stay longer in one pose than practice several poses for shorter periods. You can also integrate restorative poses into an active yoga session.

Nesting Pose

Nesting pose creates a sense of security and nurturing. It may also be a position you are comfortable sleeping in, making it an excellent posture to practice if you have insomnia or other difficulty sleeping.

Lie on your side, legs bent and drawn in toward your belly. Rest your head on a pillow, and place a pillow or a bolster between your knees. Rest your arms in whatever position feels most comfortable. If available, another bolster or pillow may be placed behind your back for an extra sense of support.

Rest in the natural rhythm of your breath, observing each inhalation and exhalation as it moves through the body. Take comfort in the simplicity and effortlessness of this action.

Supported Bound Angle Pose

This pose relaxes tension in the belly, chest, and shoulders that otherwise can restrict the breath. Lean a bolster on a block or other support (such as telephone books). Sit in front of the bolster with your legs in a diamond shape. Place a pillow or a rolled blanket under each outer thigh and knee, making sure that the legs are fully supported without a deep stretch or strain in the knees, legs, or hips. Lean back onto the bolster so that you are supported from the lower back to the back of the head. Rest your arms wherever is most comfortable.

Now notice the whole front of your body relax and gently open as you inhale. Follow this sensation and feel the ease in the front of the body as you breathe.

Supported Backbend Pose

Supported backbend is a heart-opening pose that reinforces your desire to embrace life and not let challenges—including pain—separate you from life. This pose also works magic to release chronic tension in the back and shoulders, undoing postural habits that come from spending too much time at a desk, at a computer, or driving.

Sitting, place a bolster or a stack of pillows or blankets under slightly bent knees. Place one folded pillow or rolled blanket or towel behind you; when you lie back, it should support the upper rib cage, not the lower back. If you need extra support underneath the lower rib cage and lower back, roll a small towel to support the natural curve of the spine. Place a rolled towel or a small blanket to support your head and neck at whatever height is most comfortable.

This pose improves the flow of the breath in the upper chest, rib cage, and belly. Allow yourself to feel this movement as you inhale and exhale. Imagine breathing in and out through your heart center. Visualize the movement of breath from your heart to your lungs as you inhale, and from the lungs back out through the heart center as you exhale.

Supported Forward Bend

This pose relaxes the hips and back, unraveling the stress of daily activities on the spine. Hugging a bolster and resting your head on its support provides a natural sense of security and comfort.

Sit cross-legged on the floor. Lean forward onto the support of a sofa, a chair, or a stack of pillows, blankets, or cushions. If you have a bolster, place one end in your lap and the other end on the sofa, the chair, or the stack of support. Rest your head on whatever support is available. If you are using the bolster, you can hug it in any way that feels comfortable, turning your head to the side. Be sure that whatever support you are using is high enough and sturdy enough to support you, without creating strain in the back or hips. If you feel a strong stretch that is uncomfortable to hold, you need more support.

In this pose, the belly, chest, and back all expand and contract with each breath. Feel the movement of the whole torso as you inhale and exhale. Feel your belly and chest gently press into the support of the bolster or pillows as you inhale. Let the sensation of your breath deepen the sensation of being hugged.

These simple relaxation practices will lead you on the path of ending your suffering. Yoga can teach you how to focus your mind to change your experience of physical pain. It can give you back the sense of safety, control, and courage that you need to move past your experience of chronic pain.

Adapted with permission by New Harbinger Publications, Inc. from Yoga for Pain Relief by Kelly McGonigal, PhD. ©2009 Kelly McGonigal. McGonigal, PhD, teaches yoga, meditation and psychology at Stanford University. She is the editor in chief of the International Journal of Yoga Therapy, as well as the author of Yoga for Pain Relief and The Willpower Instinct.

Diaphragmatic Breathing in 3 Key Yoga Poses 

If you’d like to deepen your practice of asana, pranayama, and meditation, learning diaphragmatic breathing is the key to success. 

Breath training is an integral part of yoga as well as a means of creating a more balanced, healthy lifestyle. Practicing relaxed, diaphragmatic breathing is refreshing and restful, and creates a sense of well-being. It calms the nervous system, helps prevent psychosomatic disturbances, including panic episodes, and centers attention. Because we are always breathing, breath awareness is a self-management tool that is useful even during the busiest times of the day.

For students of yoga, breath training is an indispensable preparation for the proper performance of asana and pranayama and for deepening meditation. It involves learning to recognize the sensations that accompany diaphragmatic breathing and gradually becoming accustomed to breathing deeply and smoothly.

Anatomy of the Breath

It surprises many people to learn that the lungs are not muscles. Without help, they cannot move air in and out of the body. This fact lies at the heart of breath instruction: Questions about how to breathe are really questions about which muscles to use in order to expand the lungs and draw air into them.

We have choices regarding the muscles we use for breathing. The muscles of the neck and upper torso, by themselves, have a relatively minor effect on breathing. Breathing with these muscles alone results in bringing in air in small amounts. The isolated use of these muscles for breathing, called clavicular breathing, is most commonly seen in people who have lung illnesses, such as emphysema, that limit their ability to draw a deep breath.

The bands of muscle (the intercostal muscles) that lie between the ribs account for about 20% of normal breathing. Because these muscles surround the lungs, it might seem natural to breathe with them. In fact, after strenuous exercise nothing is more satisfying than to breathe deeply with the mouth open and the chest heaving. But in normal circumstances, chest or thoracic breathing is considerably less dramatic—the ribs simply rise and fall with the inhalation and the exhalation.

Although there is a certain logic to breathing with the chest muscles—that is where the lungs are, after all—it is not helpful to use these muscles as the primary tool for everyday breathing. Breathing primarily with the chest muscles makes breathing too labored. The effect is to arouse the sympathetic nervous system and to maintain levels of tension that sap energy and dramatically increase your susceptibility to emotional disturbances. Overusing the chest muscles for breathing is a subtle but major cause of physical and emotional distress.