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Having just come back to the real world after my splendid retreat in Puglia, Italy, I am already planning to be back in Puglia this summer planning my 2013 retreats there. Yoga in Italy might just be in your future after you read what my guests from this year's retreat at Trullo Solari wrote:
“Sara was great and her selection of this location was excellent.” “I highly recommend Trullo Solari to anyone who truly wants peace and quiet . . . It is truly a paradise!!” “I had a wonderful time! The setting was lovely: beautiful and comfortable.” “Sara is a great instructor, and it was nice to be able to practice indoors and out. Classes were a good mix of breathing, stretching, and strength.” “The food was stupendous—abundant and perfect.” “Having three vegetarian meals a day was great. I thought I would miss having meat, but I did not.” “Sara is helpful with all things related to yoga, and to have her undivided attention was best of all! I would definitely attend one of her retreats in the future!” And if you need more incentive to make a yoga retreat your next vacation, read this [sadly, the link for the article I wrote is no longer live. Note to self: Always download a PDF of externally-hosted writing!].
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Why is it that most yoga teachers believe that spinal flexion helps alleviate back pain? Let's explore.
What is spinal flexion? Flexion of the spine occurs when your rib cage rounds closer to your pelvis or thighs. In most yoga classes, flexion is achieved by performing common Forward Folds, such as Balasana (child's pose), Uttanasana (standing forward fold), and Paschimottanasana (seated forward fold). However, there is no anatomical support for yoga teachers' choice to put students with low back pain immediately into a forward-folding position. For those of you taking my Yoga without Back Pain series who'd like to practice at home, here are the asanas we have covered so far. Thanks to your fellow student Shauna for asking that I send out the list.
By the way, you'll each get a complete list of the pranayama, meditations, and asana that we've practiced after the fourth class, so make sure I get your e-mail address for that. And now, the asana from lessons 1 and 2: [Performing all with bandhas engaged] Tadasana (mountain pose) Vrksasana (tree pose) Utthita hasta padangusthasana (standing big-toe pose) Natarajasana (dancer) Salabhasana (locust) Dhanurasana (bow pose) "Moving" cow pose Upavistha Konasana (seated wide-angle pose) Savasana Virabhadrasana II (warrior II) Trikonasana (triangle) Tadasana Dwi Pada Pitham (two-legged table) Apanasana (the "vital air" pose, with legs crossed over) Jathara Parivrtti (belly twist, with legs extended) Savasana Remember to practice with excellent spinal posture, deep and full breathing, and your bandhas engaged, and these should feel great! See you next week . . . As you know, I love to talk about the mind-body connection and how we can use our minds to our advantage in every realm of life. One of the leaders in this arena is Kelly McGonigal, PhD. She is also a yoga teacher, so I love her approach and her dedication to relieving people's pain. Be aware, though: If you watch her segment on Yoga for Back Pain, two of the four moves she advises doing are not usually good for low-back-pain. If you've been my client or taken any of my Yoga without Back Pain classes, you know exactly which moves I am talking about! Most yoga teachers make the same mistake McGonigal has made. That reality was the inspiration behind my posting of "why yoga classes can make back pain worse" on my YouTube channel. My functional fitness background continues to serve me well as I delve deeper and deeper into the worlds of yoga and back-pain management . . . Jonah Lehrer, author of the new book Imagine: How Creativity Works, recently wrote a fantastic piece for Wired magazine called, "Trials and Errors: Why Science is Failing Us."
The entire article is worth a quiet, concentrated perusal. The section of greatest interest to readers of this blog may well be the section on back pain. Lehrer discusses the oft-documented finding that vertebral disc damage (such as herniation and bulging discs) is not correlated with pain. Medical journals have been reporting these results for more than a decade, yet physicians have continued to use MRIs and x-rays to "diagnose" back-pain patients with disc damage--even when that diagnosis does nothing to explain the pain a patient is experiencing or guide their treatment. For a succinct yet descriptive blog post about the region in Italy where I and a few lucky guests will enjoy my Spring 2012 Yoga Retreat, this year-old post by Tina Ferrari takes the cake.
Puglia as a region is "the most beautiful in Italy," according to my Italian teacher, and "untouched by mass tourism," as Ms. Ferrari reveals. Beauty, tranquility, and a luxurious traditional trullo that only our small group will share? What better place to turn inward as we explore yoga asana (postures), pranayama (breathing), and meditation. The best part about the region and our trip there? The food is amazing, as illustrated by Helen Graves's blog post about cibo pugliese (the food of Puglia) on her Food Stories blog. There's still time to join us next spring! Why deprive yourself any longer? This piece by Elizabeth Landau on CNN.com is a beautiful account of how mindfulness can change the shape of both physical and emotional pain.
Back pain is the type of pain that I see and work with most frequently in my events and classes. When a person is experiencing pain--or is accustomed to feeling pain--the mind runs amok with negative thinking. Whether it be anxiety, depression, blame, shame, or the anger that Monty Reed (in Landau's piece) describes, those negative emotions actually cause pain to increase or intensify. Judging yourself for having a particular feeling or emotion, or believing you are victimized and disempowered, can cause anyone's back to hurt! This brilliant TED talk (posted below) by Dr. Brene Brown of the University of Houston Graduate College of Social Work reveals such important truths about our world today. Every single point that her research (and personal experience) reveals leads us to the importance of vulnerability in everyday life. Vulnerability is not honored in our society. In fact, it is condemned. But, as Dr. Brown so beautifully describes, we can't live authentic lives or have truly loving relationships without being vulnerable. Yoga is the ultimate means for experiencing vulnerability--just think about how insecure and judgmental we feel when we're in any balance pose! Embracing that vulnerability, that uncertainty, and leaning into it opens up whole new worlds of emotion that a controlled, invulnerable, fearful life doesn't allow: Love, Joy, Gratitude, and Worthiness. I hope you'll join me on the mat for some ecstatic vulnerability soon! Now, enjoy the video. HealthDay News just posted a brief review of recent research published in the Journal of Pain by Leong, Kano, & Johansen that shows a connection between spousal communication and physical pain.
The topic of this study supports my whole existence as a back-care and yoga practitioner. Part of what makes my work so effective is my unwavering validation of my clients' emotions and lived experience. In graduate school, I focused my study on the methods of interpersonal communication that foster trust, respect, and partnership when one party is facing difficult life changes or emotional upheaval. Unfortunately, most couples have not completed such communication training. So when one spouse is in pain, the pain-free spouse is inadequately trained to actually help the other feel supported and "heard." Yet, that emotional support is crucial to the healing process. Without such emotional support, people can cope very poorly with pain and, in fact, hold on to pain for decades . . . or a lifetime. I'm so happy to read major peer-reviewed medical journals are publishing this type of psycho-social-medical research. Pain research has typically been focused on medications (which are more addictive than they are effective) and surgical interventions (which are shown to be less effective than just about any other pain treatment over the long-term). We all know someone who has tried yoga in order to alleviate their aching back, neck, hips, or shoulders. Yoga has become such a common--and successful--method for addressing orthopedic issues that doctors are even recommending it to their patients.
Dr. Loren Fishman, a physiatrist in New York, is one such physician. This summer, The New York Times featured Dr. Fishman's use of yoga with his orthopedic clients. I applaud the author, Jane E. Brody, for dedicating a large segment of the piece to rotator cuff injuries. Having coached all type of fitness and back-pain client, I have dealt with many such injuries. In fact, the vast majority of people over the age of 50 have some sort of tear in one of the rotator cuff muscles. These tears are normal, are not likely to cause lasting pain, and will not be resolved by surgical means--but surgeons frequently cut away at the shoulder anyway. I'm encouraged that doctors like Fishman are actually using yoga to solve such structural issues. I've seen similar results with my own clients, for all manner of joint pain. One statement in the article with which I do take issue, however, is the final sentence of Brody's piece. I'd get rid of the phrase "medical guidance" and instead say "Seek the guidance of a highly-specialized fitness or yoga practitioner." Because we are not licensed medical practitioners, we are not able to prescribe you addictive pain pills, expensive injections, and unnecessary surgeries that won't relieve your pain. We are required by the restrictions of our profession to deal with the two things that actually will make a difference in how your body feels: The physical structure (bone, muscle, joints) that you carry around, and the mind with which you control that physical structure. Click here to read Brody's piece. Dr. Nortin Hadler and Dr. John Sarno were interviewed on The People's Pharmacy to discuss their vast body of research about the mind's implication in the experience of back pain.
Having worked with clients with back, knee, ankle, foot, shoulder, neck, and generalized pain, I can attest to the power of the mind in the treatment of pain--above and beyond physical treatment modalities. This body-mind connection is the rationale behind my work with clients, which always includes a wellness coaching component. I realized that, while I could train back-pain clients to do back- and core-strength exercises very effectively and relieve their pain within minutes of working with them, a handful of my students had their pain return (or move around) despite continuing their prescribed exercises with perfect execution. I learned very quickly that the mind can have unbounded control over the body's experience of pain. So much so that people with back pain undergo surgery, injections, manipulations, and astronomical medical bills trying to alleviate their pain, and nothing works. The simple reason is that for some chronic pain sufferers, the physical body is not the source of the lingering pain. Drs. Hadler and Sarno have written and presented brilliantly on the power of the mind to create and alleviate back pain. I highly recommend all of their books, most recently Dr. Nortin Hadler's Stabbed in the Back and Dr. John Sarno's The Divided Mind. (If you're in the U.S., I recommend using the Indie Store's bookstore finder to locate a local bookstore from which to buy these books, rather than ordering from a big-name store. Here's the link. Listen to Dr. Hadler's brilliant interview.  This article I wrote for Wellness & Fitness Entrepreneur in October 2006 is timeless. The content applies not only to helping professionals like fitness trainers, yoga teachers, nurses, doctors, and anyone else who cares for other people’s bodies, minds, and spirits. It applies to all of us who wish to live a full, contented life free from guilt, blame, and emotional exhaustion. One of the things my coaching clients present most often is issues related to caring for themselves when they feel they “should” be caring for everyone else first. In the article, I explain how our own wellness/priorities must come first, or we eventually suffer the consequences. I hope you find it a valuable read. 
The PDF viewing window in my website editor is not working properly. If you click on the Adobe symbol or file name, above, you can download and read a PDF of the original article.
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Sara Hauber
Coach, listener, observer, and sometimes teacher; constantly curious student of life. Former back-pain expert with a back full of metal and a heart overflowing with Love. 
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