“Le cœur a ses raisons que la raison ne connaît point”. The heart has the reason which the mind does not understand. So follows, our bodies store memories that our mind does not always understand. In the event one finds oneself becoming aware of an imbalance in their physical, energetic and mental bodies, how does one facilitate the healing process in order to return to wholeness? Does one seek an allopathic physician, choose an “alternative” practitioner or work with several?
A story I have heard from clients several times in my practice, “I have seen physicians and alternative practitioners and nothing seems to help alleviate my symptoms of pain.” The experience, investment and time to visit several practitioners can be a frustrating experience for client. Often they feel not heard and invalidated by the testing processes. Sometimes something works and a change occurs for the client and they experience less symptomology and less pain. How does this happen after many failed attempts? What is the solution to treating complex symptomology often referred to as chronic pain?
Chronic pain is pain experienced over three months. It is often associated with other symptomology such as trauma, anxiety, insomnia and depression. In early March, I was driving to the airport listening to NPR and Dr. Ajay Wasan, a pain doctor, was being interviewed and he stated that whether it is acetaminophen, opioids, acupuncture, cannabis or other forms of treatment the results are usually 20-30% effective dependent on the patient. In other words, a patient has to try several modalities until they find what works for them (Shapiro). No wonder patients get frustrated, it a little like rolling the dice. Additionally, types of physical therapy, occupational therapy and movement therapies such as yoga therapy were not included in the discussion. “Researchers found that yoga was as effective as standard physical therapy for treating moderate to severe chronic low back pain in people in underserved communities (Hicklin)”.
The 20-30% effective rate really struck me to step back and reflect on what truly helps my clients? As I reviewed the clients I have worked on who have chronic pain, some common threads from client’s feedback emerged. Integrity of the practitioner and an ability to listen and show up. In other words, the importance of relationship between practitioner and client. In fact, I have experienced clients with chronic pain needing supportive relationships to heal. Conversely, isolation is impactful on a client’s well-being. Studies show isolation in adolescence can lead to more addiction (Author Unknown). Another study correlated loneliness and increase in depression and sleep deprivation in elderly (Choi). A third studied showed “Studies on breast cancer survivors also suggest that those who feel lonelier experience more pain, symptoms of depression, and fatigue (Jaremka)”.
As a practitioner of 22 years, one of the most important pieces I bring is commitment to my client’s healing process. A willingness to listen and be supportive in their process while offering a healthy mirroring to help find our way through the “dark night of the soul”. I am curious if the 20-30% effective rate stated by Dr. Wasan would increase with an inclusivity of the social relationship or if indeed it is the relationships that triggers the effectiveness rate. My experience validates that a willingness to relate to our clients maybe one of the most important tools in our tool box. I don’t believe anyone tool is better than another, no matter how much research we can site to validate our own opinion as practitioner. The research is helpful in eliminating ineffective tools or may point us in a more practical treatment protocol. With this in mind, how do we show up for our clients as a practitioner to improve outcomes?
In my experience, showing up means doing our own healing work and continuing to receive work. In receiving body work we maintain an awareness of how we treat our clients. Then bringing this awareness in our mirroring process to our clients. We can only facilitate what we have experienced ourselves.
In the following exercises, I am drawing upon my background in working with the fascial body. My sense of working with trauma is that the fascial body responds in unison with limbic system to triggers and are fascial body has memory of past experiences of trauma. For example, a simple e-mail or phone call may put you in a fight or flight response pattern if you grew up in unstable household. Our nervous system maps a response based on our own history of patterning. Often practitioners are not aware of the impact of the sensory nerves on our response patterning. The sensory nerves (a.k.a. mechanoreceptors) are sensitive to slow stretch response, vibration, rapid change in pressure and sustained pressure. The fascial net, superficial fascia, is highly innervated with the sensory nerves. The exercises invite the sympathetic to “switch off” and parasympathetic to “switch on” via the sensory nerve input.
Here are some simple exercises for practitioners and clients can somatically tune in on a daily basis to manage their triggers and pain. They are meant to be simple and attainable for those experience chronic pain. These can be done individually or together as a sequence depending on how much time you have to practice.
1. Body Scan-Lay on the ground on your back as in Corpse pose, bend your knees if you have low back discomfort, and begin noticing your breath for a few minutes. Then bring your awareness to your feet and notice any sensations. Take the time to make your way up your whole body noticing sensations as you maintain awareness on your breath. When you come to your head shift to breathing into skin of the whole body. Then send your breath just beyond your skin into the energetic body. Then notice the space around you, the ground supporting you, the edges of the room, the ceiling above while breathing to skin and sending your energy to the edges of the room. This should take between 5-10 minutes. Finish by bringing your awareness to skin sensation and breathing.
2. Exhale Sounding (Ahhh)-Breath in through the nose and gently open the mouth to make “Ahhh” sound for 3 to 5 repetitions. The process will release tension stored in the body and open the throat chakra.
3. Yawn Stretch (Pandiculation)-Reach your arms over head while laying on your back on the floor and stretch from side to side yawning and focusing on exhalation.
4. Wiggle-While laying on your back on floor wiggle and shake out any tension. Our fascial body loves wiggling.
5. Sacral Torsion-On your back, reach your thumbs to measure either side of your pubic bone. The side that is superior (higher toward your head) will be the side you will lay on your side. For example, if left side is superior, roll onto your left side and bring your knees up as in reclining child’s pose. Drop your top ankle behind the bottom foot and slightly underneath. Use the top foot to resist the bottom foot as you take an exhale and press the bottom foot towards the sky for 3 to 5 seconds. Repeat 3 times. Then roll back on to your back and measure the pubic bone to see if they are level horizontally. If not repeat to the higher side and recheck.
6. Meditation in Corpse Pose-Lying on the ground face up, tuck your shoulder blades into neutral, feel your hip bones become heavy, allow your shoulders to sink into to the earth, soften your jaw bone and breath into to skin. Allow 5 minutes for a reset.
Relationships imply a level of commitment in listening, presence and mirroring. It is an honor and gift to be able to offer presence in relating to our clients. Through tuning in to the fascial body we can offer a little more space for healing.
Kirstie Bender Segarra, PhD, LMT, RMTI, E-RYT, C-IAYT is a practitioner of Structural Integration, Doctor of Integrative Medicine and Structural Yoga Therapist. She teaches full time at the University of New Mexico-Taos and maintains and private practice at drkirstie.com.
Shapiro, Ari (March 9, 2018) Pain Specialist Doctor Discusses Different Ways to Treat Chronic Pain Retrieved From
Unknown Author, Socially Isolated Rats are More Vulnerable to Addiction, Report Researchers (Jan. 23, 2013) retrieved on March 21, 2018 https://news.utexas.edu/2013/01/23/socially-isolated-rats-are-more-vulnerable-to-addiction-report-researchers
Choi H, Irwin MR and Cho HJ Impact of social isolation onf behavioral health in elderly: Systematic review World J Psychiatry. 2015 Dec 22; 5(4): 432–438.
Published online 2015 Dec 22. doi: 10.5498/wjp.v5.i4.432
Retrieved Marc 21, 2018 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4694557/)
Jaremka LM, Andridge RR, Fagundes CP, Alfano CM, Povoski SP, Lipari AM, Agnese DM, Arnold MW, Farrar WB, Yee LD, et al. Pain, depression, and fatigue: loneliness as a longitudinal risk factor. Health Psychol. 2014;33:948–957. [PMC free article] [PubMed] [Ref list]
Jaremka LM, Fagundes CP, Glaser R, Bennett JM, Malarkey WB, Kiecolt-Glaser JK. Loneliness predicts pain, depression, and fatigue: understanding the role of immune dysregulation. Psychoneuroendocrinology. 2013;38:1310–1317. [PMC free article] [PubMed] [Ref list]
Hicklin, Tianna Yoga eases moderate to severe chronic low back pain (June 27, 2017) Retrieved on March 26, 2018 https://www.nih.gov/news-events/nih-research-matters/yoga-eases-moderate-severe-chronic-low-back-pai