Yoga and Science in Pain Care - The Transformative Learning Potential
By: Paula Reeves, MA, MS, C-IAYT, E-RYT
By: Paula Reeves, MA, MS, C-IAYT, E-RYT
Estimated reading time: 11 minutes
This blog post is the 4th of a series based on the Yoga and Science in Pain Care book club series, a 15-part course based on the book by the same title, by Neil Pearson, Shelly Prosko, and Marlysa Sullivan. You can find the blogs corresponding to Chapter 1 here and Chapter 2 here, and Chapter 3 here.
Introduction - Yoga and Science in Pain Care Chapter 4
Chapter 4 of Yoga and Science in Pain Care: Treating the Person in Pain collectively written by the editors of the book, Shelly Prosko, Neil Pearson, and Marlysa Sullivan, serves as a concise survey of yoga and defines yoga, explains pain and suffering from a yoga perspective, provides the International Association of Yoga Therapists’ definition of yoga therapy, and briefly surveys the history of yoga and the various paths of yoga for both health professional and their clients/patients to consider when integrating yoga in pain care.
The following post was inspired after reading Chapter 4 and completing the corresponding training available through Embodia’s online learning platform in which each author shares their recommendations and suggestions for applying the principles of yoga and yoga philosophy when working with clients and patients living with persistent pain.
When we think about pain and pain care, most of us don’t immediately associate pain care with a learning experience.
Health practitioners and patients alike have been conditioned to look at pain as something to manage or resolve using medications, invasive surgery, physical therapy, and cautionary preventative measures. Healing has been a dependent experience, one in which patients rely on medical experts to provide instructions on what to do, how to do it, and when to do it.
Patients typically have not been “allowed” to think independently or given the tools to educate, empower, and transform themselves in the face of injury, diagnosis, healing, and persistent pain.
My personal pain experience is evidence of this.
My personal experience
Twenty years ago, I was in a near-fatal car accident and suffered a cervical spine fracture, concussion, collapsed lung, and a meniscus tear to my right knee.
I spent three days in the Intensive Care Unit in a medically induced coma. I woke up surrounded by the people who loved me the most on all sides of the hospital bed, touching me and speaking and smiling at me.
I remember hearing their voices as I watched their mouths move, but I comprehended nothing. I was too overwhelmed by a deep sensation of sorrow mixed with confusion as to why I survived. My mind was jumbled and unable to process the gravity of where I was, how I got there, and where I was going.
Upon discharge a few days later, I was given prescriptions for pain medication and physical therapy. They wheeled me out of the building with my neck and right knee both in braces. On the drive home, I felt helpless. I had no idea how or if my body was going to heal.
Despite what seemed like an abundance of care and support coming from the hospital staff and my family and friends, I could not shake the brokenness, shame, and extreme disappointment I was feeling inside.
For the next several weeks and months, I took the pain medication as prescribed and completed the recommended physical therapy sessions. Although I did as directed by my doctors and therapists, I continued experiencing pain and discomfort in my head and neck and progressively lost partial mobility in my right knee over the course of the next 8 years. During that stretch of time, I elected to have arthroscopic knee surgery. Prior to the operation, the physician explained there was a small 1% chance that the procedure would not be effective.
Well, lucky me, I was a member of THAT 1%.
At the time, I was living in Denver, Colorado along the foothills of the Rockies, one of the top locations for outdoor activities and adventure sports, including hiking, biking, trail running, kayaking, skiing, snowboarding, etc. You name it, and the beautiful state of Colorado delivered it. But I could not partake in the smorgasbord of fun (at least that’s what my mind was telling me).
I mostly watched from the sidelines, frustrated by my body’s limitations. And like most humans who have been conditioned to succumb to hopelessness rather than gracefully challenge it, I buried my grief and focused on things that did not rely on my physical body, like attending graduate school.
I studied non-profit management, adult education, and communication because I was working as an education program director for a small nonprofit in Denver that brought education opportunities to felons and ex-felons living in a community corrections facility, more commonly referred to as a halfway house. I taught GED, ABE, and life skills and wanted to learn as much as I could in hopes of helping my students and the communities in which they would hopefully live and thrive one day.
Before doing this work, I took my education opportunities for granted and was unaware of the connection between education and crime. I had no idea that felons who sought education opportunities while incarcerated, like earning their high school diploma or gaining some type of certification, reduced the likelihood of reoffending once released. This reduction in recidivism not only positively impacts the individual’s life, but also has the potential to positively impact the communities in which they live and work.
Education is a win-win for everyone.
While attending graduate school, I was able to glean a clearer understanding of why a person’s education level plays such a large part in decreasing their likelihood of committing or recommitting a crime: when we move through the process of learning something new, we activate our brain’s cognitive thinking channels, which increases our executive thinking skills, which results in better decision-making from a place of self-control and increased metacognition – the awareness of one’s thought processes when contemplating a decision.
When we continuously choose to learn new things and remain curious to keep learning new things, we continue to increase our self-control and metacognition.
Seems so simple.
But I was still left scratching my head and questioning the idea that learning automatically leads to increased self-awareness.
I certainly did not feel more self-aware and in control of my thoughts and actions, and I had experienced lots of formal and informal education opportunities up to that point in my life. I failed to view myself as an example of being an educated human with a heightened state of self-awareness that led me to make better decisions and increased my ability to weigh right from wrong. From where I stood, I was making some terrible decisions, and no amount of learning new things seemed to help me make better ones.
Then I stumbled upon the theory of Transformative Learning developed in the 1970s by Jack Mezirow, an American sociologist.
Mezirow describes transformative learning as “learning that transforms problematic frames of reference to make them more inclusive, discriminating, reflective, open, and emotionally able to change.”
Transformative learning shifts mindsets, unlike common, everyday non-transformative learning in which knowledge is acquired over time and conditions individual behavior, good or bad, as best described by behavioral psychologist Pavlov. So it seems, up to that point, I was learning, processing, and subconsciously picking and choosing new information that already aligned with my conditioned beliefs. I was not being transformed by the act of learning.
If transformative learning is supposed to work in tandem with conditioned beliefs to shift an individual’s worldview, why was my worldview not shifting? Why were my conditioned beliefs not getting shaken up?
According to Mezirow, an individual must first experience what he coins a disorienting dilemma before the cycle of transformative learning can begin. A disorienting dilemma is that experience, thought, or feeling that’s so uncomfortable and causes us so much suffering that we either deteriorate from it or we surrender to it and allow it to shake us out of our zombie-like state, propelling us forward on a path of transformation to include the following steps:
- Self-Examination of beliefs and how they correlate to the disorienting dilemma
- Critical Assessment of assumptions and acquired knowledge
- Recognition of Shared Experiences with others who have been faced with similar challenges
- Exploring Options for New Behavior to include new roles, relationships, and actions to explore
- Planning a Course of Action to help maintain the momentum of learning and shifting perspectives
- Acquisition of Knowledge by putting a plan in place and learning new skills
- Trying New Roles by experimenting with and actively applying and testing the impact of newly acquired skills
- Building Confidence grows over time along with increased self-awareness
- Reintegration of our new self with the entirety of our environment and relationships
Still, after studying and eventually earning my degree, I was unable to clearly see and measure transformative learning in my life. Despite having experienced many of my own disorienting dilemmas, the least of which was the acute trauma and chronic pain resulting from my car accident at age 30, none of them seemed to rattle me enough and redirect me down the road of transformation.
After finishing graduate school, it would be another five years before yoga and I discovered each other. A single 90-minute session in a neighborhood yoga studio blossomed into a daily asana practice. Within a few months of settling into a physical practice, I became interested in the history of yoga. The more I practiced and learned, the more connections and similarities I began to see between Mezirow’s theory and yoga principles.
Yoga and Transformative Learning
Through self-study and acquiring basic knowledge of yoga and its principles, similar to what is shared in Chapter 4 of Yoga and Science in Pain Care, and expounded upon in the online training, I began to understand how holding onto my conditioned beliefs and rushing away from the discomfort of my disorienting dilemmas caused a bulging dam of unnecessary pain and suffering.
The first time I realized this was while in a group class holding a posture I disliked holding (but I held it nonetheless) and experiencing simultaneous releases of pressure and pain in my body and mind. I distinctly remember the moment, because I felt a pop and release of pressure in my right knee and almost instantly started to cry. I could not stop crying until I suddenly found myself smiling and laughing. These emotions and sensations freely flowed through me without being obstructed. It was liberating and euphoric and something I had not experienced prior.
What an absolute gift I was given, and all it took was a little patience with my body and a suspension of disbelief in my head for less than 60 seconds.
From that experience, I propelled myself down a path to becoming a yoga teacher and ultimately earned a master of science degree in yoga therapy.
Not only did yoga, especially the eight limbs of the raja yoga with an emphasis on the yamas and niyamas, seem to perfectly complement what I had learned about transformative learning, studying yoga therapy as a profession – its scope and approach – also helped me understand why my personal transformative learning experience seemed so elusive and out of reach for all those years.
Yoga and Yoga Therapy
I had been operating from a powerful conditioned belief that my conditioned beliefs could not be altered, leaving me stuck inside the genetics, behavioral patterns, and ancestral trauma I was born into.
I was in a perpetual state of disbelief and continuously rushing past the discomfort of each disorienting dilemma I encountered. I was not allowing myself to sit with the cognitive dissonance of the disorienting dilemmas, because I was convinced no amount of contemplation and self-examination would boost my confidence or change my perspectives. So I avoided those things. Besides, I lacked patience, too. Before yoga, I would dabble in contemplative practices for a few days only to prove to myself that contemplative practices did not work for me. I expected instant results and progress from what I now understand is a process requiring a long-term commitment – certainly more than the 21 days touted as being the minimal length of time necessary to practice a new behavior before it becomes a habit.
(Side note - Realistically, you can change a habit in as little as one day, like cold-turkey quitting smoking or drinking alcohol, but quitting alone doesn’t transform your conditioned beliefs about why you smoked and drank in the first place. Plus, this type of “blind” quitting leaves the door wide open to welcome smoking and drinking back into your life.)
Changing a habit alone does not transform you.
If all you do is change a behavior in the absence of critical contemplation and self-examination of that changed behavior, you simply create more fertile ground for your conditioned and dogmatic beliefs to run amok in your life.
Something more than a change in habit or behavior is necessary to dismantle conditioned beliefs and create fresh and less restrictive beliefs. That something is what I like to call a pair of instigators, which include one internal instigator (yourself) encouraging a shift in thinking and a second external instigator (someone else) validating and reinforcing you with compassion and empathy.
From my perspective, a dedicated yoga therapist makes a great external instigator.
The yoga therapy relationship encourages behavior change, knowledge acquisition, and the self-inquiry and examination necessary to move through the cycle of transformative learning.
As Shelly Prosko expounds in the supplemental training for chapter 4, the yamas and niyamas of raja yoga can be used to inform the direction and focus of yoga therapy sessions in the best interest of the client’s goals and preferences. I would also add that the very presence of a well-trained and compassionate yoga therapist acts as an external instigator validating the client’s internal desire to shift their mindset and transform their pain and suffering.
For example, a client may come into a session with a learned, conditioned belief that certain movements of their spine could damage them or cause them pain. Instead of viewing these beliefs as limitations, a yoga therapist can harness the opportunity and create a safe space for their client to explore that particular belief with a carefully crafted sequence of asana, breath work, and self-reflective, guided inquiry. The client may still experience discomfort and resistance, but with the yoga therapist’s presence, the client is more likely to move through the discomfort of this disorienting dilemma while allowing themselves to experience the empowering delights of ahimsa (non-harming), svadhyaya (self-study), and satya (truthfulness) in action.
When we offer yoga and yoga therapy to our clients and patients, we simultaneously grant them permission to trust themselves and be an integral part of their healing process. They shift from being dependent learners who look to the teacher to provide all instruction and guidance, to being independent, self-guided learners who use a facilitator for initial direction and occasional guidance and course correction.
As yoga therapists, we create the space and opportunity to simultaneously facilitate healing and learning, in particular, the transformative learning potential of yoga and its many paths to healing. Not only does this represent and require a mindset shift for health and well-being practitioners to find harmony between evidence-based medicine (EBM) and an evidence-informed practice (EIP) as alluded to in part 2 of this series, it also allows a mindset shift for the patient/client who is now free to demonstrate and practice personal autonomy and agency, neither of which have been historically encouraged within healthcare environments.
As yoga professionals working in pain care, the better our understanding of the incredible mental and emotional force necessary to break through a disorienting dilemma blocked by an ocean of conditioned beliefs, the more likely we are to show up for our clients and patients with the compassion, patience, and acceptance they are unable to grant themselves.
After all, if behavior change seems tough to most, the idea of transformation on all levels of being is absolutely daunting to those of who have never experienced it. Fortunately, the panca maya kosha model—the physical, subtle/energetic, mental, emotional, and spiritual layers symbiotically communicating and existing within each of us—reminds us that “we can affect any aspect of our existence through any aspect of our existence,” as Pearson succinctly states in the training. Armed with this type of understanding, a yoga therapist may be exactly what someone needs to keep them on the path of transformative learning regardless of the particular yoga practices or paths with which they choose to experiment.
“Truth is one. Paths are many.”
- Book: Yoga and Science in Pain Care: Treating the Person in Pain (Pearson et al., 2019)
- Online Course: Yoga and Science in Pain Care Chapter 4 - Yoga and Yoga Therapy
- Christie, M., Carey, M., Robertson, A., & Grainger, P. (2015). Putting transformative learning theory into practice. Australian Journal of Adult Learning, 55(1), 10-30.
- Mezirow, J. (2009). Transformative learning theory. In J. Mezirow, and E. W. Taylor (Eds), Transformative Learning in Practise: Insights from Community.
- Zoukis, C. (2015). College for convicts. McFarland and Company.
Date published: 7 July 2023
Last update: 7 July 2023
MA, MS, C-IAYT, E-RYT
Paula has been practicing, studying, and teaching yoga for over a decade. She is a registered teacher (RYT-500) by Yoga Alliance and a certified yoga therapist (C-IAYT) by the International Association of Yoga Therapists.
She holds a master of science degree in yoga therapy from Maryland University of Integrative Health, Laurel, Maryland, and a master of arts degree in communication and adult education from Regis University, Denver, Colorado. Paula founded Love Travels Yoga & Wellness in 2022.
Her mission as a mind-body health practitioner is to 1) embody the principles of yoga and yoga therapy and 2) share what she learns and experiences from yoga. She absolutely believes we are each “destined to heal”, and yoga can serve as a trusted blueprint along the journey. In addition to yoga, Paula also enjoys a professional career as a mentor, educator, content strategist, and program manager/director, spanning decades and sectors, including higher education, government contracting, and the travel industry.
Marlysa is a physiotherapist and yoga therapist with over 15 years of experience working with people suffering with chronic pain conditions. She is an Assistant Professor in Yoga Therapy and Integrative Health Sciences at Maryland University of Integrative Health and holds an adjunct position at Emory University, where she teaches the integration of yoga and mindfulness into physical therapy practice in the DPT program. She is also the author of Understanding Yoga Therapy: Applied Philosophy and Science for Well-being and co-editor of Yoga and Science in Pain Care: Treating the Person in Pain as well as several peer-reviewed articles.
Marlysa has been involved in the professionalization of the field of yoga therapy through the educational standards committee of IAYT, which helped to define the competencies for the field, and in characterizing the yoga therapy workforce through research. Her research interests focus on defining the framework and explanatory model for yoga therapy based on philosophical and neurophysiological perspectives.
PT, C-IAYT, PCAYT
Shelly is a physiotherapist, yoga therapist, educator, author and pioneer of PhysioYoga who has been integrating yoga into physiotherapy since 1998 with a focus on chronic pain, pelvic health, compassion in healthcare and professional burnout. She guest lectures at numerous yoga therapy and physiotherapy schools, presents at yoga and medical conferences globally, contributes to academic research and writing, provides mentorship to professionals, and offers courses and resources for yoga and healthcare practitioners and the general population. Shelly is a Pain Care Aware Lead Trainer.
She considers herself a lifelong student and emphasizes the immense value gained from clinical experience and learning from the patients she serves, the professionals she teaches, and the colleagues with which she collaborates.
Shelly has written several book chapters in yoga therapy and integrative rehabilitation textbooks and is co-editor/author of Yoga and Science in Pain Care: Treating the Person in Pain. She maintains a clinical practice in Sylvan Lake, Alberta, Canada and believes compassion is the foundation of healthcare and overall well-being.
Learn more about Shelly’s work at www.physioyoga.ca to learn more
PT, MSc(RHBS), BA-BPHE, C-IAYT, ERYT500
Neil is a physical therapist, yoga therapist, author, researcher, Clinical Associate Professor at the University of British Columbia, faculty in three IAYT-accredited yoga therapy programs, board member for the International Association of Yoga Therapists and pain care advocate. He conducts research into the effects of yoga on veterans with chronic pain and people with osteoarthritis. Neil is the recipient of awards honouring his work in pain care, patient education and physiotherapy by Queen’s University, the Canadian Pain Society and both provincial and national physiotherapy associations, including the Canadian 2021 Medal of Distinction.
Neil is a consultant to Partners in Canadian Veterans Rehabilitation Services, and to Lifemark’s 300+ clinics in Canada. Neil is a past board member for Pain BC, Canada’s premier non-profit transforming the way pain is understood and treated. He co-authored – Yoga and Science in Pain Care 2019, authored the patient education ebook, Understand Pain Live Well Again in 2008, and is lead contributor to many free patient resources offer by Pain BC.
For more information and course offerings, see www.paincareaware.com