Mindful Breathing

In an article discussing a study exploring yoga and meditation as a way to manage fibromyalgia symptoms, Janet Hennard (see library) mentions one of the pain responses people have is shallow breathing.  With yoga and meditation, patients learn to control their breathing, mindful breathing.  In the yoga sessions I’ve been taking, the instructor regularly tells us when to breathe, when to exhale, and our motions are coordinated with breathing – a yoga basic.  At the same time, she tells us to pick a sore place and to “breathe into” it.  I breathe into my hips a lot.  I understand the concept of oxygen circulating through the blood and reaching vital areas, so I understand the concept of breathing “into” an area of the body, but I think what we’re really doing it making ourselves conscious of specific pain points, the opposite of what I’ve been doing for several years.  I’ve been studiously ignoring pain points because when I focus on pain, it intensifies.  Instead yoga (and the meditative aspects of it) as a fibro management strategy tells us to focus on the pain and to breathe into it.

This got me thinking about subconscious reactions to pain. In high school, shortly after I started having chronic pain, my mom took me to a holistic doctor.  I don’t remember a lot about it except for one thing:  When I was having an initial consult with the doctor, he mentioned that he’d been watching me, waiting for me to breathe, and I wasn’t.  Of course I was breathing.  I was alive, wasn’t I?  But what he was focusing on was that I didn’t breathe deeply or regularly.  I still find myself holding my breath when I’m stressed.  At work I would regularly remind myself to breathe…. breathe….  When people around me are stressed, I remind them to breathe… breathe…  It helps stress to breathe into it.  It’s not a distant leap to think of breathing into pain points.  Mindful, deep breathing spreads oxygen through your body.  Allowing yourself to acknowledge pain points coordinates breathing with pain reduction.  I’m starting to understand that.  It’s not focusing on the “chronic widespread pain” that the commercials go on about, but about concentrating your breathing and controlling your pain focus.  It’s a compromise between obsessing over your pain and completely sweeping it under the carpet.  Is that called coping?

Self-Defeating Beliefs

Reading about why yoga is considered to be beneficial to relieve fibro symptoms, I came across an article that looks not just at yoga but compares yoga to yoga plus massage therapy (specifically Tui Na, a Chinese “manipulation therapy”), see Da Silva et al in library.  For yoga (“relaxing yogic practice”), they indicate that practicing physical posture, breathing exercises, and relaxation techniques are probably what is beneficial. Seems very straightforward.  However, when they divided their study group so that half of them were only doing the relaxation yoga techniques and half were doing yoga plus massage therapy, things go awry.

The two groups had about the same results at the end of the 8-week study, with those also receiving massage therapy having slightly better results.  Upon followup, however, those with massage therapy had returned very closely to their original baseline pain range. Those without therapy had longer lasting benefit.  This goes against common sense to me. Massage is definitely beneficial – I’ll attest to that.  It was my first therapy when I was first officially diagnosed.  Yoga… I’m still trying to determine the benefit.  But looking at their results, it is very clear.  There is benefit for those with massage, but it is not lasting.

The authors conjecture that this is for one very simple reason.  The subjects became dependent on the massage therapy: “…massage may enhance a patient’s dependence, and if this approach [massage] is incorporated into the patient’s chronic pain behaviors, it may become disabling, because the patient will expect things to be done to him or her and not by him or her” [italics added].  The patients with massage therapy all expressed dissatisfaction at the end of the study.  They go on to mention the need to change patients’ “self-defeating beliefs.”

During the yoga sessions I’ve been attending, this is one of the elements that are addressed while we work out, “self-defeating beliefs.”  We are told to even focus on one problem area, and breathe into it.  Don’t suppress it, acknowledge it, and move on.  If we have thoughts like oh my gosh I think my hips are splitting in half, acknowledge those thoughts and move on.  Breathe into my hips.  The self-defeating beliefs, according to my personal yoga master, is what actually causes our suffering, because we pile negative thoughts on top of our pain.  I can acknowledge the common sense of this approach.

At the same time, I have to go back to the it’s-better-to-ignore-it philosophy too.  While negative thoughts are definitely something for people with fibromyalgia to combat, “self-defeating beliefs” takes it one step further, maybe too far.  There’s a difference.  I’ll have to work on figuring out how to explain that difference and why the phrase annoys me….

Confounding Factors

Think of a pinball machine.  For those of you too young to know the rock opera Tommy, go to Google.  Remember how the little steel ball bearings bounced all around and you couldn’t tell where it was going to go next so it was impossible to know when to make the flipper flappers flap instead of flip and the ball would end up going down the drain and the machine would commiserate or jeer at you, depending on if it was evil or nice?  I think I played pinball once.  For five seconds.  Lost all five balls in that time.

Thinking of the bumpers and the flipper flappers and the grooves in the game which made the ball seemingly randomly bounce around like a bat out of hell, those are confounding factors.  Confounders knock the predictable off track.  You’re pretty sure you know that the bowling ball is going straight at that head pin, but all the sudden it veers right into the gutter.  The spin you unconsciously put on the ball is the confounding factor.

In medicine, confounding factors can take on lots of forms.  One of the most well known confounder is diabetes, which can be a game changer for many other medical conditions.  It can make them unpredictable.  Fibromyalgia is, practically by definition, it’s own confounder.  There are so many variables that it becomes very difficult to understand what makes the symptoms better or worse.  If you don’t change anything in your management strategy, and all the sudden you have a flareup, you are left wondering why it happened?  It was probably a confounder.

The thing is, there can be confounders going the opposite way too.  For example, you change your management strategies for the worse, and you don’t have a flareup!  It’s rare, I admit, but it happens.  Here I sit at work eating a piece of pizza, a bag of Lays oven baked BBQ chips, and a chocolate pudding.  This is not a lunch of champions.  And I’ve been having a chocolate or vanilla pudding pretty close to every day for a couple weeks now.  I’m not pain free, but I’m not flaring either.  Is it the yoga?  Maybe, but the yoga still can hurt quite a bit even as my body gets used to it.  Is it happiness?  Maybe?  Yes, mind can dominate matter.  So the little steel ball bearing in my personal pinball machine is happily, randomly, and perhaps manically bouncing off the rubber bumpers.  Maybe the flipper flappers will work in my favor for once this time.

Next Steps

So here I am at the Dan Abraham Healthy Living Center waiting to have an orientation and tour.  Places like these sort of make me sit back and think, “do I really belong here?”  Everyone seems so fit.  They can sit in chairs with arms without bumping their hips.  I’m not jammed into my seat, but…  They can walk up and down the stairs without holding the rail in case their knee buckles.  They can sit in these chairs for an extended period of time and not have to stretch out to let their joints pop and crackle before they can start to walk. They don’t have that tell-tale stand up and hold their lower back for a moment, then straighten slowly… then move… forward…. but don’t let gravity get you going too fast or you won’t be able to stop and then there you are at the bottom of the stairs looking up at the ceiling thinking, “yep, that was the fast way.”  There’s no doubt I feel out of place and I’ll feel more out of place if I do join this haven of healthy living.  No doubt.  But I do belong here.  I’m not the only one struggling, and others here, despite the outward appearance have all their own struggles too.  Even the slimmest, fittest person in this place probably feels a little out of place now and then.

The fact is, moving is not going to get any easier.

Crossfit worked for a while.  The verdict on yoga is still out.  I’ve decided next step is swimming.  And so here I am preparing the way to cannonball into the pool and doggy paddle from end to end of the pool.   When I get tired of doggy paddling, I’ll froggy paddle, maybe just float, maybe run – I can run in a pool.   Do you suppose they’ll let me cannonball?  I better ask before I sign up.  Could be a deal breaker.

Cello Solos and Hard Rock Bands: Yoga vs Crossfit

Last night after my third yoga class, I commented on Facebook that yoga is really the same as Crossfit but yoga is like playing a violin solo and Crossfit is like being in a hard rock band.  I was wrong.  Yoga is more like playing a cello solo.  Violin solos can get a little wild, and yoga is all about control and smooth breathing, like a cellist.

Really they are two polar opposite techniques trying to achieve the same thing: core strength.  No matter what type of yoga you enjoy, that’s what it’s all about.  For Crossfit, the end result is core strength, but layered with biceps, quads, and six packs.  Yoga revels in quiet inner peace and staying in touch with how each of your individual muscles move and feel.  Crossfit is about loud music, personal bests, and pushing yourself to the limit.  Yoga isn’t supposed to hurt; with Crossfit it’s inevitable.

Since this is all about fibromyalgia, what about that pain?  First, with Crossfit (sticking to bootcamp rather than adding weightlifting), 90% of the pain AFTER working out was muscle pain.  That oh-so-you-think-you’re-an-athlete type pain.  During the workout, the joint pain that I had was largely in the hips and knees.  If I was very careful about how I moved, I didn’t injure those joints.  When I added weightlifting, everything went downhill.  I can definitively say that weightlifting is not good for my personal brand of fibromyalgia.  However, the extreme aerobic conditioning was excellent.

Second, yoga.  I am hoping that it’s too early to make judgments, but the pain in yoga is almost entirely joint pain.  My hands are swelling with wrist flexion exercises.  My hips are literally getting stuck in one position with a tremendous amount of pain.  That pain is lingering well beyond doing the exercises.  Stairs and my knees are in a fight to the death, and even the motion of sitting down in my chair is flaring into 9 out of 10 pain scales for hips, knees, and back.  There is very little muscle pain (which was actually a satisfying pain).  I’ll be modifying some positions to take pressure off my hips.  I’ll need to figure out how to utilize my leg muscles more than my wrists and hands when balancing in some precarious position.  And when they say yoga is not supposed to hurt, it’s worthwhile to note that there are very few motions that don’t hurt, and yoga – at least at this point – is underscoring the pain regular motions create.

I’m not going to stop.  My plan is to get through this research trial and then decide.  My body is not used to slow sustained movements.  I’m hoping it settles in and appreciates all that extra oxygen.

After the yoga study, I plan to jump into a pool and try to learn to swim and see how swimming laps works out.  Going back to bootcamp is definitely an option for next year.  At this moment, while I sit here feeling like I’m sitting on legos, yoga is not on my radar for the future.  Six and a half more weeks to convince me….