Non-Extreme Exercise: Yoga

There are quite a few studies that discuss the effectiveness of yoga for fibromyalgia management (see library).  Yoga fits much more into the type of exercise usually recommended for fibromyalgia, with its deep, regulated breathing techniques and slow, mindful stretching movements.  When done right, people doing yoga break a sweat and can get out of breath, all while holding perfectly still. While yoga is not considered a cardio workout generally (although there may be some yoga methods that would qualify since intensity, duration, and frequency are vital to determining a cardio workout [see “Is Yoga Cardio?” in library]), it builds muscle mass, increases oxygen flow, and improves heart function and flexibility.  These are all things that can help with fibromyalgia management.

On top of what could be considered a cardio workout, yoga combines the psychological component of calming the brain, relaxation.  For fibro patients this means mentally acknowledging stress and pain instead of ignoring it and letting it eat away at the subconscious.

This combination of the physical and psychological seems like it would be the perfect way to combat a disease that has both the physical and psychological intertwined.

Types of Yoga
There are a lot of different styles of yoga (see Yoga Styles in library), my favorite of which is laugh yoga.  Yes, it is a thing, and if you haven’t tried it, google it and give it a shot. It is exactly what it sounds like – a great cardio workout.

As with all types of exercise, it is important for a fibro patient to find a style that is suitable for that patient’s symptoms and abilities.  Equally important is recognizing that every yoga position has modifications, so while flexibility and strength increases so can the difficulty of the poses.

Some yoga styles focus on positions and holding the positions for longer periods of time. Some have series of movements, and the yoga student is led through the series at varying speeds, with emphasis on breathing through the movements (for example Ashtanga or Vinyasa yoga).   Some are strict so the instructors don’t have a lot of freedom; some are the opposite and rely on instructors’ creativity with workouts.

The biggest plus for yoga in terms of managing fibromyalgia, is all this variety.  If one style doesn’t benefit a patient, another may.  I just found out about “adaptive yoga” but have not had a chance to try it.  This is for people with mobility issues.  Some students are even in wheelchairs.  Others sit on chairs instead of the floor.  Positions are adapted to the needs and ability of the student.

Fibro Management
There are three elements of yoga that make it a prime candidate for fibromyalgia management:

  1. Strengthening and flexibility
  2. Breathing
  3. Psychology (Pain and suffering)

Strengthening and flexibility.  While it is possible to look at these as two different things, they are really integral to each other.  For example, when I started the yoga “intervention” (as the instructor calls it) sitting on the floor was a problem for me.  I can get onto the floor, I can get up off the floor, but sitting on the floor for an extended period and breathing, or worse, sitting on the floor in specific poses, made my hips actually lock in place so I couldn’t stay seated, but I couldn’t straighten my legs either.  The result was rolling on the floor in pain.  Very counterproductive.  The solution was to prop my legs up while sitting because first of all, I wasn’t flexible enough to have my knees on the floor, and secondly, I wasn’t strong enough to hold them up.  The strain of holding my muscles in position because I didn’t have the flexibility to relax them was what was causing my hips to lock.   Within the weeks I’ve been doing yoga, I have both increased flexibility and strengthened those muscles so I no longer have to prop my legs.  As an added benefit, this has decreased my bilateral trochanteric bursitis enough that I no longer feel like I need the regular cortisol shots I’ve been getting.  While I’ve always exercised the muscles suggested by a physical therapist who did not want me to get the shots, I think it was the combination of both strengthening and increasing flexibility that has settled this very chronic, very painful condition down to something very manageable.

For fibromyalgia pain, I’m not sure I’ve had the same effect.  There has been a decided increase in tissue swelling, particularly in my hands, wrists, and feet, which is always accompanied by discomfort or downright pain.  There has been an increase in shoulder pain and movement limitations.  Can I say yoga has caused this increase?  Absolutely not, because these are very typical of a fibro flair, and they will pass as always.

However, the combination of strengthening and increasing flexibility seems like a very good way to decrease pain – in the long run, if not in the short run.

Breathing.  One thing that I’ve read several times is that people with fibromyalgia tend to breathe in shallow breaths or unconsciously hold their breath.  I haven’t read about what the physiological connection between shallow breathing and fibromyalgia pain is, but obviously it makes sense.  Athletes train their breathing, and lack of oxygen causes all sorts of problems during sports or exercise.  Does it mean people with fibromyalgia need more air? No.  But people with fibromyalgia probably do need to learn to breathe consciously and deeply, and make it a habit, allowing the oxygenated blood to circulate more freely and deeply.  Whenever I become conscious of my breathing it’s usually because I’m not breathing – usually in times of stress – or because I’m out of breath from some sort of activity.  I’m pretty close to oblivious otherwise.  Since doing yoga, however, I have caught myself not breathing or only taking little gulps of air and reminded myself to breathe, deeply, evenly, slowly.  I am learning to get out of the shallow end of the breathing pool.  Oxygenated blood is a good thing.

Psychology.  Throughout the yoga intervention, we have been told to “breathe into” a painful area.  At first I was really skeptical, because let’s face it, when I breathe, the oxygen is going into my lungs, and I have no control over where the oxygenated blood gets pumped.  However, it’s not really about actually physically breathing into a painful area; it’s allowing yourself to focus on that problem area, explore what the muscles are doing in that area.  This goes against my personal philosophy of ignoring pain and just doing what I want to do.  Instead I’m focusing on a specific pain, even when there are several, and “breathing into” it, and remarkably, that specific pain usually eases up as I go through a yoga workout.  Usually the pains that I focus on are back pains, and since many of the positions that we do work the back muscles so much, it’s very likely that consciously working those muscles (by breathing into them) near the pain I focus on physiologically eases the pain.

There is a psychological component as well, however.  An attitude adjustment.  The type of yoga I have been trying for several weeks now is Forrest yoga, not a commonly known type of yoga, developed by Ana Forrest.   The research study I am participating in is using this type of yoga to see if it is beneficial specifically to individuals with chronic pain (including back pain, joint disorders, balance disorders, etc).  It is a combination of positions that are intended to train the student to be able to focus on specific muscles or problem/painful areas.  It is a method that brings the student into a conscious awareness of his or her body, how movement feels, how simply standing feels, a conscious awareness of how the student is moving or how the student is standing or sitting.  It is a form of meditation, an acknowledgement of pain, weakness, stiffness, and an invitation to go a little bit further.  Whenever talking the group through a move, the instructor always says, “And if you have further to go…” with a suggestion of how to increase the difficulty of the move and a reminder that it is not necessary to go further if you have no more to go.

The instructor regularly talks about our wiser self, and how we should listen to that person. Are we doing more than our wiser selves?  Are we doing less?  Are we falling into traps that our wiser selves would recognize and avoid?  Are our minds falling into old patterns with negative thoughts or by wandering into other places?  This gentle nudging keeps focus on what’s important, the position, the breathing, our goals.

There are, however, a lot of “now that you mention it” moments that I have in class.  My mind is often happily blank when the instructor may say something like, “Be conscious of those thoughts your old self might have, like ‘how much longer do I have to hold this’ or ‘why do we have to do so many repetitions?'”  Those thoughts aren’t usually in my mind at all, so there is a tendency to plant them.  At the same time, she will say something about the sensation in specific muscles with certain moves, and it’s only then that I really notice the pain.  However, the reminder to acknowledge that pain is so completely different psychologically, that it helps for the times when the pain is overwhelming, which it is in certain positions, particularly in the hips and back.  Acknowledge and leave it behind, as opposed to exercise regimens like Crossfit, in which you power through the pain.  There the goal is of utmost importance.

Comparing Crossfit with yoga is the cliche comparing apples and oranges, and having had both experiences now, it is safe to say that they both have very positive benefits.  With Crossfit, however, I have to rule out weightlifting absolutely – at least for me.  It’s the aerobic exercise and pushing beyond what you think you can do that’s the most beneficial. It’s psychologically beneficial too, to realize that you can actually do it.  For yoga, the push is gentler and much quieter.  The strength is in doing so much with so little movement and the calming environment.  Breathing is a struggle in Crossfit – it’s part of yoga.

As with any other exercise group, it is be very necessary to be comfortable in the group.  I heard an add on the radio this morning for an exercise center who promised no “gymtimidation,” so that guy who can balance on his pinky can’t rub it in your nose when you’re struggling to achieve Warrior I without bobbling from side to side.  Support and encouragement are a large component for any kind of exercise, and being in an environment that doesn’t embrace support and encouragement will be detrimental in the long run.

ADDENDUM – January 20, 2017
It has been a month since the last yoga class.  I was diverted by holidays and a tropical vacation and then exhaustion and laziness, and I have not done yoga again until last night. My knees, hips, and back are all falling apart.  It’s frustrating that it takes such a short amount of time for all the benefit of exercise to completely go away and leave me back at what feels like square one.  However, after doing some yoga last night (I didn’t make it through the whole workout), today I have more energy and less pain.  I’d still give my pain a 7 on the relentlessness scale (5-8 on the pain scale), but I feel better.  My head is less murky.  So tonight, again, I’m going to do a little, even if I don’t make it all the way through.  See what happens…