Back pain is one of the most common reasons people seek help—and one of the areas where our understanding has changed dramatically. For yoga teachers and therapists, this raises an important question: what are we actually trying to understand when someone says, “My back hurts”?
Pain is real. But pain is not simply a matter of tissue damage.
We can have pain without obvious injury, and we can have changes in our tissues without experiencing pain. This is particularly relevant to back pain, where findings such as disc bulges, disc degeneration and arthritic changes are common—even in people who have no pain at all. The relationship between what we see in the tissues and what a person experiences is therefore much more complex than we might initially think.
Pain is also influenced by the nervous system, previous experiences, expectations, emotions, attention, stress, movement and our sense of safety. When pain persists, the nervous system can become more sensitive, and movements or situations that were previously harmless can begin to feel threatening. Fear of movement can then lead to avoidance, reduced confidence and reduced activity, potentially reinforcing the cycle.
This does not mean that pain is “all in the mind”. This is never a helpful approach. Pain is a genuine experience involving the whole person. Understanding this can help us move beyond the idea that we simply need to find the “damaged” structure and fix it.
For yoga teachers and therapists, this opens interesting and exciting possibilities.
- How can we use movement, breath, attention, awareness and relaxation to help someone feel safer in their body?
- How can we encourage movement without reinforcing fear?
- How should we respond when a student says, “I can’t do that because it will damage my back”?
- And when should back pain be referred for further medical assessment?
Exploring these questions through contemporary understandings of pain and back pain is part of our workshop on Sunday 18th October. We will look at the difference between nociception and pain, why pain can persist after tissues have healed, how the brain and nervous system contribute to the experience of pain, and how our beliefs and expectations can influence recovery.
Most importantly, we will consider how this understanding can inform practical, compassionate and empowering approaches to working with people with back pain.
If you teach or work therapeutically with people, understanding pain can change what you teach and how you see the person in front of you.
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