The Flexibility of Yoga

Portions of this blog are from an interview with Dustienne Miller. Dustienne is the creator of the two-day course Yoga for Pelvic Pain. She passionately believes in the integration of physical therapy and yoga in a holistic model of care, helping individuals navigate through pelvic pain and incontinence to live a healthy and pain-free life. 

Have you noticed when you are afraid or don’t want to feel something you hold your breath? Imagine what it's like to have daily pain that limits function and how that could impact rib cage, abdominal and pelvic floor expansion. Dustienne Miller discusses this in her remote course, Yoga for Pelvic Pain, upcoming on July 31 - August 1, 2021. Her course focuses on two of the eight limbs of Patanjali’s eightfold path: pranayama (breathing) and asana (postures) and how they can be applied for patients who have hip, back, and pelvic pain. 

Dustienne explains "We teach our patients how breathing patterns inform our digestion, our spine, our emotional state, our pelvic floor, etc. It’s one of the most powerful tools we have to inform our system that we are safe. Despite this knowledge, we will often find ourselves holding our breath or breathing in non-optimal ways without even realizing it." Dustienne focuses her practice on introducing yoga to patients within the medical model. Yoga can be included in pelvic rehabilitation in so many ways, including incorporating yoga home programs as therapeutic exercise and neuromuscular re-education (both between visits and after discharge). 

Pelvic conditions that can be positively impacted by yoga are interstitial cystitis/painful bladder syndrome, vulvar pain, coccydynia, hip pain, and pudendal neuralgia. Treatment for these conditions often involves an individualized approach that may include both pharmacologic therapies (prescription drugs, analgesics, and NSAIDs) and nonpharmacologic interventions such as exercise, muscle strength training, cognitive behavioral therapy, movement/body awareness practices, massage, acupuncture, and nutrition.

A systematic review of the 2017 clinical practice guidelines evaluated 14 randomized controlled trials and found that yoga was associated with lower pain scores (1). Similarly, in 2020 there was a review of 25 randomized controlled trials that examined the effects of yoga on back pain. Out of these trials, 20 studies reported positive outcomes in pain, psychological distress, and energy (2).

The great thing about yoga is that the asanas (postures) can be modified to accommodate your strength, experience, and health conditions. An example of this is the Downward Facing Dog pose. There are so many ways to made Downward Facing Dog work for your body. Use straps, the wall, or the plinth/countertop to provide support for your body as needed, which might look different each day.

Some folks think you need to be flexible to have a yoga practice. Dustienne stresses "What is necessary is to be flexible with understanding that every day might feel different. If you are in an active pain flare your practice will look different than on the days you are feeling better. That can be a challenging aspect of a mindful practice - embracing that every day is different. Have the courage not to judge yourself, but to celebrate that you are meeting your needs with kindness."

People have been doing yoga for thousands of years. It is a mind-body and exercise practice that combines breath control, meditation, and movements to stretch and strengthen muscles. Join Dustienne Miller in Yoga for Pelvic Pain on July 31 - August 1, 2021, to learn more about incorporating yoga into your clinical practice. 

No prior experience with teaching yoga is required to attend the course. However, all participants must possess a working knowledge of pelvic pain conditions and foundational rehabilitation principles. 

1.  Chou R, Deyo R, Friedly J, et al. Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians clinical practice guideline. Ann Intern Med. 2017; 166(7):493-505.
2.  Park J, Krause-Parello CA, Barnes CM. A narrative review of movement-based mind-body interventions: effects of yoga, tai chi, and qigong for back pain patients. Holist Nurs Pract. 2020;34(1):3-23.