From Pain to Possibility: How Yoga Teachers Can Support Students with Chronic Pain

The Impact of Chronic Pain: From Economics to Your Classroom

Chronic pain’s economic burden is more than $700 billion dollars a year in the United States alone. Between the cost of health care and lost productivity in chronic pain patients, the burden is greater than heart disease and cancer combined. Most importantly, it can be debilitating for those living with it. People living with pain are at a higher risk of suicide, divorce, mental health conditions, isolation, and financial struggles. Pain creates this burden because it is complex and we don’t treat it easily. Managing your own pain or working with students with chronic pain can feel daunting.  Thankfully, using yoga to work with pain that persists can be an extremely effective tool. While we know that the systems that produce pain are not straightforward, using yoga to work with pain can be as simple as using familiar techniques with a few adjustments. Yoga’s efficacy in both pain management and improving pain can hinge on the approach you take in a yoga class. 

At any given time, approximately 20% of people in North America live with chronic pain. This means that as a yoga teacher, you likely already have people in your yoga classes who are managing chronic pain. This number may be much higher depending on the age, socioeconomic status, race, and gender breakdowns in your classes. Given this reality, it is both practical and responsible to create classes that are not only accessible but also supportive for people living with pain. It allows yoga teachers to help alleviate the burden of pain for both individuals and for our health care systems.

Before we dive in, it is important to note the difference between a yoga teacher and a yoga therapist.  A yoga therapist is trained to work with individuals and small groups to help manage health conditions, whereas a yoga teacher is not trained to teach or design classes to treat specific conditions. While this is the case, through mindful language, trauma and pain-informed approaches, and simple interoceptive-centered practices, yoga classes can become environments that foster positive change for people with chronic pain.

How can we understand chronic pain in the context of yoga? 

Chronic pain is multifaceted and is often studied and treated through a biopsychosocial model. Current research tells us that pain is a predictive output by the brain. This output is shaped by our history, genetics, current circumstances, immune function, and many other factors. This explains why we can experience pain both acute (short-term) and chronic (typically 3 months or longer) even when there is little to no tissue damage or, in some cases, without tissue at all (such as with phantom limb pain). 

Chronic pain, sometimes referred to as persistent pain, is defined this way by the International Association for the Study of Pain:

Pain is further broken down into three categories:

Nociceptive Pain can be associated with tissue damage or disease.  Nociceptive pain is how most of us typically think of pain. This is the type of pain we usually experience with broken bones, cuts, or post-surgery. This understanding of pain is problematic, though, as pain is much more complex than merely the result of tissue damage or disease. In a yoga class, you might encounter nociceptive pain in a student who pushes a backbend too far, tears a hamstring, or damages their rotator cuff.

Neuropathic Pain is often caused by damage or irritation of nerves. It is often characterized by burning, tingling, or electrical-type pain. This can be caused by diseases like diabetes, neurological conditions like M.S.,  compression of the nerves from spinal cord injuries, or chemical injuries like chemotherapy-induced neuropathy. In a yoga class, you might encounter neuropathic pain in a student who has recently had chemotherapy, has diabetes, or has an existing back injury like spinal stenosis.

Nociplastic Pain is the third and most recent category of pain. It is sometimes referred to by the term pain system hypersensitivity. The term plastic means changing or adapting.  This is an adaptive sensitization of the pain system. Receptors in the tissues can become more reactive or sensitized, the brain becomes more protective, and our ability to modulate pain becomes compromised. This can also affect the immune system and can lead to increased inflammation in the body. Nociplastic pain is often categorized by widespread pain, like with fibromyalgia, or persistent conditions like some chronic headaches or migraines.  

People with this type of pain are often told their pain is “all in their head”. This is not imagined pain; rather, it is changes in how the pain system functions, making it more effective at producing pain. In a yoga class, you might encounter nociplastic pain in a student who has widespread body pain that is made worse unpredictably or while doing simple postures that are unlikely to create tissue damage. 

The application of these three categories is not always clear.  Pain that begins as nociceptive or neuropathic can change and adapt our nervous system and brain over time, resulting in a sensitization of the pain system. This means that much of chronic pain develops into a mixed pain type. Now, not only are we dealing with pain as a biopsychosocial condition, we are also working with pain that is changing the way the brain, nervous system, and immune system function.

The adaptation and sensitization of the brain and nervous system can: 

• alter proprioception (our sense of where we are in space)
• affect interoception (our ability to accurately feel our body), 
• create fear around movement, 
• change our autonomic nervous system, making it harder to downregulate.  

Here are three things we can do when teaching yoga to help people dealing with chronic or persistent pain:

1. Create an accessible atmosphere and approach for students navigating chronic pain. It can help people with chronic pain feel confident to approach movement through the lens of safety. By using practices that encourage curiosity and exploration in our yoga classes, we can help students learn to re-regulate their autonomic nervous system. Permission and agency can activate our parasympathetic (rest-and-digest) nervous system, calming the protective response. Teaching students to down-regulate and explore movement can reconnect them with their bodies without increasing pain. Curiosity fosters a non-judgmental relationship where the goal is not a particular shape but rather an interest in sensation, movement, and experience.
2. Reintroduce students to subtle sensations. Pain is a blunt form of communication. With a loud and persistent voice, it can overpower other bodily cues and sensations. In all of that noise, subtlety is lost. Pain’s unpleasant nature can create a sense of overwhelm, which is often met with a desire to check out and become distracted from the body. This can create a pain-dominant relationship in which the body and the brain become a potential danger-surveillance system – constantly vigilant for threats.  The brain takes in information and interprets much of it as dangerous, whether or not it actually is. The output of this is unpleasant and protective- pain, fear, guarding, anxiety, etc. Because of this, the brain can misinterpret what is happening in the body, causing harmless movement to create more pain. The brain and nervous system err on the side of caution, and, over time, people navigating pain become attuned to danger signals and are unable to feel neutral or pleasant sensations. Yoga can introduce a new response for a brain that has adapted to protect.
   
   Neutral and pleasant sensations can be (re)introduced through yoga practice, specifically, through somatic inquiry.  Designing a class that provides opportunities to feel the breath, softness, ease, release, relaxation, temperature, lightness, and other sensations introduces novelty paired with safety to a brain that hyperfocuses on protection.  This approach reminds the brain to check back into subtlety rather than just the bluntness of the pain and the danger-monitoring it has become accustomed to.
3. Provide option-rich classes without placing value on one option being better than the other. Gradual, supported movement can reduce fear-avoidance behaviors and help restore confidence. Rather than pushing toward goals or ideal shapes, movement becomes a process of listening, responding, and adapting.

Through repetition, these experiences can begin to reshape neural patterns. The nervous system learns that movement can be safe, and the brain reduces its protective outputs.

Yoga, when approached with curiosity, playfulness, and permission to explore and feel with an open, non-judgmental mind, gives practitioners an opportunity to begin reshaping their relationship with their body. Essential in this approach is agency to choose, space, and permission to say no or bow out of practices, and options to adapt practices to fit their needs. A slow, gentle introduction to movement can reduce fear and avoidance behaviors and help people trust their body and their ability to move again. 

Beyond the potential benefits of yoga practice, one of the most positive outcomes for people navigating pain is the connection to a community of curious, relaxed participants. Pain can be isolating, and yoga can bind us back into relationship.  

In this way, yoga supports students navigating chronic pain not just through movement and awareness but also through the relationships they build with other practitioners. It helps restore a sense of belonging, safety, and possibility with the body, mind, and community.  Yoga teachers, classes, and communities can become havens for students navigating pain. There is a huge opportunity to reshape common perceptions of yoga from a practice that prioritizes flexibility and fitness to a space that can address one of the largest health challenges we face across the world.