Robin Rothenberg, a certified yoga therapist, recommends the following teaching strategies when designing a yoga class for chronic-pain sufferers. Rothenberg designed and taught the classes for a recently published randomized clinical trial of yoga for chronic low back pain (Sherman et al. 2005). This was the first large-scale study to compare the benefits of yoga and traditional exercise for chronic pain. The researchers found that a yoga practice using the following guidelines was more effective than traditional exercise. For the study, each class had a specific focus (such as relaxation, strengthening the hip muscles or customizing a personal practice), and included a question-and-answer period, an opening and closing breathing exercise, five to 12 adapted yoga postures, and a guided deep relaxation.

1. Start with relaxed breathing in a supported position, such as lying down. As you introduce movement, go slowly, and structure the class to include plenty of repetition and rest.

2. Break down complicated classical yoga poses into simple movements and stretches. Individuals with chronic pain may hold tension in many areas of the body, and have many pain triggers. They need the opportunity to explore basic movements that do not cause pain. For example, have students lift and lower one arm, lying on their backs. Ask them to notice where they feel tension: in the neck, shoulder, back? Does one side feel different than the other? What can you do that does not cause pain? Include a few “whole body” poses near the end to help students integrate the isolated movements.

3. Encourage students to explore a movement rather than hold a pose for a long time. Focus on moving in and out of poses with the breath. Rehearsal creates greater ease and confidence, and can reduce the fear of movement so common among individuals with chronic pain.

4. Use props, such as blankets or chairs, to make poses more accessible. This also helps students notice how they chronically hold tension in the body, and how to release it using support.

5.
Know basic principles of yoga alignment, but do not force students with chronic pain into preconceived ideas about what a pose should look like. Look at the student in front of you and what she can do. Be willing to create an intelligent adaptation, and allow different students to practice a pose or movement in different ways.

Resource for adapting yoga poses to individuals:
Kraftsow, G. 1999. Yoga for Wellness. New York: Penguin Arkana.
Resources for using props and support in yoga:
Lasater, J. 1995. Relax & Renew: Restful Yoga for Stressful Times. Berkeley, CA: Rodmell Press.
Iyengar, B.K.S. 2001. Yoga: The Path to Holistic Health. London: Dorling Kindersley.
Sherman, K.J., et al. 2005. Comparing yoga, exercise, and a self-care book for chronic low back pain: A randomized, controlled trial. Annals of Internal Medicine, 143, 849-56.