Yoga and Fibromyalgia.
By Shannon Sexton
When Sarah Bates was 42, she could hobble into yoga class on crutches and, later, flip her thin, flexible body upside down into a perfect headstand. The year was 1998; the city, San Francisco. Sarah was inching her way out of a disabling fibromyalgia flare-up that had kept her mostly bed-bound for two years. She was inching out of the illness the way you inch your car forward through fog on a dark night—driving the muffled length of your headlights on faith, hoping that when you get there, you can drive the length of your headlights again.
According to the National Fibromyalgia Association, fibromyalgia (FM) is “a chronic pain illness characterized by widespread musculoskeletal aches, pains, and stiffness, soft tissue tenderness, general fatigue, and sleep disturbances.” Additional symptoms may include irritable bowel and bladder, headaches, restless leg syndrome, cognitive difficulties, skin sensitivities, dizziness, neurological symptoms, and impaired coordination.
Fibromyalgia affects between 2 to 4 percent of the population and most of them are women.
Before the flare-up Sarah was a whirlwind of activity. By preference she worked 16-hour days, paying the bills as a full-time occupational therapist while she pursued a Ph.D. She was bubbly, full of life, determined. Fibromyalgia had mostly been a nuisance in the background.
Then, in January of 1997, while snowshoeing in northern Minnesota, Sarah injured her left knee. Her doctor diagnosed it as a partially torn meniscus and advised her to stay home from work for two weeks to heal. Unfortunately, it wasn’t that simple. The injury triggered FM’s escalating pain cycle, and instead of retreating with time, the pain spread. Sarah’s entire left leg swelled and began to hurt; then her right leg began aching too.
Soon, her body hurt so much she could barely think. Sarah forgot appointments, blanked out mid-sentence, tripped over things. Her doctor told her to stay home from work for six more weeks. But Sarah was stubborn—no injury, no health problem had ever stopped her before.
So instead of resting, she doubled her studying time, gluing herself to the computer night and day. Her symptoms got worse. By May, she couldn’t walk without crutches. Alarmed, the doctor told Sarah that her fibromyalgia had flared out of control. He ordered her off the job and out of graduate school for good. Consumed by searing pain, the woman who loved to work 16-hour days dragged her body into bed and stayed there for nearly two years.
For Sarah, being in bed with a severe FM flare-up was like being pinned down in a moonless, starless field of pain. The field stretched on forever in all directions. Hers was a pain that honored no boundaries—it was like a migraine that had seeped into every muscle, joint, and bone in her body. Light hurt her eyes. Sound shattered her ears. It hurt to move. She was tense, dissociated, exhausted, unable to think. All she could do was stare out her bedside window at the faded, red brick wall of a neighboring building. Her vision seemed cloudy even though there was nothing wrong with her eyes.
One day, it took her an entire hour to drag herself from the bed to the bathroom. When she returned, she looked back, realized she had left the bathroom light on, and burst into tears. Sarah—the straight-A student, the occupational therapist, the professor-to-be—was too tired, too sick, too achy to hobble across the room and turn off a light.
Finally, after years of downplaying the effects of her diagnosis, after years of ignoring her body and living her life above her ears, Sarah admitted to herself that fighting wasn’t working. Depressed, too tired to struggle anymore, she simply gave in. She said: Fine. This is my life right now. Pain. Closing her eyes, she tried to accept her situation. This time, the field of pain, which had been unrelenting for years, changed shape.
The cold, hard ground beneath her began to glow and swell, soften and puff up, and suddenly Sarah was lying on a soft, pink down feather comforter that stretched on for miles. She sank into the field the way you sink your body into shavasana after a long asana practice, releasing every muscle and bone. Then she curled up in the center of the comforter, the center of pain, and for the first time in years Sarah Bates slipped into a deep and dreamless sleep.
Soon after, Sarah says, she “crawled back to yoga.” She had practiced for years before the flare-up but quit when her life got too busy. “But if you have fibromyalgia,” she says, “quitting yoga is not a good idea.” Slowly, Sarah had lost touch with her body and her physical capacity. Her breath became shallow and erratic; her concentration waned. Her sense of wholeness and hope began to slip away; achiness and depression lumbered in. The pain was a whisper at first, then a full-blown siren.
She tried everything—acupuncture, panchakarma treatments, anti-inflammatories—but nothing helped. Now Sarah began to wonder: could yoga slowly reverse the flare-up and get her back on her feet again?
It couldn’t hurt to try. So once a week, Sarah forced herself out of bed, onto crutches, and into her car. It took every ounce of energy to drive across town to a beginner hatha class, and by the time she arrived, she was so exhausted she could barely move. But at least she was taking a step in the right direction. She curled up on a yoga mat under a blanket, listened to the class, and then, like a tortoise, slowly made her way home. For the rest of the week, she stayed in bed.
“I finally had to learn how to stop and be present without having to accomplish anything,” Sarah recalls. “I learned that I could lie in bed, look out my window, and watch the subtle color changes against the brick wall as the light shifted through the day. I came to see the beauty in that old wall—it taught me something about enduring through time…and allowing change.
I learned that if I could go into the very center of my experience, into the very center of pain, instead of trying to escape it, I could find a place of absolute peace.”
Slowly, she began to investigate her body’s abilities and determine what kind of yoga practices she could do within the pain. She could breathe. She could lie in shavasana. She could rest with her legs up the wall. Gradually, the darkness lifted and her vision cleared. Sarah began going to classes two, then three, then four times a week. The rest of the time she stayed in bed. Eventually she could do restorative poses on the floor, then modified asanas on a chair. She was still in pain, but she had learned to work with it instead of against it.
Then Sarah began to practice yoga in her daily life. For the first time in years, she approached her body with mindfulness. She observed which foods, which scents, which movements triggered the pain cycle, and made changes accordingly. She devoured translations of the Yoga Sutra and tried to approach her illness from a yogic viewpoint.
Concepts like vairagya (non-attachment), ahimsa (non-harming), and svadhyaya (self-study) took on new meaning. Gradually and gently, Sarah deepened her hatha yoga and meditation practices. And she got better.
By the fall of 1998, Sarah’s symptoms, including the disabling leg pain, were receding and her strength, flexibility, and endurance had improved. Within two years, she traded her crutches for a cane, and—believe it or not—she graduated from a two-year yoga teacher-training program. By 2001, she started teaching. A year later she tossed away her cane and began walking freely for the first time in over four years.
Today, in Los Angeles, Sarah has a thriving therapeutic yoga practice geared toward people with FM and other forms of chronic pain. Her neuroanatomy background, combined with her personal experience and her love for yoga, have made her a skilled teacher in a barren field. New clients come to her via word-of-mouth. Speaking invitations fall into her lap. Reporters in the FM and yoga communities want to talk to her.
She also trains medical providers, consults with the American Academy of Pain Management, and has just produced the first DVD tailored specifically for people with fibromyalgia and similar disorders.
“People made yoga available to me when I could barely function,” she says. “I want to do the same thing for others.” Sarah bases her yoga classes on her own slow, incremental journey toward healing—that’s why she calls one of her classes “Yoga from the Ground Up.”
“When I’m teaching students with FM,” she explains, “we don’t begin with standing poses. We begin on the mat, lying down, sometimes for months. We do simple things like pavanamuktasana, hugging one knee to the chest, suptabaddhakonasana, reclining bound-angle pose, and lots of breath and body awareness, lots of alignment.
“Once they get the basic concepts we go up to all fours. We do cat and cow, downward dog….Depending on the person, it’s anywhere from six months to two years before I take them up to standing poses, because they’ve got to build enough strength and alignment and body awareness to be ready for them.”
When practiced appropriately, Sarah says, yoga can turn an FM sufferer’s life around. First, the basic breathing, relaxation, and stretching exercises can help coax their nervous system out of crisis mode. Then, the practices help them tune into their bodies and discover what triggers their pain cycle.
“When you’re living with chronic pain, you distance yourself from your body in many ways,” she adds. “It’s so understandable. Who would want to stay connected to a body that hurts all the time?”
But the key to getting out—and staying out—of a fibromyalgia flare-up, she says, is to stop fighting and be still. Once you learn how to be present with the pain, you can find a way out of it—or at least begin to find relief.
Years ago, Sarah remembers thinking: If I accept myself as disabled, I’ll never get well. I’ll be on pain drugs forever. I’ll become one of those addicted pain patients. “Today I know that kind of thinking is a trap,” she says. “What I’ve seen—in myself and in my students—is that the people who are willing to let themselves go way down, just really rest, do a lot of yoga practice, and focus on healing, get better. Depending on the person, it takes one to three years. People who keep fighting, who won’t practice, won’t stop—they never get better.”
When one of Sarah’s students, Jo Ann McKarus, was disabled by a “hideous” FM flare-up in 2001, she suffered from relentless fatigue; stinging, burning, throbbing, and stabbing pains in her muscles; plus spasms, aches, and numbness in various parts of her body. After hearing that a San Francisco yoga teacher had used yoga to recover from an FM flare-up like her own, Jo Ann began to hope that yoga could accomplish something that her pain medication could not.
She contacted Sarah, who led her through three weekly therapeutic yoga sessions for three years. Like Sarah, Jo Ann recovered and no longer needs pain medications to get through the day. She has returned to her psychotherapy practice, and she has enrolled in a Ph.D. program in psychoanalysis. Her yoga practice, she says, has been “an integral component” of her recovery.
Describing the magnitude of her physical pain and inability to function during the 2001 flare-up, Jo Ann says, “On a scale of one to ten, with ten being the worst, I was a ten plus. Now, every once in a while, I will have a little flare-up and the pain gets up to a three, or I will go through a period of fatigue. But none of it makes me unable to function.”
Sarah reports similar improvements and says that her health is the best it has been in seven years. “There is some achiness in the background, a few focal points—my left shoulder, right knee, sometimes my right hip. It drains some of my energy but I can still think and function.” (And, she fails to mention, work 16-hour days again.) Sarah hasn’t had a severe flare-up in a long time and has learned to nip smaller ones in the bud.
“I can pinpoint what starts a flare-up pretty easily now and change it as soon as possible,” she says. She has also designed a daily “flare-proofing” routine to keep them at bay. This includes:
Avoiding repetitive movements and repetitive exercise routines. As Sarah explains, “With fibromyalgia, any pattern of activity or any yoga posture you do too frequently becomes a pain trigger.” That’s why she does seven different asana and vinyasa routines during the week and tries to vary (or avoid) housekeeping chores, computer-related activities, and other repetitive activities.
Walking and running outdoors on alternate days.
Practicing conscious breathing as much as possible.
Following a mostly organic, high-protein diet.
Avoiding potential allergens and toxins such as scented products and chlorinated water.
Trying to rest before she gets tired. “If I wait to rest until I’m tired,” she explains, “I feel like an overtired child that can’t settle down.”
If a flare-up does come along, Sarah determines the trigger (wearing high heels, for example) and stops contributing to it. She also drops all “non-essential activities” immediately, starts to rest as much as possible, and relieves acute pain with restorative yoga, pranayama, meditation, ice packs, and over-the-counter pain medications such as ibuprofen.
“This system works so well that when I had a flare-up in 2004, from the end of May through the start of September, I was able to teach yoga all the way through—plus film and produce the DVD,” Sarah says. “I had pain and fatigue, but never to the point where I could not function. The only symptom that got bad at times was the brain fog. I kept losing my cell phone, but I just had to laugh and trust it to come back, and it always did.”
Life is good, Sarah says—thanks to yoga. Her teaching schedule is booked, and so is her day planner. Plus, she’s got a list of several more DVDs she’d like to produce, workshops she’d like to offer, and year-long yoga research projects she’d like to do. Looking back on the last seven years of her life, on the eve of her 50th birthday, Sarah says, “Yoga has freed me from so much suffering.
It helped me turn fibromyalgia (which was the worst thing in my life, the illness that destroyed my OT career, my chance for a Ph.D., and left me disabled) into the foundation for a whole new life….Yoga has given me a wholeness I never had before, even prior to fibromyalgia. I would not trade the life I have now for the one I had planned. This is better.”
Diagnosing Fibromyalgia
You have been sick for several years but the doctors are stumped. Profound, chronic, widespread body pain and flu-like fatigue keep you in a haze for weeks at a time, but you don’t test positive for any of the obvious illnesses. On any given day you may suffer from throbbing, gnawing, shooting, stabbing, twitching, or burning pains in your muscles, but the pain migrates and the symptoms change. The doctors run a slew of tests—even muscle biopsies—but everything comes back normal.
Your joints ache, too, but additional tests detect no inflammation, no swelling, no damage. And speaking of swelling—sometimes your hands feel clumsy, ballooned. The doctors examine them closely, but they look and feel perfectly normal. Sometimes you experience numbness or tingling in your arms or legs, but extensive neurological tests come back normal, normal, normal. This is not normal. Everything is amplified—the kitchen light is too bright, the TV too loud, your colleague’s perfume overpowering. Cold weather hurts.
Exercise hurts. Stress hurts. Even your lover’s touch is painful. But your symptoms wax and wane. Your pain plays hide-and-seek all over your body. There are days when you can barely get out of bed and days when you feel practically normal. Chances are, it will take you five years to receive a proper diagnosis of fibromyalgia—in part because the illness is so controversial.
There is no laboratory test, no X-ray, no muscle biopsy, no blood test that can pinpoint fibromyalgia; it doesn’t fit the allopathic mold. So even though the American College of Rheumatology (ACR) determined diagnostic criteria for the syndrome about fifteen years ago; even though fibromyalgia affects more people than epilepsy, MS, and rheumatoid arthritis; even though studies show that fibromyalgia can be as disabling as rheumatoid arthritis, many people in the medical community don’t recognize it as a true illness.
Many think it is psychosomatic; others don’t believe it exists at all. Some physicians (most commonly, rheumatologists) will make a diagnosis based on the ACR’s criteria: a history of widespread pain lasting more than three months and the presence of 11 out of 18 designated tender points in all four quadrants of the body. But some experts say the diagnosis is questionable because it is based on the patient’s self-reported symptoms instead of on a standard, objective test.
However, recent findings by one of fibromyalgia’s leading researchers, Robert M. Bennett, M.D., has given increasing credibility to the illness. His Central Pain Sensitization Theory explains how the pain centers in the brain of an FM patient overreact and perpetuate the pain even after the trigger that caused it has healed. That makes it very easy to re-trigger the pain, which can quickly get out of control. Although fibromyalgia isn’t curable, Bennett’s work is reassuring because it proves that there are changes in the physiology of the brain—that FM is a physical process.
If this is true, then physical practices like asana and pranayama can help. And since studies show that conventional treatment for fibromyalgia—education, rest, exercise, medication, and lifestyle adaptation—rarely leads to long-term relief, specialized therapeutic yoga might be the secret to keeping your FM in remission.
Yoga for Fibromyalgia—A DVD
If you or someone you know has fibromyalgia, check out Sarah’s new three-hour DVD, “Yoga for Healing.” She’ll lead you through a series of “safe, gentle, graded yoga practices,” starting with brief routines you can do in your bed and progressing all the way up to a vigorous sequence of standing poses for those who are capable of it. Inspiring testimonials from Sarah and her students will give you hope that you, too, can alleviate your symptoms and lead a more fulfilling life. Yoga for Healing with Sarah Bates Deluxe DVD Edition, Downward Dog Productions © 2004.
Former Yoga International editor Shannon Sexton writes about food, travel, yoga, and natural health.
