Fibromyalgia is a syndrome characterized by widespread chronic musculo-skeletal pain and a set of symptoms such as sleep disturbances, nervous system dysfunctions, fatigue, headache, irritable bowel. A decrease in the pain perception threshold is associated with neuro-endocrine and/or psycho-affective and mood alterations. Women are affected three times as much as men.
In 2020, I started teaching yoga to patients with fibromyalgia.
I conducted a three-month cycle of twelve classes. Slowly I was able to continue one cycle after the other.
In most cases, patients (I prefer to call them people) with fibromyalgia are particularly prone to self-doubt, mental rigidity, feelings of inadequacy, and overextending themselves. Given a kind of obsession with duty, they tend to ‘execute a task’ rather than enjoy a yoga practice in a relaxed way, thus running into more pain, frustration, feeling inadequate, and discouragement. Also the fear of pain generates even more tension and pain, even persistent, triggering a vicious circle.
In each class I undertake to welcome, empathize, listen, observe, appreciate their every success and progress, reassure, follow their rhythms and not those of a typical yoga lesson, guide, provide alternatives, whenever needed, even to simple practices, to explain their meaning, motivate to develop a positive awareness of the body, sensations, breath.
And so, little by little, people have come to experience their body, hitherto perceived as a perennial source of malaise, in a completely new and different way. Compared to ‘normal’ lessons, it was necessary to reiterate several concepts over and over again:
Overcoming can only come from acceptance. Thus one does not need to do the perfect position, like lifting the arms all the way up, but the position that feels good, even just creating a space between the arms and the body.
Of course, as the lessons progress, it is also necessary to encourage to gently extend the limit, especially in cases of associated rheumatoid pathologies: in fact, if moving hurts, not moving destroys the joints. Using the exhalation and a subtle sustained sigh is a great help, imagining to inhale a beneficial light and to remove the pain with the sigh.
It is normal that in every lesson there may be a movement or a position that just isn’t right for someone: instead of trying it anyway, causing discomfort, let it go and relax with a few quiet breaths. Or, perform it mentally, with a positive visualization of oneself. All this with as few words as possible, at the right moment, also using non-verbal and para-verbal language.
In most cases it is not possible to immediately assume the sitting position. Therefore, in the first lessons I demonstrated how to take correct positions on the chair, using or not the backrest. Then I invited them to sit on the mat and experiment with how they felt, sitting cross-legged with and without a brick, pillows under their knees, back against the wall, legs stretched out, etc. After a few lessons, everyone left the chair (which I recommend to keep close anyway).
It is very important to accompany people, not taking anything for granted, even if it has already been said several times. For example, in the transition from supine to sitting, I indicate to bend the legs, keep feet on the ground, move to one side and push with the free hand on the ground to come back sitting… Generally, the students need to move, to change position often, especially those who work while sitting for a long time. Even maintaining the pose of shavasana presents difficulties for many: therefore, especially for yoga nidra, which in any case must be particularly short, I have given various options, such as using pillows, practising it in bed, in an armchair or in matsya kridasana, doing half rotation of awareness on each side, which has proved to be particularly effective.
I wait several times before coordinating the movements with breathing: first I lead people to discover how nice it is to move slowly, to become aware of all the positive sensations associated with movement, to move without causing the slightest pain, continuing to breathe normally without blocking their breath. Then I explain something more about breathing, the importance of inhaling and exhaling through the nostrils and not through the mouth (which everyone does instead) and finally I introduce the idea of coordinating breath and movement. I invite them to associate with inhalation a sense of lightness and expansion of the body which, like a kite, is moved by the breath and, with the exhalation, relaxes, or descends gently like a falling leaf.
Micro-movements especially of the neck, back and shoulders are very useful. One of them is the ‘wave movement’, which gives relief to the back: supine, bend the legs with the feet on the ground and perceive the support of the whole back on the floor. Inhaling, lift just a portion of the lumbar spine, as if to let a line of ants pass from one side to the other; leave shoulders and pelvis on the ground. Breathing out, place the lumbar spine back, as if to leave its print in the sand or to crush a soft little ball. The pelvis always stays down. The movement can be refined by reducing its range to a few millimetres and increasing awareness and perception at the same rate, until it is directed only to a couple of vertebrae, where it needs to relax more.
Occasionally inserting slow motion movements gives surprising relaxing and regenerating effects.
Some adaptations are also useful. For example, the Pawanmuktasana Series 1 or arm extensions like in hasta bandha utthanansana can also be done lying down. Particular caution should be used during neck movements: if people remain within their limits, they will be able to improve later; while, if they try to overcome their limits immediately, they will have pain the following days. To facilitate full rolls (jhulana lurhakanansana) they can separate the knees well. But every yoga teacher can understand what to adapt and how, by observing people, and developing a connection with them.
Many times, it may be necessary to divide asanas, like tadasana, into various simpler phases, without wanting to get to the final pose in one go. As we continue with lessons, it is also necessary to consider other additional pathologies, like knees or back.
Excellent results are obtained by sometimes inserting quick ‘perceptual images’, such as in a relaxing position imagining, one’s face like that of a sleeping infant; or to sit like a king on a stable cross-legged base. The image of the inner smile is very useful, which illuminates and relaxes all the features of the face, then bringing serenity and relaxation also to the head, mind and whole body.
Learning to relax your face, as well as making it more beautiful, leads to relaxation in life: this is an excellent motivation!
Suggesting the concept of ‘playing’, ‘enjoying’ or ‘dancing with Life’, instead of ‘doing an exercise’ largely eliminates stiffness and promotes physical and mental flexibility.
Associating words such as expansion, freedom, immensity, lightness, fluency, relaxation, peace, with breathing phases and poses concretely helps people to replace negative images and ideas they have of themselves.
Less is more: It is better to do less yoga practices, accompanying people with calmness, care and attention, helping them to value every single positive effect they experience. Then they understand that they can keep fit, not with effort, but by relaxing and remaining calm, even finding a smile again.
Finally, the idea associated with the movement or any other practice is more important than the practice itself. If people are encouraged to put ideas and feelings into their minds such as ‘the pleasure of awakening life’, ‘the breath that feeds me’, ‘the good feeling that I discover with this movement’, their bodies will shape accordingly. It is obvious that if they think: ‘I have to do it’, ‘I don’t like it’, ‘It is difficult’, tension and pain will be the masters.
The following impressions express the many physical, mental and emotional benefits and the greater ability to adapt to the challenges of daily life.
The visualizations are beautiful. I am a school teacher and I do some practices in class. Some children would like to do yoga every day.