Finding the Words for Pain.

Via on Jul 4, 2012
At the Met with Rodin and Robert Sturman two months post-op, Photo: www.RobertSturmanStudio.com

On Knees, Discomfort, and Language

I have spent the past few months thinking about pain, searching for words to describe its various tones and shadows. I have the luxury of doing this since the discomfort I am in is not ultimately as serious as many other experiences of bodily discomfort. But as an asana teacher, having an injury that offers an ongoing experience of what we refer to as pain calls upon many other significant aspects of my yoga—my meditation practices, my breath, my ability to observe and analyze, and my capacity to be receptive to the needs of my body.

A few months ago I was walking up some stairs when I felt a brief sharp sensation in my left knee and then a wet flooding feeling. Just like that, I had torn my left lateral meniscus. I spent a few weeks gathering medical opinions, curtailed my travel schedule, and scheduled the operation. I adjusted during this period, wearing a knee brace and moving in a very frontal manner. I became extremely verbally precise in my teaching since I could no longer just kick out a demo. Then I had the operation, and, despite my being assured a rapid recovery, I was sidelined with swelling and inflammation that has continued to surge unpredictably.

Post-Op Still Life on my Couch

I’ve been insisting that I am not in pain but in discomfort. To me, pain is something that you want to curl, arch, and crawl away from. It is sharp or piercing—hitting nerve endings and causing involuntary reflexive movement. Discomfort is what more accurately describes the bloated feeling in my knee that feels as if lead has been poured into it. I’ve described the sensation as a water balloon pressed to its limit and about to burst. I also mentioned to my doctor, when I called to say that I needed it reexamined and possibly drained, that my knee felt as if it had just consumed a sickeningly excessive Thanksgiving dinner.

By now I’ve been told by more than one medical expert that I have a “high pain threshold,” but I think that it’s just that I have so many different definitions of what pain is that I find it hard to describe my current state so simply. Pain is too general and too vague a term. To me, pain is not a singular experience, but a vast range of very particular sensations for which we lack specific language, so these sensations are best conveyed through metaphor, simile, or anecdote, as I have written above.

Pain Scale

Here are examples of different types of pain experiences: when I smash my toe against a piece of furniture, that thudding, nauseating sensation is pain. The piercing slice of a paper cut is pain. When I was little and snapped two bones in my arm, that shock and crunch was pain. When I had to have a chunk of my jaw cut out to remove my impacted wisdom teeth, that grinding feeling that gripped me in convulsive waves was pain. For the most part what I’m experiencing right now is a dense, stretched to the limit sensation of discomfort.

Pain Scale

In the past few months I have filled out countless sheets of questions asking me to rate my pain level. On a scale of 1-10, how would you rate your pain when you bend your knee to 90º? When you squat? When you run? When you walk? When you stand? I’ve been crossing out the word pain and replacing it with the word discomfort. Only one of the questionnaires I’ve filled out has asked me to describe the quality or nature of my pain with examples of descriptive words to circle.  There is a problem with the vocabulary—we need a more effective semantics of pain.

Is it just because I am an asana teacher who spends enormous amounts of time working with my body that I notice this? It seems to me that there is a confounding of pain with discomfort. And just as there is a wide range of discomfort experiences, there is an equally vast spectrum of pain.

Pre-op teaching in Barcelona, left leg outstretched. Someday Lotus Pose will return…

I still have a way to go in my healing process, which is frustrating, but should ultimately be okay. Have I learned from this? Yes. I’ve learned the obvious things such as compassion and patience, but I’ve learned even more about language and how it shapes our ways of thinking. Some of what I’ve learned I will gladly abandon, relieved to spend more time moving on my mat and less time thinking on my couch, forgetful of this brief period of agitated mental movement within the stillness of sedentary days.

My deepest thanks to Robert Sturman for creating beautiful photos within the post-op limitations of my practice.

About Susanna Harwood Rubin

Susanna is passionately committed to finding beauty in everyday life. She is a yoga teacher, visual artist, and writer, which means that she rarely stops moving except to meditate. She has been teaching for over a decade, and has spent over 11 years immersed in studying Rajanaka Tantra with Dr. Douglas Brooks, with whom she travels regularly to South India to delve into the traditions that inspire her teaching, writing, and artwork. She teaches internationally, but her yoga home is Virayoga in NYC. Susanna's artwork is represented in collections such as the UCLA Hammer Museum, the Berkeley Museum, and the Addison Gallery of American Art. She lectured and wrote for MoMA for years, including co-writing the book "Looking at Matisse and Picasso." She will still happily talk about Picasso for hours if you ask her. She has been profiled by the Today Show, Yoga Radio, FIT YOGA, YogaSleuth, SocialWorkout, and ChaudiaChan.com. She gives talks on yoga, Hindu myth, and philosophy for the Yoga Teacher Telesummit, and teaches Writing Your Practice writing courses and workshops for yogis. Susanna is an Origin Magazine columnist and writes for Rebelle Society . Overall, she is amazed at the richness of her life. Find her on Twitter , Facebook , & Instagram

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13 Responses to “Finding the Words for Pain.”

  1. such a subjective experience — thanks for sharing! It is the strangest gift — injury for a yoga teacher, when my back injury occurred I too felt it actually catapulted my YOGA practice in so many areas…hope you heal in the best way possible!

    • You are welcome, ARCreated Wellness! And thank you for your thoughts & sweet wishes as well. I am sorry to hear that you have gone through a back injury, but it is interesting what you explore when some of the given aspects to your practice are suddenly denied. Early on I became obsessed with unusual triceps stretches because I was spending so much time sitting on my couch. It definitely expanded my teaching as it limited my personal practice. I'm curious to hear what your injury taught you since you mentioned it.

      • I think first and foremost it made me even MORE compassionate for my student's experiences. I am now in that enviable position where some poses are forever out of my practice (unless I too get some surgery and until I have insurance I have to live without) And I had to face that humbly and gracefully if I was going to be a good teacher. It changed my entire relationship with asana and I began to delve even deeper into the other practices and my meditation became my haven, my hope and my salvation. I came to yoga via power vinyasa and it was exactly what I needed at the time but as my life and body changed I needed to learn to sit and be quiet and I have, my injury taught me patience and helped me see yoga way beyond asana. There was a time when I felt if I didn't work up a good sweat and didn't stand on my head or do hanumanasana then the day was wasted. Being bedridden that first week I thought I would go crazy (well crazier!) and that is when I learned yoga nidra and I re-read the gita, and the ramayana. And did a lot of chakra work, and when I went back to teaching everything was different for me. I think it made me more a yoga therapist than a vinyasa teacher and my classes slowed down and became more and more about the experience rather than the poses (I was already sort of like this but this enhanced it) Ultimately it led me to Vippassana. And each day it teaches me because one wrong move and I'm toast so I have to be very very mindful! Hope you are healing well – Aminda

        • Aminda – Your attitude is pretty amazing. You've managed to step into the constraints and get wildly creative within them – so smart – your students are fortunate. Interestingly (but I guess not surprisingly), that is what I was teaching about this morning at Virayoga – about how every asana is a set of boundaries that enables & fosters a certain flavor of creativity. Then the question becomes, "How creative do we want to be? How can we take the materials at hand – our strengths & limitations – and really become artists of our bodies & minds?"
          Thank you! I'm slowly healing & I hope that you are too!

  2. Nice post, Susanna. Love the photo up top too.

    Pain is subjective. It's an opinion. Discomfort that's constant is enough to tell us that something's wrong is a good measure of things. In the yoga practice this is true as well. Something wrong in the practice might just be tight muscles in folks who find stretching terrifying and I have known these folks. And feeling that something is wrong is also often just a sense and that is a subtle field. We have to know when to pay attention to that. I too have been told I have a high pain threshold and that level for tolerance has gotten me in trouble on the mat and in life.

    I ask my students: Does it hurt or is it hurting you? You have to learn the difference and then err on the cautious side when there is uncertainty. I ask that because often they perceive discomfort as a hurt that they recoil from and there is a chance that fear is more the problem.

    I'm glad you wrote about your experience here as it brings up an important issue for teachers and students alike.

    • Thank you so much for your thoughts, Hilary! I agree pain is subjective and we don't have an adequate vocabulary with which to describe the sensations that we simply group under the umbrella named "pain." There is "good pain" that signifies that we need to stop what we are doing in order to take care of ourselves and there is pain that is simply bad & serves no purpose. Funny that there is no difference semantically. I keep wondering if this actually limits understanding between doctors and patients since the descriptions are so vague & generic that they are not as helpful in fostering communication as they could be.

  3. Rita Kirkpatrick says:

    I think that you're absolutely right in saying that there are not enough words for pain or discomfort. One of the things I love about my instructors (and a quality I hope to have someday) is their ability to have clear, concise language. Being able to describe the mechanics of moving into or deepening a pose really helps a student be more at ease and having more descriptive words for the different levels of pain would be beneficial for everyone. This may be something that is limited to the English language. I wonder if other languages have more words for pain and what that says about them as a culture.

    • Rita – I was having that exact conversation with my Physical Therapist (while he worked on my scar tissue!). We were wondering about which languages have a more extensive vocabulary for pain. Neither one of us could come up with anything. The only other language I speak is French & no – not really much there, but there must be languages that offer more expressions or words. So interesting. Thank you for sharing your ideas!

  4. Louise says:

    As always… articulate, insightful, honest, valuable … thanks so much for sharing your thoughts and experiences on this topic. Wishing you a complete recovery and hoping it's soon!

  5. Or Haleluiya says:

    Oh Susanna dear!
    I remember that in Barcelona you were thinking whether to go through this operation or not…I was hoping your knee got better since than…I wish you all the best and hope to see again in Shinny Barcelona!
    Much love,
    Or

    • Sweet Or!
      My knee is doing SO much better now – it has been a long drawn-out process, but I am finally making lots of progress in my healing. I loved being with all of you & hope to return with two healthy knees this March! Sattva & I were talking about collaborating to teach. Thank you so much for writing & hopefully see you soon!
      xox-Susanna

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