Yoga And Pain Science Education With Physiotherapist Neil Pearson

Welcome back to the Healing Pain Podcast with Neil Pearson, PT

In this episode, we are exploring physiotherapy, yoga therapy and pain science with physiotherapist, Neil Pearson. Neil is a Clinical Assistant Professor at the University of British Columbia and the founding chair of the Physiotherapy Pain Science Division in Canada. He is a recipient of the Canadian Pain Society’s Excellence in Interprofessional Pain Education Award and faculty in international yoga therapist training programs. Neil develops pain care resources, collaborates in research and serves as a mentor for health professionals and yoga practitioners looking to enhance their therapeutic expertise. He’s also a lead contributor to Pain BC’s Pain Foundations and Gentle Movement Series as well as the coeditor of Yoga and Science in Pain Care: Treating the Person in Pain along with physiotherapists, Shelly Prosko and Marlysa Sullivan. You’ll learn all about yoga and yoga therapy for pain management, as well as the neuroscience that supports its effectiveness and use in the world of yoga, yoga therapy and physiotherapy. I want to thank Neil for his contribution. This episode is a great tool that you can use if you’re a yoga therapist, a physical therapist or a physiotherapist, and you’re interested in the intersection between yoga and/or pain science. It’s great to share with your patients, your clients or your colleagues.

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Yoga And Pain Science Education With Physiotherapist Neil Pearson

Neil, welcome back. It’s great to have you. 

Thanks a lot, Joe. It’s been a while since we spoke.

I’m excited to talk to you though. I know you wrote an awesome book, which I’ve had the chance to read multiple chapters from. You wrote of course with Shelly Prosko and Marlysa. I had them on the show. I’m looking forward to having you on to talk about the book as well. Of course, the book that the three of you primarily wrote, you have other contributors. It’s called Yoga and Science in Pain Care, which is an interesting topic. It’s a great blended marriage between yoga and pain science or pain neuroscience. Tell me why was this the moment? Why was it right to write this book about these two important topics? 

I don’t know if it’s the right moment to do it, but it’s a moment that really works. There are more and more people paying attention to pain in a new way and paying attention to pain care in a new way is growing. At the same time, it seems that more and more people are coming to yoga because of pain or we also see people coming to yoga and ending up in pain. Sometimes we’re moving all that much and movement will start to kick up some stuff we hadn’t noticed was there. The other thing is there’s a big move, especially within the United States in terms of yoga therapy, is that a shift to the growth of the International Association of Yoga Therapists. Yoga therapists are starting to see people coming to them for one-on-one interventions. We can provide yoga classes, traditional yoga, but when a person comes to a yoga therapist and they had pain, it’s important for yoga therapists to have an understanding of this. It’s interesting when we have a curriculum for yoga therapists, it’s quite extensive and you can see it’s a little bit like healthcare education used to be. They talked about pain all over the place, but they never talk about pain in one place.

We definitely know from our previous experience in healthcare and in the research showing that if you don’t specifically get people to sit down and think about what they think about pain and people in pain and pain care, they’re not doing what they need to do. We’ve got this growth in the yoga therapy world, the growth in people coming to yoga, an increase in the research that’s suggesting that yoga can be helpful for a lot of chronic pain conditions. Marlysa, Shelly and I were finding that so many other people were asking questions about when you are going to write the book. We heard it so many times that we finally decided to move forward.

Obviously, within the world of physiotherapy and other licensed healthcare practitioners, there’s been interest around pain, neuroscience, pain science education, pain biology. They’re called a couple of different things. I’d like to say pain education. It’s relatively simple. Although there are people who have started that which had certain words that are attached to. Have you noticed in the yoga world, whether it’s yoga for exercise or yoga for therapy, that people are starting to ask more questions about pain education and pain science?

I don’t know that I’ve noticed that people are asking. What I’ve noticed especially those of us who are regulated health professionals, who have learned more about pain and understood more, worked with it more, that our cross involvement in the yoga therapy world we’ve been asking people to pay more attention to it. Us being more vocal has lifted that up because yoga therapists would be in the same places as pretty much everybody. Without thinking about what we think about pain, we believe we fully understand it. It’s simple, you damage the body, you get pain, then more damage and more pain. When the damage goes away, the pain goes away. That’s easy. We still see this within yoga therapy the same as we see it within physical therapy. We still see people are actually functioning from a more tissue-based or Cartesian view of pain. This thing still has a stronghold. There’s been this big gap for all of us who are working in the biopsychosocial and the physical therapist and the psychology therapist. We saw that trying to fill that gap in the physical therapy world has been beneficial. A little bit of what we’re trying to do is see if we can fill the gap in the yoga therapy world as well.

That can be a big gap because the yoga therapy world is large. It’s established but still growing movement that practitioners of yoga look for education. I’m glad you guys are filling that. In your personal experience, you practice yoga, you take yoga classes, and you travel and do workshops. Is it challenging for you to take a class from a yoga instructor who’s not up to date? They may be using words or terminology that is not in line with your current knowledge about pain and/or have you used that to obviously helps spur the thought process of this book?

Yes, absolutely it is. When I travel, I don’t go to as many yoga classes as I used to. Especially for that, the challenges to turn off my being a teacher’s brand.

That’s really hard. 

It is, when I’m going there and what I want to do in my practice. I’ve got a pretty substantially long both meditation and yoga posture practice. I love doing it on my own, although I like doing it with other people because it’s something that’s there within different pieces of our book is the importance of in terms of pain care of social engagements and the power of being around others. I was reminded of one of the first times that I had such a hard time because, within a minute of starting to class, this fellow said in a great, well-intentioned way, “Remember that if there’s pain during any of the postures, that pain is your friend.” All of a sudden I went into, “If there was anybody who has chronic pain in this room, who doesn’t know this person, they’re going to be angry at this.” This whole fantasy comes on for me and they’re having to push it down and come back. It is beyond the book that we’re talking about. We’re in the process of creating a new training plan but more for yoga teachers. Within yoga, there’s nothing for yoga teachers to train them about this. We put together something we’re going to call Pain Care Aware. It’s a continuing education process to teach yoga teachers the basics, understanding of pain and then talk about how we might shift language around. It’s almost a bit of a mirror of what’s happening in the trauma-informed yoga because so many people were coming to yoga with past trauma.

HPP 158 | Pain Science Education
When a person goes through a movement practice in yoga and at the end of the day can move with more ease, it’s an educational moment.


How do we get your teachers to understand it and to shift the language? You don’t need them to assess anything, you just need to know how to make some shifts. I know Shelly has talked about this so much and such great terms about how the language of, “Make sure you do that to protect your knee.” That language brings us back to pain equals tissue damage. What we see there is the yoga teachers are doing their best to keep people safe, and at the same time as keeping people safe, we haven’t considered that we can inadvertently create fear in the people that we’re working with. How can we balance those two? It’s not up to the yoga teacher to assess people’s individual issues. You can keep people safe by saying, “If it hurts, don’t do it.” You can keep people safe by saying, “If it hurts, modify your physical body.” The whole process of yoga says that that’s not the only way you can do it. If a person is having pain, what would happen if you changed your breath? What happens if you change the way you think? What happens if you changed your perspective or your emotions? How do we figure out how to get people to that yoga? It’s not that easy. We’re putting together this continuing education thing called Pain Care where we to try to address that.

That’s an important topic. Of course, they don’t come up in the yoga world. They come up in the world of Pilates. They come up in the world of personal training and other fitness type arenas. They’re all really important topics. As you’re talking about this, it starts me thinking that yoga may be one of the few things that’s a cognitive behavioral movement type of therapy. We have movement therapies or we have exercise therapies. We have Cognitive Behavioral Therapy, which is more sitting in a chair and talking. Yoga falls somewhere in between both. Can you talk about that a little bit?

One of the chapters that our road is looking at is the idea of pain education. Matt Taylor suggested to me is that maybe we should call it for pain literacy because it’s broader than about science or biology and physiology.

I liked that because we have such a problem with health literacy in general and then a big problem with health literacy with regard to pain.

The chapter in the book is about pain education and reviewing some of the research around that and saying that maybe we should consider using yoga as the educational agent. The experiences of yoga. You could look at it as a cognitive-behavioral movement process. Within the practice of yoga, if we’re doing a full practice of yoga, we pay attention to how we treat ourselves, how we act in the world to our breath or prana to how we move our body. We also do enteroception and awareness practices. We do focus and concentration practices as meditation. You’re covering this broad perspective. It’s almost like yoga looks at a biopsychosocial, spiritual and spiritual meaning. It looks at what makes your heart sing and it looks at what’s your life purpose. It’s all part of that. It even goes beyond the common behavioral. The chapter in the book is looking at the practices of learning new things. When people have pain, we often give people this pain education to help them to understand. We often talk about. We help them to understand physiology but to me, it’s broader. We’re teaching people that pain is not immutable.

We’re teaching people that we have some influence, sometimes a lot but at least some influence over pain and over ease of movement. When a person goes through a movement practice in yoga and at the end of the day can move with more ease. It’s an educational moment to say, “That’s amazing. Your pain changed.” What would happen if we kept on doing this? If we go back to the explained pain approach, this is an approach that we could say is primarily cognitive because you’re giving a person information. It’s helping them reconceptualize pain, decreasing the threat value of the pain. It’s interesting research looking at people who partially reconceptualize pain. Some people reconceptualize it merely know what to do in terms of how to approach movement in a new way and they fully got it. Other people understand the new information but don’t know how to apply it to themselves. Most people with ongoing pain need that physical embodied experience, that lived experience, “I can use this information and make a change in the physical me.” Yoga provides that opportunity. You might say, “Maybe we should give people this cognitive foundation through education.” Use yoga to consolidate it or prove to the person that those ideas actually work. You could flip it around the other way and say, “Maybe some people invest through doing rather than through sitting, listening or reading a book.”

You could use the practice of yoga that the physical experience or the movement experience of yoga as the person’s had this change. Sometimes when that happens, the person is thinking back, “Was it real? Was that some weird thing?” It is some mumbo jumbo thing. They’ve had that experience. If you tell the person about pain science, they might go, “It’s real.” It’s almost like we could do these things one after the other or what we could do is we could figure out how to integrate them. When you’re getting a person doing the practices of yoga, could we keep in our mind the idea that this is an educational process and educational agent? The person is having new thoughts and they’re having new emotions and they’re experiencing new things in their body. Is there a way that we could form a language that would help the person to actually learn the things we want everyone to learn about pain in that moment?

It makes me think there are people who are kinesthetic learners first who learn through movement. Especially if you may be a dancer or an athlete early in life, you may learn more kinesthetically versus sitting down and reading a book on pain education.

Most of us as healthcare people, we’ve been trained to learn in a certain way. The thing that we need to consider is that maybe the people who we’re working with have not been trained to learn by sitting and listening. I went to look at the literature around, can we find stuff about kinesthetic learning? About doing learning versus listening and reading? There’s some around these children that are all over the place in terms of what it says. I couldn’t find anything good related to adults. We have this theoretical premise that people are more kinesthetic learners or a person is better at cognitive learning first. It’d be nice if we could identify the person. One of the things is sometimes we have to do by process of elimination is try one, see how it lands on a person, try another one. Maybe it will be for so many people that you need to almost do both. Having both maybe as needed because our beliefs about pain seem so hard to shift.

It’s interesting you bring this topic up because when I look back, I’ve probably interviewed as many physical therapists as I have psychologists or mental health providers, the tremendous support of pain psychology and mental health providers. They have got a lot of positive press since the opioid epidemic. Since we’re not using opioids street pain, we’re realizing that there are other types of therapies out there. All the myriads of cognitive-behavioral therapies are important. However, when you look at the research of cognitive-behavioral therapy for chronic pain, most of that research shows minimal to moderate improvements. When I look at the research and I’m like, “It’s awesome research and we need to continue delving more into the cognitive-behavioral therapies.” I’m always like, if we can include some movement in there, I’m willing to bet you see things go from minimal to moderate, to moderate to maximum improvements for people. In some ways, we’re taking people who are deconditioned, who are fearful of movement and we’re putting them on a chair for an hour or more and saying, on some level literally, “Let’s think and talk about what’s happening here.” That might not be the best approach for people.

It may land funny. We know that we can use cognitive interventions to change things or influence things. It may land in the person’s lap as, “You’re telling me I can think my way out of pain. If it was that easy, I wouldn’t be here.” It is amazing how we are shifting our view. My first yoga therapy training that I went through was through Phoenix Rising Yoga Therapy. I was amazed that the number of psychologists and counselors that were there in that training program. There was this general consensus that the reason they were there was because in their work they couldn’t do things to the body. That wasn’t within their scope of practice. They needed something to be competent in. They were coming to yoga therapy so that they can actually do the psychotherapy and the counseling with the body as well. To get back to your ideas, that’s one of the reasons why we’re seeing people finding benefits from yoga. It integrates things together.

HPP 158 | Pain Science Education
Movement is something that’s vital for the majority of people to feel more health in their body.


I have to say in terms of the yoga world that we often say there were four or five original paths of yoga. There’s Jnana yoga, which is the yoga of attaining wisdom and discriminative knowledge. There’s Bhakti, which is through love and devotion. Another one Karma through self-service. There’s the one that everyone knows about and that we write about in the book, the Raja yoga, the extensive one. It seems that what the yogis were saying was that there’s not one path to less suffering. Even within yoga, you can do it through meditation, the Jnana yoga, wisdom and introspective. You could find a way to suffer less by helping others, serving others. You could find it through love and devotion or this other path.

It’s like the eightfold path. There are many paths. If you studied meditation, there are many paths to get to that point where suffering doesn’t affect you as deeply as it did at one point. In one of your chapters in the book, you talk about Jnana yoga. With regard to it as almost being that part of it is that cognitive intervention. Can you tell us a little bit more about it? It’s more than movement is what I’m trying to get at. There’s a thought process and theory behind how that works.

Within Jnana yoga, it’s a sitting process where you sit and you contemplate and you expand your awareness, but expand your awareness internally. You’re contemplating how the things that you are noticing, how they’re interacting with other things that are happening within you as an individual. Also, there’s even one part of it that relates to pain. Learning how to be okay with pain and to discern the pain that is okay. You can imagine if you’re going to sit for a while, it’s going to hurt. One fascinating thing to consider around that is we used to teach children to sit still. Sitting still, you’re potentially teaching somebody a pain management strategy, in this case, teaching the person that you can be uncomfortable and still be okay. It’s almost like we’ve taken some of that stuff out of our life. Within Jnana yoga, there’s that part of discernments, contemplation and then a meditation on what you’re experiencing. Getting into the depths of considering equanimity and your place in the world and all those other avenues of thought and philosophy.

When we look at what the yoga texts said, I should point out that I’ve never had a yoga guru or teacher of Jnana yoga. I’ve had teachers of many of the other ones. Most of my understanding of it is through reading. What we’re doing is taking our attention inward and trying to find the answers from inside. Almost like doing Socratic dialogue without Socrates around. Asking around things and all those questions yourself to try to come up to it. Definitely within the texts, it’s repeated over and over again. This is the hardest path of yoga. They even say that there are some people who should not do this path. This path will cause anxiety and angst. We know that some people who go through the Mindfulness-based stress reduction program have reported that it did everything opposite of what was expected. Not being the path for everyone.

Every intervention may have an adverse side effect for a certain small group of people. 

My wife is a swami of Kriya yoga. There are a lot of statements that she makes a lot. One of them is the Kriya yoga belief is, “Everything is medicine and everything is poison.”

It can be. That’s true. In that form of yoga, is there a movement aspect to it as well?

Within Jnana yoga? There’s not.

It is more like a meditative contemplative form of yoga. 

That’s what my guess from all of the reading and talking to some of the teachers about it. It sounds like that’s part of the reason why it’s harder. When you move, you can feel more health of your body. A lot of times we use movement to be calm. We look at the chemistry of us. We’re so much better. I know you had Dr. Sluka on and she was talking about some of these things too. Even the pro-inflammatory chemistry of our body is different when we move. That becomes important in the face of ongoing pain. Movement is probably something that’s vital for the majority of people that you have that piece. Effect size, there are some pretty great research where they’re trying to put together lots of the chronic pain research outcome studies. The Cognitive Behavioral Therapy by itself was the effect size wasn’t that big. When you put Cognitive Behavioral Therapy or Acceptance Commitment Therapy together with a movement process, the effect size was way bigger. This gets interesting because there is same study showed that if you only do movements, the effect size of movement by itself was less than the effect size of cognitive-behavioral therapy. We don’t know what they’re doing in the movement, but that’s a little surprising, with our physiological understanding. With everything I know, I would’ve guessed that moving the body would give you a better benefit alone than CBT alone.

I’ve read some of those studies too. My question with those pure exercise studies, I always wonder what the instructions were to the person or how they inform them. To me, you have to give some instructions to someone who’s exercising. Tell them what you want them to do. What should it look like? How many reps or sets? How many minutes? Right there is some form of cognitive overlay that you’re putting over the exercise. I’m always wondering how is it described of what was said? They pick that apart a little bit more. Talking about movement in general and there’s a lot of controversy over this with regard to pain education, pain neuroscience education, we know that pain is not an accurate measure of tissue damage. Should we tell people to move through the pain? This comes up in yoga class all the time. 

The first thing to consider when we’re talking about people who have chronic pain is to take that population. The majority of people who have chronic pain have done that already. At some point, they have gotten tired of not being able to move or something needed to get done and they grit their teeth and they said, “I’m going.” When we hear that history of the person having done that approach and not succeeding, that gives us a bit of prediction that maybe it won’t work. If we look at the understanding of the pain part, some people will say, “If the person understood this new stuff about pain, if we could decrease the threat value and we conceptualize it, maybe it would work differently.” I’d say, “Maybe.”

HPP 158 | Pain Science Education
There is no physical examination test that is 100% accurate.


Here’s my logic around this. As physical therapists or anyone who does a physical assessment, there is no physical examination tests that we do that is 100% accurate. When we come up to that, so I’m assessing your shoulder, I do a test. It does not have 100% sensitivity and specificity. I don’t throw it away. What I need to do is use that test along with other tests and put them together to come up with the best solution. If we look over at pain, we say, pain is one of the ways of protection, but it’s not 100% accurate. It doesn’t tell you exactly what’s happened to the tissue or how hard should you push. We could throw it away. Some people are saying, “Don’t pay attention to it because it’s not accurate.”

What I would say is, “Why don’t we listen to other protective signals or mechanisms?” One of the things that happen when we are pushing too hard is we feel our breath gets stuck, we hold our breath. When we’re pushing too hard our body gets tight, or when we’re pushing too hard, we start to feel anxious. We’ve put together these movement guidelines and say, “Rather than not paying attention to pain, why don’t we pay attention to pain in a new way as one of many alarms you could listen to, and that over time you need to pay attention to a number of them to learn how to be more discerning.” I wish I could reframe this and saying what we came up with, we didn’t really come up with it. We’ve listened to people in pain who’s succeeded. We’ve since learned that Navy SEALs are trained this way. They teach Navy SEALs to become more aware of their body, their breath, their thoughts and their emotions. They teach them how to regulate their body, breath, thoughts and emotions. There was this guy writing with us. We get them to sit in a chair and listening to Enya and there’s aromatherapy. We get them to do it standing up, they’re standing outside in the rain, they’re crawling in the dirt and then they’re crawling in the dirt under barbwire and we’re shooting rubber bullets.

What he’s saying is that to be able to do difficult things, potentially dangerous things and stay calm to decrease the threat value of all this stuff, we need to practice it in the best place and then move forward. He’s using the same kinds of guidelines. When you’re doing movement, if you feel the pain increase, we’ve played it a little bit with what Lorimer and David Butler has said. We get people to ask the question, “Is it safe for my physical body to be doing this?” The next question is, “Will I be okay later?” If the person says, “Yes, it’s safe. I’ll be okay later,” the next step would be to say, “Can I keep my breath calm? Can I keep my body calm? Can I pay some attention to the pain?” We know that when the pain starts to build up, people tend to do one of two things. They either ignore it, suppress it and push it down as best they can or what people do is their brain gets so focused on it, they can’t think of anything about it. If you find yourself moving towards those things, you’re probably going too hard or you’re pushing too much.

What we want you to do is similar to what we get people with rheumatoid arthritis to do is not pay attention to one alarm. If you have rheumatoid arthritis and say, “How much should I exercise?” We say, “Pay attention to the pain, the heat, redness and swelling.” Pain by itself is not accurate. If we go further, in rheumatoid arthritis, we don’t tell people, “Pain is not accurate, don’t listen to it.” Somehow it doesn’t make any sense there but when a person has chronic pain, we’ve decided it does make sense. I’m curious about this because there is that study that they did exactly this. They told people, “Remember we told you that pain is not an accurate indication of what’s happening to the body, so you’re not going to pay attention to it. When the pain gets worse, you’re going to keep on going.” They did that and it worked. Because of my bias, what I think is, “Are they really charismatic? Did they build such an amazing therapeutic alliance with people that the therapeutic alliance became so powerful that it didn’t matter that they were potentially firing up the nervous system?” I state that because I don’t have another way to explain it.

It’s possible potentially for someone with pain. Let’s say you’re the top pain researcher in Belgium and you’re going to that person and you enrolled in a study. That may be a context where you feel hopeful, excited or safe that you’re learning from someone who can potentially help you with your pain or help you cope or take your pain away, that may be right. A lot of the things that you said, you’re talking about concepts of paint exposure, which is still new in the literature. We have some things around the pain avoidance model, cognitive functional therapy with Peter O’Sullivan. There were some concepts in there, some pain exposure concepts from CBT and ACT. I wanted to distill this down a little bit more.

Let’s say, I’m someone with chronic lower back pain. I am taking a beginner yoga class. I’ve been through a couple of sessions with you and I realize that when I do Downward dog that I noticed my back pain starts to increase. Not only do I notice my back pain starts to increase but I get sweaty, I notice my heart rate increases, my pulse increases, my respiration increases. I notice I get tight in my shoulders. I notice my toes curl and grip the mat a little bit more. I also noticed that my thoughts start to race and I start thinking about images of a disc pushing on a red, hot nerve in my back. All those things are happening. You and I and other practitioners, those are signs of the pain response, signs of what’s happening, signs of danger. In that moment all those things are increasing, if you’re saying we can teach people to autoregulate, they can go perhaps a little bit over the edge and they can be safe and start with things like the principles you’re teaching in yoga and a lot of these principles show up in other areas. They can autoregulate and start to come out of that excessive response.

When it’s happening the first time, it would make the most sense to stay calm to the person. Let’s find another posture, let’s regulate things again. With the understanding that a lot of people we work with, there’s so much autonomic dysregulation. Not only the person’s systems get cranked up so easily, it’s hard to calm them back down again. If you’re doing it and you weren’t in that state, I might be able to say, “Joe, calm your breath, soften the muscles here and you might be able to find that regulation.” Where if it’s new and the person doesn’t have practice, we probably want to move them away from the exposure and find that ability to regulate again and then talk to the person about, “When it happens again, we have some options here.” You could shift your position. We could see if you could check your breath and breathe in a different way. We could see whether if your body is getting tight, you could actually soften that a bit. There are lots of different ways to go at it. Yoga research is growing and is like a lot of the other research. It’s showing great effect. One of the biggest gaps that we have that we haven’t talked about a lot that was a little bit like pain education is a lot of the times the people who are doing the practical aspect of it are amazing.

The top in their field, they’ve got charisma, knowledge, expertise and conviction. One of the biggest things that we need to figure out is how do we build capacity in these areas? If I can do something and we research it and I show that it’s effective, can I show somebody else how to do that same thing and what does it take for them to be effective? That’s part I believe that accessibility to good pain care is important. I know we can’t leave it all to the researchers, but sometimes I read through the research and see what people are doing and think, “I get it. You can do that, but can you teach other people to do that?” Somehow, we need to try to figure out how to distill these things down so that people can walk away from the researcher or a clinical training program and be able to make good change without years of mentorship. I’m not saying mentorship should be thrown away, but I think that there’s a capacity issue that we need to figure out how to address it that’s so important.

There are training hurdles that we have to overcome. David Butler and Lorimer Moseley are brilliant researchers and clinicians and they’ve been doing this for 3 to 4 decades. Maybe even five decades if you consider how long because first, they were licensed PTs and treated patients and then went on and got advanced degrees. They did all the research and then finally clinician training. Everyone gets excited about that as they should. It’s definitely valid that we should all be excited about that. How do you take that charismatic researcher-practitioner and teach that to practitioners so that they can then move on? Of course, they went through their own trial and error process and most of us have to do the same thing.

In the yoga world, sometimes I wonder whether it’s even harder. It is a biopsychosocial spiritual approach. There are even more areas of expertise and skill to get. I want to say that because I think it’s so important that we start to realize that the research says that yoga can do this. There is an average researcher. For the average person, it potentially has that effect. What we need to figure is how do we get other people to be able to do that same thing.

It’s interesting though because the yoga world has, for example, 200, 400, 600-hour training and they are common in many different yoga trainings so that you get your experience and you step up. In the physical therapy world, we have continued education courses and they’re important but oftentimes, they’re one and done and that’s it. For instance, I hate to keep picking on Explain Pain. I love David Butler and Lorimer Moseley and I appreciate them. I’ve taken Explain Pain. It’s an excellent course and everyone should take it. When I took it, I left the course thinking, “It was great, awesome weekend. I learned a lot but this can’t be it. There’s got to be more from here.” The yoga world is good at stepping to 400, 600 hours. I know you’re working on yoga training, combining yoga and pain science, have you thought about what those frameworks might look like for yoga therapists?

HPP 158 | Pain Science Education
Pain is not an accurate indication of what’s happening to the body, so don’t pay attention to it.


Within the International Association of Yoga Therapists, I can’t speak with them to know what they’re doing. You’re right, there’s a culture there in the physical therapy world of continuing education. We have a culture of continuing to learn stuff, but there is a culture of building, almost picking an area that you want to gain some expertise and skill and then focus there and carry on. Where it does seem, at least in the Canadian physical therapy world, it’s like get as many tools as you can and stick them in your toolbox approach a lot of times.

That can be really challenging for clinicians too.

We’ve been trying to figure out how to do that within the pain care yoga world. I’ve been teaching pain care yoga training courses for many years, and for healthcare people and for yoga teachers bringing everybody together and yoga therapists. We’ve been developing these things. We originally had a three-day-course and then we’ve extended into a six-day-course. We have an advanced one. The advanced course is interesting because it dives more to the biomedical stuff because yoga therapists don’t have a lot of background to that. It goes in two ways. It dives into the biomedical and then expands out into the more social and life purpose dharma stuff of yoga, which are both important. I’m lucky my wife being a swami, she can work out there and I can work there and we do it together. We have also created ten months long mentorship program for people who want to learn more. Where every month people read books, do book reports about pain, do research studies and start to work with people and get mentored in case management things. We’re working on building that. We’ve realized the pain care bit is at the beginning, which we didn’t have something from yoga teachers because, within the yoga world, lots of people go to yoga teaching and then may decide, “I want to move into the yoga therapy side.” You’re right, we need to figure out how to build paths like this and we don’t fully have a guide to play around with these.

You are doing work. It’s pioneer work that you, Shelly and Marlysa have done, especially with this book. Everyone can hop on to Amazon and order Yoga and Science in Pain Care. It’s awesome if you’re a physical therapist or you’re a yoga therapist or yoga instructor or maybe you’re two of those things. Oftentimes there are PT’s who are multiple things. Thanks for being with us, Neil. It’s always great to talk to you and I wish you guys the best of luck with your book. Let us know how everyone can learn more about you.

Thanks, Joe. It’s been a pleasure talking. My website is You can go in there and learn more about pain care yoga. Maybe I can come back and talk to you next time because it looks like I’m going to go do the ride with the Pain Revolution in Australia in 2020.

That would be lots of fun. 

They take all that stuff to the rural communities. We were fascinated to be part of that.

If you go out there and you do a bike ride, let us know, we’ll support you. Maybe we can help you raise some money. I put it in my email and I know a bunch of people contributed. I want to thank everyone on my email list who contributed. We always support everyone who has worked there in Australia. I want to thank Neil for being with us. Make sure to check out and of course, check out Yoga and Science in Pain Care. Share this with your friends and family on Facebook, Twitter, LinkedIn or drop it into your favorite Facebook group where there are lots of yogis and yoga therapists, physical therapists, physiotherapists and mental health providers, all interested in the natural care of pain. It’s been a pleasure being here with you. We’ll see you next time. Take care. 

Thanks a lot, Joe.

Important Links:

About Neil Pearson, PT

HPP 158 | Pain Science EducationNeil Pearson is a physiotherapist and Clinical Assistant Professor at University of British Columbia. He is an experienced yoga teacher, a yoga therapist and creator of the Pain Care Yoga training programs for health professionals and yoga therapists. Neil is founding chair of the Physiotherapy Pain Science Division in Canada, recipient of the Canadian Pain Society’s Excellence in Interprofessional Pain Education award, and faculty in international yoga therapist training programs.

Neil develops pain care resources, collaborates in research and serves as a mentor for health professionals and yoga practitioners seeking to enhance their therapeutic expertise. He is Lead Contributor of Pain BC’s Pain Foundations and Gentle Movement Series, and co-editor of ‘Yoga and Science in Pain Care: Treating the Person in Pain, along with Shelly Prosko and Marlysa Sullivan.

The Healing Pain Podcast brings together top minds from the world of pain science and related fields to discuss the latest findings and share effective solutions for persistent pain.

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