Hey guys!! I recently had the opportunity to interview Audriana who is both a physiotherapist and trauma-informed yoga teacher. I have personally had amazing experiences with physiotherapists and yoga instructors so I highly recommend reaching out to her as a resource. Her website and social media is listed at the end of this interview.

Takeaways:

• A lot of people with chronic pain have experienced some version of trauma. That’s why it is important to work with someone who has trauma-informed training.

• How we respond to a traumatic event depends a lot on our nervous system.

• Learning about and understanding how the nervous system works is an important part of the treatment process. 

• Graded exposure therapy with physical activity is an effective way to regain the ability to do activities that you enjoy and decrease your pain.

• Using a biopsychosocial treatment plan is an effective way to treat someone’s pain.

Can you tell us a little bit about yourself and how you got involved in treating chronic pain? 

Yeah, so I’m Audriana. I’m a physiotherapist and trauma-informed yoga instructor. I live in British Columbia, Canada. Getting involved in chronic pain actually started a little by accident for me, but I am really happy that it happened. I was doing typical physiotherapy which is what you would see in private practice where people are coming in with a variety of injuries. I wasn’t super happy there. A friend of mine told me about a clinic that was being started and that they were doing a chronic pain program that involved working with military veterans specifically. It was a multidisciplinary program with physio, occupational therapy, a dietitian, and kinesiologists and those types of specialties. Chronic pain was something that I was interested in prior to this because I did some electives in physio school for it and I live with chronic migraines myself. So I kind of just stumbled into it and then once I got there, I was like, “Oh, yes. This is exactly what I need to be doing”.

Was it during this process that you became a yoga instructor?

That happened during Covid because things had slowed down a little bit. I wanted to add something new to my practice. I had used yoga myself a lot and had found that it really helped. This was a couple of years after I started working with that company.

Would you say that you now function as both a physiotherapist and yoga instructor? Do you combine the modalities?

Yeah, absolutely. It depends on the person and what they want with their treatment as well as what I think can be helpful for them. I definitely do incorporate different yoga things into my practice or sometimes people will just come to see me for one-on-one yoga.

And you mentioned that you have a history of migraines. Have you found that yoga and physiotherapy have helped with migraines at all?

Yeah, definitely. I haven’t done physiotherapy for migraines, but I do think that yoga helps. In terms of calming the nervous system, yoga can be really helpful for migraines. It’s definitely something that I have used for my migraines as well as other things that have been helpful. Just moving the body can be so helpful.

I agree. Movement can be so important when it comes to treating chronic pain. You also mentioned that you have trauma-informed training that you use in your practice. Can you explain what it means to be a trauma-informed physiotherapist?

Being trauma-informed means being able to recognize that most people have gone through life and have experienced some form of trauma, whether it’s major or minor. It can impact the brain and body in a multitude of ways. Being trauma-informed means that when you’re working with people, you’re trying to not re-traumatize them in any way. You give them a lot of autonomy, control, and choice around what they’re experiencing. It also means allowing them to talk about their trauma or not talk about it. You’re still treating everybody as if they have experienced a level of trauma. 

How is it possible that in this practice or in any healthcare practice that somebody with trauma could be re-traumatized?

It honestly happens so often and it’s overlooked. I think anytime you have gone through a period where you weren’t given a choice can be traumatic. Something happened, either physically to your body or something affected you emotionally and you weren’t given a choice in what happened. A lot of times in healthcare, the healthcare provider is the expert and they can re-traumatize people by making them feel like they don’t have a choice in the treatment they’re having. You’re just being told what you need to do and it feels like you’re not given a say in it. This doesn’t just happen to people with chronic pain. It happens a lot in people who are overweight. In healthcare, it’s easy to blame everything on a person’s weight and they don’t give the right experience to those people. That can be really traumatizing.

It is something that you hear a lot of people with chronic pain and other illnesses talk about. I hear a lot about healthcare trauma where people have a hard time going back to their providers because gaslighting is so common. Or they have had healthcare experiences where their providers either didn’t believe them or made it seem like they were being overdramatic. They’ll say things like “Just lose weight, drink more water, and get better sleep” as if that will solve all of their problems.

Absolutely. That can 100% be retraumatization, especially if you go through that over and over again. You’re just really defeated and not given a choice. There’s no autonomy and it’s not a safe space to work through your condition.

In your practice, do you see different types of trauma? Are there different types of trauma?

That is a great question. Unfortunately, I’m not a mental health care provider so my answer may not be as educated as someone who’s a psychologist or a psychiatrist. From what I’ve seen, I don’t think it matters if someone experiences a large trauma compared to a smaller trauma. For example, someone could get in a car accident and that could be extremely traumatic for them versus someone else who gets in a car accident. It may not be traumatic for the other person. It’s based on how the nervous system and the body respond to what the person has experienced. That is what’s going to impact the amount of pain that someone experiences.

Taking into consideration your trauma-informed background and the fact that you are both a physiotherapist and yoga instructor, what specific techniques do you use with each client?

A big thing that I’m doing with clients is working around the fear that they have in regard to their pain and their fear of movement. That’s the biggest thing that I work on with people. I work with a lot of people who have had pain for years, decades even, and they have these experiences where their pain worsens or they have a flare-up with movement. This makes them not want to move.

One of my biggest modalities that I use as a physiotherapist is a lot of education about the nervous system and the body. I teach them that our nervous system can respond to pain differently and that things can become more painful than they were before. I like to use graded exposure therapy with movement. That could be yoga. If someone enjoys yoga, we can start by doing some gentle yoga practices. It might be weightlifting. It might be walking. It depends on the person. It’s really about choosing something that feels safer in the body and then gradually exposing them to that kind of movement. Over time they can add more and more movement as their body continues to respond positively.

Working with their mindset is also important. I encourage people to recognize that even though there is a little bit of pain, their body is not being harmed in any way. This involves working through the fear response surrounding pain.

It sounds like a lot of what you’re saying lines up with pain reprocessing therapy. And I like that you’re bringing up that fear of movement because it is so common in people who have chronic pain. I think the term we like to use for that is kinesiaphobia. 

Yeah, and I think the way the trauma-informed aspect comes into play when we give people the autonomy and choice to determine how they progress and what works best for them. Every day can be so different. Someone could come in one day and be feeling really good and be open to trying more movement. Then things happen in life and they come back next week not feeling as good and less open to trying a lot of stuff. It’s important to give people the autonomy to say, “I don’t want to do that” and be able to respond with “What would you like to do?”. That in itself can cause safety to happen within the body and help with overall pain.

And creating that feeling of safety is so important. People start to feel unsafe all of the time and they no longer trust their bodies or their environment.

Prior to this interview, you mentioned that you tend to take more of a biopsychosocial approach when treating someone with chronic pain. Can we take a moment to define what a biopsychosocial approach looks like?

Absolutely. Oftentimes in Western medicine, you see a more biological lens of pain. This means that we’re looking at what is happening in the body. Sometimes we’re looking at genetics. Other times we’re looking at tissue damage and inflammation. The treatments that we give people are very focused on the physical body. That could be surgeries, medications, or different types of injections. Luckily, I’ve noticed that there has been a really big shift around bringing in the psychological and the social aspects as well. 

When we look at pain, we know that it’s multifactorial. It is biological, psychological, and social. All of those things contribute to pain. When we talk about the biopsychosocial model, we’re not only looking at the biological aspects of pain. We are also looking at psychological things and what’s going on in your mind whether or not you’re experiencing anxiety, depression, and PTSD.

It’s biological, psychological, and social. All of those things are going to contribute to pain. So when we talk about the biopsychosocial model, it’s basically we’re not only looking at those biological things that I just mentioned. We’re also looking at psychological things. So that’s anything going on in your mind, whether or not you’re experiencing anxiety, depression, PTSD. Maybe you have fears and different thoughts around your pain and that’s going to contribute to the pain experience. Then we look at social things which is anything else in your life like your community that you live in, your job, your relationships, and your finances. All of those things can contribute to your pain experience especially if they’re negative experiences. When we look at the biopsychosocial model of pain, we’re bringing all of those things into the treatment room and not just looking at the physical body.

I love that. It’s taking a very holistic healthcare approach with each person. 

What advice do you have for someone who is newly diagnosed with chronic pain?

I think first and foremost, getting a team of practitioners around you is helpful because each practitioner has a different modality or way to help you. Unfortunately, at least in Canada, there can be long wait lists and wait times, which can make it hard to get the help that you need. If you have a family doctor, talk to them about getting a referral to see a specialist in a chronic pain clinic. If you have benefits and insurance, you can have better access to things like physio, massage, or acupuncture.

If you have the means to see psychologists, that can also be helpful, especially if they are chronic pain psychologists. Once you have that team around you, it allows you to have a larger toolbox of tools that can help you in your pain experience. Another piece of advice would be don’t go into a big rabbit hole of Googling and finding things out. That can perpetuate a ton of fear and anxiety, so getting advice from professionals or people who have been working in this field for a long time are better sources of information. There are a ton of books out there too as well as podcasts. I really like a book called “The Way Out” by Alan Gordon. “The Body Keeps the Score” is a good book but it’s more related to trauma. There are also podcasts. There are a lot of great resources out there.

What advice do you have for someone who has had chronic pain for over 10 years and has given up on reducing their pain?

This is something that I see a lot, especially in my current practice because I work in a pain clinic. I work with a lot of people who have had pain for 20 to 30 years. These people have tried a lot of stuff, but there are always other things to try. There’s always another lens that you can look at.

I think that having a bit of acceptance around your pain can be helpful for people. A lot of the time, there is a lot of resistance. People are still trying to get back to this life that they had 20 or 30 years ago. They’re still really holding onto that life when life looks different now. You might not be able to do things that you could have done before. Letting go of some of that can be helpful. It’s really like a grieving process. It’s not an easy thing to do to accept that your life looks different. I do think that’s one thing that can be helpful. And then don’t give up. There are lots of different resources. Maybe you need a second or new opinion. If you have been doing the same thing for 5-10 years, there might just be something new that you need.

I think a lot of people go through a big grieving process after being in pain for a while. I think you grieve the person that you used to be or the person that you thought you were going to be. That can be painful for a lot of people.

Yeah, absolutely. It’s like the grief you experience when you lose someone because you lose a version of yourself. Take time to grieve and get some help with that.

For our final question, can you tell us about any success stories that you have had with any of your clients?

Yeah, I have had quite a few. I think the greatest success stories I see go back to this acceptance piece. I’ve had people who feel like they have tried everything and then they try a new approach and they maybe start to accept their pain a little bit and you just see how empowered they become.

When you get people back into movement, you give them some education, do some pacing and exposure, people make progress. They come back saying, “I had some pain today, but I was able to go on a 20-minute walk and I understood that I wasn’t damaged”. Or someone will say “I was in a big flare-up today and instead of pushing through it, I decided to take a break, take care of myself, and just sit and read or watch TV”. Those are success stories to me. It warms my heart to see those little changes and have people come back and say that something was extremely helpful or that they were able to do a little bit more than they could last week. Those little things are successful to me.

Yeah, and I like that you have mentioned graded exposure therapy. I think that is a huge one for people with chronic pain because sometimes you just have to dip your toes in the water. You have to experience a little bit more of the activity and then come back the next and see if you can do a little bit more.

A lot of what you’re talking about is very similar to my chronic pain experience. 

When I first started having chronic pain, I was terrified of most types of physical activity, especially walking. I eventually discovered Yin Yoga. I advanced to slow-flow yoga. I eventually made it to Vinyasa yoga and that’s when I felt like I was capable of doing some strength training. I started going on daily walks, adding a bit more time each day. I had to slowly ease myself into that one.

Yeah, for sure. I think it’s so frustrating for people because it is a slow process for a lot of people. Some people walk a block for a month straight and then the next month they walk a block and an extra thirty seconds. It’s that slow for some people because the nervous system needs to learn safety. If you’re able to look back on where you were a year ago and see the big picture, you can see the difference. It’s just hard in the little moments to see the big picture.

When you’re in a big pain flare-up, you can get really big tunnel vision in that. You might have a day where you have a huge flare-up and you’re frustrated because you feel like you have lost progress. You get out of this negative mindset by recognizing that pain flare-ups don’t last forever and you’ll make progress again.

That wraps up our questions. Is there anything else you would like to mention?

If other people want more resources from me, they can check out my website, www.empoweredmovement.ca. There are a lot of resources on there.

Website: www.empoweredmovement.ca

Instagram: audrianaphysio