The past several months I have needed to focus much of my energy on postpartum healing. After having an enjoyable, comfortable pregnancy and a relatively easy natural home birth- and being able to maintain a fairly intense daily ashtanga yoga practice throughout my pregnancy- I was surprised when a few months after giving birth, I started experiencing very significant stiffness and pain in my lower back during my postpartum yoga practice. The pain eventually spread to my hips and legs, and I started experiencing it outside of my practice as well, especially at night, when I got up in the morning, after nursing, and after sitting in a car for a long period of time. It became so intense that lying on my back or stomach was impossible, and at times I had difficulty picking up the baby or doing basic chores around the apartment. Although I had already built back up to practicing a relatively rigorous full primary series by the time I began experiencing this pain, it eventually became so intense that I stopped practicing everything but the sun salutations, and even that was often extremely painful.
I’m accustomed, in my yoga practice, to pain coming and going, and so I waited several weeks to see if the pain would dissipate. When it didn’t, and eventually became even worse, I began a process of trying to determine the cause of the pain and to find a way to heal myself. This process has lasted almost four months. Now I am at a point when I feel I am clearly on a path to healing and the pain, while not completely gone, has significantly diminished. I have also rebuilt my yoga practice from the beginning, and am doing most of primary series again, but with more gentleness, mindfulness, and patience.
During these last four months of self-healing, I tried many different approaches to identify the cause of the pain and many different healing modalities, and so thought it might be helpful to share some of my experiences for other women who may also be experiencing postpartum musculoskeletal pain. The information may be most relevant for women who return to a yoga practice shortly after giving birth, since the pain I experienced and my path to healing are both interwoven with my yoga practice, but I think the information about various possible approaches to self-healing after birth will be beneficial for all postpartum women.
Preparing to Heal
When I first began researching the pain I was experiencing, it seemed that the lower back pain might have been caused by having a weak pelvic floor and a minor separation I had in my abdominal muscles after giving birth, and not doing my yoga practice in a way that was mindful enough of this, causing strain to my back. Also, when the pain began radiating through my hip and leg, it seemed likely to me that I had been too overzealous in my hip opening work, wanting to take advantage of the new feeling of openness in my body after childbirth, and that my piriformis muscle was spasming and pressing on the sciatic nerve.
One of my first strategies was to take a week off yoga to give my body time to heal, and to take away some of the pressure I had been putting on myself to get back to where I had been in my yoga practice before giving birth. Instead of yoga, I went for walks, watched the sunset, swam, went to the steam room at my gym, and went to a kirtan.
At the end of this week, I consulted the I Ching, an ancient book of divination, about my prospects for healing. The hexagram I got was 44, “Coming to Meet,” the theme of which was yin energy surrendering too readily to yang energy, and fortunes and health changing for the worse. This resonated with me, since very shortly after my pregnancy, which was a very yin time for me, I went back quickly to my former way of being, which was more yang oriented, and also began doing a very yang yoga practice, not allowing for a more gradual shift in energies. The I Ching, though, said that while the condition would get worse before it got better, the situation would eventually be transformed into hexagram 50, “The Caldron,” which is a very auspicious fortune, especially if the question asked is about prospects for recovery from sickness. The image of the cauldron is a pot of food cooking over a wood fire, balanced on a tripod. I liked the image of fire, which reminded me of the yogic concept of the purifying fire of tapas, or discipline; the idea of the cauldron being on the strong and stable foundation; and of the cauldron being used to prepare something nourishing to enjoy and share with others. I found this fortune encouraging and inspiring, and so accustomed myself to the idea of practicing with chronic pain while patiently working to heal myself and rebuild a strong and stable foundation for my practice, both for my own benefit and for the benefit of others around me.
Before returning to practice, I took a Prema breathwork workshop. The idea of Prema breathwork is to use the breath, combined with music, to release any emotional blockages that are manifesting themselves in the physical body, and in doing so create space for energy to flow more freely, and become open to positive, healing energy. The idea is to enter an altered state of consciousness that activates the healing powers of the psyche. I did find in that workshop that my consciousness was significantly and I experienced a transformative shift in my energy. After the workshop, my pain was gone for the rest of the day, only returning when I went to sleep that evening. This made me more open to the idea that there could be a connection between the state of my emotional body and the pain I was experiencing in my physical body.
Initial Approaches to Self-Healing
After this week of preparing to heal myself, I returned to my yoga practice, but made some changes to how I was practicing.
Previously I had been practicing in the morning, but the pain and stiffness at that time of day was sometimes too difficult to bear, so I switched to practicing in the evenings. In the mornings I did the postpartum postural realignment exercises and exercises to close the body from the book Yoga Sadhana for Mothers by Sharmila Desai and Anna Wise, or I simply meditated or chanted. In the evening I did a modified practice, usually focusing just on the sun salutations and standing postures. The pain and stiffness, while reduced, still persisted in the evening, and I found that I needed to take a hot shower and give myself a ten to twenty minute oil massage every day in order to be able to practice, so this became part of my early evening routine.
At the same time, I embarked on a process of exploring additional approaches to pain management and to healing.
One was to add some healing herbs and foods into my diet. I began taking chamomile, which is a gentle antispasmodic, and also turmeric, which is an anti-inflammatory. Many evenings, I made warm almond milk with turmeric, ginger, and black pepper, and added in ashwaghanda and shatavari. I tried to reduce my consumption of processed sugars, alcohol, and caffeine- which was already fairly low- since I had heard that these things can cause inflammation of muscles. I also started cooking kitchari in the afternoons when the baby was sleeping and eating a small bowl after coming home from my evening yoga practice. It was helpful to have this nourishing meal already prepared and waiting for me when I returned.
I also got an Ayurvedic postpartum massage at the New York Ayurveda and Panchakarma Center. The masseuse covered me in a very generous amount of warm sesame oil and gently massaged it into my body. She even massaged oil into my eyelids. The warm sesame oil can balance an excited vata dosha, I learned, and this kind of grounding is important after giving birth. Sesame oil also has pain relieving properties. While the massage didn’t significantly alleviate the pain I was experiencing, I would nevertheless recommend this kind of massage for all postpartum women; I found it to be very relaxing and afterwards I felt calm, grounded, and nourished.
I also tried getting several acupressure massages, but I found those massages to be too intense and painful, which was surprising to me, since I had enjoyed them before becoming pregnant. Since then, I’ve only gotten gentle Swedish massages, which have been relaxing and helpful.
After the baby was six months old and had begun to eat some solid foods, and so was breastfeeding a little less frequently, I resumed a practice I had before becoming pregnant of giving myself a weekly massage with warm castor oil. There is a separate post on this blog about the castor oil massage. Many weeks, I added in geranium essential oil, which I had read helps build ojas, or vital life fluids, because I was exclusively breastfeeding and this can deplete ojas. I found this practice to be immensely helpful and to significantly reduce the pain and stiffness in my body. I am still continuing this practice every Saturday morning.
Getting Information and Advice
In addition to these self-care practices, I also reached out to my midwife for advice, and she recommended a pelvic floor therapist. I talked to her, and she felt that physical therapy would be a better approach for me, so I reached out to a physical therapist she recommended. The therapist told me it seemed that that my spine was out of alignment, that my pelvis was torqued, and that my sacroiliac joint was jammed, which are all common problems in postpartum women. She recommended doing exercises to create space between the pelvis and ribcage, so I could gradually correct the postural misalignment, and also doing exercises to straighten and stabilize the pelvis. I learned from the physical therapist that the hormone relaxin, which loosens the ligaments of pregnant women, stays in the body for up to three months after the woman stops breastfeeding. This was important information, because while I had been aware of the need to not overstretch my muscles during my pregnancy, after giving birth I was not thinking about the fact that this hormone might still be in my body, and so was perhaps not mindful enough of the fact that my ligaments might still be overly loose and not providing the strength and stability to my muscoskeletal system that they had before I became pregnant. I realized I had very likely overstretched my muscles during my yoga practice while the relaxin was still in my system.
After visiting the physical therapist and getting this information, I also went to a postpartum yoga therapy class recommended by a prenatal yoga teacher I met who had recently given birth. The teacher of that class was also a craniosacral therapist, and I made an appointment with her. She helped me identify that the part of my pelvis where I was experiencing the most pain was the sacroiliac joint. I also learned from the craniosacral therapist that when I was engaging mula bandha in my yoga practice, I was also tensing all the muscles that stabilize the pelvis, especially the hip flexors. She also explained to me that the muscles that support the pelvis can become extremely tight in order to provide stability to the pelvis when the ligaments are loose, and that I was perhaps tightening the muscles even more in my yoga practice to compensate for not being able to engage bandha as deeply as I had before giving birth. She worked with me to be able to contract the pelvic floor muscles without also contracting other muscles at the same time, and then helped me work on releasing the tension in the hip muscles. After this session, I tried doing an exercise program designed to strengthen the pelvic floor, recommended to me by another ashtangi who had also recently given birth. It focuses on helping women learn to isolate the three key muscles that support the pelvic floor from other nearby muscles, and to strengthen the pelvic floor. This was all very helpful in terms of helping me understand why I might be experiencing so much muscle stiffness and pain in my back, hips, and legs.
After gathering the information from the physical therapist and craniosacral therapist about the possible causes of the pain I was experiencing, I worked with my ashtanga teacher to explore how to best approach my practice and whether there might be ways to use the practice to heal myself. That experience helped me commit to myself to embark on a process of gradually building my practice up again, moving through the series at an appropriate speed and not over exerting myself.
The following weekend, I was travelling out of town and decided to drop in on the local Mysore program. Serendipitously, the teacher had recently given birth herself. She talked with me at length about ways I might approach my postpartum practice. When I told her I felt like I was practicing in someone else’s body, she encouraged me to try to drop back into my own body using breath work and bandhas. She helped me recognize that I might have been focusing too much on my alignment when I began relearning the practice after giving birth, and emphasized the importance of my doing more “root work.” This different framing, in yogic terms, of the recommendation health care practitioners had made about isolating and strengthening the pelvic floor muscles, was extremely helpful to me. It also led me to think about how else in my life, outside of my asana practice, I could be strengthening not just my pelvic floor, but my root chakra as well. This gave me a helpful focus for rebuilding my practice and for approaching my postpartum healing more generally. The teacher also recommended seeing a chiropractor. While other people had given me this advice before and I had been hesitant to follow it, the pain had been persisting for so long by this point that I was more open to the idea and decided to schedule an appointment.
When I returned home, I found a gentle chiropractor who specialized in working with prenatal and postpartum women. After only one visit I felt confident that chiropractic care, coupled with my own self healing work, would eventually eliminate the pain in my body. The chiropractor has been working over the past several weeks to help correct my postpartum musculoskeletal misalignment and to increase the mobility in my joints and muscles. I’ve found that working with her has caused a significant reduction in my pain, and that over time, it is taken longer and longer for the pain and stiffness to return to my body after each session.
The chiropractor recommended applying arnica oil externally and also sleeping with a pillow between my legs to stabilize the pelvis, and both of these recommendations were very helpful. Another thing she recommended was that I take a supplement to strengthen my ligaments. Unfortunately, I wasn’t able to take the particular supplement she recommended because I am a vegan and it is made from bovine heart, among other animal products. But looking at the ingredients, I noted that it included lots of Omega 3 fatty acids and also B vitamins. There are very few vegan sources of these nutrients so I realized was possible that my stores of Omega 3s and B vitamins were depleted after almost eight months of breastfeeding, and that I didn’t have as much as my ligaments needed. When I learned this, I added more flax seed and flax seed oil into my diet, which are vegan sources of Omega 3s, and also started taking a vegan supplement made from algae, Ovega. I also started taking a B12, B6, and folic acid vitamin.
At the same time that I added these supplements into my diet to promote ligament healing, I also reached out to an herbalist with whom I had done an apprenticeship for recommendations of food or herbs that would support my healing. She reiterated the importance of high omega 3 and fat soluble vitamin rich foods. She also recommended external application of St. John’s Wort oil, and taking a tincture of Solomon’s Seal oil to strengthen the ligaments. She made sure to emphasize the importance of the Solomon’s Seal being cultivated rather than wildcrafted, since it is an at-risk plant.
Current Self-Healing Practices
Currently, I am seeing the chiropractor every one to two weeks. Also, in the mornings, I am taking: echinacea, which alleviates pain and is an anti-inflammatory; a placenta tincture; and Solomon’s Seal root tincture, along with Ovega and B vitamins. I take a hot shower and give myself a massage with an herbal body oil I made myself, of sesame and olive oil infused with arnica and lavender. I also use St. John’s Wort on the most painful areas. I do some light stretching and also chant if I have the time, which I find to be calming and grounding, and to connect me with something larger than myself. I often chant to Ganesh, the remover of obstacles- who sometimes also puts obstacles in the path if we need to be deviated. Then I do my yoga practice, trying to focus on breath and bandha, especially mula bandha. My morning practice, which is self practice, is focused on self-healing; I practice in a relaxed way, and sometimes deviate from the traditional ashtanga sequence to add postures I know will support my healing process. During the day, I make an effort to eat nutritious foods and stay hydrated, and to rest whenever the baby is resting. And I have even incorporated playing the Tibetan singing bowl that has the tone of C#, which corresponds to the root chakra, as way to meditate on and strengthen my root chakra. I practice yoga again in the evenings, doing a more traditional ashtanga practice in a Mysore class, and since I have started working with the chiropractor have been able to work back through most of the primary series. My sacrum and SI joint, while still hypomobile, are beginning to regain their function, and I am starting to experience much less stiffness and pain in my practice — and in my daily life.
I have found the process of identifying the source of my pain, managing it, and working to heal myself has actually brought me a tremendous amount of joy. It has taught me to be patient with my body and grateful for its capacity to heal, when given the proper support. And the experience of learning to practice yoga with chronic pain has given me more mindfulness, softness, and humility in my practice. It has also helped me understand that the ability to practice is truly a gift, and that I should not to take a single upward facing dog or jump back for granted. Rather, I should appreciate fully every opportunity to use breath and bandha to connect more deeply to myself, and find delight in the moments, no matter how fleeting, when the resolve I have to continue to practice is rewarded with a glimpse of my capacity for strength, grace, openness, or serenity.
I initially intended to write this blog post at some triumphant moment in the future, when I was fully healed and had a strong and powerful yoga practice again. But the process of healing myself has somehow helped me come to recognize that there is no future more perfect than this moment, that my entire life may be a journey of healing, and that my journey and my destination may actually be one and the same. And so I’m writing it now, as a part of that journey.