Day One: The fear is obvious. Something in their eyes. The slow, shuffling steps. The wariness as they drag bolsters and blocks from the shelves. Attempts to muffle timidity with parchment thin bravura and the fierce slap of a fresh sticky mat hitting the floor don’t work. I know how they feel. I’m afraid, too. I’m as afraid of hurting them as they are of being hurt.

When practice begins a woman whispers, “I can’t get to the floor.” I offer a chair. Ten minutes later a man grumbles and stands in order to walk off a spasm’s flair. I encourage the group of six to have open boundaries; to roam and move as needed. But at the same time I want them to look for stillness. But they won’t find it. Not yet.

Asana demonstrations are met with disbelief and so I use a soft tone and gentle words to coax their worn bodies into shapes. I offer support with pillows and props. When they discover that what I’m asking them to do is not impossible after all their fears – and mine – begin to subside. Within a few sessions confidence has taken a tentative hold as pain is accepted not as the victor but as something with which one might co-exist.

Up to seventy-five million Americans endure persistent chronic pain. According to statistics from the National Institute of Health the cost of chronic pain in medical expenses, lost income and lost productivity is more than five hundred billion dollars per year. Chronic pain is too often either untreated, under-treated or masked by drugs leaving 42% of patients with symptoms so severe they are unable to work and up to 63% unable to engage in activities those of us who are pain-free take for granted.

I began teaching yoga to chronic pain patients at Feinberg Medical Group in Palo Alto, California in 2010. FMG offers a Functional Restoration Program that is an interdisciplinary outpatient management approach for patients with persistent pain. The goal is for patients to acquire the skills needed to facilitate the behavioral changes necessary to restore function and to improve the quality of life. This is achieved through an individualized curriculum of exercise and psychotherapy, group wellness classes, stress and medication management, the development of relaxation skills and – of course – yoga.

The men and women entering the program have no yoga experience and are burdened by the consequences of chronic pain: low self-esteem, appetite and sleep disturbances, a sense of powerlessness, hopelessness and depression. My job is to find a way to move them beyond these states and to help each patient build a new relationship with their body.

But these are individuals whose pain has become like a brick wall separating them from health and wellness. They don’t want to know about gunas or gurus, Sanskrit or sutras. At least not yet. What they want is to feel better. The practice has to be personal. Clear and immediate. Achievable.

I ask myself, “What is it that I can I do, right now, to help?” My answer is simple. Build trust. Build trust in the process. And build trust in me.

I was introduced to Yin Yoga in 2009 by a student who had attended a Sarah Powers workshop in nearby Menlo Park. She described a practice that was deceptively challenging but deeply soothing. Intrigued, I attended my first Paul Grilley workshop a few months later and by September of the following year had been certified to teach Yin.

Yin Yoga applies stress to the connective tissue: fascia, tendon, ligament and even bone. Intellectually this might feel counterintuitive, and indeed we can all agree that over-stretching any tissue whether it’s muscle tissue or connective tissue will be injurious. But a mindful Yin practice does not overstretch – it gently stresses and unwinds. It doesn’t require tremendous strength or flexibility and yet it delivers profound physical and mental release. A Yin practice asks the body to open to the discomfort of the pose and to accept the stillness required to maintain the pose without grasping or grabbing either physically or mentally. Working to an appropriate depth for the appropriate amount of time gives the connective tissue, the heart and the spirit space to open and, in a sense, breathe.

At first they are resistant, as unyielding as their bodies. I talk about the importance of our intentions. I remind them that what we have is this moment and this body and this one constant – change. But if we want to see change in our bodies we have to listen to what our bodies are trying to tell us about pain and healing.

We alternate between a manageable Hatha practice that includes chair yoga and longer held floor poses. They find the silence of Yin a challenging aspect of the practice. I ask the group to watch their breath and the sensations they experience. We manage for sixty seconds one week, ninety the next. And then, eventually and collectively, it begins to work.

A few months later a young client stops me after class and with tears in her eyes thanks me.

“I don’t know what we did but it held for three hours.”

This is a woman with cervical pain and radiculopathy so severe she can not lift her arms. But during our practice she found the strength to be fully present and subsequently experienced Yin’s benefits. Michelle remained relatively pain-free for the remainder of the afternoon. In this population, that is considered a victory.

I’m not suggesting Yin cured her. All the components of FMG’s Functional Restoration Program work together to support healing. What happened during one Yin practice on a rainy afternoon is that a beautiful young woman discovered wellness was possible. Within a few months she had returned to school, returned to driving and was attending a weekly Hatha yoga class.

For chronic pain patients, Yin teaches trust. Clients demonstrate this trust in the questions they ask and in the confidence they have in creating their own modifications during our practice. They know the difference between challenge and pain, moderate stress and injurious stretch. Our work is slow and they appreciate the opportunity to explore and release, to hold and to melt.

Clients enter into a six to eight week commitment with the Functional Restoration Program at FMG. During that time new clients will enter while others graduate to the Aftercare Program. The “rolling” nature of participants contributes to the program’s success. New attendees are unofficially mentored by clients who have been in the program for a number of weeks. Patients nearing the end of their training will look in the nervous eyes of a new client and say, “I used to be you. But now look at me. Look at what I can do. You’re going to be able to do this, too.” And then they lift a bolster from the shelf with ease. They pick up two blocks and one strap. The slap of the sticky mat as it unfurls on the floor is a reassuring sound. As they lie down I see them slip into stillness as they settle into another hour of Yin.