This past weekend, I was out walking with a friend whom I’ll call Eva. Eva’s had persistent pain in her knee for about nine months now. At this point she’s seen all the specialists, been through a round of physical therapy, and is considering injections as a next step.

As we strolled and admired the foliage, Eva told me about an appointment she’d had a couple of weeks ago with a new orthopedist. He’d done a thorough exam and treated her respectfully, and she liked him well enough. And when he carefully moved her hip into extension and asked if it hurt, she said “no.”

But here’s the thing: it did hurt.

And what Eva just couldn’t understand is why on earth she’d said that it didn’t.

To be honest, I wasn’t all that surprised.

Here’s why: People say all kinds of things about their pain that they don’t really mean. I know that sounds weird. But consider this: Pain is a bio-psycho-social phenomenon. It’s tied up in how we feel about ourselves, what kind of mood we’re in, how we expect people to react, memories of past times we admitted to feeling pain, beliefs about our so-called pain thresholds, past experiences with authority figures like doctors, difficulty trusting our perceptions, and on and on.

Please understand - this is not in any way to say that Eva’s pain was not real. ALL PAIN IS REAL.

But pain is like a tapestry; it has a lot of threads running through it. And sometimes we don’t know how to talk about it so we come up stories to tell ourselves.

I’ve done it myself at doctors’ offices. I’ve said something didn’t hurt when it did, because I just couldn’t deal with the idea of there being yet another messed up thing in my body to manage. I’ve also denied pain because I thought it made me seem brave or because I was afraid a doctor might think I was lying or … what’s that word … malingering.

Now, yoga therapy is very much NOT psychotherapy, but in private yoga therapy sessions, we do start to tease out some of this stuff. Most important, we put a premium on being able to notice and say, out loud, what sensations we are experiencing in the moment, without expectations, without explanations, without judgement.

It can be a real relief and it can also be … fascinating. When we’re able to replace fear and uncertainty with curiosity — that’s when we start to make real progress.