Some Frank Words About Back Pain

I’m assuming that, after all you’ve tried, you still have back pain.

I’m also assuming that, since people resort to unconventional sources of help only once they have exhausted their other options, you have tried a number of approaches to get rid of the pain and they have been unsuccessful.

In resorting to these unsuccessful methods, it is likely either that you tried them armed with the hope borne of professional assurances but without a technical understanding how they work with the body’s own processes — or — that the methods employed to correct the problem weren’t quite suited (relevant) to the condition they were used to correct. In either case, it’s likely that you and your practitioners — all of them — had something in common — an incomplete view of the nature of your condition and of how to resolve it. Results are telling; the “proof” of the pudding is in the eating.

Let’s take an inventory of some of the options you may have tried and their underlying operating premises.

YOUR MEDICAL DOCTOR
The Diagnosis: one or more of the following: disc bulge, nerve compression, degenerative disc disease, spinal stenosis, facet joint syndrome, sprain, strain, or muscle spasm.
The Premise: There is something wrong with your spine or the muscles of your back.
The Treatment: pain medication, muscle relaxants, bed rest, strengthening exercises, stretches, surgery.

YOUR CHIROPRACTOR
The Diagnosis: spinal subluxation (misalignment), emotional stress, improper diet.
The Premise: Spinal misalignment causes back pain; you’re under stress or there’s something wrong with your diet.
The Treatment: spinal adjustments, massage, dietary changes or dietary supplements, stress-reduction techniques, spinal decompression therapy, laser treatment.

YOUR ACUPUNCTURIST
The Diagnosis: blockage or stagnation of chi.
The Premise: The flow of chi, obstructed, leads to illness.
The treatment: acupuncture, herbs.

YOUR PHYSICAL THERAPIST
The premise: facet joint irritation, ligamentous instability, inflammation, hypermobility weak and/or tight muscles cause the pain.
The treatment: moist heat, stretches, strengthening or therapeutic exercises, ultrasound, electrical stimulation, tissue manipulation.

YOUR MASSAGE THERAPIST
The premise: tight muscles or restricted soft-tissue cause pain
The treatment: massaging and stretching.

YOUR SURGEON
The premise: something is mechanically wrong with your spine -discs (bulging or herniated), vertebrae (stenosis, foramenal narrowing), nerve root compression, bone spurs (osteophytes).
The treatment: remove discs, fuse or cut the vertebrae, and bore out the spinal canal (involves laminectomy), enlarge foramina, replace discs, implant rods – a mechanical approach, sometimes exactly needed.

That’s enough to start.

Regardless of how verifiable the observations, and of how reasonable the interpretations, the understanding of practitioners of various practices is based on certain premises — assumptions — that determine how they interpret what they see going on in a person, and whether they believe that what’s going on in the person is occurring in spite of the person (diseases with external causes) or because of the person (diseases of lifestyle). Some people confuse the two because habits, like diseases, feel involuntary (although they often, but not always, form from voluntary actions). So, assumptions.

Simply: People see what they learned (or were trained) to see. If the tool you have is a hammer, you start looking for nails. If what you have at hand is nail polish that’s also likely to involve nails. So it’s nails, nails. But we are more than nails. With a narrow view, one may not see enough of the situation to make enough of a difference.

We know, from the results, whether a mode of treatment actually and effectively addressed the condition.

What some people may not have considered is that one approach may address a condition more effectively than another because it is more pertinent to the condition. In other words, treatments may be applied, in standard practice, to conditions to which they are not pertinent because they are not well-understood. Sometimes they work; sometimes, they don’t — but they have a good enough track record to have been accepted.

So we have two considerations:
A. Was it pertinent to the condition being addressed?
B. Was it pertinent to enough of the functional pattern to make a difference? or did it just address a “point” (i.e., a symptom), leaving “loose ends”, other remaining causes, and possibly side-effects in its wake, leaving the possibility of a reappearance of the problem?

These are not generally questions answerable by the layman – except for the obvious questions, “Did it work?” and “Were there side-effects?” – but these questions should be the central consideration of any health professional.
A. Above, may be restated, Did treatment deal more with cause (control center) or with effect (symptom)?
B. Above, may be restated, Did it deal with enough interrelated factors (as diet and exercise are interrelated with heart health) to bring about a durable improvement? or will the symptom resurface as evidence that not enough of the health pattern has changed, only its symptom was temporarily suppressed?

There is a reason you still have back pain, and it lies in the underlying premise of all of these approaches. That premise goes like this: “The body is a marvelous machine that goes out of adjustment and something must be done to it — physically, chemically, energetically, or through manipulation — to put it back into adjustment.”

As appealing as this logic may sound, and as useful as these approaches may be for certain conditions in certain situations, we know, from the results, that it is, in a fundamental sense not quite right or could be better.

How might the underlying premises be “not quite right?”

Simple. You may adjust the body, but it doesn’t stay adjusted the way you put it because it has its own way of putting itself. The body isn’t a marvelous machine, but a marvelously self-regulating, self-aware process – the process of you. The key terms, here, are “self-regulating” and “self-aware” — in other words, as you are. Your body automatically regulates your temperature, weight, digestive processes, heart-rate, and muscular tension, among other natural processes. Of these examples of self-regulation, the one with which we are most familiar (though it may not seem so, at first) is muscular tension; EVERYONE regulates their muscular tension through a common action. It’s called “movement”, and the master control center for your movements (muscular tension) is your brain and the master control center for your brain is you.

We learn our movement patterns, starting with creeping, crawling and walking. Then comes talking, eating with a fork (or chopsticks), riding a bicycle, playing a musical instrument, typing, and you name it — it’s learned. All of these actions involve two things: moving in particular ways and sensing the results of those movements. We get better at them through a process of self-correction. We move, sense, and adjust our movements for better results, and that adjustment of our movements is self-regulation (obviously, if you think about it). In that sense, we learn by teaching ourselves, and that’s how, with or without the help of teachers, we learn every ability we have.

Once we learn to do something, how we do it becomes a habit, stored in our brain — again, the master control center of our muscles, movements, and senses.

Posture is a kind of habit or persistent pattern maintained by muscle tension controlled by your brain. Now, we know what happens when someone tries to get us to change a habit. I hardly need to say it — but I’ll say it anyway: the habit persists; habitual behavior returns.

Muscle tension is a habit formed out of repetitive activities, stress and injury. It becomes a memory of how we feel and move that displaces our older memory of how we felt and moved – a kind of amnesia. The usual therapeutic options try to manipulate the body without dealing with our “brain-muscle” memory of how we regulate ourselves. They miss part of the way human beings work. Stretch a tight muscle, it automatically returns to its tight state out of unconscious habit – in days, hours or minutes. Medicate a person, adjust a spine, free the flow of chi, the change is often temporary because the person returns to their previous state out of habit, by familiarity. They can’t help themselves because that’s the way they know how to be. Your larger life pattern has a self-sustaining resiliency, based in memory.

Your muscles obey your brain; they have no mind or control of their own. That’s the crux of the matter. Even if you have surgery, your tension habit remains unchanged (which is one reason why back surgery is so rarely successful). So I want to dissuade you from the notion that anything done to you or for you can conclusively help you with your back pain. Whatever benefit may be available from manipulative methods (and that includes surgery), conclusive improvement must include your free control of yourself, apart from involuntary habits, lest you revert back to the automatic, involuntary pattern. Mostly, that’s the situation.

Your tight muscles are what are hurting you. Tight muscles are sore muscles, prone to spasms. Other medical conditions treated to alleviate back pain (with rare exception) come from tight muscles, which compress discs and trap nerves, leading sometimes to more serious conditions or to conditions that don’t resolve with standard treatment.

Your brain controls your muscular tension through learned habits of posture and movement. Your habits have a “large” effect on your life and that the only one who can change your habits is you. If you’re in the driver’s seat, driving, and if someone reaches over and turns the steering wheel, what do you do? You resist, reflexively, don’t you?

That’s what your brain does when someone applies some sort of therapy to you. Even if you want the improvement, you revert to the way you are used to being out of habit and will continue to do so until you replace the “movement memory” of how you were (bound) with a new memory of how you could be (free of your own tension habit).

How do you do that? How do you change a habit, even a muscular tension habit? There’s only one answer: You learn your way out of it, and you have to use proper methods of learning to succeed. It isn’t mental learning, but learning of movement, as in learning to walk.

That’s the domain of the field called, “clinical somatic education.”