The first thing to consider is, "What is the origin of the sharp or sudden pain of a back injury?" To some, it feels like a sharp, stabbing pain; to others, a seizing grip that interferes with breathing. Perhaps it is just that: the seizing grip of muscles going into spasm, causing stabbing back pain and restricting the movements of breathing. Sound familiar?
Back Pain Treatment and Physical Therapy
Medical practitioners, including physical therapists and surgeons, face a peculiar quandary with regard to back pain in general: because their patients' pain so often comes from back muscle spasms, much of their efforts go toward ending back spasms or correcting their consequences (facet joint pain, herniated discs). Still, according to one physical therapist, the likelihood of a back pain patient returning in another episode of back pain is about 80%. Back surgeries have a success rate of about 15%. Money concerns also lead people to suffer unnecessarily: When their health insurance pays for back surgery, people tend to choose back surgery over newer treatments not covered by health insurance, even with back surgery's 15% success rate. It's unfortunate, and that's been the situation, until now.
Let's take another look at back pain, in particular.
Overview of Back Pain and Muscle Spasms
Unless you have had a violent accident, your back pain, whether sudden or chronic, has been coming for a very long time. Muscular tension builds up for a long time before crossing the point of no return and becoming a back spasm. Then, like the proverbial "straw that broke the camel's back," a small movement can trigger a crisis: muscle spasm.
So, we return to the therapists' quandary: back spasms. What causes back spasms? What controls muscular tension?
The answer may be obvious to you: your brain, the master control center for your muscles; your brain causes your muscles to go into spasm.
Why?
Muscle Spasms -- Usually a Brain-Conditioning Problem
Here, the answer may not seem so obvious -- until you understand it: conditioning. Your brain controls your muscles. Your brain gets conditioned through repetition: repeated overuse, repeated overstrain, repeated stress. Your brain learns to hold muscles tight until you can no longer relax them. It's what is meant by "nervous tension." At that point, your tight back no longer comes from bending or lifting, but from a tension habit stored in your brain. You're always tight, on the verge of spasm or in spasm. The problem isn't exactly "all in your head" -- but it is in your brain.
With tingling or numbness, the muscles of your back are so tight that they are pulling your vertebrae (the bones of your spine) so close that they trap and pinch nerves.
So the problem is simpler than you might expect. You probably do not have a medical problem; you probably have a conditioning problem. By relaxing those muscles, you end the pain of spasms. You also free the nerves from pressure and end the symptomes of a pinched nerve.
Fortunately for those using the right methods, a muscular conditioning problem can often be cleared up fairly quickly -- past experience notwithstanding.
Perspective on Therapeutic Methods to End Back Pain
The view of most therapeutic methods holds that back pain comes from weak muscles. They therefore prescribe or practice "strengthening and stretching."
This view is understandable. Tight muscles are tired muscles, and tired muscles feel weak and seem to need strengthening. Tight muscles are shortened muscles, and shortened muscles seem to need stretching. Tight muscles cause postural changes, and postural changes imply the need for strengthening and stretching.
But the problem isn't weakness or muscles in need of stretching; it's muscular overactivity and muscle fatigue (tiredness and soreness).
In that way, common therapeutic methods -- psychological, manipulative, many surgeries, therapeutic exercises in general -- use models that lead people to misunderstand (or miss a part of) the situation. They concentrate on muscles instead of on the brain-level control of muscles.
It's simple: When muscles relax, they rest and get refreshed (feel stronger); they lengthen out (no longer seem to need stretching). With normalized muscular functioning, alignment improves, movement normalizes, comfort returns.
A more direct approach, then, is to improve muscular control. People with back pain generally need a brain-muscle approach -- either to avoid surgery or after surgery.
Muscular Control
Muscular control has two parts: the ability to regulate muscular tension (regulate strength and relaxation) and the ability to sense muscular tension. Both abilities are needed.
Therapeutic methods typically neglect the sensory awareness part of control. Too often, people are given therapeutic exercises but no instructions in how to do them (e.g., slowly or maintaining awareness of the sensations of movement), only what to do (e.g., do abdominal strengthening exercises, i.e., crunches; they're told, "These are strengthening exercises," so people go for strength instead of control; they go for effort (measured by numbers) without sensory awareness (experienced by feeling). That's why most therapeutic methods don't work as well as they might. To the extent that they do work, they do so through gains of muscular control at the brain level. Progress comes slowly, at best, often from working too fast and too mechanically (if not too hard).
If you can't feel how to control your muscles, you can't feel how to relax them. You need to improve your ability to control your muscles and that involves your ability to feel your muscles working under your control (not merely the pain of muscles in spasm).
As you do, you recover comfortable freedom of movement; you recover the ability to relax; you stay more relaxed without thinking about it.
About (click:) clinical somatic education
To, show you how do-able this is, I'll present some coordinated movements that can often restore comfort to sore backs.
NOTE: If your problem is severe, (numbness or tingling in your extremities) see your doctor to rule out conditions that can be addressed only by surgical means, such as a disc tear.
Simple Somatic Coordination Exercises to Help End Back Pain
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- Do these movements as a way of creating sensations of movement.
- Move slowly and smoothly.
- Be gentle, working within the range of sensations you're willing to experience. Done gently, they are safe to do even with disk problems. If in doubt, consult your physical therapist before proceeding.
- Always separate repetitions of a movement with complete relaxation.
If you do these movements mechanically (for example, by counting repetitions instead of feeling movement), if you do them too quickly or too hard, you deprive yourself of the sensations needed to discover your own control over yourself. You may make yourself tighter, instead of looser. You will get better results by doing too little than by doing too much. You will have an easier time if you have somebody read these instructions to you. The movements should feel comfortable to do; if they create pain, do a smaller amount of movement. Move more slowly, more gently.
A: STARTING POSITION:
- on your belly
- face turned to the right
- right hand under your left cheek (like a pillow, palm down)
- left arm loosely by your side
- Slowly lift just your left leg.
Feel the first sensations of muscular effort. Go slowly.
- Slowly lower your left leg.
Feel the last sensation of relaxation, as it happens. Take a deep breath and let everything go.
REPEAT THIS LEG LIFT FOUR (4) TIMES AT DECREASING LEVELS OF EFFORT.
- Simultaneously lift your left leg, head, and right arm.
- Slowly lower yourself down, take a deep breath and relax all the way.
REPEAT 4 TIMES AT DECREASING LEVELS OF EFFORT, THEN SWITCH SIDES.
B: STARTING POSITION:
- On your back
- knees up
- feet near your buttocks
- Fingers interlaced behind your head.
- Elbows out flat on the floor
- Arch:
- Inhale.
- Gently, gradually turn your tailbone down into the
surface (arch your low back).
- Gently press your elbows down.
- Tug your heels toward your buttocks and hold.
- Curl:
REPEAT THIS "ARCH AND CURL" MOVEMENT FOUR TIMES
MORE AT DECREASING LEVELS OF EFFORT.
Do these movements for ten minutes daily for a week or two. Many people get just the results they need.
