Emily walks into my office and smiles. I ask her how she is going. She looks at me and breaks down crying. I think to myself this is not such a good sign. Then she says, “After last session I got home and walked down the hallway and realised that for the first time in 30 years I walked without pain. I can’t tell you what that means to me”.
Chronic back pain is a debilitating condition. If you have experienced chronic back pain you are not alone, as surveys suggest over 50% of Australians will have chronic back pain at some time in their lives. What I have found in my teaching and clinic is that, while many people have it, few understand its causes or what can be done to remedy it.
There are many therapies that may help, such as yoga, kinesiology generally, applied kinesiology (chiropractic kinesiology), osteopathy, chiropractic, acupuncture, remedial massage, physiotherapy, NST, Bowen therapy, myotherapy and other myofascial therapies, and therapies that improve brain function such as neurofeedback, cerebellum training, and primitive reflex therapy. In back pain surveys, stretching exercises, particularly yoga and Pilates, are nominated highly by patients for the relief they bring to back pain. Understanding what causes back pain, and how each therapy can help, will enable you to pick the right therapy or combination of therapies for you.
What causes back pain?
Generally people answer the question of what causes back pain by saying something is wrong with the vertebra, discs, muscles or the nerves. What very few people ask is, ‘Why is there something wrong with these aspects of the back?’
The most frequent cause of pain is tight and fatigued or traumatised muscles. This can lead to disc and vertebra problems over time if muscle tightness and fatigue remains and poor posture results.
So what causes tight, fatigued or traumatised muscles? Accidents, sprains, repetitive movements and strains can all play a role in the short term. It is also common for major traumas, like a car accident, to trigger long-term pain.
When three people are involved in a car accident commonly all three experience pain afterwards. However, they usually have pain in different areas of the body and they recover at different rates. After three to six months each person generally has very different experiences of recovery and very different areas of the spine affected.
Their experiences differ because each person has different postures and each posture has different strengths and weaknesses. Trauma usually triggers long-term problems in the weakest link in our structure. So if you have a forward head carriage and you receive a whiplash you are more likely to have long-term neck pain than someone with good head carriage.
The end impact of an accident may well depend on what your posture was like before the accident, rather than what occurred in the accident.
Posture is vital to long-term pain. It is important to remember that the body has great capacity to recover from trauma, accidents, sprains and strains. So to understand and overcome long-term pain we should focus on what hinders the body from recovering.
What hinders the body recovering?
The key factor hindering recovery is poor posture. Poor posture is the result of how we move; how muscles coordinate and help each other function. If coordination is poor and balance is poor, certain muscles are overworked and some are under-worked. The result is poor posture, muscle fatigue and tightness and pain.
How we move is the responsibility of the brain. The main areas of the brain involved in movement are the motor cortex, basal ganglia, brain stem, and cerebellum.
The key factors that impede good movement patterns are:
- emotional stress;
- poor access to postural reflexes; and
- poor general brain function.
The emotion centres of the brain (e.g., amygdala) directly interact with the motor centres. This is an inbuilt survival mechanism that takes priority over other systems. The body needs to react quickly in the sight of danger. So whenever we experience any of the survival emotions our posture will change as the body prepares to quickly respond to the source of stress. Survival emotions fear, anger, anxiety and excessive vigilance, withdrawal, freeze and excessive seeking behaviour (cravings and lust) all trigger motor responses.
How often do we feel these emotions – too often! When we are going for a job interview, speak in front of an audience, have an argument with our partner, rouse on our kids or watch an action movie we experience survival stress.
Our emotional state is written in the way we move and in our posture. If we continually experience a particular emotion it will show in our movements and posture. For example, people that tend to close down their heart will hunch, people experiencing a lot of fear tend to have a posture where their upper body leans back (sway back), and people that over-think commonly develop a large curve in their lower spine (lordosis).
Our posture represents our life’s history
Our posture represents our emotional and life history. It is the sum total of the way we express ourselves in our life. It is amazing how much posture and movement can tell us about a person. Of course we all recognise this to an extent. When we first meet someone we automatically pick up many cues about them from how they move. For example, do they move confidently, do they fidget, move quickly or slowly? However it was not until I began really analysing postures and asking clients about them that I realised just HOW MUCH of our life is written there in our posture.
This insight is very important in understanding back pain and what you can do to overcome it. There are two types of back pain clients:
- Type 1 ‘changed’ client: They have made recent changes to their life but their current posture is lagging behind these emotional/life changes.
- Type 2 ‘posture reflects my life’ client: Their current life is written in their posture.
A Type 1 ‘changed’ client is the easiest to work with because all that is required is structural work to help consolidate the changes they have already made in their life. When I first started clinic work I remember having a series of clients like this over three months that all came with 10 to 20 years’ back pain and, after a few sessions, said all their pain was gone. I thought to myself, ‘Why isn’t everyone doing this work?’ Then the next four clients that walked in took longer and longer to improve even though I was getting more efficient at the work. I learnt then that while some tools work for some people they may not work for all because not all clients are Type 1 clients.
All the therapies that directly work on the structure, as mentioned above, suit Type 1 clients. If there is acute injury, then physiotherapy, osteopathy, chiropractic, acupuncture and remedial massage, or some of the specialised forms of kinesiology would be my therapies of choice.
Don’t assume that where the mind leads the body will follow. Sometimes people make changes in their life but the body drags them back into old patterns. For example, if you have a tendency to be angry because you feel stuck and stagnant then you will develop a posture overtime that reflects that – producing chronic pain. If you start making changes and flowing more in life then the posture initially lags behind. While your movement patterns will have changed, the fascia, ligaments and tendons all take time to change to reflect these new motor patterns. As a result, the pain may remain and be a constant impediment to your flow. Over time this constant struggle to move freely may change your emotional state back to where you started.
So in this way the direct physical work can help our psychological state and help consolidate positive changes we make in our life.
Type 2 ‘posture reflects my life’ clients require a broader approach, one that facilitates their evolving and changing their life to be more reflective of what they truly desire, as well as working on their structure. This can be done by choosing a combination of therapies, i.e., a body therapy like chiropractic and a mind therapy like counselling or art therapy. Or alternatively you can choose a therapy that combines mind and body, such as kinesiology or even yoga (since yoga calms the mind as well as improving the posture). Either approach can work well so long as you address the root cause of your back pain – the emotional stress that underlies how you live your life.
Next issue, in “A mind-body approach to back pain”, David explains more about Type 2 clients and how to help them.
David Corby, Adv Dip holistic kinesiology, Grad Diploma Acupuncture, is Director of the College of Complementary Medicine and author of Finding Joy Within and Neuropressure.