Wednesday, August 12, 2009

Monte on over-use injuries, muscle imbalances, or alignment.

Here is another guest post from Monte Hueftle (you may remember my interview with Monte recently). Monte talks again about stress and tension causing physical pain.

This update is geared towards runners or active people who are battling what they think are over-use injuries, muscle imbalances, or having a body that is out of alignment.

I can confidently state to you that in most cases (90%+) your injury is being caused by inner stress and tension and it is not a physical problem. Let me qualify that statement. I am speaking about chronic pain or a chronic injury pattern. Meaning you have had your injury on and off for 2 months or longer. Or you have a chronic injury like sciatica for three months and then it goes away but now you are battling pain in your hip or back or butt. You win these injury battles but there is always a new one challenging you. You have tried numerous treatments and medical specialist but no one knows exactly what is wrong or how to fix it. If they do, what they are prescribing is not working. Does this sound familiar? These are very common experiences of people living with tension-induced pain.

I get a ton of questions about how do you know the difference from pain symptoms that are caused by inner tension and ones caused by physical deficiencies. Here are some guidelines.

  1. Does rest, ice, self-massage and anti-inflammatory products provide relief and continued progress? If the answer is yes then this is a good indication it is physical—Diligently stick with what you are doing.
  2. Have you tried many different treatments (doctors, chiropractic, massage, injections, physical therapy, new shoes, medications, etc) with mixed results and the bottom-line outcome being you are still in pain or fighting a new injury pattern? This is a good indication your pain is likely caused by inner stress/tension.
  3. Does your pain or injury act exactly like you think or believe an injury should act like if it was caused by a physical problem? If so, I want you to understand that tension or stressed induced pain will have you swearing up and down that it has to be a physical cause because of the way it feels and how you became injured. Most likely you first noticed the pain/injury while in your activity or following a workout. This can be more perfect reasoning for you that it has to be a physical cause, right? No, this is also quite common in tension-induced pain. Realize that pain symptoms will in many cases locate in a part of your body that is dominantly being used in an activity. Tennis = shoulder or elbow; rowing = shoulder or back; running = knee, hip, piriformis, sciatica and back; typing = hand/wrist; sitting = piriformis, sciatica, hip; bending over and lifting = back.

One of the big huge points that I want to emphasize to you is that pain/injury caused by inner stress/tension is very real pain. Yes, the cause has psychological components, but in no way, shape or form is anyone suggesting that it is not real or in your head. This is one of the reasons that I never refer to this chronic pain disorder as a psychosomatic disorder. There are too many misconceptions and negative connotations associated around that word and it causes people to avoid the subject all together.

Simply put, tension or inner stress induced pain is caused by behavior patterns (usually type “a” such as: striving, people pleasing, controlling, perfection, worry and being self-conscious) and the thoughts that you think when you are in these behavior modes. Not everyone who is a type “a” person generates chronic pain, but that is not the point. If you identify with these qualities and you have chronic pain/injuries then you need to investigate this disorder.

Another good way to look at this pain disorder is cause and effect. If you are behaving and thinking in ways that are (closed-off, resistant, non-allowing, un-flexible) then through the mind–body connection your body is feeling (closed-off, tight, stiff and un-flexible).

It can be helpful for many to understand the bio-chemical process taking place that is generating pain and other symptoms. When you communicate stress or tension through your thoughts and behaviors, automatically this is received by your autonomic nervous system and your nervous system responds accordingly. Your nervous system constricts blood vessel walls and less blood is now flowing to muscle and nerve tissue. You now have less oxygen reaching your tissue (oxygen deprivation) and this is pain (burning, shooting, constant or spasm, on/off, and moving locations).

What you really want to know is, “how do I stop or reverse this process”. This can be the big, huge, challenging part for athletically minded people who put significant focus on their body and how it is performing!

  1. You must begin to accept this diagnosis. At the very least, enough to genuinely engage in the key points below.
  2. You have to stop your physical treatments. Why? If you are treating pain caused by psychological factors with physical treatments then you are not treating the cause. You are not changing the whole mind-body dynamic that has you in this chronic/pain injury cycle.
  3. Regard the pain symptom as a Signal that is trying to distract you or keep you from the real psychological cause. Choose not to be distracted by focusing on the pain or physical treatments.
  4. Instead, ask yourself a psychological question like, “what is going on with me right now, or what is causing me to feel stressed right now, or which one of my type “a” patterns am I in”. When you do this you are not distracted and you are identifying the cause. This one step can break your pain cycle!
  5. Begin to practice being in the flow or present-moment based in more areas of your life. Start listening to or observing your thoughts and behavior patterns. When you catch yourself in these patterns ask yourself if there is a more open or more flexible way that you could be thinking and acting. This is important because it takes you out of the patterns that generate inner tension more and more often.
  6. Resume or continue your physical activity as long as you are not in so much pain that all you are focusing on is the pain. While in your activity you do not want to be focused in your type “a” patterns and you do not want to focus on the symptoms or on what is wrong with me and how am I going to fix this self talk. Remember, you now know what is going on and you are choosing not to be distracted. Pain is your signal to think psychologically. If you are not sure---email or call me with your questions.
  7. Start a practice of journaling about your behaviors, thoughts and feelings. Again this is an example of addressing the psychological factors that are generating inner tension and it opens you up psychologically as well as physically.
  8. Begin a practice like power yoga or root lock. Root lock is the breathing and muscle contraction used in power yoga without all of the postures. This is not a physical treatment. These are mindful, highly focused practices that allow you to release tension in the body without creating more tension with your mind!
  9. Now with all of this, do it or be it without having it be a treatment that is fixing your pain condition. It is, but as much as possible, take the striving, controlling, perfection, analyzing and worry out of it.

I understand that you just want to run or workout or train and not be in pain. I also know that you want a “quick fix” that prompts you to search anywhere and everywhere for something that has worked for someone at one time or another.

Here is the truth and bottom-line with these physical pain disorders caused by inner tension/stress. The steps that I outlined above can be the quick fix to your symptom. They can also be not quite as quick as you want them to be. I can absolutely tell you that these steps are the permanent solution to end chronic pain/injuries that are caused by inner tension/stress.

This information will resonate with you on some level or not. If it does but you are not quite sure drop me a note. If not, “no worries”, keep it in the back of your mind for future reference if need be.

Stay the course,

Monte Hueftle

P.S. If you would like a personal response from me on your pain/injury situation and the psychological factors that could be involved, fill out this brief survey


Marc said...


Chris, thank you for this.
I'm suffering from a nagging pain in my right forearm....


Chris said...

I am really convinced of the psychological basis o much pain Marc, it is a really interesting area.

Koen Overdijk said...

Dear Monte,

To my opinion the pain almost always starts with more physical components. (overuse, or lack of use, bad posture, bad coordination of movement, trauma and so on) Depending on your psychological status you maybe more vulnerable to it. ( a depresive state makes also a bad posture, it also makes bad concentration also more vulnerable for trauma) Principally it's wrong to trie afterwards to separate the mind and the body, (like descartes did)also to trie to separate afterwards the physical and psychological and social causes. They are responsible for not healing and turning the disorder into chronic. Only treatments that treat both aspects can be succesfull. Because of the bad diagnosis capacities of most medical people it is an easy way out to blame it on the psycho- (and social) problems when the treatment does not work out. Actually doctors thereby say it is your fault and not mine when you don't heal, which may lessen there own frustration. Tackling this psychosozial bariers directly is very difficult as man can see in your explanations. Because it does not deal with the persisting medical causes it mostly only modifies the problem and does not heal it really. Thereby it does not help which name you give it. Psychosomatic or behavioral)

Effective selftreatment and experience how you can get selfcontrol over the pain have both of this aspects and is in fact also an behavioral treatment. Bad thoughts (catostrophizing) and fear to move dissapears immediatly when the pain lessens because of a pair of exercises or at least does not get worse despite of doing them. Selfconfidence in the body returns.

For this effect it is extremely important the exercises must be choosen right. That is part of the diagnostics. So you have to go to someone who knows beacuse of his daignostics what he prescribes (the load, the type of exercise and the direction) and tell you what sort of reaction you will get. That is exactly what i and other therapists in 40 countries of the world do with the MDT, the mechanical diagnosis and therapy of McKenzie.

After 12 years of doing so I am still as ethausistic as on day one. I strongly can recomend this for both therapists and patients that srtuggle with this problem.

Koen Overdijk
physiotherapist, cred MDT. Netherlands
Email: look on my website (only in dutch)

The MellowJohnny said...


I appreciate your comments and undersand where you are coming from.

In physical pain disorders that are caused by psychological factors there is not a physical exercise/treatment that will heal the pain symptoms. In fact physical exercise or treatments that are aimed to heal the pain symptom will actually keep the physical symptoms alive and usually make them more profound.

This is one of the most mis-understood aspects of pain disorders caused by psychological factors. The pain is real and the pain strategy is keeping you focused on the body and away from the feelings/emotions that are underlying. When a person then attempts to heal by physical means they actually keep the strategy alive, they have been successfully distracted away from the cause (emotions/feelings) while focusing on the physical aspect.

I experienced chronic pain for 20 years and I was diagnosed with over-use, muscle imbalance, leg length discrepancy, pinched nerves, and curvature of the spine. I experienced years of physical therapy, chiropractic, special massage, nerve stimulation, etc. Nothing worked.

When I discovered that there was a physical pain disorder that is caused by psychological factors I began applying that philosophy of treatment. Basically stop all physical treatments and treat the cause (thoughts and behaviors that generate inner tension and repress emotional energy). It worked.
I have now been pain free for 9 years and at the age of 48 I am runnng 70-80 miles per week pain free. And with the same leg length discrepancy, pinched nerves, muscle imbalances and poor spine that I have always been diagnosed with.
I am not debating physical therapy and it's benefit. I practice power yoga, work the core and do other strength and flexibility training daily. My body is balanced and strong and flexible. However, if I begin to generate tremendous inner tension and I do not address it correctly, as the cause of my new pain symptoms, then I will find myself back in a physical pain symptom caused by psychological factors (inner tension). Treating my body will not adjust a mind creating inner tension. I must treat the mind and the body will follow.


Monte Hueftle