Tuesday, December 8, 2009

Back Pain...TMS or Z...or both?

I've posted some stuff in the past about back pain, particularly looking at TMS - the pain being real but a physical manifestation of something going on psychologically. Your mind creating real pain in your body to distract you from subconscious worries and anger and other emotions. Your mind is giving you real physical pain to distract you from what is really stressing you....

My interviews with Monte and Adam explain this all in more detail.

Then I was at that workshop with mc last week and she was talking about how the body reacts unconsciously to threat....health is about threat modulation....Emotions effecting, causing something physical.....now something physical can affect emotions.....

Things connect...that there are emotional factors at play, even at an unconscious level.


In my interview with Frank Forencich he alluded to something similar:

Depression is epidemic. The World Health Organization forecasts that, by 2020, “depression will be second only to heart disease in terms of disability or disease burden.”

To me, this is even more shocking than our epidemics of heart disease, obesity and diabetes. This is a disease state that’s psychospiritual as well as physical. There are many explanations, but I like the work of Kelly Lambert. She’s a neuroscientist who’s traced reward centers in the brain. She’s discovered a strong association between areas that coordinate movement and those that deliver a sense of satisfaction. I call this “the ancestral reward system.”


mc has discussed back pain more in a new post:

Thoughts on Low Back Pain


The big take away seems to be that especially chronic low back pain is frequently not about the joints - pain is way more interesting and intriguing it seems than that, but it does make sense that the low back is where so much chronic pain gets filtered.

12 comments:

Deadsunrise said...

Just a small anecdotal evidence. About 4 weeks ago I started wearing barefoot/minimalist shoes. My back used to pain almost every day but barefoot walking solved the problem instantly and I've felt great since then.

The strange thing is that last monday I was feeling a little bit down, it was a holiday and there was nothing to do at home so I was feeling pretty bored and miserable and my back pain came back.

I even mentioned to my girlfriend because it was just another "bad" thing to add to the depression and it seemed weird because I hadn't felt pain in weeks.

Reading your post now it makes sense that the pain came directly from the emotional state.

Dr. David Hicks said...

I have yet to see a lumbar spine within normal limits in both front and side views that belongs to a patient complaining of back pain. Do you know what a normal lumbar spine is supposed to look like? Do you know what yours looks like?

OLDDUDE said...

Yes I do, yes I do. The real question is do you and your profession? I already know the answer.

Chris said...

Dr Hicks

What does a normal spine look like then?

Anyway, if it is out of shape, what is causing that? It is being pulled out of shape by the muscles. What is causing the muscles to be pulling out of position?

Dave Hicks said...

The normal lumbar spine is straight from the front, and has an elliptical lordosis from the side. A lordosis is a curve such that the convexity is toward the front. This was established by Harrison et.al. and published in the journal SPINE. Now, an elliptical curve is different than a circular curve in that it has more curve at the bottom than at the top. Also important is the angle of pelvic tilt. Ideally, the measurement (using posterior tangent lines) is 39.1 degrees when measured from L1 to L5, and 40 degrees angle of pelvic tilt when measured at the sacral base, as compared to horizontal. Bear in mind that these are IDEAL measurements, and are not really necessary to have a pain free lower back. Getting the patient within one standard deviation is usually sufficient. With this in mind, irreversible degeneration can obviously occur before this correction can take place. If your disc is gone, it's gone, man. This goes back to the phases of spinal degeneration. Once heavy degeneration of bone (Wolf's Law) causes joint immobilization, bone fusion, nerve atrophy and scar tissue occurs on a permanent basis there is little that can be done conservatively. My point here is that without knowing what's wrong with the shape of your spine, it is extremely difficult to know how to fix it, what exercises to prescribe, etc. "What causes it?" is also a question that is answered by, "it depends" as the answer varies from case to case; But to write it off a psychological is sloppy thinking.

Dave Hicks said...

Next question, of course is: "Can my emotional state effect my posture, and, therefore, the shape of my lower back?" and the answer, of course, is "Yes, of course!" However, that does not necessarily mean that "getting happy" is the answer to solving chronic low back problems. Sure negative emotional states mimic stress, stress causes pro-inflammatory chemical response, etc. etc. but someone with a reversed lumbar curve, a postural fault from the front such that a pseudo-scoliosis occurs, or some other mechanical problem will not have his problems solved by an emotional solution; even though a proper mental attitude is one of the pillars of health.

Chris said...

Dave

I don't think it is either/or.

Of course there can be pathology causing pain - disc degeneration or whatever.

However for so many people with back pain there is no clear pathology and doctors can find nothing wrong...the pain comes and goes and moves around. I believe much of it is psychological. Sarno also has accounts of people whose pathology indicates degeneration ruptured disc etc and who have no symptoms.

Sometimes the emotional solution does solve the problem - relaxing the muscles will change posture.

Dave Hicks said...

Chris

I can respect that, but by the same token let's understand what our colleagues in the medical profession look for when reading films: pathology such as fracture, dislocation, mass or infection. What we DC's call subluxation, (a bone out of place that causes nerve interference) MD's (including my buddy the spinal pain specialist)refer to as "spinal pain without radiographic evidence". They simply do not consider the weight bearing position of the lumbar spine..why would they? That's not their job. That doesn't mean the pain is idiopathic, psychosomatic, or imaginary. It's insensitive and just plain wrong to tell a patient suffering with mechanical back pain that "It's all in your head"

The MellowJohnny said...

Chris & Dr. Hicks,

The TMS docs have quite a bit of evidence that people in pain or painfree quite often have the same looking pathology. I know in my case I was diagnosed with curvature of spine, degenerated disc and pinched nerve. This was well over 10 years ago. I reversed all of my symptoms by treating the cause as psychological while stopping any physical treatment/therapy aimed at fixing my body parts.

If I were to go back today for an mri I would still have a crooked spine and degenerated disc even though I have been painfree for 9 years now.
What most medical professionals don't get is the complete cause of pain being oxygen deprivation and how powerful the pain/distraction strategy is in these disorders. For example someone with TMS but on the fence and having some doubt would be totally set back by reading that it can't be fixed by simply addressing the psychological.
And it is not about being happy...it is about communicating more open, allowing, aligned and balanced behavior and thought energy to our nervous system. Our nervous system takes whatever we give it and processes it. If we give it closed-off, tight, unflexible energy (via thoughts/behaviors/attitiudes) then we get that effect in our body
(restricted blood vessel walls) means lack of oxygen to muscle and nerve tissue. When we make the adjustment to be more open this is communicated to our nervous system and then to our body. Cause and effect processed automatically through our autonomic nervous system.

Monte Hueftle
www.runningpain.com

Chris said...

Thanks Monte

Joanne at Open Mind Required said...

I've had chronic low back pain for decades. It includes stiffness and pain from the sacrum all the way up and around my ribcage. Neither chiropractic nor numerous forms of deep tissue therapy, including the full set of Rolfing sessions, helped.

Since giving up gluten a few months ago, my pain and tightness has all but disappeared. I just have some lingering tightness in my ribcage.

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