Sunday, May 31, 2009

Perspective...back pain

I've had a bad back the last week or so. Work has been busy recently and I've been doing 10-12 hour days over the last few weeks. Lots of sitting and lots of stress too.

The lower back was getting very tight but it would always loosen off quite quickly when I started moving. Then last week we were out for lunch at a pub in the country and afterwards while walking round the loch I decided to climb a tree (!) and I got this massive back spasm that I've been recovering from all week.

I've had episodes of back pain over the last 15 or so years and am used to it but each time it really makes me appreciate basic health and fitness.

When you cannot move due to intense muscle spasms literally immobilising you, when you cannot put your own socks on or wipe your own arse then all this health and conditioning discussion seems a bit stupid.

It is only when you are injured that you truly appreciate what it is to be fit, mobile and healthy. Of course when you are well, you soon forget to appreciate what you have.

I coudl blame it on tight hip flexors but part of my back pain I am sure is about stress and I am really sympathetic to the whole Sarno approach - the idea that sometimes the pain is derived from your subconscious - your mind is giving you the pain to distract you from what is really stressing you. Emotional factors are really important for lots of pain and illness.

Sonnon's mobility stuff is related to all this too. His mobility booklet and the full book - Free to Move - talk about the impact of emotional factors e.g.:

Common mental and emotional issues faced as a result of the lower back not being Free to Move:
  • Feeling unsupported
  • Feeling insecure
  • Lacking stability
  • Lacking community development

I think there is more to it - massage really helps me too. Maybe it is just a placebo, but it works. I'm always looking for other placebos or course - hence some of the things I refer to in this blog.....

Art Devany has remarked before that the body is the subconscious. I think posture has something to do with it as well. When you are weighed down mentally, your posture collapses too.

There is a good interview with Sarno here.

And another is below:


Todd said...

I coughed really hard yesterday morning, and my back seized up - this is the first time this has happened to me, and I can really relate to your statement about appreciating basic health.

Also, I think I notice immediate results from rubber ball massages on my trigger points. I'm new to the whole trigger point concept, and I'd like to see more research, especially since the effects seem to be so positive for me.

Chris said...

Todd, if you find a good trigger point therapist they can be excellent. I've always struggled to treat my own trigger points though. Clair Davies book on Trigger Points is fantastic and worth reading.

Sometimes I think it is still treating the symptom not the cause however.

I've coughed and had a back spasm so I know how you feel. However I really wonder if that is the true cause? Why woudl a cough cause that?

Anonymous said...

You have my sympathies Chris. As for coughing- along with sneezing it's an incredibly powerful reflex that causes huge and fast contractions of many large muscle groups in the body. It's not the first time I've heard of people pulling muscles coughing/sneezing. As for the spasms, they often originate from some kind of injury or inflammation of the lower back. It's also thought that sitting for long periods of time with poor posture can cause spasms as the lower back can be under a great deal of strain whilst sitting.

I've spoken to many physiotherapists about the mental and emotional issues manifesting themselves in muscular injuries. It's not the first time I've heard stories of patients breaking down in tears while receicing a massage.

I'm not sure what you can do to help get over this Chris- perhaps find a new job. Work less. Find ways to alleviate your stress levels. Better yet, find out why you feel stressed and treat the cause rather than the symptom. Spend a few minutes stretching for every hour you spend sitting. Oh and maybe warm up before climbing trees ;)

Hope you get better soon.

John Sifferman said...

I hear you, Chris.

I went to bed with back pain every night for two years, then I woke up in even more pain. A great way to start your day, eh?

I definitely think that the physical pain causes mental and emotional pain as well, but it was after the fact for me. When I first started getting back pain I was in denial (it was from a herniated disk from a barbell deadlifting session). I reasoned that it may have been a really bad muscle pull or tear, and so I waited it out. It didn't go away, even after a long break from weightlifting, and that's when the mental/emotional issues starting raising their heads.

It was like a battle at first, I would get thoughts that would tell me I was really hurt and weak, but I would put it out of my mind immediately, rationalizing that I could still be just as good despite the pain. I would repeat a mantra, "pain is weakness leaving the body." But after several months, I got weary of fighting the mind gremlims and eventually gave in. I admitted that I was severely injured, weak, and incapable. I couldn't perform well in almost anything that involved movement. I was in pain when standing, sitting, and sleeping.

So, the mental emotional issues were linked to the back pain I was experiencing, but I had the ability to override it with conscious thought. When the unconscious took over, my body just started getting worse and worse - I had lost control of my positive thoughts. I had come full circle.

My recovery was not guaranteed until after I had got my mind back in order. I had to believe that I would get better. Placebo effect? That's certainly possible, but I don't think that's the whole story - and I think we need a little more research into placebo territory to understand what's really going on physiologically.

Get better soon, Chris!

Todd said...

Chris, I just got the Clair Davies book, which is why I'm all excited about trigger points.

I agree with you regarding trigger points being a symptom rather than a cause: I have trouble with forearm and back tightness that I'm sure stems from the repititive motions involved in playing guitar. However, I think trigger point therapy will benefit me greatly, as it enables me to release tension in muscles enough to give them a proper stretch. Also, if the muscles are a bit looser, my technique improves significantly as well. It's all about breaking that feedback loop.

Calvin said...

Hey Chris,

Sorry to hear about your back--argggg! Anytime there is muscle cramping, the first thing to consider is Magnesium status--load up dude. Also, remember that many things deplete Mg, including stress (long work hours included). The always witty and esoteric Dr. BG at Animal Pharm has a great recent posting on Mg.



Chris said...

thanks Calvin - i'll check it out

Calvin said...

Hey again Chris,

I know that you've already posted links on Ester Gokhale and Kathleen Porter which are basically take-offs on the Alexander Method (all great); I'll add few more for your posture category: Here is a link to good article by Liz Koch ( /articles/sitting-at-your-computer/ ) on sitting and the psoas--notice that when the upper thighs are in the typical seated position, things get tight which has consequences. Notice the upper leg position in the proper seated position . . . She also has a few good books that cover the psoas in greater detail on Amazon.

Personally, I seat on a Variable Balans chair design by Peter Opsvik--this chair makes good posture so easy, positions the upper leg angles correctly for psoas health, AND the rockered base makes seating very dynamic, rather than static as with typical chairs. Go to Peter Opsvik's design website and click on the Variable balans animated link . . .

Another, "better chair" idea is sitting on a exercise ball--it makes it easy to assume many various dynamic positions frequently while seated, just be sure to get one that positions the butt high enough for the proper down-slopping upper leg angle. Also, the exercise ball makes it so easy to perform back stretches (opposite of hunched over a computer position), feet elevated push ups, crunches, etc.

Chris said...

Thanks Calvin.

I'e got Liz Koch;s Psoas book and certainly tight hip flexors are often an issue for me - I spend too much time sitting down at work, particularly in this busy period. Interestingly she also makes a lot of the emotional issues associated with pain.



Stephan Guyenet said...


I think I mentioned a while back that Sarno's approach helped me tremendously with lifelong back/neck/jaw/shoulder/sciatic/foot pain. It reduced the pain by about 90%, to the point where I don't really notice it anymore.

I'm starting to suspect there's another factor for me though. I've been gluten-free for about 5 months now (low-gluten for the 6 months before that). I accidentally ate gluten at a party a few days ago, and I've noticed that my back and shoulder pain has increased and I feel stiff overall. It could be a coincidence-- I also drank too much and flew on an airplane-- but this is the second time eating gluten has corresponded to increased pain. Peter at Hyperlipid says that even small amounts of gluten trigger back pain for him. Is it in my head?? Maybe. I'll have to do a double-blind placebo-controlled test on myself to see.

Chris said...

Thanks for the comment Stephan.

My girlfriend is an immunologist, researching in Crohn's disease. She is constantly berating me for my tendency to blame everything on a single cause. You see it all the time on the internet. People have their pet culprit - carbs, food chemicals, stress, gluten, fat, etc or their miracle cure-all: omega 3, magnesium, yoga, fat etc. She is always telling me that problems usually have several causes. There is a genetic susceptibility and then whatever factor - pathogen or environmental issue - that kicks off the problem.

So, I am sympathetic to the idea that there are lots of factors involved. I do think Sarno has much to commend him - stress and its effects on is a huge factor in a lot of illnesses. However I am very much convinced also that gluten can be a problem for many people and that most of us are better off keeping away from the grains.

This waters down sarno a little - blaming something physical - but as I said I think things may be a little more complex

Dr. B G said...

Thanks for the kudos Cal! I don't think I deserve all the credit...


Day spa's!!! You're right!!

A LLLLLLLLOOOOTT!!! De-stressing and loosens up the hams, lower back, tight shoulders from hunching up finding great resources for Conditioning . . . (preferably a MALE MASSEUSE b/c they have BIGGER STRONGER HANDS . . . dude, no time to be homophobic; the cuter, the better *wink* j/k)

(And bring your own omega6-PUFA-free oil... a wise old friend of mine recommended... he said almond oil is the BEST... and I'd totally agree)

Krill oil -- does your girlfriend know about krill oil (and the immunoprotection it affords)?
-- better than NSAIDs and aleve/ibu/motrin in one NKO trial
-- dose: 3000mg daily x1-2mos (even Poliquin and his groupies and Dr. Eades advises). Do you eat that much seafood/crustaceans out there in the UK? Neither do I...

Terrence said...

Chris -one of the problems with magnesium supplements is that most are very poorly absorbed.

The one I have found best is called “Natural Calm”. It is a powder that you bring to a boil then drink like tea. I use it to ease and eliminate leg cramps and spasms. It does work, once you find the right dosage.

A British guy developed it; I don't recall his name. But you can Google "Natural Calm UK" for the British web site, to get more info about it.

Dr. B G said...

My sister and I use Calm -- it's great stuff (which I forgot to mention). My kids don't mind it either!

Calvin has priceless advice! Speaking of superman and the psoas... here's a chiro in Juneau w/isolated exercises that might be helpful until things balance out... (he's right about the shoulder/LBP -- as long as I do 5x5 back squats at Xfit 65-95# my bum shoulder is gold, otherwise stuff like this fills in until I get to a DB)

(high heels -- avoid them... j/k!!)

Hope it helps! You'll be able to climb those mountains again SOON.

Chris said...

Terence, Dr BG, Calvin - thanks for your helpful comments and good wishes. (Follow the link and you'll see the masseur I see is a big guy)

As you'll see from my most recent post, things are improving.

Most of the issue I think is being very busy at work. There is a big deadline coming up and the last couple of months have seen a lot of 12 hour days sat at the desk. It will soon be past however. I work in local government and am responsible for a big part of administering the upcoming European elections here in Edinburgh (and part of the Scottish coordination)

Anonymous said...

We spend alot of time training and talking about our core. A big component of all of this is awareness. We can be aware of a particular muscle during an exercise but can we keep this awareness throughout the day? My, experience with all of this and reoccuring/chronic back pain is that awareness of how we are using our core throughout the day and the interaction between muscle tension and all those stressors whether they be postural,emotional etc,can be alleviated by awareness training.Controlling your mind isnt much different than controlling your lats.

j said...

I have been an enthusiastic student of Dr. Sarno's theory for almost 10 years,

i actually read almost every single book listed in the footnotes of "the divided mind" (when youre strung up with back pain for about 4 years you have lots of time on your hands!!)

i can say 2 critical things about Sarno:

1. most people think they understand the concept of the pain representing some sort of emotional tension or conflict but dont fully grasp the concept.

the pain is a distraction your mind employs to keep you from devling into emotionally troubling issues to which you mind fears would be too great a burden.

the pain is not a manifestation of your emotional conflicts, nor is it a symptom of them. think of your brain and your body as one living blob, where no distinction is made between what happens in your head or your body.

2. if you are interested consider reading the pychological approach that Sarno himself employs with patients, namely Cognitive Behvaioural Therapy (CBT or often called "short term dynamic psychotherapy") Sarno is a staunch supporter of Dr. Davanlo who is considered by many to be to modern psychotherapy what carl jung was to the foundation of psychiatry as a science.

Jorgen said...

I don't mean to be harsh, but it's going to help to both acknowledge the emotional cause of pain and then say that 'yeah, but I do sit a lot at that desk, so that's part of it'. It's really not. Lots of people sit at desks as much as you (and me, and us) and do not have stiff hip flexors.

I'm in pretty much the same boat as you. I'm investigating a meditational approach these days and I'll post back if it has any effect in the long run.

By effect I mean resolution of unconscious emotional issues -> loosening of unconscious muscle contractions -> less pain more movement.

A thought is that if this emotional stuff really is the key that means that Anatomy Trains and Cressy mobility obsession is all in vein. That would be a relief eh?

Chris said...



That is sometimes my suspicion - that the root of all this is emotional and all the stretching, massage, mobility work etc is ultimately only playing with symptoms not causes.

I know I have the sort of personality that is classic TMS but resolving the pain is not easy.

Anonymous said...

What you just said is absolutely true and I speak from experience. Throw away your preconceptions about meditation and relaxation training and what you think the mind/body connection because in reality there is no seperation. If you leave the anguish at home it really is alot of fun observing and training the mind, just dont bring the same skill set with you that created the problems in the first place.

Robert M. said...

I think I gave myself a hypochondriacs' sore neck just listening to Sarno's slow, plodding pace.

Anonymous said...

I thought it was pretty good.


Chris said...

J and Jorgen - coudl you email me?



L. Wu said...

@Chris Hey, I thought this was conditioning research :)

I've read Sarno and know from my study of Gray Cook's CK-FMS that hip mobility is important in avoiding excessive lumbar flexion and eventually lower back pain.

The two authors I recommend are Esther Gokhale (also mentioned above) and Dr. Stuart McGill from Waterloo.

McGill's books have perhaps the best resesarch-based suggestions I've seen, whereas Esther Gokhale's work addresses posture and what you do the rest of the day when you're not training.

Also see

L. Wu said...

Is emotional health an important part of the picture? Yes, definitely. However, that is not to say that your mind is not part of your body and your body not part of your mind. In other words, you can address emotional pain with physical work and physical pain with emotional work. So why not do both?

For the data, Dr. McGill's books talk about how there are components such as emotional health and so on, but physical work patterns in every day life and not-so-every day training also matter just as much, according to my reading of his meta-analysis of multiple papers in the field.

Body, mind, bodymind? Yes.

Chris said...

L Wu

thanks for the comment. I think highlyof Gokhale. If you do a searhc on this blog for posture you will see I've featured her a few times.

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