What You Can Do About Your Own Back Pain

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.


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. The entrapment is sometimes sufficient to cause radiating pain (e.g., sciatica, thoracic outlet syndrome).

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 take the pinch off the nerves.

Fortunately for those using the right methods, a muscular conditioning problem can often be cleared up fairly quickly — their past experiences of therapy 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. 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.

In that way, common therapeutic methods — psychological, manipulative, many surgeries, therapeutic exercises in general — use explanatory models of the situation that lead people to misunderstand (or miss a part of) the situation. They concentrate on muscles.

But the problem isn’t weakness or muscles in need of stretching; it’s muscular overactivity and muscle fatigue (tiredness and soreness) caused by brain-level control of muscles.

A more direct approach, then, is to improve muscular control at the brain-level — a matter of training. People with back pain generally need a brain-muscle approach — either to avoid surgery or after surgery.

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.

Muscular Control

Muscular control has two parts: the ability to regulate muscular tension (regulate strength and relaxation) and the ability to sense muscular tension. You need both abilities for muscular control.

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 whatto 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).

So, to restate the point: 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 to feel 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.

This article continues with instructions for self-help (click:) back pain and video. The self-help instructions exist at the end of that article. That article also contains additional links that explain this very different approach to back pain.

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