The most common type of pain that people experience is an aching back, so I am going to trace a typical healing journey of someone who, for one reason or another, is suffering from lower back pain and is seeking help. Most probably, the first stop on this ailing man’s journey is the office of his local physician, or MD.
The doctor takes a short history of the man’s pain and probably recommends bed rest and a few days off work. If the pain is acute, he may also prescribe pain killers plus an anti-inflammatory drug to alleviate symptoms and get rid of what he sees as one of the main causes of the problem — inflammation, also known as functional arthritis.
If the pain disappears, well and good, but many times such forms of treatment are ineffective, because doctors are not trained to understand, diagnose and treat muscular-skeletal pain. In their misguided good intention, many MDs will not admit their ignorance about this type of problem and will tell the patient to merely “get some rest” in the hope that the inflamed area will cool down and heal.
If the patient does not get better, the doctor will send him for an X-ray and then, holding the film up to the light and studying the results, he may see that there is a reduced space between two of the lumbar vertebrae. “Aha!” he says to his patient. “You’ve got a degenerative disc problem,” a pronouncement which frightens the patient and conjures up all kinds of nightmare scenarios about a crippling back problem.
The word ‘disc’ in this context is a short-form of ‘inter-vertebral disc,’ referring to a disk-shaped piece of specialized tissue that both separates and connects the bones of the spinal column. The center of the disc, called the nucleus, contains a fluid that has the quality of oil — it has a thick, gummy consistency – which softens the shock of body movements such as standing, walking, running, etc. The outer ring of the disc, called the ‘annulus,’ consists of a series of dense, inter-woven layers of fibrous tissue that hold the nucleus in place, providing structure and strength.
Discs operate like hydraulics shock absorbers. They protect your precious spinal column, with all its delicate bones stacked on top of each other, against the impact of your daily activities. They also create space between the vertebrae so that your spinal nerves don’t get pinched.
On the X-ray, the doctor may see a diminished space between two vertebrae, say L4 and L5, the fourth and fifth lumbar vertebrae, and conclude that the disc cushioning these two bones has somehow degenerated.
He might conjecture that there is a herniated disc, meaning that the outer ring has fractured and the fluid is starting to leak out. This not only reduces space between the vertebrae but can also create pressure against one or more of the spinal nerves, causing pain, weakness or numbness that may be felt all the way into the legs or arms.
Having diagnosed the problem, the doctor will then send his client to a physical therapist who will use traction, stretching the spine to create more space between the vertebrae in the hope that the disc will slip back into its correct position, or, if this fails, recommending surgery. In the latter case, the MD will send his patient to an orthopedic surgeon who will then do a series of tests, including an MRI (magnetic resonance image) to see if the soft tissue of the disc is torn and intruding into a nerve.
However, the problem is that even if there seems to be evidence of a slipped disc, 95% of the time this is not the cause of the pain that is affecting the patient. In fact, if you make the same investigation of apparently healthy people, with no back pain, you would almost always see evidence of diminished space between some of the vertebrae. It’s part of the normal wear and tear of your spine’s life and doesn’t necessarily indicate a source of pain.
The Chiropractic Option
In this way, many people are misdiagnosed, and those suffering with ailing backs who are suspicious about conventional medical wisdom may seek alternative treatment by going to a chiropractor. I grew up in California, where this kind of treatment is very popular, so much so that you are likely to encounter many chiropractor’s offices in each city. Muscular-skeletal pain is big business — successful chiropractors will see up to a 50 to 100 people a day.
A chiropractor adjusts or manipulates the spine with firm, sudden movements that typically create sounds like a crack, or pop, which occur when vertebrae that are out of alignment are swiftly snapped back into their correct positions. This can be an effective technique, at least in the short term, and I want to say that I appreciate the chiropractor’s art — I have been helped by it personally and I have seen many others helped.
A chiropractor’s method is to manipulate the spine, to move the bones, so it’s not surprising that any client who walks in his door with back pain is going to look like he’s suffering from some kind of joint dysfunction and in need of manipulation. It reflects the old saying that if your hand is accustomed to holding a hammer, everything you see looks like a nail.
But, again, in many cases, this form of treatment will not provide long-term help. Why? Because in my 42 years of treating people, I would say that the source of pain in 90 -95 percent of cases of people who come to me with back problems is not located in the joint or disc, but in the soft tissue, by which I mean the muscles and fascia.
Chronic Myofascial Spasm
All of us have myofascial tissue that is chronically contracted, forming rigid holding patterns throughout the body, but most of the time we don’t feel this as pain, because at a certain level of contraction our nervous system shuts down to sensation; we don’t experience that part of our body; we don’t even feel it. But if we suddenly take on an additional load of stress — for instance, some type of emotional or psychological problem caused by difficulties in a love relationship or at work — the muscles will contract even more to the point where they register as pain.
Most people know what it’s like to have cramp in the lower legs or feet, in what is sometimes called a “charlie horse,” whereby the muscles suddenly go into severe contraction, balling up in a big knot, which is excruciatingly painful but luckily does not last very long. This pain, often encountered in sport, is caused by muscles contracting to a much higher degree than normal.
As I’ve said, we all have chronic spasms in our muscles and fascia, but this ongoing level of spasm does not cause pain until additional stress creates more contraction, moving the soft tissue beyond the numbness threshold into a higher register of pain that can be experienced as anything from an aching muscle to a debilitating cramp.
When this kind of pain hits us in the back, the first thing most people say is, “Oh, something is out in my lower back.” This is how we have been educated to think, and partly it may be correct, because one or more of the vertebrae and discs may have been affected. But bones do not move on their own. They move because contraction in the surrounding muscles and fascia has pulled them out of alignment. So snapping the vertebrae back into alignment will address only the symptoms, not the real cause of the pain, and there is a good chance that the contracted muscles will again pull the bones out of line and affect the discs.
Cycles of Myofascial Spasm
When you have chronic myofascial spasm in your back, the affected area will tend to suffer from an increasingly degenerative condition, because when muscles and fascia are in strong spasm they prevent fluid from reaching and leaving their own cells. Little vessels, called capillaries, that bring blood to the cells, get compressed by the spasm, so the needed nutrients — oxygen and other essential supplies carried by the blood — don’t make it to the cells in the quantities required to keep them healthy, and waste products cannot be easily carried away.
Therefore the muscle cells are underfed and swimming in there own waste, and at the same time overworked because they are in a constant state of contraction. This creates three degenerative cycles:
- At the first level, the myofascia feels sore and moves into a light pain. At this point, the ache and pain are trying to get our attention. If we get the right bodywork now the symptoms will be easily alleviated.
- At the second level, the muscle and fascia become more contracted and less fluid goes to the cells. Here, micro-tears start to happen in the fascia and so the body begins to create scar tissue to mend them. This kind of tissue is not very elastic or porous. It inhibits movement in the muscle and creates more tension, which in turn reduces circulation — it’s a vicious circle.
- At the third level, scar tissue becomes more and more prevalent, often taking the space of the muscle tissue itself. The pain here is debilitating, the fascia is very dry and rigid, the whole area is dehydrated and tense and creates a very strong pain. This is the most difficult level to relieve.
The pain is gone: Good News
The good news is that in each level there can be help and a regeneration of tissue.
My own breakthrough in understanding this syndrome came when I was 34 years old and dancing in a discotheque. Suddenly, a sharp pain entered my back and I could not dance any more; in fact, it was difficult for me to get home – I could barely walk. Next morning, I could not stand up. I could crawl on all fours, on my hands and knees, like a small baby, but I could not come to the upright position because there was so much pain… and it was scary.
Until that moment I’d been confidently enjoying my flexible and athletic body, feeling myself to be in great physical shape, teaching others bodywork and how to move, stretch…. Next moment, I felt like an eighty year-old cripple whose life was basically over.
I went to my local doctor and he diagnosed it as a disc problem, then he recommended all the typical disc treatments that I’ve just described and nothing worked. After that, I went to a series of bone doctors and joint doctors who gave me traction and epidural ejections to try to bring disc back in, but nothing really touched it. I went to chiropractors, rolfers, acupuncturists and rebalancers… nothing helped.
I was able, finally, to walk, but always with a lot of difficulty and pain. If I sat down for more than five minutes, my back would go into intense spasm as soon as I tried to stand up again. This went on for months, then over a year, without relief until I went to a body therapist in San Diego who specialized in myofascial spasm. He looked at my back and started working directly on the affected area, going deep and staying there for long time, which nobody had done before — the rolfers and rebalancers had worked on it, but only as part of a general body treatment.
This therapist worked on me for about 20 minutes and, when I got up from the table, even though I was experiencing only a small improvement in my back, I intuitively knew that this was the man who was going to cure me. He explained that the pain was coming from a deep and chronic myofascial spasm, which felt absolutely correct, and I thought to myself, “I have to move to this city for a while in order to get this man’s help,” which may seem like an extreme solution, but, believe me, when you are in that degree of pain and incapacity, your whole life becomes focused around it. Nothing else matters.
So I moved to San Diego to have regular treaments. After the the fifth session I estimated that I was 80 percent better. After 15 sessions, I was 95 percent better and I continued to have sessions with him, doing the homework exercises he’d prescribed for me to support the process of healing until finally, after 20-25 sessions, the pain was completely gone.
Shortly afterwards, I started my own practice in San Diego, became friends with this therapist, and we began to learn each other’s methods and trade sessions, so gradually I learned the method of releasing muscle spasm and also the knack of educating people about back pain – where it comes from, and in what degree of spasm the muscles are contracted. The notion of ‘degrees of spasm’ I found important, because it helps people understand that this is something that is acquired slowly and can be reversed, even if it takes a while.
Why Myofascia Goes Into Spasm
Why does myofascia go into chronic spasm? In my case, it was pretty obvious: at the time I was working 10 hours a day, seven days a week, with a full-on social life, and was probably sleeping no more than five hours a night. I was young and strong, but I had a tendency towards lordosis, or swayback, a common condition in which the pelvis tilts forward and there is an exaggerated forward curve of the spine creating a weakness in my lower back area that was compensated by tension in the surrounding muscles.
It was a case of chronic myofascial spasm leading eventually to chronic pain, which in turn led to incapacity. This kind of thing happens to millions of people with bad backs, but the sad part of the story is that most of them get misdiagnosed and then mistreated, so they remain in pain and feel helpless to heal themselves.
For instance, a 68 year-old businessman came to see me while vacationing in San Diego – somebody had recommended me to him — and he told me he’d been diagnosed with a herniated disc about eight years previously. He did not opt for surgery, but was always in pain and could no longer play his two favorite sports: golf and tennis.
When trying to locate the source of his pain, I found that it was not really in his lower back, as he’d been told, but in the large gluteal medius muscle that attaches to the upper ridge of the pelvis. I looked at it, touched it, palpitated it and could feel it was as hard as rock. Finally, I told him, “I don’t think your pain has anything to do with a disc. I think that this muscle is just in a state of over-contraction.”
I gave him one session, releasing some of the spasm, and afterwards he felt about 60 percent better. It was the first time he’d had any kind of relief, so he prolonged his stay to continue the treatment. After five sessions, he was a hundred percent better, but we went on to do a total of eight just to make sure the spasm was gone – plus I gave him some general guidance and daily exercises to help the area stay relaxed.
Now, this businessman had thought that he was a hopeless case and that he would never play golf or tennis again. We stayed in phone communication and he told me, months later, that he was playing his favorite sports regularly and was not in any pain, just a little soreness now and then, which he treated with exercise and rest.
This is a typical story of how bodywork heals pain by releasing chronic myofascial spasm. I have had hundreds of cases where people have come to me with what they consider incurable pain and have then been helped — and it’s not because I am an amazing healer. It’s simply that I see the pain is not caused by disc or joint dysfunction, but by myofascial spasm, and I treat it accordingly.
Body Alignment Stress
As I’ve already indicated earlier in this article, one of the most common origins of muscular-skeletal pain is when the body structure goes out of alignment. This creates stress because gravity is constantly pulling us downwards, towards the earth. When, for instance, my pelvis is tilted too far forward, the increased curve in my spine means that lower vertebrae cannot provide a good base of support for the ones above them. When vertebrae don’t have support, what takes over is the myofascial tissue, the soft tissue, which has to grab the bones really hard and hold on tight, becoming harder and harder, creating more and more spasm.
When I work with pain, I work by releasing the symptoms first, including muscle spasm, but at the same time I look at the whole body structure, how each part relates to the next, starting to integrate these parts so that there will be better alignment. This is what I call creating structural balance. Then, when the cramp in the myofascia has been released and the pain has gone, the client will not revert to the same condition, because his body is now better aligned and the muscles and fascia can relax.
Another aspect of pain is the influence of the nervous system, because it is the brain that sends information to the muscles saying, “I need to hold on, I need to hold myself this way.” The muscle obeys, contracts, and communicates the same message to the fascia, which surrounds the muscular contraction and holds it in place by hardening and shortening.
But the nervous system can send the same commands for other reasons. Maybe the client has emotional problems, is feeling stress or fear, or experiencing difficulties at work or in his love life. One of the first defenses of the body under emotional stress is to contract its myofasci, getting ready for flight or fight — the ancient, instinctive, response to danger. But when there is no fight or flight, just an ongoing stressful situation, the muscles will remain tense, holding the contraction until it becomes a chronic habit or pattern.
In other words, our bodies are an outer manifestation of our inner emotional and psychological life. When people come to me and I ask, “What caused the pain?” they usually say things like, “I am sleeping on a bed that is too hard,” or, “I must have lifted something the wrong way.” Almost always, they will say something in terms of how they are using their body. Rarely will they relate the condition to their emotional life. So I usually have to dig a bit, help them look at the stress in their lives and understand how most back pain has its origins in psychological and emotional problems.
3 Steps in Healing Pain
So there are three steps in healing pain:
- Relieving the symptoms by releasing myofascial spasm.
- Restoring structural alignment.
- Becoming aware of the underlying causes of stress in one’s life.
In this way, I am working with the client holistically, and I find it very effective.
I also look at a client’s basic movement patterns: how he sits at his desk, how long he remains there without moving, how he walks and so on. The goal is to re-educate the client to move with better alignment, putting less stress on the back, staying relaxed and creating more space between the vertebrae. This is an important part of preventing recurrence of pain.
By the way, it’s not only people with spine problems who come to me. A few months ago, a man came to me with a bad knee pain and he had been diagnosed by an osteopath as having insufficient cartilage at the knee joint, as well as advanced arthritis. The osteopath had tried several treatments, none of which worked, then told his client, “You’re gonna have to live with this and eventually have a knee replacement operation.
I looked at the affected leg and noticed that it was extremely out of alignment, with the upper leg rotating inward at the hip, forcing the lower leg to rotate outwards in order to maintain balance – in the trade, we call this an ‘x leg,’ because if you put two of them together, it forms an ‘x’ shape. When he bent his knee forward, it did not go over his foot at all, so he had virtually very little support from his lower leg, which put severe tension on the knee joint.
I said, “The first thing I’m going to try is to create proper alignment in the leg.” So we worked for a series of sessions until the leg was realigned, which immediately resulted in much less pain in the knee. Pretty soon, he was able to dance again – he loved to do the salsa – and could even run without difficulty. Last time I saw him, he was 98 percent better and functioning normally.
These case histories invite an important question: why is this kind of work so much overlooked by conventional medicine? As I see it, the medical profession focuses on small areas of the body, localizing the problem; it’s a reductionist approach, for example, reducing the problem to a knee, without bothering to look at the whole body structure in relation to the affected area.
So a doctor may look at the knee and say, “Well, clearly there is inflammation in the knee, so the logical solution is to prescribe anti-inflammatory drugs,” or if this does not help he will recommend the client to clean out the knee through a operation. I often see clients who have tried all the conventional approaches and after a few sessions with me they feel much better.
Slowly, these attitudes are changing. Structural and holistic understanding is starting to come more in play now, with the renaissance of bodywork. There is more research being done about how the whole body structure determines the health of an individual, and this may revolutionize how we look at pain. In particular, more professional athletes and dancers are coming to soft tissue clinics with their problems, because they need to be pain free in order to perform at a high level, and traditional methods are not helping them very well.
For me, personally, it’s a constant evolution of understanding how to work with people in pain, and it fascinates me, because it’s such a gift to be able help people who are in chronic pain and think they can’t get out of it. Anybody who has been in chronic pain knows that it completely destroys your life, because from the minute you wake up until the moment you go to sleep – if you can sleep at all — it takes all your time and energy, and, of course, is extremely uncomfortable.
To be able to heal pain, and teach others to do this for people, is something that will always be needed, because the truth is that, seen from an evolutionary perspective, we human beings have never adapted well to standing on two legs. We are insecure in our body structure; after leaving behind the solid experience of moving on all fours, we never really learned the art of how to stand in this planet’s gravity field while maintaining good body alignment — and we lost our tails, too. So people like me will never be out of business; there will always be plenty of work, because back pain is such an endemic part of being human.
Certainly, our modern, urban life style hasn’t improved the situation. Hours of sitting at desks, or lounging in armchairs, lack of exercise, and our general tendency to disconnect from the body, are all reasons for pain. Above all, it’s the chronic numbing of the body that dulls us to what is really going on with our muscular-skeletal system, because muscles that are in spasm don’t manage to get our attention until suddenly our pain threshold is reached and finally the body screams to us, “Hey, I need fixing… now!”
Even when we do notice, our first inclination is to reach for the aspirin, or ibuprofen, or sleeping pills, and send the body back to sleep, which then creates more tension in the muscles, so more drugs are needed, creating a vicious cycle in which many people get caught.
Almost all of us have the wrong attitude about pain. Because it’s so uncomfortable, we just want to make it go away with any kind of quick fix. But really, it’s a sign, a well-intended signal from the body that something is wrong. Pain is hard-wired into our nervous system for a very basic and important purpose: to keep us healthy. It deserves our respect, attention and understanding.
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