Understanding and Overcoming Chronic Back Pain
Written by David Corby.
Emily walks into my office and smiles. I ask her how she is going. She looks at me and breaks down crying. I think to myself this is not such a good sign. Then she says, “After last session I got home and walked down the hallway and realised that for the first time in 30 years I walked without pain. I can’t tell you what that means to me”.
Chronic back pain is a debilitating condition. If you have experienced chronic back pain you are not alone, as surveys suggest over 50% of Australians will have chronic back pain at some time in their lives. What I have found in my teaching and clinic is that, while many people have it, few understand its causes or what can be done to remedy it.
There are many therapies that may help, such as Holistic Kinesiology and Kinesiology generally, Applied Kinesiology (chiropractic kinesiology), Osteopathy, Chiropractic, Acupuncture, Remedial Massage, Physiotherapy, NST, Bowen therapy and other myofascial therapies, as well as therapies that improve brain function such as Neurofeedback, cerebellum training, and Primitive Reflex therapy. In back pain surveys, stretching exercises, particularly Yoga and Pilates, are related highly by patients for the relief they bring to back pain. Understanding what causes back pain and how each therapy can help, will enable you to pick the right therapy or combination of therapies for you.
What causes back pain?
Generally people answer the question of what causes back pain by saying something is wrong with the vertebra, discs, muscles or the nerves. What very few people ask is why is there something wrong with these aspects of the back?
The most frequent cause of pain is tight and fatigued or traumatised muscles. This can lead to disc and vertebra problems over time if muscle tightness and fatigue remains and poor posture results.
So what causes tight, fatigued or traumatised muscles? Accidents, sprains, repetitive movements and strains can all play a role in the short term. It is also common for major traumas, like a car accident, to trigger long-term pain.
When three people are involved in a car accident commonly all three experience pain afterwards. However, each person usually has pain in different areas of the body and they recover at different rates. After three to six months each person commonly has very different experiences of recovery and very different areas of the spine affected.
Their experiences differ because each person has different postures and each posture has different strengths and weaknesses. Trauma generally triggers long-term problems in the weakest link in our structure. So if you have a forward head carriage and you receive a whiplash, you are more likely to have long-term neck pain than someone with good head carriage.
The end impact of an accident may well depend on what your posture was like before the accident, rather than what occurred in the accident.
Posture is vital to long-term pain. It is important to remember that the body is built to win and has great capacity to recover from trauma, accidents, sprains and strains. So to understand and overcome long-term pain we should focus on what hinders the body from recovering.
What hinders the body recovering?
The key factor hindering recovery is poor posture. Poor posture is the result of how we move; how muscles coordinate and help each other function. If coordination is poor and balance is poor, certain muscles are overworked and some are under-worked. The result is poor posture, muscle fatigue and tightness and pain.
How we move is the responsibility of the brain (see Figure 1 below). The main areas of the brain involved in movement are the motor cortex, basal ganglia, brain stem, and cerebellum.
The key factors that impede good movement patterns are:
- emotional stress;
- poor access to postural reflexes; and
- poor general brain function.
The emotion centres of the brain (e.g., amygdala) directly interact with the motor centres. This is an inbuilt survival mechanism that takes priority over other systems. The body needs to react quickly in the sight of danger. So whenever we experience any of the survival emotions our posture will change as the body prepares to quickly respond to the source of stress. Survival emotions fear, anger, anxiety and excessive vigilance, withdrawal, freeze and excessive seeking behaviour (cravings and lust) all trigger motor responses.
How often do we feel these emotions – too often! When we are going for a job interview, speak in front of an audience, have an argument with our partner, rouse on our kids or watch an action movie we experience survival stress.
Our emotional state is written in the way we move and in our posture. If we continually experience a particular emotion it will show in our movements and posture. For example, people that tend to close down their heart will hunch, people experiencing a lot of fear tend to have a posture where their upper body leans back (sway back), and people that over-think commonly develop a large curve in their lower spine (lordosis).
Our posture represents our life’s history
Our posture represents our emotional and life history. It is the sum total of the way we express ourselves in our life. It is amazing how much posture and movement can tell us about a person. Of course we all recognise this to an extent. When we first meet someone we automatically pick up many cues about them from how they move. For example, do they move confidently, do they fidget, move quickly or slowly? However, it was not until I began really analysing postures and asking clients about themselves that I realised just HOW MUCH of our life is written there in our posture.
This insight is very important in understanding back pain and what you can do to overcome it. There are two types of back pain clients:
- Type 1 ‘changed’ client: They have made recent changes to their life but their current posture is lagging behind these emotional/life changes.
- Type 2 ‘posture reflects my life’ client: Their current life is written in their posture.
A Type 1 ‘changed’ client is the easiest to work with because all that is required is structural work to help consolidate the changes they have already made in their life. When I first started clinic work I remember having a series of clients like this over three months that all came with 10 to 20 years’ back pain and, after a few sessions, said all their pain was gone. I thought to myself, ‘Why isn’t everyone doing this work?’ Then the next four clients that walked in took longer and longer to improve even though I was getting more efficient at the work. I learnt then that while some tools work for some people they may not work for all because not all clients are Type 1 clients.
All the therapies mentioned earlier, that directly work on the structure, suit Type 1 clients. If there is acute injury then physiotherapy, osteopathy, chiropractic, acupuncture and remedial massage, or some specialised forms of kinesiology like Applied Kinesiology, Dynamic and Functional Structure Kinesiology or Sports Kinesiology, would be my therapies of choice.
Don’t assume that where the mind leads the body will follow. Sometimes people make changes in their life but the body helps drag them back into old patterns. For example, if you have a tendency to be angry because you feel stuck and stagnant then you will develop a posture overtime that reflects that – producing chronic pain. If you start making changes and flowing more in life then the posture initially lags behind. While your movement patterns will have changed, the fascia, ligaments and tendons all take time to change to reflect these new motor patterns. As a result, the pain may remain and be a constant impediment to your flow. Over time this constant struggle to move freely may change your emotional state back to where you started.
So in this way the direct physical work can help our psychological state and help consolidate positive changes we make in our life.
Type 2, ‘posture reflects my life’, clients require a broader approach, one that facilitates their evolving and changing their life to be more reflective of what they truly desire, as well as working on their structure. This can be done by choosing a combination of therapies, i.e, a body therapy like chiropractic and a mind therapy like counselling or art therapy. Or alternatively you can choose a therapy that combines mind and body, such as Kinesiology or Holistic Kinesiology or even yoga (since yoga calms the mind as well as improves the posture). Either approach can work well so long as you address the root cause of your back pain – the emotional stress that underlies how you live your life.
A mind-body approach to back pain
Kinesiology and Holistic Kinesiology address both the mind and body. Kinesiology uses muscle testing, counselling, body reflexes and energetic medicine to help treat muscle dysfunction, and the health and wellbeing of the client. Holistic Kinesiology is a broad based complementary medicine that makes use of kinesiology as well as many areas of complementary medicine (Chinese Medicine, nutrition and diet therapy, homoeopathy, neurophysiological assessment and movement therapy) to enable a fully integrated mind-body approach to clients, particularly focused on chronic illnesses and emotional stress.
There are also specialist areas of Kinesiology that combine aspects of sports medicine with kinesiology in order to focus specifically on structural and pain related problems such as Applied Kinesiology, Neural Organisation Technique and Dynamic and Functional Structure Kinesiology.
There are many forms of yoga, but styles that combine both meditation and breathing exercises with postures can have a profound effect on both body and mind.
Heidi, a 38 year-old receptionist is a good example of a Type 2 client. She had chronic back pain resulting from major degeneration of her lumbar spine, particularly in the disc between the third and fourth lumbar vertebrae. Nerves were being impinged, giving her constant pain for ten years. She had tried many therapies without any long-term relief, although one kinesiologist had helped the pain cease for several hours. She had received advice that an operation to fuse the vertebrae was the only option likely to give relief.
In my experience it is possible for pain to be overcome even for someone like Heidi whose condition has become severe to a point where discs and vertebrae are involved. The key to pain being removed is to restore good posture. Once the muscles coordinate well, the pressure is taken off the spine and pain usually is reduced or eliminated.
The fact that Heidi had relief from one treatment, even though it was just for a few hours, suggested that longer term relief was possible if the posture could be improved. If a symptom can be improved for hours, then it should be able to be relieved for long periods of time, so long as you can find and tackle the cause of the symptom.
The other key aspect of this case is that Heidi had seen a lot of good structural practitioners from a range of different therapies without any long-term improvement. This clearly suggested that she was in the Type 2 category. Experienced practitioners of most structural or physical therapies generally produce good results. If you go to an experienced practitioner and do not improve as much as you want, you should not write off that type of therapy, but rather recognise that other Type 2 factors are probably involved.
In the first two sessions we looked at the emotional pattern that was driving her structure and worked on her making the changes she wanted to her life. Then in the third session I directly worked on her structure. She felt immediate relief after the third session and progressively over the next month the pain ebbed away until she no longer felt any pain. The last time we had contact, three years later, she still had no pain.
It is unlikely that my structural work was better than the other professionals she had seen. What this case illustrates is how the mind can be a key component for some clients being able to transform back pain.
Another key to improving back pain is improving brain function, particularly coordination and balance. Therapies that improve brain function can have marked impacts on body structure. For example, retained primitive reflexes (reflexes that are used by babies but hopefully not used by children or adults) produce marked postural problems.
The most significant example of this was a boy, Adrian, 11 years of age, who had suffered from epilepsy and leukaemia. Because of his past illnesses he had poor brain function resulting in very poor coordination and balance, being unable to organise himself to get ready for school in the morning and unable to plan tasks and having difficulty prioritising time. When I had Adrian march on the spot he had absolutely no coordination of legs or arms, left or right. He marched with an amazing lean backwards almost as if he were reclining on a seat. He was troubled because he wanted to be like other boys and be able to play sports. However when he went to play football he was not able to run and catch the ball.
Looking at his posture it was clear his hips (pelvis) were tilted a long way back. This was setting up his very unusual backward lean. I assessed and worked on one of the primitive reflexes – the Moro reflex which is the primitive startle reflex that causes us to breathe in and arch backwards and throw our hands upwards. Stress can sometimes cause these primitive reflexes to become active in later life. In Adrian’s case his illness had probably prompted this reflex to become active.
At the end of the session Adrian hopped up and marched upright with much more coordination. His whole posture had changed. When he returned for his next session Adrian walked in ecstatic because he had played football, run and caught the ball for the first time. For him that was an incredible breakthrough.
This is a good example of how poor brain function can directly affect structure.
Our body reflects our history. Chronic back pain develops from poor brain function, often caused by psychological and emotional stress. If you recurrently experience one emotion, such as fear and anxiety, your movement and posture overtime begins to reflect that, and pain can result. To improve the pain it will be important to tackle both the mind and the body aspects causing the pain.
When you have already made changes to your life but the pain still lingers, therapies that focus on the body’s structure can be very useful for eliminating pain. When you are still stuck feeling fear or anxiety or some other emotion, working with the mind and body will be critical to improving pain. This can be done by combining two or more therapies, one focused on the body and one on the mind, or by using therapies that tackle both body and mind together.
David is CEO of CCM, teacher of holistic kinesiology and mind body medicine and published author of ‘Finding Joy Within’, ‘Energetic Protection’, ‘Neuropressure’ and numerous accredited courses. David is a registered Acupuncturist, a mind body practitioner and holistic kinesiologist. A world renowned lecturer who teaches in Australia and overseas.