Back Attack

When other treatments don’t seem to help, there are some alternative (and inexpensive) ways to treat back pain.

By William Atkinson

It’s no secret that back pain is by far the most common and expensive workplace safety and health concern. Each year, millions of worker hours are lost and many more millions of dollars are spent through health care plans and workers’ compensation programs to help employees heal from back pain. Treatments include analgesics, pharmaceuticals, physical therapy, back belts and braces, chiropractic care and even surgery. Not only are these treatments expensive, but the greater concern is that, in some cases, they never solve the problem.

Two solutions may be worth a look. Not only are these treatments effective in a number of cases where nothing else has worked, but the real beauty is that they are extremely inexpensive – often nothing more than the cost of a book.

It is important to note that these treatments are not effective in cases of actual physical injury or trauma to the back, however. They are designed to address back pain in situations where actual injury cannot be confirmed and where other conventional treatments have not been successful.

The two strategies are tension myositis syndrome treatment (TMS) and somatics education.

TENSION MYOSITIS SYNDROME (TMS)
TMS is a physical condition with real physical pain, but it is triggered by the brain as a result of emotional tension. Dr. John Sarno, a physician with the Rusk Institute of Rehabilitation Medicine in New York City, came up with the concept of TMS about 25 years ago when he noticed that almost 90 percent of the patients he was treating for back pain had previous histories of tension-related conditions, such as heartburn, irritable bowel syndrome and tension headaches. He began to conclude that the cause of their back pain was also related to mental and emotional tension.

Sarno says several emotional triggers can lead to TMS. One is stress that leads to repressed anger. Another relates to unresolved emotional conflicts or other issues. If a person is aware of these issues, brings them to the forefront and resolves them, TMS is unlikely to develop. However, if the person ignores and/or represses these emotional issues, TMS may well result. “The brain considers it more important to prevent the person from becoming aware of emotional phenomena that it considers more threatening than physical pain,” explains Sarno. As a result, the brain triggers the autonomic nervous system, which subsequently causes muscles to become tense. This leads to reduced oxygen flow to the involved area of the body (usually the back), which leads to chronic pain.

To address skeptics of the “mind-body connection,” Sarno offers a couple of responses. “First, if you go back 50 or 60 years ago, you don’t see anywhere near the frequency or severity of back problems that you do today,” he notes. He adds that this is in spite of the fact that the whole science of ergonomics has cropped up in the last couple of decades with the mission of trying to reduce muscular tension and pain in the workplace. In other words, if workplaces are supposedly more ergonomically friendly than they were 50 years ago, why is the incidence of back pain continuing to increase rather than decrease?

“In addition, there are medical studies that demonstrate the link between stress and back pain,” he continues. One particularly large study was conducted by physicians at the University of Washington. They interviewed several hundred employees with back pain at a large employer and found that the one thing almost all of them had in common was high levels of job stress.

Addressing TMS
As noted, if you make the decision – consciously or otherwise – to not address stress, anger or other emotional issues that confront you in life, the brain will redirect the resulting repressed emotional pain into actual physical pain (TMS).

The solution to TMS, then, is to become aware of the emotions and feelings you’ve been suppressing, then deal with them. In other words, you need to express, confront and resolve your emotions.

Dr. David Schechter, a physician and TMS practitioner based in Beverly Hills, Calif., does quite a bit of counseling in his practice. “Once patients understand that the back pain problems they are having may not be the result of serious medical conditions, they can usually get rid of a lot of the worry and fear they harbored as a result,” he explains. In other words, once his patients realize that their pain is the result of a benign condition, this alone may be enough for the pain to disappear. “Others may need some extended counseling to get to the root of the psychological issues that are causing their physical pain,” adds Dr. Schechter.

TMS in the workplace
Unfortunately, although TMS can be effective in resolving some back pain that has not responded to any other treatments, it can be a difficult “sell” to a lot of employees. “Because of the medical culture that exists today, most people are not inclined to put much confidence in this diagnosis,” says Sarno.

One reason TMS is not well accepted is because the link between mind and body is not yet well-established in the mainstream medical community. That is, most physicians continue to treat physical problems only, leaving mental and emotional concerns to psychiatrists and psychologists.

Adding to the challenge is that there are very few physicians around the country who are capable of making the TMS diagnosis. “There are only about 15 physicians in the U.S. who have identified themselves as doing TMS work, but the number is growing,” says Schechter.

Not all is lost, though. Employers can take steps to educate back pain-suffering employees to the concept of TMS and, in many cases, help them resolve their own problems.

The first step, according to Schechter, is to have the patient medically examined to make sure there isn’t a structural problem that can explain the pain, such as an enlarged disk, a fracture, a torn ligament, etc. If one of these is the case, then traditional medical treatment needs to occur.

Then identify those employees who suffer from back pain for no apparent medical reason and who just don’t seem to be getting well. “Resist the temptation to automatically label them as malingerers,” continues Schechter. Rather, arrange for a qualified individual in the organization to speak with the employee one-on-one. “Try to find out what’s going on in his life, especially as it relates to stressful situations at home or work,” he adds.

Then open the employee up to the idea that the back pain may be linked to stress or other emotional concerns. “Emphasize the stress component,” suggests Sarno. “Explain how stress at work and home can turn into anger, which can end up being repressed and transformed into physical symptoms of back pain.”

If the cause of the back pain is indeed TMS, not only will the employee be relieved of the pain, but it will be better for all concerned. “The result will be reduced expenses for surgery and other traditional medical care, less lost time and fewer long-term claims,” says Schechter.

Resources
For an introduction to TMS, visit Schechter’s Web site. He also offers a home workbook program that is available through the Web site. And if you want to determine whether your back pain is the result of TMS or something else, you can take a quiz on the Web site.

For those who prefer paper pages to electronic pages, pick up one of Sarno’s books. While he has published three, he personally recommends the second one (“Healing Back Pain: The Mind-Body Connection”) as the best primer for employers and employees to understand TMS and how to deal with it.

SOMATICS EDUCATION
In his book “Somatics: Reawakening the Mind’s Control of Movement, Flexibility and Health,” Thomas Hanna, Ph.D., stated that back pain is the most common disorder for which people seek medical help, and it is the most common cause of worker absenteeism in industrial society. Furthermore, it is the disorder for which the largest amount of money is spent on insurance, pharmaceuticals and medical service.

Hanna also estimated that as many as 50 percent of chronic pain cases are not the result of tissue damage or disease, but rather from chronic muscular contractions (overtight muscles) that are maintained by brain patterns called Sensory-Motor Amnesia, or SMA. The brain patterns send orders to the muscles via the central nervous system. Hanna estimates that 75 percent of the adult population suffers from SMA at one time or another.

Overtight muscles can be the result of three things:

• The first is repetitive conditioning, often caused by poor work habits (such as hunching over a computer) and/or athletic overconditioning. “When performing thesame job over again, whether it be hunching over a computer, bending over a machine or climbing utility poles all day long, the brain will begin accommodating these physical postures by tightening the appropriate muscles,” says Lawrence Gold of Santa Fe, N.M., a certified Hanna Somatic educator and practitioner. The problem is that the muscles tend to remain tightened. “It’s not the fault of the muscles,” he said. “The muscles are performing well, in that they are doing exactly what the brain is triggering them to do.”
• A second cause is chronic emotional or mental stress or nervous tension.
• A third cause can be a single injury that led the person to begin using different muscles to compensate for the pain associated with the injury. This places undue stress and tension on other muscles. When the injury heals, the person may continue to rely on the new muscular activity that he or she adopted to adjust to the injury.

The result in all cases is painful, sore, tight muscles. This can lead to stress and pressure on joints and the skeletal structure, joint degeneration and nerve entrapment. Entrapment can lead to tingling, numbness and nerve pain.

Sensory Motor Amnesia (SMA)
“The function of muscles is movement,” notes Gold. To do this, they are capable of doing only two things: relaxing and tightening. That is, in order to move, certain muscles tighten, and to permit this movement, other muscles relax. Muscles are not designed to stay stuck in a state of permanent tension or permanent relaxation.

Any time a muscle or muscle group becomes contracted in one part of the body, all other muscles and muscle groups in the body are forced to change in one way or another. The brain automatically and subconsciously creates these compensations in an attempt to maintain balance and movement even in an injured condition.

Muscles that seem to need stretching are holding tension. They are actively contracting as a result of brain signals sent via the nervous system to the muscles. The nervous system controls the muscular system. That is, muscles have no control of their own. As such, the signals that the brain sends to the nervous system are what determine muscular activity. When a person has overtight muscles, it is the result of a signal the brain is sending via the nervous system to trigger the muscles to contract.

This tension habit, called hypertonicity, is the result of what is called Sensory Motor Amnesia (SMA). SMA is a state of tense muscular activity that was created years ago and that the person no longer senses because it has become habitual. In other words, SMA is a state of habituated tension, not a state of injury.

What doesn’t work for hypertonicity
An unbalanced muscular system resulting from SMA can lead to numerous problems: painful feet, legs, arms, hands, backs, necks and jaws; and sciatica (pain, numbness or “pins/needles” feelings as a result of nerves that are being trapped and pinched by tight muscles). Many physicians will diagnose these problems as being the result of neuralgia, lordosis, bursitis, osteoarthritis, spinal stenosis, subluxation (spinal misalignment), compressed disks, bulging disks, slipped disks, herniated disks, muscle spasms, etc. They will then recommend pharmaceuticals, electrical or manual manipulation, ultrasound, heat, ice, traction, strengthening, stretching and/or surgery.

Unfortunately, these treatments are usually ineffective as ways to relieve chronic muscular pain caused by SMA. While the treatments may lead to temporary relief, the muscles will quickly return to their hypertonic state as a result of the brain’s SMA pattern, leading to the return of the pain. “In other words, things like drugs, manipulation and stretching won’t resolve tightened muscles in the long run, because they don’t affect the brain-level conditioning that is keeping the muscles tight,” explains Gold. “After the effects of the drugs, manipulation and stretching wear off, the brain automatically returns the muscles to their familiar tight patterns.”

Appropriate solutions
The solution to hypertonicity, then, is not to focus on the muscles, but rather on the brain’s control of the muscles. “The best solution is to unlearn the tension habits underlying pain and stiffness, and relearn freedom of movement,” says Gold. As muscles relax, pain disappears.

In other words, the most effective way to loosen a tight muscle is not to massage it or stretch it. Rather, it is to gain control of it again. The way to do this is to contract it even more and then to relax it with awareness. This action creates sensations that remind the brain of what it has been doing (keeping the muscles contracted). That is, the action “reawakens” the nerve pathways of natural muscular control that allows the muscle to loosen to its normal length while giving it full-strength capacity.

One of the basic exercises of somatic education is called the “pandicular response,” more commonly called the “whole body yawn.” “Like a yawn, the contraction-release action brings relaxation and comfort,” explains Gold. The whole body yawn is a series of strong, steady, slow, voluntary contractions, followed by relaxation and movement. This strong muscular action sends a sensory signal to the brain to refresh the link between sensation and movement. It is a way of moving from rest to activity.

Why does it happen? Muscles are composed of fibrous connective tissues called collagen, somewhat like a cloth that wraps muscle cells to provide strength and direction to muscular pull. Collagen fibers naturally shorten during sleep (as part of tissue healing and regeneration). This “microshortening” leads to shrinkage and restriction of muscles and movement. The whole body yawn does not attempt to relax the muscles, but rather engages in a coordinated pattern of movement designed to contract it even further. This action sends a strong signal to the brain to “wake up” or “refresh” the relevant nerve pathways from the brain.

The next step is to release the contraction in slow motion. This reawakens the brain’s control of the muscles (via the nerves). Slow-motion performance gives the nerve impulses time to travel to and from the brain for more sensation and better control.

To maintain the new muscular freedom that results from the whole body yawn, you can engage in the practice once or more a day, including just before retiring at night.

Resources
For more information on somatics education and for a list of practitioners, including those who offer on-site training programs, visit www.somatics.com.