Walking on the long and winding road to a pain free back

So what can you do to make your back pain free, to really get that feeling of having a spine as strong and viable as a tree’s trunk? First thing: get to know your pain! I mean really. Get to know it. I like to think of pain as an old relative that you wouldn’t say you like, because she’s nagging and complaining way to much, but still, she’s a relative and you need to make sure she’s all right. Most importantly, you would never do anything to hurt her. It’s the same with your pain, you may think angry thoughts about it, but it’s still a part of your body and your body deserve nothing but your unreserved love, no matter how deficient it is and how bad it works and how much it hurts. Especially than, when it hurts and doesn’t work the way you want I to. 

In practice: Keep a pain journal. Take notice of when you feel pain and how bad it is. For instance you can do it three times a day, when you wake up, somewhere in the middle and before you go to sleep. This will allow you to recognise any patterns that your pain follows. 

The importance of movement for the back cannot be pointed out enough. While it is beyond doubt good to walk, bicycle, run, swim or whatever you like to do, you can also try to move through conscious, slow yoga flows with focus on the somatic experience of being in the body. The reason why mind-body techniques such as yoga works so well for treating back pain is because they include both body and mind, and back pain is a body and mind issue. 

What I believe has been most valuable for me was a new approach to yoga. I did a teacher training with Julie Martin, who applies a rather rebellious approach to yoga. She works with freedom in movement and moves away from the old understanding of what constitutes a yoga position, or asana. Instead of being based on static strength like traditional yoga, it’s soft, fluid, dynamic. By moving ni this way, I have reached a whole new range of motion in my spine and in my hip joints. I work my hips a lot, because – surprise! – it’s all connected. The spine is part of the pelvis so naturally the pelvis affect the spine. I also work my feet, or rather try to keep them healthy by not (not anymore) squeezing them into shoes that are too small. 

Building stability and strength, especially if you have a tendency of hyper mobility (that is, if your joints can easily move beyond a normal range of motion), can rally help easing back pain. One of my favourite things to do when I start to feel that pinch in my lower back is to go to the gym and do dead lifts. Check out this guide if you want to learn how to do deadlifts! http://www.styrkelabbet.se/marklyft/ (in Swedish.)

There is also a lot to say about posture. Having a ”bad” posture is not connected to having back pain. This seems a bit counter intuitive but as you may have noticed a lot of people walk around life slouching like question marks without ever having any trouble with their backs. However, just because there is no correlation between posture and back pain does not mean that posture is irrelevant in treating back pain. Having a good posture, which I define as finding support for the spine from the feet, legs, and pelvis, takes focus away from the back. Imagine never having to think about where you place your spine, no more arching and no more rounding to find ease, the back can just be there without you thinking about it. 

A good posture should be one that offers support and stability for the spine to be in its natural curve. 

Last but not least something needs to be said about the illiopsoas. The psoas muscle has been called ”the muscle of the soul” (by Liz Koch of http://coreawareness.com). I really don’t want to go into the discussion about the validity of this claim, but limit myself to saying that the psoas is important as it connects the upper body to the lower body, stabilises the back and life the legs. It is one of the deepest muscles of the body and it originates along the spine and joins to the thigh bone. Typically most people would benefit from strengthening the psoas, more so then to stretch it. typically, what most people do is stretching it…
This is the illiopsoas:

An easy exercise: stand tall, arms alongside the body and lift and bend one leg so that you draw your knee towards your chest. Stay for a minute or so and make little circles with your knee, while allowing the pelvis to move with the circles. Do the other leg. Repeat. 

And of course, I’m announcing a workshop on back pain to the held at May 20. Please join me for a possibly life changing event! (Check out separate post!)

Is it gonna hurt? Fear of pain and fear of movement

Pain and fear of feeling pain can interfuse so that sometimes it’s hard to distinguish the two. It’s the fear of pain that makes us grip to protect the part that hurts, to try to keep everything still, or at least within a restricted pain free range of motion. It’s like we want to build an imaginary fortress around the painful area, mobilise our own tissue to shield and protect. The mere thought of how it would hurt to make an uncontrolled movement is frightening and sends chills of discomfort down the spine. After a while this fear may lead to an altered pattern of movement. You learn to move around the pain and never have to go directly into it. Thinking that if you only keep everything absolutely still it will heal. This is useful when it comes to a broken arm, but not so much when it comes to back pain.

I was told, by one of the numerous physiotherapists I have seen, that I had unstable shoulder blades and lack of strength in my upper back. The way I interpreted that information was that I had to keep everything stable and in place in order to avoid pain in my neck and shoulders. And so I gripped. I tried to move my arms without moving the shoulder blades, which is definitely not useful because the shoulder blades will have to move when the arms elevate above shoulder height. That, I have come to realise, was a non-constructive fear of movement. I have had it with my lower back as well, trying to keep everything stable and move slowly and carefully to avoid visiting that painful range of motion. 

Fear of pain, leading to fear of movement. There is even a term for it: kinesiophobia: an excessive, irrational and deliberating fear of physical movement activity.

Often what happens when we go to see a specialist, a physician or physiotherapist, is we get a diagnosis or some sort of explanation as to why we’re having pain. We may even be told to be careful, avoid heavy lifting or uncontrolled movements. Peter O’Sullivan, the radical physiotherapist, holds the view that health professionals should try to give patients a different view on the pain. Instead of talking about the back pain as being caused by structural damage, wear and tear, bulging discs, etc., the message should be that those things are normal and that there is no need to worry about them. Instead treatment should be focused on giving pain patients ways to know their pain better and ways to move out of their pain cycle. The back should be trusted to move in its normal way, according to Peter O’Sullivan.

I like to think of the spine as the trunk of a tree. Tremendously strong, stable and yet flexible.

Pain may create a sense of vulnerability. Your body is a piece of the world that is yours and yours only. Its home to your mind, your consciousness and perhaps even your soul and it is supposed to be a safe home. Your body is also the entity through which you interact with the rest of the world, you move around, walk, talk and dress. You express yourself through your body. No wonder we may experience some desperation when the body is not working properly. Having a painful body truly puts the entire world at bay. As a counter mechanism we try to move in such away that allows us to avoid pain. As long as we manage to live our lives around the pain we can keep the illusion that we have a well functioning body that does not hurt, and this restores a sense of security. However, it does not work in the long run. Instead of moving around the pain, we can try to move right into it, accept it and take care of it. the way we would take care of an old relative whose company we may not really like but who still deserves our love and care. This takes courage. And it takes guidance. A good yoga teacher is one that you can trust never to take your body to places that can be harmful. She will encourage you to enhance your range of motion slowly and to increase your knowledge about your pain so that you can handle it consciously and eventually become pain free.