I have been a postural therapist for 12+ years. I have worked with hundreds of people who have come to me in chronic pain. Most of these clients have already tried standard Western Medicine practices. Their doctors performed an MRI or X-Ray with detailed imagery of what was wrong. The doctors prescribed injections, medication, physical therapy, or in extreme cases surgery to try to fix the site of the pain. The pain may get better for periods of time, but often continues to persist in one form or another. Sadly, people are in more pain today than ever before.
In my practice, I have found that only treating the site of the pain does not provide long term relief. Western medicine saves lives and is amazing at treating emergencies with antibiotics, immunizations, and many surgeries. Allopathic medicine has a vital place in our healthcare system; however, it also has its limitations. It teaches us to focus on our symptoms, which often creates emotions of fear and anxiety that exacerbate the issue. It teaches us that our pain is purely structural, and this old model of pain and disease must be modified for the health crisis in this country to shift. We must begin to embrace a bio-psychosocial model, which incorporates both our biology and psychology for long term health.
Research has shown that stenosis, bulging discs, and arthritis are not what cause pain. In fact, you can take two people with the same structural abnormalities shown on an MRI and one will have pain and one will not. Why do you think that is? Why do millions of people with chronic pain not show current tissue damage?
As a postural therapist, I have seen people come in who are structurally misaligned yet have very little pain. I have also seen people whose alignment isn’t all that bad with a great deal of pain. This generates the question as to “What truly causes pain?”
For instance, I have witnessed clients come in for a session asserting their knee pain is due to a lack of cartilage or their shoulder pain is due to a rotator cuff tear; however, we relieve the pain within an hour. Did the structural abnormality heal within the hour? Probably not. What more likely happened is we realigned the load bearing joints and in doing so, we simultaneously released muscular tension patterns. Blood and oxygen is then free to flow to the injured area. These tension patterns can often be resolved using physical modalities, but in cases where we are not able to reduce the pain through physical means, we must also look at how emotional states affect muscular patterns and influence the nervous system.
The bio-psychosocial model takes a holistic view of chronic pain. It looks at the structure and physiological pathology. It also looks at how thoughts, emotions, and behaviors such as psychological distress, fear, avoidance, and coping mechanisms can play into posture and pain. The bio-psychosocial model maintains pain and muscular tension cannot be categorized into physiological, psychological, or social factors alone; instead, all three factors must be addressed.
The physical symptoms people are experiencing are very real, but in many cases, they occur in the brain, not in the structure or tissues. Physiological changes in muscle tension, nerve firing, breathing, and blood flow can create severe pain. For example, fear and anxiety can have such a physiological response in the body, that they can cause panic attacks so severe they mimic a heart attack. This intense emotional stress can also cause muscular tension patterns that have a strong tendency affect your posture. This does not mean anything is “structurally” wrong or that you are “broken.” Muscles move bones and we can influence the muscular system with a variety of modalities, provided we address the root dysfunction and not focus on the symptom or site of the pain.
Although chronic pain manifests in the physical body, we must also treat the brain response. For example, your brain learns to fear as a protective mechanism stemming from past experiences. This physiological reaction is extremely important and without it we probably would not live long; however, these danger signals have the tendency to get activated and stuck. The more often a certain type of pain is triggered, the easier it becomes for the brain to replicate it. However, we can retrain the brain that the sensations that are being interpreted as dangerous are safe. A great example of this is phantom limb pain. Amputees report pain in a limb that’s not there. There is obviously no physical damage triggering the pain and we can’t apply physical treatments to a limb that’s not present; however, in many cases, we are able to trick the brain to alleviate the pain.
John Sarno, a former professor of rehabilitation medicine at New York University School of Medicine, has helped many people in chronic pain that other doctors using standard treatments were not able to. His book Healing Back Pain was a New York Times best seller, and his approach has cured thousands of people, yet mainstream medicine still debates whether to consider his practices legitimate. In healing back pain Sarno speaks of a psychological condition that causes symptoms such as chronic back pain, migraines, fibromyalgia, and gastrointestinal problems. He calls this Tension Myositis Syndrome (TMS).
The physiology of TMS begins in the brain. Sarno believes that in cases of TMS, pain is due to oxygen deprivation caused by emotional stress. When we are under stress or repressing emotions, the autonomic nervous system will cause a reduction in blood flow to muscles, nerves, tendons, or ligaments which can result in pain. The autonomic nervous system is the part of the brain that controls the body’s involuntary functions. It’s designed to mobilize blood and oxygen to meet emergency situations and danger which can be very important; however, what the system does while under emotional stress is not always beneficial. It enters a state of reduced blood flow (ischemia) to respond to our psychology. Therefore, the tissues are not getting their normal amount of blood and there is less available oxygen which in cases of TMS can lead to pain, numbness, tingling and weakness. But why would the autonomic nervous system, which we have no control over, feel the need for this reaction? It must think that deflecting the person’s attention away from an emotion is helpful in some way.
Many other bodily reactions to tension and anxiety are the result of abnormal autonomic reactions such as peptic ulcers, colitis, tension headaches, and migraines. When we are repressing emotions, the blood vessels that bring blood to the arterioles need to only be constricted a small amount to cause less blood to reach the area; therefore, tissues will be oxygen deprived and pain will result. Heat and deep massage stimulate blood flow to muscles and are often used to help relieve pain. Movement practices also work wonders in increasing blood flow and oxygen.
In Sarno’s medical experience, he’s found the majority of back pain cases are a result of TMS. He believes this symptom created by the unconscious mind serves as a distraction to aid in the repression of strong unconscious emotions. If you have an experience that feels physically or emotionally unsafe, whether it be an injury or abuse, the brain learns to go into protective defense mode. The nervous system learns to detect this as danger.
TMS typically occurs with “chronic” pain symptoms; symptoms that linger after an injury has healed. It’s certainly not responsible for all pain. It’s not responsible for structural issues such as broken bones, torn ligaments, and other acute injuries, although you may be at higher risk for these injuries if you are simultaneously experiencing TMS. If you are physically injured, the body needs time to heal. The brain works to protect the area creating pain and a lack of mobility, so you don’t injure the area further. As a result, we often build compensatory physical patterns due to past injuries.
Just as physical compensations can occur in the body, so do compensatory emotional patterns. For example, if a child is emotionally shamed, they may shift into a restricted posture, or repress emotions which will cause a state of tension in the nervous system. An overactive nervous system may respond by producing physical symptoms such as headaches, stomach issues, muscle tension, back pain etc. At any point the nervous system can hit a tipping point and begin a cycle of chronic pain. The brain then becomes protective, detecting danger and triggering a pain response even when no danger is present.
So how do we retrain the nervous system to feel safe again once an initial physical or emotional issue has been removed? I would maintain there are many ways to re-educate the nervous system. This can be done physically, emotionally, and mentally. The most important aspect is to treat the “whole” person and not focus on the symptom, but instead address its root cause. It’s also important that the modality you are using is self-empowering. Becoming an active part of your healing process is often mandatory for long-term health. Finally, whatever approach you use, we must take the focus off the pain and focus on what the body and mind can do to heal.
There are many methods out there to choose from. Some approaches such as the ones I provide prescribe customized exercises, movements, breath-work, visualization, and mindfulness practices. These are designed to rebalance the nervous system, realign the joints, and release muscular tension thereby restoring oxygen to the tissues. We do not treat the symptom or pain. We do not see the body as damaged, instead we look for where the body is out of alignment and holding tension. We also educate and empower our clients in the healing process. Using approaches like this in conjunction with re-educating the mind to understand the biological processes of pain is very successful in reducing chronic pain symptoms.
As Eastern Medicine has maintained since ancient times, it’s the integration of physical, emotional, and mental health that creates a balanced body. You may find you need to address all these aspects to fully heal chronic pain.
We must remember the following points if we are going to re-wire our brain to release a pain cycle:
- KNOWLEDGE GIVES YOU POWER: You must begin to understand the biological processes of pain. This education is linked with a decrease in symptoms, improved function, reduced fear, improved mobility, and a balanced nervous system.
- PAIN IS DESIGNED TO PROTECT: It helps us survive by acting as a danger signal. Pain motivates us to take it easy when tissues need to rest and heal. Pain is designed to keep you safe and can be very important; however, it’s also important to recognize when you are stuck in a chronic pain cycle that is no longer serving its purpose.
- PAIN IS NOT JUST A PHYSICAL EXPERIENCE: Old models taught us that pain is caused by physical damage to the body. We must begin to recognize that this is just one of many factors.
- ALL PAIN ORIGINATES IN THE BRAIN: The pain system is sophisticated and makes highlevel decisions. All pain originates in the brain. Your brain is always calling the shots and deciding how much pain to let you experience. Although pain is in your head it is very real. What’s important to recognize is that you can have severe symptoms without structural damage. Understanding this is critical to influencing the pain cycle.
- PAIN IS AN OPINION NOT A FACT: Your brain determines how much pain you should experience in each moment to protect you. First assess whether there is “current” tissue damage. Then ask yourself, how much are you focusing on the pain? How afraid are you of the pain? How much are you trying to control the pain? In many cases the brain keeps producing pain even when the structural issue heals depending on how you think about the situation and interpret it.
- TO GET RID OF PAIN YOU HAVE TO TREAT THE BRAIN: The way you experience pain has to do with how you interpret the signal. Even if it started as a structural injury, at some point it may be important to open yourself to a bio-psychosocial model.
Below are some questions to ask yourself:
- What does your pain mean to you?
- Do you believe you are fragile? Broken?
- How can you let go of tension in your body?
- Are you getting enough movement in your day?
- Are you getting enough rest and relaxation?
- Do you fear movement? How can you overcome your fear of movement?
- How can you retrain your body’s pain response?
- How can you tackle your unique pain stressors and break the cycle?
- How can you build confidence in yourself and your body?
- Do you feel you are able to get a full breath?
- Are you following your gut, heart and mind in your daily decisions?
- How can you safely re-engage in life’s everyday activities with balance and respect for your body
The following documentary provides a deeper understanding of Sarno’s work:
Lisa Decker holds a master’s degree in Human Movement and has12+ years as a postural and movement therapist. She is a certified postural alignment specialist through Egoscue Institute. She’s also certified in Foundation Training and has a 3-year certification in Medical Qigong. Lisa is also a certified personal trainer, corrective exercise specialist and performance enhancement specialist.
John Sarno: Healing Back Pain
James Nestor: Breath