Book Review – Healing Back Pain: The Mind-Body Connection

Posted by abraham.williams@gmail.com on in Back Pain, Reviews

Healing Back Pain book imageThere was a point when I realized that if I wanted to get out of back pain I had to get positively aggressive and make things happen for myself.

When I started searching for answers, I came across John E. Sarno’s book, “Healing Back Pain: The Mind-Body Connection” and got excited. It was the #1 best seller and had over 1200 reviews that were mainly 5 stars.

While I had hesitations about the “mind-body connection” title, I have had so much pain for so long that I would try anything. I immediately bought the book and finished reading it the same day.

This book is primarily composed of anecdotal evidence from a particular doctor and practice with the inclusion of various studies validating sub points. While I read with an open mind, I couldn’t help but think about the author’s bias towards a particular diagnosis of Tension Myositis Syndrome (TMS) which is a very controversial one. However, the number of patients who experienced relief from their back pain as a result of this diagnosis is definitely cause for an open mind. It’s unclear if the placebo effect is taking place here. Regardless, it appears to have a hugely positive effect on a sizable group of patients. I’m part of this anecdotal evidence as well…it appears to have worked for me.

1. Back pain may not be related to any injury or a postural issue.

The main case from the book is that a person’s back pain may not be the result of a structural issue but of a repressed emotional pain that exhibits itself through the body. The biochemistry resulting from emotions definitely causes direct feelings within the body. We all know this, and it’s clear from science as well. It is also known that emotional stress can be related to heart disease. However proof that emotions create an indirect effect of back pain is new territory.

2. Changing how you think about back pain changes it.

Throughout the book, Dr. Sarno presents patient case after patient case showing that once patients accept the diagnosis and acknowledge the stress they are repressing (potentially using psychotherapy for difficult cases) that the pain eventually subsides after a few weeks. The general prescription is to take a pain killer when it hurts a lot, consider deeply and acknowledge what emotional event has just occurred or perhaps been triggered, and once the pain subsides get back to moving without fear of re-injury.  It’s as if the idea of just knowing that there is no injury or postural issue and that your mind is running a continual habit of pain thinking actually stops the pain.

3. This approach appears to work very well for his patients with back pain but it’s not clear what the underlying mechanism is.

It’s not clear what mechanism is at play here. It could be a placebo effect. Surgeries can have a placebo effect. Also, the placebo effect looks to have  even more potential as we learn more about it. Regardless, given the number of happy patients, myself included. It’s worth a read.

My takeaway:

I think that book puts down some very useful ideas. Perhaps the assumptions about one’s back pain can be incorrect. It might be a structural thing and it might not. If there hasn’t been an injury and there isn’t evidence in disease, there shouldn’t be any pain. That’s a powerful place to think from as opposed to thinking that you are injured and the psychological consequences of that. Of course, dealing with repressed emotions, that can only help. This books is a great read for anyone having back pain.

Note: The links I used in this post are affiliate links. I put work into this stuff. If you like my work, use the links. Otherwise, google is free. 🙂

The Minimalist Guide to the Foundation Back Exercise Program

Posted by abraham.williams@gmail.com on in Back Pain, fitness, Tutorials

When you have back pain, you want to be out of pain and to be stronger so it never happens again. It’s about getting out of that pain and never having it again. Back pain can linger. It can be all the way up to level 11 and then hover around 3 or 4 for days. Sometimes, it seems like it will never go away. Sometimes you know what caused the pain, but often you don’t. It’s a mystery. Maybe it was when I carried the trash can or maybe when I twisted in the car to get something out of the back seat? Switching to the detective mindset is very common for back pain sufferers.

When a friend of mine recommended that I check out the Foundation Training program to help with back pain. I bought the book on my kindle and read it front to back the very same day. I wrote down the exercises on a 3×5 note card along with the protocol and did it every day for 6 weeks. I got very familiar with each and every exercise and did them all. Here’s a shot of the book on Amazon.

Image of the Foundation book on Amazon

I had back surgery 14 years ago and did physical therapy, acupuncture, active release technique, chiropractic care, rolfing, yoga, stretching, strength training and all kinds of foam rolling. Nothing got me as far as the Foundation program.

If you’ve ever worked on your posture where you’d try to sit straight and then realize you were slumped, then this is something that will completely surprise you. It surprised me because after about 3 weeks into the exercises I’d check my posture and find that my posture felt perfect. I wasn’t even trying. Also, any time I felt my back feeling a bit weak, I’d do the exercises and come out able to move more freely and without pain. Nothing I had done before ever worked this well.

If you’re suffering from constant back pain, here’s the fast path I recommend.

  1. Get Ok’d by a doctor and read this post on the steps to end back pain. 
  2. Get the kindle version of the book and jump right to chapter 4 and read it to get the main principle of the S-curve.
  3. Read chapter 5 on the Basic Workout.
  4. Get a 3×5 index card or sheet of paper and write down the exercise progressions.
  5. Pick up a yoga mat if needed.
  6. Do the exercises every morning for 15 minutes for 6 weeks.
  7. Refer back to chapter 5 often as you will refine the movements as you get more familiar with them.

Make the workouts practical

I wish the book had just this basic workout on one page with the progressions laid out. If you try to do the workout from the book, you’ll end up flipping through the pages back and forth as you try to remember what move comes after the one you are doing and how long you do it.

Essentially, you can get stuck trying to remember the name of the exercise and the progressions. To overcome this, I made this terrible set of drawings for my daughters. It’s not pretty but it works. You can do the same or download the cheatsheet.

An 3x5 index card with foundation exercises

Here’s a list of the exercises.

  1. Foundation Pose Progressions
    1. Foundation pose with arms back 20 seconds
    2. Foundation pose with arms up 20 seconds
    3. Hip hinge 15 seconds
    4. Back to Foundation pose with arms back 15 seconds
    5. Foundation pose with arms up 15 seconds
  2. Back Extension 15 reps with hands by rib cage and elbows pulled back
  3. Back Extension with legs off the ground and knees and ankles pressed together 20 second hold
  4. Child’s pose for however long you want
  5. Kneeling Foundation pose with arms back 15 seconds, arms up 15 seconds
  6. Iliopsoas stretch both sides 20 seconds

Stick with it!

Often the exercises can be painful to do, do them anyway as they say. The exercises are very uncomfortable. Still, It can be very uncomfortable to get the low back into an S-curve. Follow their advice and stick with it. Refer back to chapter 5 for tips on the exercises. You always learn more about an exercise once you’ve done it and then reread the instructions. Really, in 6 weeks time, you will have a much improved back!

Resources

 

4 Steps to end back pain and feel strong again

Posted by abraham.williams@gmail.com on in Back Pain, Studies

Vintage Spine PhotoWhen you feel your back pain come on, there is an entire mental shift from whatever you were doing before to the now all encompassing and limiting world of back pain.

Clouds roll in, thoughts of joy and fun fade away. The day’s plan is assessed and frustration takes over your mind when you realize you won’t be able to get comfortable standing up, sitting down or lying in your bed for the next few days let alone even lift a single thing.

The thought of putting your socks on, untying your shoes, or picking up that tiny piece of trash on the floor will keep you immobile as a statue and the limitation of your movement will circle your every moment of consciousness.

If you’ve had a stint of back pain, you know exactly what I’m talking about. The days grow dark. You don’t notice the sun except that you have to get up to close the shade and getting up sucks. It sucks a lot.

Over 80% of people will experience back pain in their lifetime and many will not have ever had an injury. These people, I was one of them, will hear things like “normal wear and tear” and “arthritis”. These are the terms given when there is no clear evidence as to why there is a persistent terrible no good back pain that comes and goes at it’s own schedule.

However! There is a way out of this complete and awful crud. I’ve spent near twenty years now navigating this myself. I’ve seen what works and what doesn’t work. Trust me now and believe me later. Here’s what you need to do.

Step 1: Educate yourself ASAP

  • For herniated discs, the #1 strategy to get healed is an aggressive physical rehabilitation program consisting of back school and stabilization exercise training. We are talking about a “90% good or excellent outcome with a 92% return to work rate”.  source
  • For chronic low back pain, “intensive, specific exercise using firm pelvic stabilization to isolate and rehabilitate the lumbar spine musculature” resulted in over a 90% positive outcome. source
  • Take care with back surgery. It should be your ultimate last resort unless you’ve been in an accident. “Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy … associated with significant increase in disabil­ity, opiate use, prolonged work loss…” – source
  • Herniated discs can disappear and MRIs do not predict your need for surgery. “MRI assessment of disk herniation did not distinguish between patients with a favorable outcome and those with an unfavorable outcome”. – source

Step 2: Have a doctor check you out

Go see a doctor about your back pain. Make sure that there isn’t some godawful problem that’s making your back hurt. Doc’s will do blood tests and check you out. Hopefully, you get a physical therapy prescription.

Physical Therapists really know their stuff and their exercises will be targeted. It’s likely that you’ll get a sheet of paper with the exercises badly illustrated and be instructed to do the routine a few times a week. Definitely do this. It will be a piece of your plan. Even if there is some kind of disc issue, back specific exercises are very effective and very likely in your future.

Step 3: Correct any postural issue

Go see a postural specialist. Don’t try to do this yourself. You probably don’t remember what you ate during lunch two days ago. Go find an expert. Put effort into it. Treat it like a project where you are the client and you have already paid to see results.

The one I found that was really, really good was an Egoscue clinic. There may be other folks in your area who are really good. Find them, take action!

Step 4: Take corrective action every day

Listen, it will take a bit of time and work. Maybe it’s 4 weeks of concerted aggressive effort, more or less. Take the knowledge and the exercises from the Doc, the PT and the Postural Specialist and use it daily. Do it for 6 weeks. Do it every day. On top of that, get the foundation exercise program. Hands down, this will strengthen your back generally and specifically.

There are many psychological tricks you can do to keep yourself doing the corrective actions. More on those later. Check James Clear if you are hankering to apply concepts now. However, the number one thing to do is to commit to do these exercises every morning and every evening.

Done!

Get out your calendar and put a 45 day reminder in. Once you’ve been doing this corrective action and you’ve stayed on it doing effectively 45 consecutive days of back focused rehabilitation, your back should have no reason to hurt.

Understand this, you will have worked the back muscles into a new habit of movement patterns and retrained the muscle memory to not hurt. You’ll find that when you sit, you strengthen the back because your posture has changed. You’ll find when you lay down, you can relax. You’ll find that you are stronger when you stand. Now, you can put this behind you and get back to your life and goals.

A simple workout log method

Posted by abraham.williams@gmail.com on in Workouts

If you train physically, then you likely care about your progress in a given modality. For those who track their training, I haven’t found a great method for tracking weight training.

I’m sure there will be a future device that can be worn to track reps, cadence, rest period, weights used and with what exercise. If it exists, tell me. I will buy it. Maybe I’ll make it.

Anyway, I’ve tried spreadsheets, log books, and apps. They all are cumbersome. The best method I have found so far is a 3×5 notecard.

On one side, I write my workout for the next 6 or 12 week cycle.

FullSizeRender

On the back, I track what I did.

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That’s it. Super simple. Super easy. Low overhead.

Detach to observe

Posted by abraham.williams@gmail.com on in General, meditation, Philosopy, Stress, Success

Recently, I listened to a podcast by Mr. Tim Ferriss interviewing Jocko Willink. In that, Jocko described, and I paraphrase, stepping outside of himself and assessing the situation in order to gain a better understanding of the hostile situation he and his Seal team were in. With a greater perspective of the situation, he was able to take command and understand what actions to take. This reminded me of many passages in “Meditations” by Marcus Aurelius. The essence of observation, reflection, and perspective guided the hand that wrote those words. An example…

Remember that your higher self becomes invincible when it withdraws into itself and calmly refuses to act against its will even though such resistance may be wholly irrational. How much more, then, when its decision is based on reason and circumspection! Thus a mind free from passion is a very citadel… – Marcus Aurelius, Meditations

We have incredible power and focus when we can hold our mental ground from the emotional torrents that sweep us in all directions without our even realizing we have been swept, all day long. Clearly, an everyday citizen has a softer and less intense existence than a soldier in war time. Regardless, the key step is to look at yourself from above as an external observer. To be clear, I mean to mentally construct an image of yourself and the situation from above and outside of yourself. When you do this, you see the situation more clearly and you know your thoughts. This powerful combination tempers your emotional view of the situation with a greater perspective.

With practice, you can see that extent of the situation and what the best options are. You will also see a person going through things that humans have been going through since our time began. This creates a distance from the situation and inserts a perspective that is broader. Here is an example of detaching and observing across humans over time. .

Look back over the past, with its changing empires that rose and fell, and you can foresee the future too. Its pattern will be the same, down to the last detail; for it cannot break step with the steady march of creation… – Marcus Aurelius

In the beginning reference to Jocko, he is a Navy Seal in a war training exercise or an actual war situation. In this example, he is likely pulling out far enough to gain a vantage large enough to see himself, his team, civilians to avoid, and the enemy in an area of battle. The ability to detach and observe is critical in most any situation wether hostile or tranquil. However, how far or how high you create your image will give you a different perspective. You can imagine viewing from a 300 foot tower, from space as Nietzsche did, or across history. You can imagine viewing across society as Krishnamurti often does. That same power of detaching to observe is referenced throughout his teachings.

Now, can we as individuals be aware of our conditioning, and is it possible for the mind to break down all this limitation so that it is free to discover what is truth? Because it seems to me that unless we do free the mind from its condition, all our social problems, our conflicts in relationship, our wars and other miseries, are bound to increase and multiply, which is exactly what is happening in the world, not only in our private lives, but in the relationship between individuals and groups of individuals, which we call society. – J. Krishnamurti, Can We Create a New Culture?, Total Freedom

This is a very leading question. It’s begging for an answer of being aware of how we think in any situation. When you can see how your thinking is constrained by some conditioning or a torrent of emotions, you can see other options. To do this is to become almost another person who is observing you. Isn’t it very easy to judge the mistakings of others because you are not in their situation? Of course it is. You must become an observer of yourself to do this. It is not hard. You just have to know how to do it and to practice it. Try it now.

  1. Visualize yourself doing what you are doing right now.
  2. Imagine being a different person watching yourself.
  3. State what see yourself doing and also state the intentions behind the action in the second person.
  4. Didn’t that create a shift in perspective that opened the door for alternate choices?

Some recent observations I’ve had for example:

  • I’m hard on myself, but what I am doing makes sense or is admirable in some way because I’m doing it for my family or to better my situation. This leads to relief and calmness in relation to my goals. I’m doing what I should be doing.
  • I’m acting out some pattern and being careless of another. Time to pause and check in with said person and course correct. This leads to empathy from me and trust in the other person.

It may seem odd to combine a Navy Seal that is a soldier for a nation, a leader of an empire, and Krishnamurti who is clearly the antithesis of a soldier for a nation. It is not. They are using the same principle of detachment and observation, but clearly they are applying it at different levels. Granted, Marcus Aurelius and Krishnamurti are more similar.