My husband, a body worker specializing in injuries and chronic pain issues, recently was called to make an emergency visit at a birthday party, where the host was in an awkward predicament. The host had been getting out of his chair to greet a guest, when suddenly his back froze up, forcing him back into the chair. He was still sitting in that chair three hours later, completely unable to move, when my husband arrived to help him.
This startling, out-of-the blue onset of intense back pain is a surprisingly common experience for many back pain sufferers. If you're lucky enough to not have experienced it yourself, you probably know someone who has. You're going about your normal business and suddenly your back spasms up, seemingly for no apparent reason, and you just can't move.
It's a curious phenomenon, and one that holds a key to understanding why many types of back pain arise and what you can do about it. Of course, there are times when back pain has clear causes, originating from an accident, overuse or sports injury. But just as often, back pain strikes like lightning, for no apparent reason. And if it has happened to you once or twice, the more likely it is to happen again.
To cast some more light on the reasons behind this phenomenon, I caught up with Dr. Loren Fishman, a HuffPost blogger and physician specializing in Rehabilitation Medicine and author of "Cure Back Pain with Yoga" and yoga therapist Ellen Saltonstall, co-author with Dr. Fishman of "Yoga for Osteoporosis" and "Yoga for Arthritis."
Question: According to statistics, eight out of 10 people will develop back pain at one point in their lives. And in many cases, people come down with a serious case of back pain for no apparent reason. What's the reason behind this phenomenon?
Dr. Loren Fishman: It's true, many cases of back pain do seem to arise from something very trivial. Sometimes it's obvious: for example, you're pulling weeds in your garden at the end of the season when the weeds are really tough. We can exert a tremendous leverage on the spine; the kind of pressures that you can generate may be a hundred times greater than normal. You may only realize it when it's too late.
But then there's also the case where you're doing something seemingly innocuous. It can be something as simple as a sneeze, which causes the back to go into a spasm. A sneeze may even cause a herniated disc; we see that quite frequently.
Ellen Saltonstall: However, while it may seem to be something that strikes from out of the blue, it's really just the straw that breaks the camel's back. The movement or sneeze that triggers the back pain incident is preceded by a whole syndrome of muscular imbalances.
For many people, some muscles are chronically way too tight. It can be due to their daily habits or due to structural imbalances, or both. Correspondingly, some muscle groups will be too weak. If these muscular imbalances persist over time, it sets you up for the situation where one little thing is enough to trigger back pain. It doesn't take much to cause the muscle spasm to start, because for months or years those muscles have been forced to do something that they are not really designed to do.
As the muscles get increasingly worn out, they will be more likely to go into spasm. But in cases like that, there is a generally a long-standing pattern of muscular imbalances behind it, and then one little incident is enough to trigger a muscle spasm.
Question: You are both among a growing number of health practitioners advocating yoga therapy and other forms of therapeutic exercises to help avoid becoming yet another back pain statistic -- or help people deal with back pain without surgery. Why would mechanical approaches like exercise and yoga help people prevent back pain in the first place?
Dr. Loren Fishman: Well, the point is that back problems are years and often decades in development. Practices like yoga, the Alexander technique, the McKenzie method and similar movement therapies improve the overall health of the back, so it's just common sense prevention.
Yoga can be particularly helpful, because it has a whole range of balanced effects. Yoga helps prevent or relieve back pain by increasing the range of motion of your joints, by strengthening and coordinating weak muscles, by improving posture and by generally giving people a better outlook on life so that they don't slump into poor posture. And, in general, yoga helps people become more familiar with their body and what it can do and cannot do and what it must do.
Ellen Saltonstall: Building greater body awareness is key. Most of us don't pay a lot of attention to how our body is positioned in daily life. For example, many people sit or stand in ways that create chronic muscle tightness in certain parts of the body. So practices like yoga can help to create better balance in different parts of the spine, so that your daily movements have a healthy equilibrium of strength and flexibility. That's really the goal of yoga, to build strength and flexibility, and of course greater body awareness of the mechanics of how you use your body.
Question: There are numerous studies showing that yoga and other types of exercise like the Alexander technique and the McKenzie method are not just useful to prevent back pain, they can often offer effective treatment for back pain as well. What's the relativ effectiveness of yoga and similar types of exercise vs. surgery for treating back pain conditions?
Dr. Loren Fishman: If you have had surgery, of course, it's too late for exercise that time, but not next time. If you do exercises, the odds are high that you will not need surgery. The proper exercise helps about 80 percent of people with operable pain. Eight out of 10 of won't need surgery. Usually you see results within 10 days, and often even within ten minutes. After two to three months, many people say, "I can't believe I ever considered surgery!"
But having worked with people with pain issues for more than 30 years, I also have to say that there are times when we've tried everything, and the person is still in pain. Obviously, those are the times that call for surgery. And sometimes people are just in such severe pain that immediate surgery is the only merciful solution.
But from a statistical point of view -- with yoga, the McKenzie method, Feldenkreis, the Alexander technique and similar movement therapies you can take care of eight out of 10 cases of back pain. So the practical advice is to try the innocuous methods before you go to surgery, whenever possible. But, of course, people have to stick with the exercises. The need to persist turns a lot of people off. That's the difficulty with the exercise approach from a practical point of view. However, yoga is so pleasurable that millions keep doing it for decades.
Question:That's a surprisingly high success rate. Yet, for the most part when it comes to dealing with back pain, surgery and painkillers seem by far to be the most common treatments.
Ellen Saltonstall: Yes, there's not nearly enough awareness of how much you can do to prevent or reverse back pain issues with modalities like yoga therapy or other types of movement therapy targeting back health. But it's coming along.
Dr. Loren Fishman: Yes, I can say from experience that there is definitely not enough awareness of this. But part of the problem is that many people go to the doctor and expect the doctor to be responsible for getting them better. Doctors and patients need to work together as a team with a common goal, but many people don't realize how important a role they have to play themselves in getting better, particularly when it comes to many back conditions. However, that is changing. I see more and more people that have a greater reliance on themselves and each other than they did in the past.
Question: What advice can you give people looking for alternative approaches like yoga or movement therapy to deal with back pain?
Loren Fishman: One size doesn't fit all. There's no such thing as one yoga pose that's good for back pain. So it's important to work with someone who has experience working with people with back pain and knows what he or she is doing.
Ellen Saltonstall: Look for a yoga therapist or movement coach trained in the McKenzie method or the Alexander technique, who has had particular experience teaching people with chronic back pain. There's always a place to start; it's never too late to build flexibility, strength and good body awareness little by little. The key is to choose something that you enjoy enough to commit to actually doing it!
For more information on the use of yoga for back pain see "Cure Back Pain with Yoga" by Dr. Loren Fishman and Carol Ardman.