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Back Pain: Is It All in Your Mind? No, and Yoga Helps

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There was a time when the common wisdom went along with the teachings of John Sarno, M.D.: that low back pain -- and much of all spinal pain -- results from repressed emotion and unresolved issues, especially anger. Patients were encouraged to stop physical therapy and chiropractic and to write about their emotional problems, and sometimes to seek psychotherapy. I agree that back pain can be exacerbated by stress and emotional problems, but in general I think the Sarno approach is seriously misunderstood and sometimes dangerously one-sided. X-rays, MRIs, EMGs, ultrasound and other technologies indicate that much of back pain has a physical cause. The onset of back pain is often accompanied by diagnostic information of this kind, and that matters. What I mean is that a person who feels just fine one day may then injure her back by leaning over to pull a weed or by twisting while hoisting a suitcase into an overhead airplane bin. Then in addition to the sudden and exquisite pain, an MRI may show a herniated disc or spondylolisthesis.

The Body Can Affect the Mind

Back pain can, on occasion, have a mind-body connection, as Dr. Sarno believes, and addressing that may bring relief. But it can also work the other way. Not only can the mind affect the body, the body can also affect the mind. When a person tightens up in response to pain, when a person experiences even unconscious negative emotions, the muscles can harden and stiffen or go into spasm. That's where yoga comes in. In addition to Dr. Sarno's contribution, that the mind can give you back pain, proper bodily work can have major positive effects on your mental life. I have been prescribing various yoga poses and doing them with patients for decades, and I find that this medical yoga is often extremely beneficial, relaxing, spiritually rewarding and in some cases even helps in overcoming negative emotion.

So far more than 100 clinical studies in peer-reviewed journals overwhelmingly point to benefits of yoga for back pain. Of course more study is needed, but as medical yoga enters the mainstream, yoga for back pain is beginning to seem like common sense rather than an unusual approach. The reasons are simple. While some people think staying in bed is good for a backache, few people are used to languishing about all day, and staying in bed can actually cause back pain. In fact, when you have back pain, moving around about 40 percent of your normal amount can be beneficial. In addition to movement, stretching relieves spasm and other musculoskeletal problems that are common causes of the aching back. The relaxation and stress reductions that are an integral part of yoga have well-documented benefits for almost everything, including negative emotions and almost all types of back pain.

Different Diagnoses, Different Treatments

The problem, as I see it, is that many of the clinical trials that show yoga is good for back pain lump all the diagnoses together, much as Dr. Sarno has done. For the reasons I just gave, yoga does some good almost no matter what the problem is. But to get the really substantial, situtation-changing benefit requires more specific information. Treating all back pain one way is extremely unfortunate, because in reality there are seven major causes of backache. These causes of pain are different from one another. The treatments for them are also different, so different they are sometimes contradictory. Actually what may definitively help someone with a herniated disc may hurt another person who has stenosis.

If I had to choose one pose for each type of back pain, I would recommend child's pose for spasm; locust for herniated disc; head-to-the-knee pose for central spinal stenosis; the twisted triangle for piriformis syndrome; half-lotus forward bend for spondylolisthesis; the cow for sacroiliac derangement; and twisting poses for arthritis. Since yoga is thousands of years old, teaching yoga has been going on for millennia, too. Therefore there are beginner versions of all these poses, and they can be modified to fit the needs of people with injuries. Also, there are many, many more poses I haven't listed that are good for each of the major causes of back pain.

My main recommendation is no matter what you do, don't lump all back pain together. Find out your diagnosis. Only then you can start a rational individualized treatment program.

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