THE BLOG
08/10/2010 05:04 pm ET Updated Nov 17, 2011

Low-Back Pain: Is It Really All in Your Head?

As Amanda entered my office she looked liked she was walking on eggshells, clearly in great pain. Aside from her obvious suffering and constricted movements, I noticed something else I'd seen many times before with clients who had lower-back pain. Amanda was holding in her belly real tight, and her breathing was very shallow. When I asked why she was doing this, she explained that she'd been having low back pain for many years and had been told that tightening her stomach muscles would help support her lower back and reduce the pain. "However," she added, "the pain is as bad as ever." I gently told her, "This tightening might be great if you were a table but we humans are built to move."

As Amanda told me about the different therapies and ways she tried to get rid of her pain, it became clear to me that the most important part of her healing equation was missing--the brain! When I told her this, she said, half-jokingly, "Are you telling me it's all in my head?"

"If you are asking me if I think your pain is all psychological, I can assure you that's not the case," I said. She was relieved to hear this.

I continued to explain that all of our movements--from the movement of our bodies to the movement of our thoughts and feelings--yes, even these are movements-- all are organized by our brains.

For nearly 30 years I worked with professional musicians, various athletes, regular folks and even small children who suffered from lower-back, shoulder, neck, hip and other kinds of pain. I discovered that with Amanda, just as with most clients, the pain she experienced was the result of the way she was moving her body--her movement patterns. And these movement patterns issue from the brain!

The long-term solution is to be found not with the muscles and joints themselves, but by changing the habitual pain-causing patterns the brain has learned. Amanda's present movement patterns were creating stresses in her muscles and joints that caused her pain. The good news is that our brains can change, as current research has confirmed. (1) As I explained this to her, she seemed to relax. I told her that I would be guiding her through very gentle movements that will give her brain the information needed to create new patterns; these new brain patterns will organize her body to move in pain-free ways.

"These new movement patterns have many benefits," I told her. "They will not only eliminate your pain, but you will be stronger, more flexible and will feel more vital and energetic overall."

"You are saying the change has to first occur in the brain?"

"That's exactly right," I said.

The pain Amanda had suffered for nearly seven years began dissipating during our sessions together as her brain began forming new patterns for moving her lower back and the rest of her body. As with many of my clients I was inspired to observe Amanda's life gradually opening up in magnificent ways, no longer constricted and defined by her pain. She was now able to play freely with her children, enjoy long walks with her husband and find pleasure in everyday activities that were once struggles for her.

Pulling the belly in and holding it tight to restrict movement in an effort to avoid pain in the lower back is a natural reaction and a useful one for the short term. But if we are seeking long-term, life-enhancing solutions, we need to understand that this pattern of restriction changes the movement patterns in the brain, ultimately creating a host of new problems. We not only immobilize our lower back by pulling in our belly, but we greatly restrict movement in our pelvis, our back, our chest and even our neck will become tighter. (2)

The center of our body is the greatest source of our muscular power, coming not just from our abdominal, but from all the muscles attached to our pelvis. When we immobilize this area by tightening our bellies, we not only weaken ourselves greatly, but we also lose flexibility, restrict our breathing, accelerate aging and we settle for a limited version of ourselves. And we still have not solved our original back problem.

Brain research shows that we can change the movement patterns of our brains very quickly. (3) Movement -- rich, varied, gentle movement done with lots of attention and awareness -- is the language through which our brains wake up, gather new information and problem solve. (4) Contrariwise, when we learn to restrict our movements to avoid pain, we deny ourselves the opportunity for our brains to find better, more sophisticated, life giving, long-term solutions.

Applying This Information in Your Life

Movement With Attention: For the next two to three minutes, wherever you are -- perhaps sitting at your computer -- turn your attention to how your shoulders are feeling at this moment. Then scan your arms, your buttocks, your legs and the soles of your feet for what you feel there. Notice how your neck feels, your upper back, your lower back. Each time you move, for example as you reach for the computer mouse or an object on your desk, scan all these parts of your self and pay attention to whatever you are feeling in those areas. After a few moments, get up and briefly walk around. Are you aware feeling any differences? Perhaps you feel a bit taller or shorter. Do your shoulders, arms, legs or lower back feel any different? You do not have to do anything with whatever you notice. Your only objective is to pay attention in the ways described.

Repeat this two to three minute movement with attention exercise during other activities in your life, be it while you are dressing in the morning, while cooking your breakfast, getting into your car, when talking with your spouse or kids, or during your exercise routine.

Bringing attention to your movements provides information for your brain to draw upon and create alternative movement patterns, free of pain. Research shows that when we move without attention there are practically no new connections formed in the brain. Through adding attention to what you feel as you move, your brain grows millions upon millions of new connections. (5)

If you do this simple exercise regularly you will begin noticing not only greater comfort in your lower back but improvements in your mobility, your mood and your ability to concentrate and problem solve. The regular practice of movement with attention is also a powerful tool for preventing future back pain and injury.

Gentle Movement: Gentle movement means reducing the effort and intensity with which you move. For example, next time you reach to pick up glass of water, close your car door or put on your shirt, see if you can do it successfully with a lot less force. If you have exercises you do for low back pain, reduce the effort and intensity with which you do them. Reduce it greatly! Think gentle, easy, lazy and comfortable as you move. Doing this will increase your ability to notice and become aware of how you presently move and give your brain the opportunity to improve the way you move. You can never move too gently.

Remember, gentle movements provide your brain with new information to create pain-free patterns. As you go through the day, performing thousands of different movements, remember to occasionally apply gentle for a few minutes at a time. You will be amazed at how much you will discover about yourself and the new options that will open up for you. Over time you will also become more efficient and effective in whatever you do. Many people report that after just a few weeks of gentle, tasks that were once difficult and unpleasant become effortless and even pleasurable to do.

Varied Movement: Select any movement that you do on a regular basis, for example walking. As you walk, slow down a bit and begin varying the ways you do it. For example, put your head down and focus your eyes on the ground. After a few steps lift your head, look forward and continue walking in this way. Now lift your right hand and place it on your left shoulder. Walk like this for a minute or so. Drop your hand back to your side. Now, instead of walking forward, step sideways, first to the right for a few steps, then to the left for a few steps. Resume walking forward. Cross your arms over your chest as if to hug yourself. Then -- make sure you're in a safe area for this one -- walk backwards. As you walk, vary the speed or the length of your step a bit, or raise your knees slightly higher than you usually do. Resume walking normally and notice any differences in the way you feel.

When introducing variations you do not need to go to extremes. They can be subtle. The number of possibilities is endless. Repeat your variation exercises in different situations a few times a day. All you need is to take three to four minutes and be creative, experimenting with five or so variations in the activity of your choice. Each time, as you finish your exercise, take a moment to notice differences in the way you move and feel. Of course, notice if your pain diminishes over time.

We are built biologically to always optimize ourselves -- do the best we can -- with the information available to us. Your brain will work it out in your own unique way -- provided it gets the new information it needs. Movement with attention, gentle movement and varied movement are sources for that information.

For more about this process, and to try out our animated movement exercises for reducing pain and optimizing your potentials, go to: www.desk-trainer.com

Notes and References

1. As science writer Sharon Begley recently stated "For decades the prevailing dogma in neuroscience was that the adult human brain is essentially immutable, hardwired, fixed in form and function, so that by the time we reach adulthood we are pretty much stuck with what we have ... But research in the past few years has overthrown the dogma. In its place has come the realization that the adult brain retains impressive powers of neuroplasticity --the ability to change its structure and function in response to experience." S. Begley. 2007."How the Brain Rewires Itself." Time, Jan 19.

It was only in 1999 that Torsten Wiesel, who won the nobel prize with David Hubel in 1981 for his studies of the development of the visual cortex, after much public denial, admitted in print that adult neuroplasticity was a genuine phenomenon. T. N. Wiesel. 1999. Early Explorations of the Development and Plasticity of the Visual Cortex: A Personal View. Journal of Neurobiology. 41(1): pp 7-9.

2. "Core stability exercises (are) not superior to conventional physiotherapy exercises in terms of reducing pain and disability" Muthukrishnan R, Shenoy SD, Jaspal SS, Nellikunja S, Fernandes S. The differential effects of core stabilization exercise regime and conventional physiotherapy regime on postural control parameters during perturbation in patients with movement and control impairment chronic low back pain. Sports Medicine Arthroscopy Rehabilitation Therapy and Technololgy. 2010 May 31;2:13.

"Despite the large variety of treatments which have been evaluated through randomized controlled trials and meta-analyses, the effect sizes are often small, even for commonly used treatments such as exercise for chronic low back pain." Hayden JA, van Tulder MW, Malmivaara AV, Koes BW: Meta-analysis: exercise therapy for nonspecific low back pain. Annals of Internal Medicine 2005 , 142(9):765-775.

3. At birth the brain contains in the region of 100 billion neurons each of which connects to anywhere between a few thousand to 100,000 other neurons through specialized junctions called synapses. A conservative estimate of the total number of synapses in the adult brain is 100,000,000,000,000_ or 100 trillion. The formation of synapses begins in the cerebral cortex, for example, during the 7th week of gestation and continues well into childhood. It is estimated that at its peak each neuron forms an average of 15,000 connections. This equates to a rate of formation of 1.8 million synapses per second during the period from the second month in utero until the child's second birthday. Not all of these synapses survive. See A. Gopnik, A.N. Meltzoff, P.K. Kuhl, P.K. 1999. "The scientist in the crib: Minds, brains and how children learn." New York: William Morrow. pp181-186;

4. "Movement is the language of your brain;" Nobel laureate Gerald M. Edelman states that, "The brain's motor functions ... are ... critically important, not just for the regulation of movement, but also for forming images and concepts." He says, "In the mammalian nervous system, perceptual categorization is carried out by interactions between sensory and motor systems...(we first) sample the world of signals by movement and attention and then categorize these signals as coherent through ... synchronization of neuronal groups." G. M. Edelman. 2005 "Wider than the sky." Yale University Press. pp23 and 49

5. "Experience coupled with attention leads to physical changes in the structure and functioning of the nervous system." M. M. Merzenich and R.C. Decharms, "Neural Representations, Experience and Change," in "The Mind-Brain Continuum," ed. R. Llinàs and P. S. Churchland, (Boston, MIT Press, 1996), p77. G.H. Recanzone, M.M. Merzenich, W.M. Jenkins, K.A. Grajski, H.R. Dinse (1992b) Topographic reorganization of the hand representation in cortical area 3b of owl monkeys trained in a frequency discrimination task. Journal of Neurophysiology. 67:1031-1056. RJ Nudo, GW Milliken, WM Jenkins and MM Merzenich 1996 Use-dependent alterations of movement representations in primary motor cortex of adult squirrel monkeys. Journal of Neuroscience. Vol 16, 785-807