*I. Introduction: A Holistic Approach
It is no secret that pain, especially chronic pain, comprises a huge public health concern. In fact, many experts now classify it as an epidemic. Despite ongoing technological advancements, pain remains the most frequently asserted medical complaint and troubles over 70 million Americans annually. The truth is, many types of pain will remain resistant to diagnosis, let alone treatment, through technological means. Unlike automobiles, pain often eludes a "quick fix." Consider the following:
Fact: Many people with bodily abnormalities, such as degenerative or herniated discs
torn cartilage, or rotator cuff tears, report experiencing no pain.
Fact: Many people without corresponding bodily abnormalities report severe levels
of pain.
Fact: Some cultures do not experience significant problems with back pain, while others
(such as our own), report it at near epidemic levels.
How can we explain these otherwise paradoxical findings? As I explore in my book, Re-Thinking Pain, pain is best understood holistically, emerging from dynamic interactions between mind, body, and life circumstances. Thus, pain is sometimes called a "bodymind" phenomenon. This contrasts significantly with the common view of pain, I call it the "body-machine" view, which assumes that all painful problems result from bodily damage or structural abnormalities (e.g.- herniated discs, cartilage tears, etc.)
Because pain is influenced by multiple factors such as beliefs, muscle tension, expectations, and stressful emotions, it is helpful to think of it as an indicator of imbalance in the bodymind. More specifically, when the bodymind's limits, its "threshold," of imbalance is exceeded, pain will be experienced. If the level of imbalance remains below this threshold, other symptoms such as stress, fatigue, and tension may serve as preliminary warning signs that something is awry and needs to be addressed. It is important to recognize that some people rarely experience stress psychologically or emotionally, but through their bodies, that is, through physical symptoms. If this is true of you, you may notice fewer warning signs prior to the onset of pain, making it feel as though the pain "came from nowhere."
Through my research and experience as a physical therapist, I have found that pain is most effectively treated with a more holistic approach, including consideration of life circumstances, beliefs, stress, tension, and other factors. In my book, I use the acronym "CEO" to outline critical components of healing pain:
Change your thoughts and behavior toward pain.
Enhance awareness of body, mind, and emotions.
Optimize other aspects of your health and life.
As CEOs, we serve as the epicenter of our bodily life, endowed with the capacity to choose health-promoting and self-healing behaviors. By learning to view your pain from this perspective, you become empowered to make choices that are proven to make a difference. The information provided in the book and this website can serve as helpful tools as you begin your journey of personal transformation.
II. Letting Go
Since publishing Re-Thinking Pain, I have come to recognize the importance of "letting go." I discovered this art form somewhat unintentionally through the practice of meditation and body awareness exercises. This was truly a mind-body endeavor, as I learned to be more aware of my body (such as muscle tension, posturing, and the way I moved through space), as well as my thoughts and emotional habits (particularly how I reacted under stress). I also learned to stop trying so hard to control my life and surroundings - my possessions, my future, my friends and family, etc. - and began to trust that everything will in fact be okay.
Letting go can be likened to allowing oneself to be moved by the current of life's waters. This stands in contrast to our tendency to resist the natural flow of life and attempt to swim upstream. Although at times it may feel safer to resist, since we are propelling ourselves rather than allowing life to move through and around us, it is obvious that doing so will eventually become tiresome and is ultimately fruitless. Personally, when I stopped trying to micro-manage my career, my family, what other people thought about me, and my life in general, I experienced an enormous sense of relief and freedom.
In my work as a physical therapist, I have learned that people with pain and tension often have difficulty letting go. They are holding themselves tense (often unknowingly), vigilantly attempting to swim upstream to find reasons and solutions for their suffering. This trend toward mind-body tension should not come as a surprise, since our society is oriented toward over-achievement, perfectionism, and constant vigilance toward our surroundings. In order to change then, we must come to recognize our tendency (of which we are often not wholly aware) for controlling things and learn to be aware of its presence in our daily affairs.
I've discovered it is usually better to laugh and remain relaxed when faced with life's absurdities, instead of allowing them to serve as a constant source of frustration (of course doing so requires practice). Gradually, with continued attention to your state of being and actions, you can retrain yourself to move with the underlying current of life, rather than attempting to control or resist it. I think this is the reason many of us seek massage or other forms of hands-on care. In these instances, even if for a short time, we can begin to let go and release our bodies into the care of another, perhaps simulating the comfort of the womb or our mother's arms.
Fortunately, our ability to let go can extend beyond these bodywork sessions, even to the point of becoming our usual way of being. In fact, you can begin to do so right now, wherever you are, by attuning to your breathing and allowing yourself to more deeply relax with each exhalation. In fact, learning to re-inhabit our bodies is often a good place to start this process. A relaxed body cultivates a calm mind, just as a calm mind engenders a relaxed body. Anyone can learn to let go, little by little, of whatever restricts us from experiencing the fullness and freshness of life. I hope you will join me on this journey, learning to let go of life while, ironically, coming to experience it more abundantly.
III. Self-Healing
The placebo effect, which involves the power of expectation to catapult self-healing, is far more potent than any humanly engineered pharmaceutical. Given the opportunity to do so, our bodies can heal nearly any ailment, sometimes to the bewilderment of medical professionals and scientists. To put it simply, our bodies are vastly more intelligent than we typically give them credit for. If we all possess what Howard Brody has coined an “inner pharmacy,” why are we so slow to consult its wisdom? Regardless of your response to this question, maybe it’s time that we start.
In my book, Re-Thinking Pain, I make the observation that our society has in many ways prescribed our movements, postures, and behaviors for us, part of what some might call “social norms.” In other words, if one feels like moving in a way that might look a bit strange, perhaps beyond the boundary of idiosyncratic, people might begin to get worried that he or she has gone off the deep end. Unfortunately, the result is a tension-filled chasm existing between socially acceptable movement and self-generative expression. This chasm is represented in the human body by blockages, especially muscle tension, which serve to restrict our expression, be it verbal, kinesthetic, or otherwise. As you might have guessed, I think this carries significant import with respect to chronic pain and other health problems.
I think a good place to this process is through some form of body work or therapy. Allowing yourself to move, to be moved, and to let go can serve as the foundational starting point for a more authentic and enjoyable life, a life that more fully embodies who you are. Or, you may wish to experiment with some new explorations independently, in which case you might care to read the next section.
IV. Reducing Pain and Tension by Retraining your Muscles
The “E” component of my CEO concept involves enhancing awareness. This includes awareness of your emotions, thoughts, and body. Bodily awareness involves the ability to sense your muscles, how they move and feel, as well as whether they are tensed or relaxed.
Those who struggle with chronic pain, though aware of pain in certain bodily regions, are almost always deficient in their awareness of their level of muscle tension. This inability to feel and sense what our muscles are doing can have a variety of causes, but is often related to some type of past trauma. Trauma, whether physical, emotional, or otherwise, often results in muscle tensing/guarding as a means of protection from further harm; this same protective mechanism also exists in animals. In successful healing, what follows this protective phase is a period discharge/release of that tension. Such a release can be physical and/or emotional in nature, sometimes occurring rapidly through muscle trembling or emotional catharsis, or via a slower course of release and relaxation over time.
When we lose our ability to control certain muscles in a painful bodily region, several muscles will often tend to move as an undifferentiated block, lacking the subtle, fine control that is essential to effective movement. Without this finely coordinated control, muscles have to work harder and with increased tension, resulting in quicker fatigue and the need for even greater effort. This cycle of tension, fatigue, and lack of muscle control is prolific in chronic pain or fatigue syndromes.
In order to reverse this tension-fatigue-pain cycle, we need to regain the ability to sense and voluntarily control those muscles that are stuck in chronic tension/protection. We need to overcome what somatics pioneer Dr. Thomas Hanna coined “sensory-motor amnesia.” I like the use of the term amnesia, as it points to the fact that we have forgotten something we once knew how to do.
So how do we go about getting reacquainted with these disowned muscles and forgotten movements? The first step is to learn to feel/sense the area again. This is why Hanna called it SENSORY-motor amnesia. In order to move a muscle, we need to be able to distinguish it from the muscles around it, we need to feel it. Fortunately, through the use of "relaxed awareness" of movement and other bodily sensation, we can begin to relearn what we have forgotten. Though some of these things can be accomplished without the assistance of a practitioner, the process can be expedited with the help of a knowledgeable teacher.
Both general and specific relaxation training is important in recovery from chronic pain. General relaxation techniques, such as meditation, can serve to relax and modify the entire nervous system. However, generalized relaxation may be unable to overcome sensory motor amnesia in specific body regions. Thus, learning to feel and relax specific muscles is also important. In fact, chronically tense areas are often difficult to feel and in some cases could be considered numb. Sensing and relaxing those muscles can in many ways bring them back to life: improving blood flow, sensation, and reintegrating them into bodily affairs.
Exercise Instructions:
1. I cannot emphasize enough the importance of setting aside ample time, finding a quiet and relaxing atmosphere, and approaching the exercises as a time of self-exploration and learning rather than something you just need to get done. Simply going through the motions (no pun intended) will produce little benefit.
2. You need to be mentally present as much as you are physically present. I regularly remind people that it is not what you’re doing as much as HOW you are doing it. In this case, “how” doesn’t refer to technique per se, but your way of being, your state of mind.
3. The following acronym may also be of use, exercising with “CARE”: Comfort, Awareness, Relaxation, and Ease. You should not experience an increase in pain with the movements. If you do, it is likely that you are not yet moving with ease and may wish to practice a simpler movement with a smaller amount of movement.
4. Start small and slow, and gradually increase your range of movement as your body comfortably allows. Remember that movement quality is much more important than quantity. Don’t concern yourself with counting repetitions.
5. Pay attention not only to the movement, but to your breathing and bodily tension. Often times, people will tend to hold their breath or tense themselves elsewhere when performing a movement. Allow yourself to breath normally during all of the exercises and monitor your body to ensure you are not tensing or bracing somewhere else in your body.
6. All of these things require practice, so don’t get down on yourself if they don’t all come together at once. You may wish to reread these instructions on a regular basis to remind yourself of the importance of “how” you are moving.
7. Wear loose-fitting, comfortable clothing. Working on a firm surface will aide your ability to feel your body and movements more distinctly.
Introductory Movement: Pelvic Tilting
Among other things, the human pelvis serves to attach the legs to the spine and plays a key role in two of the most important activities: standing and walking. If the muscles around the pelvis and lumbar spine are frozen and not moving properly, both walking and standing can be compromised. Due to amount of force passing through the area, muscle dysfunction can also result in significant amounts of pain and tension.
The first step in retraining the lumbo-pelvic musculature is ensuring that you can control the forward and backward tilting/rocking of the pelvis. The majority of this motion occurs as the pelvis pivots at the hips while the lumbar spine bends or straightens. (Realize that the spine is not a solid structure and each vertebra moves individually. Thus, the idea of “a broken back” is rather inaccurate and misleading. Even if pain is involved, bending your back will not “break” it, unless you have severe osteoporosis or bone disease. So don’t worry about your spine, it is strong and capable of withstanding even the most contorting movements).
To begin, lie on your back on a firm surface with your knees bent and feet flat on the floor. Place one hand on your lower abdomen and the other beneath the small of your back. Your hands will help you sense the movements. First, practice pushing your pelvis down toward the floor. After doing so a few times, practice pressing down the tailbone more firmly than the rest of the pelvis. If done successfully, this will increase the arch in the small of your back. If you’re movement is significantly limited you may only be able to produce a slight movement at first, especially if you struggle with lower back pain.
The opposite direction, which is also important to learn, involves shifting the downward pressure from your tail bone to your lower back. In order to do so, you might think about pushing your lower back toward the floor, something you can monitor with your hands (the hand on the abdomen will feel the muscles contracting, the hand beneath will feel the downward push through the lower back). Doing so will eliminate the arch in the lower back, causing it to straighten/flatten out against the floor while the tailbone lifts slightly. (This movement does not involve the lifting the buttocks from the floor, although the buttocks will contract as part of the movement.)
Take some time to practice this rocking in both directions. Over time, it will become much easier and you will no longer feel the need to strongly contract your muscles or hold your breath. It will become a smooth, graceful, and easy movement, the way is was naturally intended.
If you’ve read this section and practiced the pelvic tilting exercise, please email me and I will post additional exercises that you can try. You may also want to find a copy of Thomas Hanna’s book “Somatics,” which contains several excellent progressive exercises with illustrations (Elkhart Library has a copy).
V. Personality and Pain
Are Certain Personality Types Prone to Pain?
In Chapter 6 of my book, Re-Thinking Pain, I briefly touch on various personality types and characteristics that may play a role in pain, including perfectionism and "dysfunctional altruism" (i.e., "people-pleasing"). At the time of publishing, I did not feel it necessary to delve deeply into these issues, but since then, I’ve come to more fully acknowledge and understand their import with respect to understanding and managing pain. As a result, I wished to further expound on what I wrote in the book, with the hopes of providing you with deeper insight into yourself and your pain.
The "People Pleaser"
We all know at least one people pleaser. Maybe you are one of them. Pleasers are often female, but certainly not exclusively. First, I wanted to point out that people pleasers are often great people, among the most loving, nurturing, and caring of all personality types. In fact, my wife is one of them. The following are some characteristics of people pleasers: possess a genuine concern for the well-being of others; highly thoughtful, generous, warm, and supportive; put the needs of others before their own; exhibit a "need to be needed;" experience difficulty saying "no." Next, I will describe some factors that may make this personality type more susceptible to pain:
1. Overload of responsibilities. Pleasers love to help and save others. Their difficulty saying "no" may lead to an overburdening with responsibilities and obligations. This stems from the belief (even if subconscious) that they must freely give of themselves in order to be loved or lovable. As their obligations increase, pleasers continue to give, give, give, thereby decreasing the amount of time and energy spent on their own health and well-being. This can result in an overloading of the bodymind, to the point where the pain threshold is crossed. It is important to note that people pleasers are often unaware that they are in fact overburdened. They may feel okay and report little perceived stress. This results from their repression of negative emotions, which we will discuss next.
2. Repression of negative emotions. In order to maintain positive feelings and preserve their self-image as a nurturer, people pleasers repress negative emotions. When this occurs, they may experience difficulty identifying and addressing their own needs. In a sense, pleasers frequently abandon their own needs for the sake of others. As a result of this repression, pleasers may experience very little warning prior to the onset of a painful episode. In fact, the pain may seem to arise from "out of the blue." This is why for some people, especially pleasers, pain is like a barometer of the underlying imbalance or pressure in the bodymind. If negative emotions are not allowed into consciousness to signal a potential problem, pain becomes a reliable standby to grab our attention.
3. Guilt. Guilt is one negative emotion commonly experienced by pleasers, sometimes in large quantities. This is especially true if the pleaser’s health is compromised, leaving her unable to help in the way she would like. Often times, this is not limited to wanting to help others, but includes elements of perfectionism, such as the desire for a clean and tidy home. This only adds to the problem, further fueling whatever imbalance may be at work in her condition.
4. Lack of social support/feelings of helplessness. Because of the nature of the pleaser personality, the people in her life are often dependent on her, rather than vice versa. Thus, if the pleaser is experiencing pain or is otherwise overburdened with life, the bottom may feel like it’s dropping from under her feet, since others may not reciprocate her care and support in an equitable fashion. This can lead to feelings of helplessness, a sense that there is little hope for escaping her current plight, not an uncommon sentiment for those struggling with chronic pain.
5. Lack of assertiveness/disguised neediness. Pleasers often fail to express their needs directly, since to their minds, doing so would seem selfish. They feel that having their own needs may drive others away. Instead, they depend on responses of others to their care efforts for satisfying their "need to be needed." At times, this failure to stand up for their own needs can lead the pleaser to maintain involvement in extremely unhealthy relationships, continuing to give and forgive, despite the presence of relational red flags. This has obvious implications for chronic pain, exacerbating psychological, emotional, and physical imbalances in the bodymind.
Recommendations for pleasers. Recognize, as I have learned through my wife’s experience, that your pain is often driven by an accumulation of repressed stresses, emotions, and needs (though this is not to say that other factors, such as muscle tension, are uninvolved). Since this is often the case, it is useful to identify what may be contributing to these subconscious pressures and make plans to augment them. This includes things such as learning to say "no," becoming more assertive, caring for yourself, improving relationships, and learning not to feel guilty about doing so. Obviously, this is easier said than done, but simply recognizing and becoming more aware of your personality habits is the first step toward bettering yourself. You may also find it useful to talk to your pain, telling it that you will no longer be fooled into viewing it as the result of some serious physical malady. Such strategies have helped my wife (among others) break out of what would previously have been long and painful back pain episodes. You may also wish to familiarize yourselves with the perfectionist personality, as there is often some overlap between the two.
The Perfectionist
Perfectionism can assume a variety of guises: to achieve the highest level of success, to gain full control over one’s circumstances, to attain the highest moral purity, to perfect oneself, to perfect the world. Regardless, perfectionists feel that they are only acceptable when they achieve perfection, or something close to it. They are similar to people pleasers in that they may disregard their own needs (physical, psychological, or emotional) to satisfy the drives of their personality. Depending on the form of perfectionism, they may struggle with guilt (i.e., moral perfectionism), anger/hostility, anxiety, self-criticism, or depression. Perhaps most commonly, anger/hostility and self-criticism are experienced, when reality fails to coincide with expected standards.
If pain does in fact function like a pressure gauge, it is not difficult to see why perfectionists may be disposed to painful problems; being a perfectionist can indeed by "painstaking." Perfectionists attempt to impose control and order on an imperfect world and imperfect people (including themselves) that are often resistant to such attempts. Attempting to control everything can result in the accrual of large amounts of internal pressure, especially when things aren’t going very smoothly. Perfectionists can often be quick to judge all that transpires around them, measuring it against their expectations and standards. When people or situations fail the test, a sense of anger or frustration may ensue. This can become even more complicated if the perfectionist represses the anger because his self-image tells him he cannot be an "angry person." This may result in projection of the anger, in which case everyone else appears to be angry or wrong. Or, the anger may be repressed and experienced through bodily symptoms such as pain (similar to what occurs with the people pleaser).
Recommendations for perfectionists. You do not need to completely overhaul your personality to become healthier. Like people pleasers, you possess a variety of positive traits to offer the world. With that said, you do need to learn to loosen your grip on life and let some things go. As with people pleasers, recognizing and becoming more aware of your personality habits it the first step. Analyze and question your behavior: Is it really necessary for this to be perfect? Can I learn to let go of this worry? Can I let someone else do this job? Why am I so angry at this person? As you do so, try to take the place of others and realize that they possess different personalities, different experiences, and therefore, will tend to go about things a little differently. Try to be less judgmental and appreciate the differences in others. Try on the attitude that others can be right, everything (including you) doesn’t have to be perfect, and you don’t have to be the best in order to be a worthwhile human being. As with the pleasers, talking to your pain can be useful, informing it that you will no longer be fooled into viewing it the result of a serious physical malady.
*Disclaimer
The information on this website is not intended to replace the services of your current healthcare team. You are advised to consult with your physician regarding specific health concerns, in particular, those that may require diagnosis or immediate medical attention. The owner of this site takes no responsibility for any possible consequence resulting from any treatment, action, or application of medicine, to any person reading or following the information from this website.
