By Alan Sieler
In an enlightening article in the 12 June, 2105 edition of The Age, a Melbourne metropolitan newspaper, Sarah Berry speaks to an experienced somatic practitioner and cites important medical research findings about the relationship that can easily occur between a person’s emotional world and their back pain.
According to a paper published in the medical journal The Lancet, back pain is the main cause of physical disability in Australia and is a significant health issue in all western countries.
Renowned physiotherapist and author Sarah Key, contends that our emotional life plays a prominent role in the health of our back. Now a veteran physiotherapist who has been practicing for 40 years, Key is convinced that what is going on with our thoughts and emotions cannot be ignored in supporting people to live their lives with less or no back pain.
Key is clear that emotions do not cause back pain: "Now emotional problems, I don't think cause a back problem out of thin air, I really don't, but I think they magnify it.” She focuses on people who seem to be catastrophisers - living too much of their lives imagining worst-case scenarios, and believing that they would not able to deal with the worst things that could happen and therefore will be overwhelmed. Readers of Volume II of Coaching to the Human Soul will recognise this pattern of thinking as being associated with a mood of Anxiety.
A mood is more than a passing emotional experience – it is an embedded aspect of our emotional being that has persistent negative thought patterns and internal conversations. The unfortunate negative power of a mood like Anxiety is that it is not apparent, living in the background of our awareness yet continually exerting a powerful effect on how we perceive the world and our ability to deal with issues that crop up.
It is important to emphasise that anxiety is a normal part of being human and can be a helpful emotion, such as being appropriately nervous and on edge before an important meeting, phone call or presentation. However, when the emotion persists to be an ever-present part of life and is felt with an intensity that has us continually being fearful of what might happen, it becomes an unhelpful mood.
In a mood of Anxiety we have a very poor relationship with uncertainty, wanting to be sure about what will happen and that we will be able to deal with it. In an increasingly unpredictable, uncertain and even volatile world it can be easy to be living unknowingly from a mood of Anxiety.
The affect of Anxiety can have us constantly in a state of alert, ready to deal with perceived threats. Understandably the body becomes tense, such as sleeping with first clenched or in a tight curled up position. Key comments, “Prolonged stress and emotional tension result in muscles that are chronically clenched and don't know how to switch on and off properly.” In a state of physical tenseness we can be vulnerable to constant back pain, which can significantly compromise our wellbeing.
According to Sarah Berry’s article, new research has found that anxiety can intensify pain and also strengthen pain pathways in the brain leading to chronic discomfort.
"When people learn skills to decrease the physiological markers of anxiety or stress, they are simultaneously treating pain," said Stanford's Dr. Beth Darnall, of the study. Certainly, most of us can appreciate how tension and stress manifests itself into gnarly knots in our necks and shoulders.
While our sedentary lifestyle is often targeted as the key contributor to back pain, for Key living in sustained tenseness is likely to be a more significant contributor to back pain. And when we are dealing with back pain we are likely to limit our movements and the activities we participate in which are likely to exacerbate the pain.
But it's more than that. Fear that our spine – our pillar of support both physically and metaphorically – is fragile or flawed can create the very things we are afraid of as we tense around it and stop moving in healthy ways. Sarah Berry quotes Dr Aage Indahl, who specialises in stress, health and rehabilitation: "Fear-avoidance behaviour has been shown to be part of the disabling pathway in chronic low back pain."
Sarah Key comments: "There are a couple of old wives' tales about backs that need to be expunged from the lexicon of bad backs and that is that you shouldn't lift, that you shouldn't bend, that you should roll over like a log to get out of bed, you should sit bolt upright and ... that's all to do with protecting your back and ... there's this sort of nexus between this emotional 'I've got to look after myself here' and ... we self-restrict.”
"Don't suddenly do it all, but physiological loading (lifting and carrying and bending and doing stuff within activities of daily living) are really the best thing the body can do – at least from a skeletal point of view because it keeps cartilage pumping, it keeps bones strong and plastic – i.e. not brittle, it keeps tendons all of the right length and it keeps the muscles strong."
Key offers 8 tips for developing a healthier spine.
Stretch over strength. "Strength you need to have ... but it is lack of stretch that cobbles you over and it is lack of stretch that tethers you into the repetitive stooped postures of function," says Key, who is a strong advocate of yoga.
Decompression. Lie with a back block or yoga brick between the shoulder blades to reverse the extended hunching in front of a computer that we do.
Don't rely on the gym to get you through. Jarring, repetitive movements offer "diminishing returns", Key says, and constant contracting of muscles can even exacerbate a problem.
Find a good, firm bed. "We used to sleep on skins on the floor."
Keep calm. A worldwide study of centenarians found a common character trait was calmness. Key says we shouldn't underestimate its importance to our health.
Find a good physio or masseuse with good hands. Find the point of pain and prise it free. "When they find the pain it is no longer hiding in your spine and holding you to ransom."
Breathe properly — through the nose. "Good breathing is another casualty of a stressful life," Key says, explaining that poor breathing uses the accessory muscles in the neck and can result in pain.
Centre yourself through meditation for stress relief.
Key refers to “cognitive interventions” by specialists such as psychologists as being a promising approach to deal with back pain.
While ontological coaches are not psychotherapists, as specialists in supporting people to transition from unhelpful to helpful moods, they can play an important role to assist people living in an unhelpful mood of Anxiety prevent or significantly reduce their back pain.