2012年3月10日 星期六

Back Pain, Therapeutics, and Somatics

To begin, I'll state my bias: I am a clinical somatic educator trained in methods of mind-brain-body training that address habituated reflex patterns triggered by stress (distress) and trauma. What I write is from that viewpoint: habituation or habit formation.

In my viewpoint, muscular activity comes either from voluntary behavior, from habitual learned behavior, or from involuntary reflexes. That means that movement, posture, and muscular tension come from either of these three general categories as responses controlled by the nervous system.

One category of involuntary reflex, the postural reflex, is largely learned, the learning built upon rudimentary primitive reflexes.

You can identify with the fact that stress and trauma leave impressions in memory and that those impressions might be associated with tension of one sort or another. The piece I'm adding, here, is that the memory of injury, if intense enough, can displace the familiar sense of movement position and control we have over ourselves, creating a kind of amnesia of the body, where we forget free movement and get trapped in tension. It's this kind of tension that conventional medicine tries to "cure" by means of manipulative therapeutics (including chiropractic and acupuncture), drugs, and surgery.

This article stands as a critique of those methods in contrast to an approach that deals with many musculo-skeletal problems in general, and back pain in specific, as maladaptive, stress-related disorders.

That this approach works better than the methods this article critiques remains for you, the reader, to see for yourself. I can't convince you, here (any more than I could be convinced before seeing for myself), but can only offer you a line of reasoning and... at the bottom of this page, a bit of evidence -- a link to a candid, two-minute video clip that shows the first moments of a client after a one-hour session of clinical somatic education.

So, I must appeal to your capacity to reason and to your intelligence and you must seek out the experience, for yourself.

We begin.


First, I'll comment on drugs, then manipulative techniques in general, then surgery, then clinical somatic education.

Two of these three approaches, drugs and manipulation, are best for temporary relief or for relief of new or momentary muscle spasms (cramp), not for long-term or severe problems.

The third, surgery, is a last resort with a poor track record (estimated by one physical therapist at 15% success rate).

You can get a comparison chart of common modalities here.


Drugs can provide temporary relief or for relief of new or momentary muscle spasms (cramp), but can't provide a satisfactory solution for long-term or severe problems. They generally consist of muscle relaxants, anti-inflammatories, and analgesics (pain meds).

Muscle relaxants have the side-effect of inducing stupor, as you have found if you've used them; they're a temporary measure because as soon as one discontinues use, muscular contractions return.

Anti-inflammatories (such as cortisone or "NSAIDS" - non-steroidal anti-inflammatory drugs) reduce pain, swelling and redness, and they have their proper applications (tissue damage). Cortizone, in particular, has a side effect of breaking down collagen (of which all tissues of the body are made). When pain results from muscular contractions (muscle fatigue/soreness) or nerve impingement (generally caused by muscular contractions), anti-inflammatories are the wrong approach because these conditions are not cases of tissue damage. Nonetheless, people confuse pain with inflammation, or assume that if there's pain, there's inflammation or tissue damage, and use anti-inflammatories to combat the wrong problem.

Analgesics tend to be inadequate to relieve back pain or the pain of trapped nerves and, in any case, only hide that something is going on, something that needs correction to avoid more serious spine damage.


Manipulative techniques consist of chiropractic, massage, stretching and strengthening (which includes most yoga and Pilates), most physical therapy, inversion, and other forms of traction such as DRS Spine Decompression.

Most back pain consists of muscular contractions maintained reflexively by the brain, the master control center for muscular activity and movement (except for momentary reflexes like the stretch reflex or Golgi Tendon Organ inhibitory response, which are spinal reflexes). I put the last comment in for people who are more technically versed in these matters; if these terms are unfamiliar to you, don't worry. My point is that manipulative techniques can be only temporarily effective (as you have probably already found) because they don't change muscular function at the level of brain conditioning, which controls tension and movement, and which causes the back muscle spasms.

Nonetheless, people commonly resort to manipulative techniques because it's what they know -- and manipulation is the most common approach, other than muscle relaxant drugs or analgesics, to pain of muscular origin.


Surgery includes laminectomy, discectomy, implantation of Harrington Rods, and surgical spine stabilization (spinal fusion).

Surgery is the resort of the desperate, and although surgery has a poor track record for back pain, people resort to it in desperation. There are situations where surgery is necessary -- torn or ruptured discs, fractures, spinal stenosis; situations where surgery is inappropriate -- bulging discs, undiagnosable pain, muscular nerve impingement; and situations where surgery is sometimes appropriate -- rare cases of congenital scoliosis. (scoliosis -- curvature of the spine -- is more commonly a functional scoliosis, the consequence of muscular tensions around the ribs and spine, rather than the result of deformed growth).


Most back disorders are of muscular (neuromuscular) origin - and correctable by clinical somatic education (which is not about convincing people that 'things are not so bad, and live with it' or 'understanding their condition better' - but a procedure for eliminating symptoms and their underlying causes, and for improving function). Severity of pain is not the proper criterion for determining which approach to take. The proper criterion is recognition of the underlying cause of the problem.

In the case of back pain, the underlying cause -- chronic back tension -- causes muscular pain (fatigue), disc compression, nerve root compression, facet joint irritation, and the catch-all term, arthritis -- all through strictly mechanical means.

Degenerative Disc Disease, for example, is no more a disease of the discs than is excessive tire wear and breakdown from an overload of weight over a long period of time. There is no such thing as Degenerative Disc "Disease".

Somatic education is a discipline distinct from osteopathy, physical therapy, chiropractic, massage therapy, and other similar modalities.

As such, it isn't a "brand" of therapy or treatment, but a category or discipline within which various somatic "brands" or approaches exist. Examples of "brands" include Trager Psychophysical Integration, Aston Patterning, Rolfing Movement, Orthobionomy, Somatic Experiencing, Feldenkrais Functional Integration, and Hanna Somatic Education.

The prime approach of somatic education, through various methods according to the 'brand' or school of somatic education, is to retrain the nervous system to free muscles from being in an excessively contracted state. The general category of training is movement education, where it is understood that the function of muscles is movement and training movement trains muscle tension.

In the abstract, what distinguishes somatic education from manipulative practices is the active participation in learning by the client. The instruction comes from outside; the learning comes from within, and what the client learns during sessions (in terms of sensory awareness and control of muscles and movement) is what produces the improvements, and not what a practitioner does to the client, per se. As education, it deals with memory patterns, which show up as habitual patterns of muscular activity: tight muscles and familiar patterns of coordination and control. Deeper-acting somatic disciplines, such as Feldenkrais Functional Integration and Hanna somatic education, deal with more deeply ingrained and unconscious habit patterns formed by injuries and stress.

More concretely, somatic education uses movement and positioning to enable the client, by delilberate effort and practice, to gain access to muscles out of voluntary control, and thereby to recapture control from conditioned reflexes triggered by injury or stress and to improve quality of movement and physical comfort. Sensory awareness techniques are a large part of the process, as are controlled breathing, controlled pacing of movements, and coordination training.

Most forms of somatic education are "enriching" in nature, as they improve movement and sensory awareness, but gradually and with practical limits as to predictability of a specific outcome. They are often successful in the alleviation of pain, where more conventional therapeutic methods -- manipulation, stretching, strengthening, drugs, surgery -- are less successful. However, the gradualness of and unpredictability of improvements make them impractical as methods to be used in a clinical setting, although they are often used as an adjunct to those conventional methods.

A clinical approach to somatic education is so distinguished by the ability of practitioners to predict with a high degree of reliability and number and kind of sessions required to resolve a specific malady and to achieve resolution efficiently.

The specific advantage seen in clinical somatic education by referring physicians is that, while being effective in the relief of muscular pain and spasticity, it has the specific virtue of teaching the client an ability so to control the muscular complaint that there is little chance of a future return of the problem.

For a technical comparison between somatic education and chiropractic (as an example of a manipulative approach), see below.

CLICK Self-Care for Back Pain for self-help.

Home Website: Somatics on the Web CLICK for video, self-help, author's qualifications.

Hanna somatic education has the requisite predictability, reliability, and speed of result to constitute a clinical form of somatic education. The approach works by using a neuromuscular response related to yawning that resets the resting muscular tension 'set-point' closer to complete rest.

Lawrence Gold is a long-time practicing clinical somatic educator certified in The Rolf Method of Structural Integration and in Hanna Somatic Education, with two years' hospital rehab center experience (Watsonville Community Hospital Wellness and Rehabilitation Center: 1997-1999) and articles published in The American Journal of Pain Management (Pain Relief through Movement Education: January, 1996, Vol. 6, no. 1, pg. 30) and in The Townsend Letter for Doctors and Patients (A Functional Look at Back Pain and Treatment Methods: November, 1994, #136, pg. 1186 ).

This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.