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Is It Possible to Feel Better?
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You wake up one morning feeling stiff in your back. "What did I do?" you wonder. You drag yourself out of bed carefully. No, this isn't just a stiff back; it hurts. You feel a twang of pain which catches you if you move too quickly. It goes across your back and into your butt on one side. Bending over the sink to wash is a mistake. Ouch! Despite being as careful as you think you can be, the pain persists for the next few days. You try to figure out what caused it but can't be very sure. Was it that gardening the other day? Your back did feel kind of stiff after you were bending over for an hour pulling weeds. Hmm.What is wrong? You begin to worry, "Should I go to the doctor?" Or maybe you already have gone to the doctor, who has reassured you that nothing serious is wrong, that this too shall pass. And it does-mostly it does-but perhaps not as much as you'd like. And perhaps you wonder when another episode will strike and whether there isn't something more that you can do to prevent it. If your back hurts, you may have already tried various types of treatment with varying effects. However, if you felt entirely satisfied, you probably wouldn't be reading this, would you? The field of back pain treatment is filled with multiple professions making conflicting diagnoses, presenting confusing claims and offering contradictory-seeming care with sometimes questionable results. When practitioners offering treatments continue to debate and fail to agree upon "Where is the pain coming from?" and "What can be done about it?" how do you, someone with back pain, decide what to believe and to whom to go to for help? Back pain can have multiple causes. Some of the apparent confusion may have to do with the fact that effectively treating this common complaint provides greater problem-solving challenges than many people realize. For example, one source of confusion comes about because any particular episode of back pain tends to run its course, with the sufferer feeling better, if not completely pain-free, with the passage of time alone. How then can you judge whether a treatment offers real benefits or simply allows you to fool yourself into thinking that it does? Another reason for the continuing and confusing diversity of viewpoints about back pain comes from the explosive growth of medical information. This has made it easier for genuinely useful knowledge to get buried and forgotten. In this book I present some ways to help you cut through the confusion. While further research is needed, some sound and practical methods already exist for helping you to reduce, eliminate and prevent your back pain symptoms. Posture-Movement Therapy and Education Back pain resear chers have long understood common, everyday back pain as mechanical.2 Dr. Richard Deyo, a noted researcher on the subject, has written that as much as 98% of back problems comes under the category of activity-related pain.3 However, the practical implications of this understanding have yet to become common knowledge to many people with back pain. Activity-related (mechanical) back pain varies with activity. Such activity includes changes in posture and movement. Back Pain Solutions is based upon my study of a number of therapeutic and educational approaches that explore the relations of posture and movement to human functioning. I have integrated these approaches into a two-tiered framework that I call Posture-Movement Therapy and Education. Posture-Movement Therapy Positions and movements can also be guided, facilitated or passively applied in the form of manipulative or manual therapy by an experienced practitioner. Manipulative techniques exist on a continuum with the previously noted exercises. My own bias is to first see what individuals can do for themselves with the necessary coaching. However, positions and movements applied by a hands-on practitioner may have great usefulness as well. Health professionals who offer one or more kinds of such activity-related treatment include physical therapists, chiropractors, osteopaths and medical doctors specializing in manual medicine. Many different schools of thought within each of these specialties exist. Different practitioners may have different theories and use different approaches and techniques. Interestingly enough, despite these differences there also exists a great deal of overlap and similarity. This also holds true for different educational methods which I'll discuss in the next section. Nonetheless, different terms for similar things or the same terms for differing things can lead to confusion and unnecessary opposition. The profusion of theories, terminology and techniques can seem daunting. I offer the term "posture-movement" as a neutral, descriptive label for the many varying approaches to therapy and education. The term "mechanical therapy and education," which could label such approaches, has lost its neutrality because it has become too closely identified with one particular school of thought, the "Mechanical Diagnosis and Therapy" of Robin McKenzie. Although I value it enough to have studied and become certified in it, I recognize that this approach does not include the full range of activity-related methods available. Also, the term 'mechanical' can have a machine-like connotation that some people may find off-putting. "Activity-related treatment and education," which I use at times, provides a more neutral term but lacks a certain descriptiveness. The term "posture-movement" labels in a descriptive and easily understandable way the kinds of problems dealt with and the types of solutions provided. It indicates the relations between posture and movement. (See The Problem with Posture in the next chapter.) It does not refer to any particular or 'patented' approach. I offer it, rather, as a unifying term that different practitioners can use to talk about the commonalities of what they do. It can refer to both therapy and education approaches. What distinguishes posture-movement therapy from posture-movement education? Posture-movement therapy, as I define it, is practiced by a properly trained and duly licensed healthcare professional. Someone offering posture-movement therapy should have the ability to diagnose or screen for non-mechanical problems that may require referral for appropriate medical or surgical care.The practitioner should also be trained to offer activity-related (posture-movement) treatment that directly deals with specific pain and other symptoms through the use of activity-related assessment, the use of specific exercises and/or manipulative treatments, and the ongoing assessment of the effects of treatment. Posture-Movement Education Posture-movement education is the second tier of activity-related solutions for back pain. It focuses on the improvement of your everyday posture-movement habits-your learned, mostly automatic postural behavior. Posture-movement education in itself is not a therapy. It does not in itself involve the diagnosis, screening or treatment of specific pain problems. Posture-movement education involves more long-term and indirect preventive instruction. In understanding the role of posture, I particularly draw upon the principles and methods of the Alexander Technique of Psycho-Physical (Cognitive-Kinesthetic) Education.5 The Alexander Technique (AT) focuses on the application of conscious thought (Cognition) and sensory perception of the body (Kinesthetic awareness) to improve posture and performance. Ronald J. Dennis, Ed.D., a researcher and teacher of the Alexander Technique, defines it simply as "a nonexercise approach to the improvement of body mechanics."6 Besides the Alexander Technique,which I was trained in, there are many other educational approaches that can address your habits of posture and movement. These include Body Harmony, the Feldenkrais method, Ideokinesis, Rolfing, Sensory Awareness, Simple Contact, and the Trager Approach, among others.7 Studies in these approaches as well as in applied anatomy, body mechanics and ergonomics, have enriched my thinking and practice. A point of clarification: Both posture-movement therapy and posture movement education exist along a continuum. Many healthcare practitioners who offer therapy also place a major emphasis on education for back pain and other problems. Educational methods such as the Alexander Technique (practiced by qualified teachers), though not therapies themselves, may lead to therapeutic effects for those who study them. This book will provide basic information that you need in order to recognize whether you have a mechanical (activity-related) problem. The combination of posture-movement therapy and posture-movement education reveals principles that work together in a unique and synergistic way. You can then begin to explore how to use both exercises and posture as self-help tools to find your own back pain solutions. A Scientific Attitude You can follow these steps as you apply the self-help methods for activity-related pain that I discuss in this book:
As a scientific explorer in your daily life, you can actually begin with any one of these steps.9 The Method of Possibilities Many researchers pooh-pooh the usefulness of studying single cases, which they call "anecdotal evidence." It is true that if you are trying to generalize about what proportion of a large group of people will respond to a form of treatment, studying one individual will not get you very far. If that is what you are trying to do, recognize that, as an old Jewish proverb says, " 'For example' is no proof."10 However, there is another equally accurate Jewish proverb, "We cannot learn everything from general principles; there may be exceptions."11 One individual, a single case, can indicate that something is possible for that individual and perhaps for other individuals as well. Social science researcher Philip J. Runkel has proposed a name for scientific methods that study the behavior of individuals. He calls such methods "specimen testing." One particular method of specimen testing has special relevance to you. Runkel calls it "the method of possibilities." The method of possibilities seeks to answer the question, "What can be done?" As Runkel puts it, the method of possibilities involves "a trial of a course of action to find out whether it might be possible to bring it off."12 It seems likely that you have not exhausted the possibilities of dealing with your back pain. You can learn to use a scientific approach to explore your back problem and reduce and/or eliminate your pain. We will start this exploration in the next chapter with a look at the personal and social costs of back pain. Notes 2. Waddell, p. 135-136 3. Deyo, p. 50 4. McKenzie’s texts for clinicians are The Lumbar Spine: Mechanical Diagnosis and Therapy, The Cervical and Thoracic Spine: Mechanical Diagnosis and Therapy and The Human Extremities: Mechanical Diagnosis and Therapy. McKenzie’s more popularly-oriented books are Treat Your Own Back, Treat Your Own Neck and 7 Steps to a Pain-Free Life. The application of this approach to other musculoskeletal problems can also be found in Mark Laslett’s clinical textbook, Mechanical Diagnosis and Therapy: The Upper Limb. McKenzie’s work is built upon the pioneering work of Dr. James Cyriax. See Cyriax’s Textbook of Orthopaedic Medicine and Illustrated Manual of Orthopaedic Medicine. The article “Spinal Therapeutics Based On Responses To Loading” by Gary Jacob, D.C., and Robin McKenzie, provides an illuminating and comprehensive presentation of “the underly- ing philosophic and practical perspectives of the McKenzie approach…” (p.225). See also the articles by John Barbis and by Wayne Rath and Jean Duffy Rath. 5. The term “Cognitive-Kinesthetic Education” comes from Ron Dennis, Ed.D. (personal communication). Michael J. Gelb’s book, Body Learning: An Introduction to the Alexander Technique and Robert M. Rickover’s Fitness Without Stress serve as brief introductions for the general reader. Wilfred Barlow, M.D., a physician who studied, taught and did research on the AT, also wrote a sound, science-based and readable introduction, The Alexander Technique: How To Use Your Body Without Stress. The essays of Curiosity Recaptured, edited by Jerry Sontag, show AT applications to a variety of areas of interest. I also recommend Deborah Caplan’s book, Back Trouble. Caplan, a physical therapist and Alexander Technique teacher, provided a view that complements my own. F. M. Alexander’s own writings are well-worth reading and provide many ‘gems’ for the serious student . See his Articles and Lectures: Articles, Published Letters and Lectures on the F. M. Alexander Technique, edited by Jean M. O. Fischer. Also see The Books of F. Matthias Alexander published by IRDEAT (the Institute for Research, Development and Education in the Alexander Technique). 6. Dennis’s definition of AT is in his outcome research article on AT and balance, “Functional Reach Improvement in Normal Women After Alexander Technique Instructions.” 7. Barrett Dorko’s book Shallow Dive: Essays on the Craft of Manual Care and the essays on his website (http:barrettdorko.com/index.htm) provide an especially important scientific and humanistic perspective on the effectiveness of such educational methods. Dorko, an innovative and skillful practitioner of physical therapy, has developed Simple Contact, a profound way of encouraging pain-relieving activity which involves “...a technique of communication, either verbal or manual, designed to enhance another's awareness and expression of their spontaneously occurring internal processes.” 8. “Might not the individual man, each in his own personal way, assume more of the stature of a scientist, ever seeking to predict and control the course of events with which he is involved?” (George A. Kelly, A Theory of Personality: The Psychology of Personal Constructs, p. 5) 9. If you have more curiosity about what taking a scientific approach to living entails, read Drive Yourself Sane: Using the Uncommon Sense of General Semantics, written by me and my wife, Susan Presby Kodish. Also see the book edited by Susan, Developing Sanity in Human Affairs. 10. Howe and Greenburg, p. 496 11. Rosten, p. 302 12. Runkel, pp. 175-176 |
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