How does the Alexander Technique help with back pain?
I'd like to begin by talking a bit about back pain. First, the type of back pain that I'd like to discuss is the most common form. This type is not caused by something that can be clearly identified. Cancer of the spine, a stab wound: this is not what I'm discussing. I'm talking about the back pain whose cause is unknown.
To be clear, there are at least two types of causes. First, there is the proximate cause. I lifted the casserole from the oven wrong. I twisted my back last week. I pulled my back weight lifting. I blew out a disc sneezing. These are all the causes that are temporally closely related to the experience of this round of back pain. The second cause is not closely related in a time sense, but is the underlying cause. The ultimate cause of back pain creates the conditions that predispose one to experiencing pain. In cardiology, the proximate cause of a heart attack is a plugged coronary artery. The ultimate cause is a lifetime of high blood pressure and high cholesterol.
At a medical conference I recently attended, the presenter claimed that this very common form of back pain should be called "non-specific" back pain. That is, the obvious causes have been excluded and the cause is not specific. Patients will tell us the proximate cause, but it is not very helpful: It is not helpful to tell patients "Well don't sneeze!" or "Don't lift anything!". Many patients will believe that the cause of their back pain is arthritis which was seen on a X-ray, or a blown disc that was seen on a MRI after their last bout of back pain. But it is very important to note that 60% of people with no pain at all with have at least one bulging disc on MRI. Also it has been shown that radiographically proven arthritic changes are poorly correlated with symptom severity. The bottom line is that the vast majority of back pain has no known cause that is acknowledged by the medical community.
But that does not make this back pain "non specific". There may well be specific cause of back pain - it is just that it has not been medically acknowledged. More precisely this back pain is idiopathic. Per Wikipedia: "Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause." This is more precise.
The other crucial understanding is that it is not useful to think of back pain as an isolated physical problem. This is the medical approach and it has failed miserably. It is based on a deep cultural presumption which has never been supported scientifically - indeed there is much evidence to the contrary. But since patients are quite sure they have a purely physical problem and the physicians are trained to see problems as purely physical the assumption that back pain is simply a physical problem is never questioned. Perhaps this is why the medical community has never found any scientific evidence that any of their interventions are provide long term benefit with idiopathic back pain. Further, the science suggests that there are only two interventions that have been shown to help with back pain. And these two, yoga and the Alexander Technique, are quite rigorous at resisting dividing body and mind.
To understand back pain, we have to become a student of modern theories of pain. I will go into this in some detail in future posts, but for now I'll says that modern theories of pain acknowledge that a persons history, beliefs, levels of stress in the body and mind, the endocrine system all play a crucial role in the creating of pain. Although the dominant determinant in the creation of a sensation of pain comes from the periphery, the creation of the sensation of pain is done in the mind which is strongly influenced by other factors. In fact, so influential are these other factors, that one may have experienced pain in a part of the body which has been neurologically severed from rest of the body. Indeed, one can have pain in a part of the body that does not exist!
Lastly, just as the inputs that prompt pain are legion we need to acknowledge the adverse consequences of pain is not limited to the creation of undesirable physical sensation. Chronic pain can completely remodel the sufferer: physically, emotionally, socially. It can destroy a person.
In conclusion, to help patients with back pain we have to be willing to set aside out deeply held beliefs in the duality of mind and body and instead become a student of modern pain theory. We have to see our patients as a unified being that is suffering. This is not to say we have to set aside reason and logic. Just the opposite. It is unreasonable and illogical to adhere to beliefs that have been disproven.
No comments:
Post a Comment