Muscle Medicine: The Revolutionary Approach to Maintaining, Strengthening, and Repairing Your Muscles and Joints (6 page)

MIND-BODY

We’re
paid to work on patients’ muscles and joints, not their psyches. And we don’t claim to understand the exact nature of the relationship between mind and body (who does?), but we can’t help but observe how deep those connections are and how important they can be. Let’s take breathing, for example. As you may recall from the last chapter, inflamed, contracted tissues reduce blood flow, and therefore the supply of oxygen, to an area,

Dr. DeStefano

There is a strong link between emotional stress and muscular dysfunction. It’s not merely stress which causes physical problems. It’s the expression of that stress and how it is stored and displayed as a physical manifestation, or rather, how that particular patient reacts to and handles that stress. Some may not show any physical symptoms at all, while another may store and physically manifest stress. Patients will sometimes burst into tears in my office. Sometimes it’s from the stress of the pain while other times it’s a result of emotional stress. A box of Kleenex in the office can come in very handy.

leading to the formation of microscopic scar tissue. That’s what’s going on at the micro level. At the macro level, well, let’s say you’re stressed-out at work or at home. Without being consciously aware of it, you respond by taking rapid, shallow breaths (which take in less oxygen) and by tensing up. The muscles in your lower back, neck and shoulders, and buttocks tighten into a hunched, defensive posture as if you’re protecting yourself from life’s blows. The consequence: less total oxygen passing through the lungs and even less reaching those restricted muscles.

Dr. Kelly

I believe the psychological state of a patient has a huge impact on recovery. Some of what I do during my office hours is positive reinforcement: “No, you’re doing fine, it’s supposed to hurt, you just had surgery.” People get frustrated at the time it takes to recover from surgery. They’ll say, “I went down to the beach and walked three miles and all of a sudden my hip started killing me. And I didn’t do anything.” I’ll tell them, “Well, your hip thinks it’s something. And it’s normal for you to feel frustrated or depressed, but that’s not helping your recovery. If you’re optimistic and positive and feel good about things, you’ll get better faster.”

“ILLNESS BEHAVIOR”

As we’ll discuss in detail in the lumbar-spine hot-spot chapter, lower-back pain can be particularly excruciating. What is the sufferer’s reasonable, but counterproductive, reaction? You rest in bed. (For an acute back spasm, some bed rest, but not much, could be helpful.) When you do emerge, you are careful to avoid the usual activities that work those back muscles —long walks, jogging, chores in or outside the house—for fear of triggering another disabling attack. In the walking you can’t eliminate, you favor the side that hurts by putting more weight on the opposite leg. When you walk, you tilt.

This is an example of what experts sometimes call illness behavior. In other words, you do things to make yourself ill even though that’s the last thing you would consciously choose. Restricting your activities weakens the muscles, making them less efficient shock absorbers. As the muscle fibers shorten and tighten, they become more prone to strain and pain. When you adjust your gait or the way you hold your shoulders to baby the painful area, you throw off the body’s normal biomechanics and overstrain the compensating muscles. Try an experiment. Actually, don’t try it, but imagine it—walk around for a day with a slightly bent-over,

Dr. Kelly

A lot of emotion surrounds injury and physical disability. I saw a new patient recently, and she gave me curt, one-word answers, wouldn’t really answer my questions. Then she just went off: “My doctor said you’d cure my problem right away, and I had to wait six weeks before I saw you!” Finally, I had to say, “Your attitude towards me and towards your hip problem is an important part of your recovery. If you have all this anger, it’s going to make it really hard for me to make you better. It’s not just a physical problem.” And then you see patients who are depressed or upset by an injury that has been misdiagnosed or improperly treated, and you’re able to figure out what’s wrong and fix them. Not only are they out of pain, but their emotional and psychological baggage is gone. I find that extremely gratifying.

crooked posture, what’s called an antalgic gait. By the end of the day, your lower back really will hurt and you won’t be acting anymore.

Remember, movement is life. Your back may not be 100 percent. But a long walk or, if you’re a runner, a slow jog might bring blood flow and oxygen to the area and could speed up healing.

Now we come to the mind part of the mind-body equation. If you’ve been lugging a heavy suitcase on vacation for a week and your lower back acts up, emotional soul-searching probably isn’t necessary: don’t indulge in illness behavior, get moving, and it will probably pass. But if back pain is your intermittent or chronic companion, then psychological issues may well be relevant whether or not, for instance, there is significant underlying damage to the spinal disks. Most obviously, the fear of crippling back spasms contributes to the muscle tension that generates, or at least contributes to, the pain—a vicious cycle. More subtly, a range of negative emotions may be bound up in trying to cope with that pain. While cause and effect are far from established, a hefty research literature has established that people who are depressed or who feel that they lack control in their lives are more likely to suffer from chronic pain. In one famous Stanford study, psychological test scores were a far better predictor of future back-pain problems than any structural damage that showed up on an X-ray or MRI.

Dr. DeStefano

I was treating a retired businessman some years ago and I just got this strong feeling that emotional problems were involved in his back pain. I suggested he see a therapist and get more in tune with whatever was going on with him. He stormed out of my office in a rage. Then two years ago, he shows up in my office and says, “Doc, have I got a story for you.” Since I’d seen him, his life had fallen apart. He’d become a kind of recluse and he’d been on the verge of suicide when his family committed him. After antidepressant meds and a couple of years of therapy, he’d fought his way back to health, both emotionally and physically. And he had some advice for me that I’ve used ever since: “When you ask a patient how he’s doing, and he says, ‘Well, I’ve still got the back pain,’ and the last time you saw him, he had back pain and neck pain, that’s a patient who is not acknowledging improvement. You’ve got to get them to acknowledge improvement.” It’s true. Some people don’t want to let go of their pain. Some patients are afraid no one will pay attention to them if they’re not sick.

THE MIND GAME

The person who has waged the most radical attack on the old conventional wisdom that damaged disks explain most intense back pain is a New York City doctor of rehabilitative medicine, John Sarno. Sarno’s influence within the medical profession has been limited, but his 1991 bestseller,
Healing Back Pain,
has persuaded impressive numbers of readers that the source of their back troubles is in their head. Tight muscles and a restricted supply of oxygen causes the pain, he says, but that’s only a physical mechanism triggered by repressed negative emotions, especially anger. The back or neck pain is an unconscious diversion strategy for people who would rather deal with their physical than their psychic pain. Confront the source of that psychic pain, he says, whatever it may be, and the physical problem will go away, usually sooner rather than later.

These days, even the most conservative orthopedic surgeons agree that emotional stress can play a role in back pain. They’ll also point out that damaged disks do often contribute to the most serious back-pain cases. Whether we agree with Dr. Sarno’s theory that the unconscious mind lurks behind every case of muscle-related back pain is another question, one that’s outside the scope of this book. However, if we can look past the negative comments Dr. Sarno makes about his colleagues, we can agree with his basic concept: in many cases, if you relax, stop contracting
tight muscles, and learn to deal with emotional stress, you can reduce or eliminate pain.

Although we agree that back pain can be a physical manifestation of repressed emotions, our treatment approach is our major area of difference with the doctor. No matter what first causes muscles to tighten up, once they remain locked in contraction, harmful physical changes take place, including oxygen starvation and scar-tissue formation. Much of this book is devoted to explaining and describing how manual therapies address those physical changes at a physical level. If, for instance, you’re lucky enough not to have a “weak link” in your musculoskeletal system, you may just experience generalized muscle tension. But if you have a “bad back,” or chronically tight neck muscles, that’s the reactive area where stress is going to manifest. Unless you deal with those damaged muscles, stress may always gravitate there.

To us, a muscle medicine worthy of the name addresses both mind and body. When you’re dealing with chronic back and neck pain, why not use all the tools available, the ones that get at the physical symptoms as well as the possible emotional underpinnings. So we coach patients on stress-reduction techniques. Whereas conventional psychological therapy gets patients to focus on their individual life issues, our stress-reduction exercises work to make people more aware of universal body processes such as breathing that have a big influence on their emotional life. Quieting fearful or angry emotions can lessen muscle tension and pain, and that’s a good thing.

As with all forms of treatment, timing is essential. If you’re having a lower-back spasm, you want a muscle therapist to help bring you out of pain before you give much thought to the emotions that may have triggered it. Likewise, if you’re having a heart attack, you’d like medical science to save your life, then it may be time to contemplate stress management. (That’s a dramatic example but not an idle one. Heart disease is the country’s number one killer; stress is a leading cause of heart disease.)