Muscle Medicine: The Revolutionary Approach to Maintaining, Strengthening, and Repairing Your Muscles and Joints (7 page)

STRESS AND STRESS REDUCTION

Before we move on to specific mind-body exercises, let’s take a closer look at this thing, stress, that your mind and your body are up against. Stress is the body’s
response to being overwhelmed by the outside world. For much of human evolutionary history, the outside world was trying to kill us—predators, environmental exposure, you name it—so our species evolved a hormonal mechanism to jump-start us into taking life-saving action, the so-called fight-or-flight response. The brain orders the endocrine system to produce stress hormones such as adrenaline that pump up the heart rate and send our nervous system into high gear. That’s great for fighting or fleeing tigers, but in the modern world, the threats to our well-being are more often psychological. Our stress response stays jammed in the “on” position without a satisfying physical release to turn it off. Most of the chronic diseases and disorders of the past century are either caused or made worse by this kind of unresolved hyperstress.

In the early 1970s, Western science began to look at the health benefits of breathing and meditation exercises, and their ability to turn off the stress hormones controlled by the sympathetic nervous system and turn on the counteracting parasympathetic nervous system. Pioneering Harvard researcher Herbert Benson documented the slowed-down heart and breathing rates of meditating subjects and dubbed this the relaxation response. Since the late seventies, an MIT-trained biologist, Jon KabatZinn, has been using meditation techniques as the basis for an influential stress-reduction program at the University of Massachusetts Medical School at Worcester, generating research and helping people get a better handle on their emotional and physical problems, including chronic muscle pain. The program Kabat-Zinn founded, now called the Center for Mindfulness in Medicine, Health Care, and Society (
www.umassmed.edu/cfm/index.aspx
), and his first book,
Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness,
are excellent places to start digging deeper into the mind-body approach to muscle pain.

Drawing on Benson, Kabat-Zinn, and others, we’ve come up with a short list of stress-reduction exercises that over the years some of our patients have enjoyed and benefited from. The common thread is encouraging patients to slow down and become aware (or
mindful,
to use the term borrowed from the Buddhist meditation tradition) of just how frantic their lives really are. Keep in mind that stress can be good. It motivates us to get to work on time and get things done. Stress itself doesn’t cause problems; it’s the way we handle it that’s the issue. When you go through your entire day hyperventilating and tensing your muscles,
without realizing it,
you’ve crossed the line from the “good” stress to the “bad” stress that will,
sooner or later, break you down. The point of these exercises is to relearn what “normal” should feel like.

Relaxed, deep breathing is the key to breaking free of that stressed-out feeling when it hits. It may sound ridiculously easy, but in our text-message-a-minute world, you probably need to practice. The breathing exercise we offer becomes the foundation for the more advanced techniques that follow. With patients who like the feeling of “doing” something, we’ll sometimes use the
body scan technique.
Taking “inventory” by concentrating on relaxing each part of your body in turn can be a great way to feel as if you are exercising control (or taking control back from chronic pain). With patients who are comfortable with the idea of completely “letting go,” we might use a more “classical” meditation exercise where you focus on the breath and let your attention go wherever it wants before coming back to the breath (see the exercises in the box on pages 36–37).

These exercises may work directly on the source of the muscle pain, reducing it by reducing muscle tension. But they can also work indirectly, changing the way you experience pain. Okay, that may sound a little far-out. But pain isn’t a solid, objective
thing
. It’s the result of a conversation between special pain-sensing nerve cells spread throughout the body and a set of nerve cells housed in the spinal cord that send the information up to the brain to make sense of it all.

When you do a body scan or meditate, you’re encouraging your body and mind to come to the calmest, coolest conclusion about the intensity of your muscle pain. The body is relaxed; the mind is focused on the present moment. Often, patients who deal with chronic muscle pain say their perception of it is driven as much by the fear that the pain will become intolerable as it is by the physical sensation itself. As someone once said, “Pain is inevitable; suffering is optional.”

And as we’ll detail in
chapter 6
, some of us would rather put the meditation cushion in the closet and go for a three-mile jog. Why not? It clears the mind and pumps up the good-feeling endorphins. No one mind-body approach is perfect for everybody. We have patients who have benefited from taking classes in Alexander Technique and Feldenkrais Method, two systems that bring awareness and disciplined training to a whole range of body movements.

Yoga is probably the most popular of these movement-based mind-body disciplines that we’ve encountered. In theory, we’re all for it. Many of our patients use yoga as a rejuvenating break in their day or week. But some are borderline fanatic,
pushing themselves into poses that are too aggressive or held too long. We see a lot of yoga-related injuries. If you’re going to make use of Eastern mind-body techniques, check your “more is better” Western mind-set at the door. And know that although your limber friend on the next yoga mat may love certain poses, if you have spinal issues, they may not be right for you. You may benefit from the gentler movements of tai chi. Research any physical limitations you have and choose activities that best suit you.

STRESS REDUCTION

Breathing Exercise
(5–10 minutes daily)

Try this exercise for a week and see whether it makes a difference in your life. Find a quiet place and comfortable position, either sitting in a chair (spine straight, shoulders down and relaxed) or lying down. Close your eyes if that feels comfortable and doesn’t send you to sleep. Bring all your attention to your breath. Concentrate on the in-breath, concentrate on the out-breath. The rhythm should be regular and relaxed. Don’t exaggerate the slowness or the deepness of your breath. Relax your belly. You may be able to feel the belly rise and fall with each breath. (Don’t worry if this “breathing from the diaphragm” doesn’t come right away. Most people have unconsciously trained themselves to breathe more shallowly from the chest.) Each time your mind wanders, bring it back to the breath without judgment or frustration.

Body Scan Exercise
(5–20 minutes daily, or as often as you find it useful)

Lie on your back on your bed or a foam pad on the floor. Close your eyes and concentrate on your breath, the rising and falling of your belly. After your breath has settled, feel your whole body, head to toe. Feel the parts of your body that are in contact with the bed or pad. Then bring your attention to the toes of your left foot. Feel every sensation going on there, good, bad, or indifferent. Then take a deeper breath, to “wash away” the toes, and move down to the heel of the foot. In this way, cover every region of your body. When your mind wanders, bring it back without judgment or frustration to the breath and to the part of the body that you are focusing your attention on. You may want to bring an element of visualization to this exercise. Picture the breath coming in through the nose, traveling to the body area, then running back out through the nose.
If you are in pain, you might imagine refreshing water or a healing light or a cool breeze traveling to the damaged area, bathing it, then leaving the body.

Meditation Exercise
(5–30 minutes daily, or as consistently as you can manage)

If you find that meditation agrees with you, see if you can build up the duration of each session to twenty or thirty minutes, and if you can do it without strain and without its becoming the point of the exercise. To begin, assume a comfortable sitting or kneeling position on cushions or sit upright in a chair (spine straight, shoulders down). If you can maintain alertness, close your eyes. Bring your attention to your breath, the in-breath and the out-breath, the feeling of air passing through your nostrils, the rising and falling of your relaxed belly. When your mind wanders, note the thought or the feeling that comes into your head, then without judgment or frustration come back to the breath. If you are aware of physical discomfort or pain, bring your attention to that for a moment. Don’t tell yourself a story about how you feel about the pain, just be fully in touch with the sensation, then return to the breath.

NUTRITION

Nutrition,
the food choices you make every day, can affect the health and durability of your musculoskeletal system, and body weight can determine how durable that system needs to be. Quite possibly the single best thing you can do to preserve the long-term health of your joints is to keep your weight under control. You’ve got to manage the load you’re asking your joints to carry. If you control the number of calories coming into the system so you
don’t
put on that extra ten, or fifty, pounds when you hit your middle years, you can significantly lower your odds of developing osteoarthritis or suffering a traumatic cartilage injury (see the box on page 39). (Recall that when you climb stairs, every extra pound of weight exerts three to four extra pounds of pressure on your knees.)

The other part of the equation is how strong and resilient your body frame is in the first place. Here, you need to pay attention to the quality, not just the number, of the calories coming in. As we’ll discuss, taking in the recommended amount of calcium and vitamin D preserves bone strength, and taking extra care to get “good” fat in your diet (the omega-3s) may protect against inflammation.

TALE OF THE TAPE MEASURE

Let’s tackle weight first, specifically being overweight. Since the mid-1970s, the percentage of obese Americans has doubled. That’s not good.

The physics of weight are pretty simple. Take in as many calories as you burn and you’ll maintain your weight; take in fewer and you’ll lose pounds. But if you struggle with weight, how do you consume fewer calories than your stomach wants without feeling cheated? Everyone who has ever seriously researched the subject (as opposed to churning out a diet bestseller) knows that crash diets don’t work. In fact, most diets don’t work. Motivated dieters can lose the weight, but their bodies, and psyches, can’t handle the long-term deprivation, and they usually gain most or all of the pounds back. The key is sustainability. Forget about “going” on a diet as if it were a temporary fix. If you can consume fewer, but more nutritious, calories and burn more calories with a metabolism-revving exercise program such as the one we present in the next chapter,
and like this healthier lifestyle well enough to stick with it for the rest of your life,
then permanent weight loss
is
possible. As for an exact recipe for cutting calories without feeling intolerably hungry, if there were such a thing as a magic diet, science, or one very rich diet guru, would have found it by now. Follow your own stomach. Some people don’t feel depleted when they take in fewer carbohydrates; others can go low-fat without feeling pleasure-starved.