Seven steps to get rid of back pain. How to Cure Back Pain People need to know the truth! tension muscle syndrome john sarno

Attention! This book does not describe a "new approach" to the treatment of the back, but a new diagnosis that requires adequate treatment. Every year, millions of people learn from doctors that the cause of their suffering is osteochondrosis, "pinched nerve", arthritis, spinal stenosis, herniated disc, and so on. But if all these diagnoses are correct, then why isn't medicine doing its job? Why hasn't a neuropathologist been born yet who would cure at least one of his patients once and for all? Dr. Sarno challenges dogma. He claims that people are not being treated for what they need to be treated for, and he diagnoses his patients with a diagnosis unknown to orthodox medicine - muscle tension syndrome (MSS). Is his theory correct? Let's leave these disputes to scientists. Practice is much more important for us - thanks to Dr. Sarno, thousands of people have already recovered! Quotes from the book: By ignoring pain or laughing at it, you teach your brain to send new messages to your muscles.

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JOHN SARNO HOW TO Cure BO AND IN THE BACK PEOPLE SHOULD KNOW THE TRUTH! JOHN E. SARNO Healing BACK PAIN THE MIND-BODY CONNECTION UDC 615.851 BBK 53.57 C20 / Transl. from English. - M.: LLC Publishing House "Sofia", 2010. - 224 p. ISBN 978-5-399-00148-7 Attention! This book does not describe a "new approach" to the treatment of the back, but a new DIAGNOSIS that requires adequate treatment. Every year, millions of people learn from doctors that the cause of their suffering is osteochondrosis, "pinched nerve", arthritis, spinal stenosis, herniated disc, and so on. But if all these diagnoses are correct, then why isn't medicine doing its job? Why hasn't a neuropathologist been born yet who would cure at least one of his patients once and for all? Dr. Sarno challenges dogma. He claims that people are not being treated for what they need to be treated for, and he diagnoses his patients with a diagnosis unknown to orthodox medicine - muscle tension syndrome (MSS). Is his theory correct? Let's leave these disputes to scientists. Practice is much more important for us - thanks to Dr. Sarno, thousands of people have already recovered! UDC 615.851 LBC 53.57 Copyright © 1991 by John E. Sarno, M.D. Healing back pain. The Mind-Body Connection This edition published with arrangement with Grand Central Publishing, New York, New York, USA. All rights reserved. All rights reserved, including the right to reproduce in whole or in part in any form. ISBN 978-5-399-00148-7 © Sofia, 2010 © Sofia Publishing House, 2010 CONTENTS Introduction 7 Chapter 1. Manifestations of muscle tension syndrome 14 Chapter 2. Psychology of SMN 47 Chapter 3. Physiology of SMN 81 Chapter 4. Treatment of SMN 92 Chapter 5. Traditional (standard) diagnoses 123 Chapter 6. Traditional treatments for the back 150 Chapter 7. Mind and body 164 Appendix. Letters from Patients 209 WARNING Be aware that this book, like any other, is not a substitute for a physician. It was not written to be used as a self-diagnosis. If you are experiencing pain, be sure to undergo a medical examination to rule out a serious illness. INTRODUCTION In my opinion, the main cause of pain in the neck, shoulders, back, lower back and joints is the so-called muscle tension syndrome (TSS). This syndrome is a major medical challenge. According to statistics, eighty percent of US citizens suffer from back pain to one degree or another. In an article published in the August 1986 issue of Forbes magazine, the following figures are given: about fifty-six billion dollars are spent annually on the treatment of the pathologies behind these pains! Back pain ranks first among the causes of absence from work due to illness and the second - in the number of visits to the doctor. Moreover, it is obvious that over the past thirty years the situation has deteriorated significantly. But why? Really, after millions of years of evolution, the backs of Americans have ceased to cope with their functions? Where did this number of patients come from? And why did doctors suddenly turn out to be powerless in the face of illness? The purpose of my book is to answer these and many other questions regarding this widespread problem. I believe that the topic I have raised needs to be looked at more broadly than it is usually looked at, since the reason for the described epidemic (dada - epidemic!) lies in the actual inability of medicine to recognize the true nature of the disease, that is, to make an accurate diagnosis. Similarly, while people knew nothing about bacteriology and epidemiology, the plague devastated entire countries. Of course, it is quite difficult to believe in such incompetence of representatives of modern high-tech medicine. Nevertheless, this is a fact. After all, doctors are also people, which means that they are by no means omniscient and may well be mistaken. Here is one of the most common erroneous stereotypes that doctors are guided by: back pain must necessarily be the result of structural disorders in the spine or muscle damage. Another medical misconception: emotions cannot cause physiological changes in the body. My experience with SMN disproves both of these stereotypes. The disorders in question are accompanied by small (albeit very painful) changes in the soft tissues of the body (not the spine) and are of a psycho-emotional nature. I first noticed this problem in 1965 when I was head of the outpatient department at the Howard Rusk Institute for Rehabilitation Medicine at New York University Medical Center. It was there that I encountered a huge number of patients suffering from pain in the neck, shoulders, back and lower back. From the point of view of traditional medicine, the causes of their suffering were various kinds of structural disorders - arthritis of the displacement of the intervertebral discs and so on, as well as muscle pathologies associated with poor posture, overexertion and insufficient physical activity. Pain in the legs and arms was due to pinched nerves. INTRODUCTION 9 At the same time, the mechanism of pain occurrence remained unclear. Is it possible in such a situation to talk about the meaningfulness of the prescribed treatment - all kinds of injections, deep heating with ultrasound, massage and special exercises? Of course not. No one really understood how exactly such procedures affect the body. Doctors were content with primitive ideas - they say, exercise prevents the occurrence of pain, as it helps to stretch and strengthen the muscles of the abdomen and back that support the spinal column. As a result, the treatment of such patients could not be called truly successful. The situation was further complicated by the fact that, as a result of surveys, it was far from always possible to establish a direct link between pain and their alleged causes. For example, according to the diagnosis, there are degenerative arthritic changes in the lumbar spine of the patient, but the incident is that completely different parts of the body hurt him. Or the patient's intervertebral disc in the lumbar spine is displaced to the left, and for some reason he feels pain in his right leg. But the most important observation was this: in eighty-eight percent of patients with problems such as migraine, heartburn, hiatal hernia, stomach ulcers, colitis, irritable bowel syndrome, hay fever, asthma, eczema, and so on, exacerbations of the disease are provoked by nervous voltage. But then it is logical to assume that the painful state of the muscles is also associated with nervous tension. Or rather, with muscle tension syndrome (MSS). 10 HOW TO CURE BACK PAIN When we put this assumption to the test and began to treat people accordingly, the results were very positive. This was the beginning of the diagnostic and therapeutic program, which will be discussed in this book. It should be clarified that the book does not describe a "new approach" to the treatment of the back, but a new diagnosis - SMN, which requires appropriate diagnosis and treatment. When doctors learned that bacteria are the cause of many infections, they began to look for weapons against them - this is how antibiotics appeared. Similarly, if psycho-emotional factors are found to be the cause of back pain, an appropriate new therapeutic technique should be applied. Obviously, traditional psychotherapeutic methods are not applicable in this case. Nevertheless, experience shows that in order for the treatment to be successful, it is necessary to explain to the patient what is really happening to him. Are we talking about holistic medicine now? Unfortunately, what is hidden under this term is a mixture of science, pseudoscience and folklore. However, at the heart of the holistic approach to healing the sick is a wise principle: a person must be perceived and treated as a whole! Unfortunately, this principle is ignored by certified doctors. Perhaps "holistic" should be called healing methods that take into account both the bodily and psycho-emotional components of health and disease. And at the same time, in no case should one abandon the scientific approach to the treatment of diseases. That is, I'm not talking about "official" and not about "holistic" INTRODUCTION 11, but simply about good medicine. Although the cause of SMN is nervous tension, it is diagnosed in the traditional way for clinical neurology - on the basis of the physical, rather than psychological state of the person. Physicians who deal with such things should learn to see the relationship between the body and mind and get, figuratively speaking, a diploma of a "specialist in holistic sciences." Because medicine is worthless if it ignores the influence of emotions on people's health. Please do not forget: SMN is a physical ailment, the “trigger” of which is emotions. This malaise should be diagnosed by a versatile trained doctor, whose qualifications make it possible to determine both the physiological and psycho-emotional components of the problem that has arisen. Psychologists, unlike neuropathologists, are able to see the cause of muscle pain in the mental discord of the patient. But because they do not have the necessary training in neurology, they cannot make a diagnosis of SMN with complete certainty. And vice versa - it is difficult to find a neuropathologist who is able to skillfully recognize the psycho-emotional roots of certain physiological disorders. As a result, SMN falls, so to speak, "between two chairs" and patients leave with the wrong diagnosis. What do doctors think of SMN? It is unlikely that they understand well what is at stake. Judging by the reaction of doctors I know when it comes to SMN, most doctors either deny this diagnosis altogether or ignore it. Some of my colleagues admit that they simply do not know how to treat such patients. I have written several medical articles and special manuals about SMN, but they are available only to a narrow circle of specialists, mainly physiotherapists and rehabilitation specialists. Moreover, in recent years, it has become almost impossible to publish work on the topic of SMN, since this diagnosis contradicts medical dogma. So I want to appeal to doctors who will read my book: it contains much more complete information than any of the articles I have previously published, so it would be nice if you would take it seriously, despite the fact that I addressed it to a wide audience. What about readers who experience neck, shoulder, back, or buttock pain and think they have SMN? Keep in mind that this book, like any other, cannot replace a doctor; it was not written to be used for self-diagnosis. I find it unethical to say the least to instill in people the hope that they can acquire proper medical qualifications by reading popular literature or watching DVDs. If a person experiences recurring pains in any part of the body, they should be carefully studied in order to exclude such serious diseases as cancer, all kinds of tumors, bone diseases and other pathologies. In other words, he definitely needs to consult a doctor and undergo an examination. The scientific approach requires that any new idea be reliably validated. A newborn concept can be adopted only after unconditional evidence of its truth is obtained. That is why it is extremely important that all the thoughts voiced here become the object of close attention of specialists. I urge my colleagues to either confirm my conclusions based on their own experience, or to object to me with reason. The only thing they should not do is remain indifferent, because the problem of back pain is too serious and urgently needs an effective solution. CHAPTER 1 MANIFESTATIONS OF MUSCLE TENSION SYNDROME I have never seen patients complaining of pain in the neck, shoulders, back or buttocks who were not sure that their problems were due to an accidental injury or excessive physical exertion during sports training. "I injured my leg while running (basketball, tennis, bowling)." “I felt pain when I picked up my daughter”, “...when I tried to open a jammed window.” “Ten years ago I had an accident and have been in constant pain in my back ever since.” The idea has firmly settled in the minds of Americans that the causes of pain can only be injuries or other kinds of external or internal damage. Of course, if the pain occurs during or after CHAPTER A B A 1. MANIFESTATION OF THE SYNDROME OF THE MUSCLE STRESS OF 15 physical activities, it is easy to assume that there is a direct link between the one and the other connection (although, as you will learn later, such assumptions are often wrong). The widespread notion that the back is vulnerable is nothing more than a medical disaster in an American society that has become a collection of semi-disabled people who are afraid of a recurrence of pain and therefore move extremely carefully. For decades, both traditional doctors and various healers have been guided by this idea. They tell their patients that pain in the neck, shoulders, back, and buttocks is due to injury or disease of the spine and related structures, or to dysfunction of the muscles and other joints, without, however, giving any convincing arguments in favor of their diagnoses. As for me, I have successfully treated such disorders for seventeen years and concluded that such pains arise from chronic tension of the muscles, nerves, tendons and fascia. The proof of the correctness of my point of view is the high percentage of healings after applying the simple and fast-acting Program described in this book. Doctors' misconceptions about the spine are rooted in the very system of their education and are conditioned by the philosophy of medicine. The fact is that modern health science is concerned with mechanisms and structures. The body is seen, explicitly or implicitly, as an extremely complex machine, and disease as its breakdown as a result of infection, trauma, hereditary pathologies, tissue degeneration, and, of course, cancer. Medicine 16 HOW TO CURE BACK PAIN cannot live without laboratory tests, believing that they are the only ones worthy of attention. I am not going to belittle the role that these studies played in its development (the invention of penicillin, insulin, and the like). But, unfortunately, when it comes to a person, not everything can be measured with instruments and described using numbers. First of all, this concerns the human mind and the brain responsible for it. It is impossible to put in a test tube and weigh or measure emotions, therefore, for modern medical science, they seem to be non-existent. And if so, then they are in no way connected with either health or illness. As a result, most medical practitioners ignore the fact that emotions can be the cause of physiological disorders, although many of them admit that often the patient's experiences exacerbate his illness. Generally speaking, traditional doctors are extremely uncomfortable dealing with emotions. They draw a clear line between "mind" and "body" problems and know much better how to deal with bodily dysfunctions. A good example of the above is the treatment of gastric and duodenal ulcers. Although it has long been known that the cause of this disease is psycho-emotional stress, most therapists, contrary to all logic, prefer to prescribe exclusively medical treatment, prescribing drugs that reduce the acidity of the stomach, and openly ignore psychotherapy. In other words, they do not care about the cause of the disease and they offer only symptomatic treatment - exactly as they were taught in medical schools. CHAPTER 1 . MANIFESTATIONS OF SYNDROM MUSTER STRESS 17 Since physicians focus primarily on healing the body, the psycho-emotional considered by them at all, even if it is the main cause of the suffering of the patient. That is why it is the doctors who bear the main share of responsibility for such a wide spread, one might say an epidemic, of diseases of this type. Although, in fairness, it should be noted that some doctors still talk about nervous tension, but somehow casually: "You need to relax and unwind, you work too much." The purpose of this book is to remedy this situation. In the first chapter, we will talk about who gets SMN, what parts of the body it affects, how pain can vary, and how it affects a person's overall health and daily life. The following chapters are devoted to the psycho-emotional side of SMN (with which, in fact, everything begins), its physiology and how to deal with this syndrome. In addition, I have devoted a separate chapter to describing the connections that exist between the mind and body and how they affect health. WHO IS SMN AFFECTED? Someone might say that SMN is an ageless disease, since this syndrome can manifest itself not only in adults, but also in children from five to six years old. Although, of course, the symptoms of a child are different from those of an adult. I am sure that the "neuralgic pains" so often observed in childhood have never been properly studied, especially since doctors have to work especially hard to convince mothers of the prevalence of this problem and that it generally does not pose a threat to the health of the child. One day during a conversation with a young mother who complained that her daughter was experiencing severe pain in her leg at night, it dawned on me that what the child felt was very similar to sciatica in adults, which is one of the most common manifestations of SMN. So, this syndrome may well occur in children. It is not surprising that no one is able to explain the nature of the so-called "neuralgic pains", because SMN does not leave obvious physical traces of its presence. You can track a temporary spasm of blood vessels that cause characteristic symptoms, but then everything returns to normal. The emotional stimulus that provokes a painful attack is the same in children and adults - this is anxiety. Some believe that in this way the child experiences a kind of replacement of a nightmare with a painful physiological reaction - instead of painful experiences that are unbearable for him, he experiences physical pain. In adults, in fact, the same thing happens. I have observed the manifestation of SMN even in octogenarians. That is, this condition has no age and potentially threatens any person capable of experiencing emotions. Still, at what age does SMN appear most often, and what lessons can we learn from such statistics? Our 1982 study included 177 patients treated for MNS. Seventy-seven percent of them were in the thirty-sixty age category CHAPTER 1 . MANIFESTATION OF SYNDROM M USTERIC TENSION 19 years old, nine percent - twenty to thirty years old, two percent - adolescents, seven percent - people from sixty to seventy years old and four percent - over seventy. These statistics confirm that the causes of back pain are primarily of an emotional nature, because the period of a person's life from thirty to sixty is the years of his highest responsibility. At this age, we strive to achieve success, to achieve material well-being, and it is then that SMN most often develops. If spinal degenerative changes (eg, osteoarthritis, slipped discs, herniated discs, arthrosis of the joints, spinal stenosis) were the main cause of back pain, these statistics would have to look different, since MRN would primarily affect older people. So, to the question "Who is affected by SMN?" you can safely answer: "Anyone." And definitely I can say the following: this syndrome most often occurs in the middle of a person's life - in the years of the highest responsibility. Let's look at the main signs of SMN. WHERE DOES SMN MANIFEST? Muscles First of all, the syndrome described here affects the muscles (hence its name). Muscles affected by SMN are located in the back of the neck, back, buttocks and are called tonic or postural. They are responsible for the correct position of the head, torso and ensure the effective work of the hands. 20 HOW TO CURE BACK PAIN Statistically speaking, SMN most commonly occurs in the lumbar region, in about two-thirds of patients. Sometimes the gluteal and lumbar muscles are affected separately. The second most commonly affected area is the muscles of the neck and shoulders. Usually pain is felt in the side of the neck and upper shoulder, as well as in the trapezius muscle. SMN can appear in any part of the back - from the shoulders to the waist, but much less frequently than in the two above areas. Most often, the patient complains of pain in one of the above parts of the body, for example, in the left buttock or right shoulder, but at the same time, a medical examination reveals something very interesting. In almost every patient with SMN, on palpation, there is increased sensitivity or tenderness of the muscles of the outer region of both buttocks (sometimes in the entire buttock), the lumbar region, and both trapezius muscles. This serves as one of the evidence for the hypothesis that pain in SMN does not arise from a specific pathology of the spine or muscle failure, but is actually generated by the brain. Nerves The second substrate on which SMN manifests itself is the nerves, especially the peripheral ones. And most often it affects those nerves that are located in close proximity to the muscles. The sciatic nerves are located deep in the gluteal muscles (one on each side), the lumbar nerves are located under the paraspinal muscles in the belt region. MANIFESTATION OF SYNDROM OF THE MUSCH OF THE MUSCLE OF THE STRESS OF THE WOMEN AND I 21 of the neck, the occipital nerves, and also the nerves of the brachial plexus - under the upper part trapezius muscles. It is these nerves that are most commonly affected by SMN. As a rule, SMN covers a fairly large area of ​​the back, not limited to one local area. All tissues in this area suffer from a lack of oxygen, so a person may experience pain both in the muscles and along the nerve trunks. When muscles and/or nerves are affected, different types of pain occur. The pain can be sharp, burning, cutting, aching, pressing. In addition, if the syndrome affects the nerves, there is often a tingling or numbness sensation, sometimes extending to the muscles of the arms or legs. In some cases, there is muscle weakness, which can be recorded using electromyography. When SMN affects the lumbar and sciatic nerves, leg pain occurs. If the occipital and brachial nerves are affected, pain appears in the arm. The traditional diagnosis for leg pain is usually a herniated disc, and for arm pain, a pinched nerve (see Chapter 5). SMN can affect any of the nerves in the neck, shoulders, back, and buttocks, causing extreme pain. One of his most frightening symptoms is chest pain. An alarmed person immediately decides: "Heart!" - and for peace of mind it is absolutely necessary for him to know that everything is in order with his heart. Having convinced himself of this, he should be aware that the cause of sharp pain in the chest area may be oxygen starvation of the nerves serving the upper back and front of the body, caused by SMN. 22 HOW TO CURE BACK PAIN At the same time, a person may complain of strange accompanying sensations and weakness. Remember: in order not to miss a serious illness, be sure to consult a therapist! This book is not a "tutorial" for those who want to make diagnoses on their own. Its purpose is to describe the clinical phenomenon called SMN. During a physical examination, it is necessary to check tendon reflexes and muscle strength to find out how much oxygen starvation has affected the nerves - whether it has affected motor skills and the speed of transmission of nerve impulses. In addition, sensory tests (eg, a pinprick test) should be performed to ensure that the affected SMN nerve is intact. The main purpose of diagnosing and documenting the facts of sensory or motor disturbances is the subsequent opportunity to discuss them with patients, who must be reassured that the sensations of weakness, numbness or tingling they experience do not conceal any threat. During the examination, a leg lift test is mandatory. There are several reasons for this test. If the patient feels severe pain in the buttock, he will not be able to raise the straightened leg high. The reason for this state of affairs lies in the muscle or in the nerve, or both. However, in most cases, this does not mean at all that “a displaced intervertebral disc is pressing on the sciatic nerve,” as patients are often told. CHAPTER 1 . MANIFESTATIONS OF MUSCLE TENSION SYNDROME 23 When there is pain in the shoulder or in the arm, the arm is checked in a similar way. Sometimes patients have bilateral pain. It is also not uncommon for people to report that, in addition to pain in, for example, their right buttock or leg, they experience intermittent soreness in their neck or one of their shoulders. There is nothing unusual in such situations, since the media can affect any muscle or all the muscles of the trunk at the same time. Ligaments and tendons Various pains in the ligaments and tendons are also part of the muscle tension syndrome (TSS). The term "myositis" is rapidly becoming obsolete, having been coined many years before nerves were also found to be affected by SMN. Then I realized that in addition to muscles and nerves, this syndrome can affect other tissues of the body, and over time I became more and more convinced of the correctness of my conclusions. First of all, I paid attention to how my patients described their condition: when back pain subsided, often pain in the tendons also disappeared (for example, the symptoms of radiohumeral bursitis disappeared). Inflammation around or in the tendon is called tendinitis. It is believed that painful tendons are inflamed most often due to their overexertion. In such cases, anti-inflammatory therapy and restriction of motor activity are prescribed. Assuming that tendon tenderness might be a manifestation of MNS, I began to explain to patients that their tendinitis was most likely associated with back pain and would disappear with it. The results of this approach were quite impressive, and over time my confidence that such diagnoses were correct grew. Now I am ready to say that tendonitis is often part of the SMN, and in some cases - a direct manifestation of it. The so-called “tennis elbow” is one of the most common types of tendonitis. In my experience, the same thing happens with the knee. The most common diagnoses for knee pain are chondromalacia patella and knee injury. However, while the examination reveals tenderness in the tendons and ligaments surrounding the knee joint, pain in the knee area usually disappears when the back stops hurting. Another weak point is the ankle, foot (upper and lower parts of it) and the Achilles tendon. Common diagnoses for pain in this area are neuroma, bone spur, plantar fasciitis, flat feet, and injuries due to too much exercise. The next area to show tendinitis in SMN is the shoulder; the most common diagnoses are bursitis and rotator muscle injury. As a rule, the sensitivity of this area is easily checked by palpation of the tendons of the shoulder girdle. The tendons of the hand are usually not affected by SMN. It is possible that what is known as carpal tunnel syndrome is also a type of SMN, but further observation and research is needed to prove this. I recently spoke with an old patient of mine who had pain in her thigh after a minor injury. The X-ray showed the presence of arthritis in the hip joint. CHAPTER 1 . SYNDROME OF MUSCLE TENSION 25 Naturally, the doctor decided that this arthritis was the cause of the pain. Since she had suffered from SMN in the past, I suggested that she be examined further. Based on the X-ray, the arthritic changes in the hip joint were quite typical for her age. The joint remained mobile, and while walking the woman did not experience any discomfort. When I asked her to point her finger at the place where she was in pain, she pointed to a small area where the tendon attaches to the bone, well above the hip joint - the pain was caused by pressure in this place. I said she had SMN tendinitis. After a few days, the pain really went away. Tendinitis most often accompanies acetabular bursitis. But in this case, such a diagnosis would be incorrect, since the location of the pain turned out to be above the trochanter of the femur, which can be felt on palpation of the upper thigh. SMN manifests itself in different places and often moves, especially if this disorder is tried to be managed symptomatically. Patients talk about how pain, after it passes in one place, appears in another. It seems that the brain does not want to give up a convenient strategy that allows it to divert attention from emotions. Therefore, it is very important that a person knows exactly where the pain is localized. I ask my patients to call right away and let me know if the pain has moved somewhere else, then we can definitely conclude if this symptom is part of SMN. So, three different types of tissue can suffer from MNS: muscles, nerves, and ligaments-tendons. Let's take a closer look at how SMN manifests itself. 26 HOW TO CURE BACK PAIN PATIENTS' CONCEPTS OF THE CAUSES AND TYPES OF PAIN ATTRIBUTES At first glance, many of my patients seem to be suffering from the effects of longstanding severe trauma, tissue degeneration, congenital musculoskeletal disorders, or muscle weakness. Most often, the version of trauma wins, because people manage to build a causal relationship of their suffering with certain circumstances in which the disease manifested itself. According to a study we conducted a few years ago, forty percent of patients say that the pain began after a load, injury, physical work. For someone it was a car accident - usually a blow from behind. Someone fell down the stairs or slipped on the ice. Others lifted weights, played tennis, basketball or ran. But since pain appears both a minute and several hours or days after the corresponding incident, the question arises about its nature. Some say that there was nothing unusual in the incident itself - for example, a person bent down to pick up a toothbrush from the floor, or stretched, taking a cup from a cupboard, and the hero who tried to lift the refrigerator on his own can feel the same pain. I remember one young man. He was sitting quietly at his desk in his office and suddenly experienced such a “backache” that he had to call an ambulance and send him home. The next two days were painful for him, at the slightest movement a wave of pain rolled over him. CHAPTER 1 . MANIFESTATIONS OF MUSCLE TENSION SYNDROME 27 Why do completely different types of physical activity provoke the same severe pain? Given the varying degrees of muscle tension and the huge variety of situations after which the state of a person changes dramatically, it remains to be concluded that the incident that happened is by no means the cause of the problem; it only acts as a trigger. Moreover, many patients do without such triggers at all - the pain they experience simply gradually increases, or they wake up with it one morning. And according to the studies mentioned above, this happens in sixty percent of cases. The assumption that the incidents supposedly causing the disease are in fact nothing more than triggers is proved by the following fact: it is almost impossible to distinguish the distinguishing signs of pain that develops gradually from pain that occurs abruptly, and it is almost impossible to accurately predict the strength and duration of such pain attacks. . This once again confirms that in such cases we are dealing with SMN. Despite the temptation to attribute everything to trauma, it must be admitted that there are no injuries in such cases - it's just that the human brain has found a reason to attack the body through SMN. There is another reason to doubt the leading role of injuries in pain attacks. The biological capacity for self-healing is one of the most powerful survival mechanisms that has evolved over millions of years of life on Earth. Thanks to this ability, our bodies quickly recover from injuries. 28 HOW TO CURE BACK PAIN Even the largest bone in the human body - the femur - when broken, grows together in six weeks, while the person experiences very little pain. That's why it seems strange that some kind of injury can cause pain after two months, not to mention two or ten years. However; most people are absolutely sure that injuries are the cause of their pain, and unconditionally agree with the same diagnoses of doctors. So, almost all patients experiencing bouts of back pain try to find a connection between their current condition and some incident in the past, perhaps even several years ago, such as a car accident or a fall while skiing. In their opinion, the injury must be mandatory. This conviction is one of the biggest obstacles to recovery. It is necessary to remove this obstacle from the patient's consciousness, otherwise the pains will be repeated. A person needs to start looking for a psychological explanation for his illness. Indeed, having learned the diagnosis - muscle tension syndrome (MSS), he begins to recall the psychological problems that he had to face during those periods of his life when he was plagued by bouts of pain: for example, when moving to a new job or when entering into marriage; these difficulties could also be related to the illness of one of the family members, the financial crisis, and so on. Or the person admits that he has always been anxious, hyper-responsible and too conscientious - in a word, a real perfectionist. Awareness of psi CHAPTER A B A 1 . MANIFESTATIONS OF THE SYNDROME OF MUSCLE TENSION 29 The psychological background of physical pain is the first step to recovery. THE NATURE OF PAINS Acute pain Probably the most common and most frightening manifestation of SMN is acute pain. It is sudden and painful, as in the case of the young man described above. Most often, such pain is localized in the lower back and affects the lumbar and / or gluteal muscles. Each movement brings a new wave of pain, which makes the patient's condition very unenviable. Spasm constricts the muscles. Spasm is a sharp contraction (tension) of the muscles, a pathological condition that can cause unbearable suffering. Almost everyone knows what a cramp in the lower leg or foot is, but the cramp quickly passes. An attack of SMN does not just stop - as soon as the pain subsides, any movement provokes it again. I believe that spasm, like other manifestations of MNS, develops as a result of oxygen deficiency. Most likely, leg cramps are also the result of a lack of oxygen in the muscles, which often occurs in bed when blood circulation is slow. People often say that at the moment of the onset of an attack, they seem to hear a kind of noise - a click or crack. Remembering him, patients say: "The back is out of order." And although in fact nothing broke in their back, they are convinced that we are talking about a breakdown. It is difficult to find an explanation for this noise. Perhaps it is similar to the sound felt during manipulations on the spine - "clicks of the vertebrae." One thing is clear - it is not a sign of something dangerous. While most attacks of acute pain occur in the lower back, they can also occur in the neck, shoulders, and upper back. But wherever this sharp, almost unbearable pain appears, the most amazing thing is that it, in fact, does not threaten your health. Quite often, with such attacks, the body warps. It can lean forward or to the side, and possibly forward and to the side at once. So far, no one has given an exact explanation for this. Of course, this position of the body is very uncomfortable, but does not cause serious harm. The described attacks of acute pain can be of different duration, and after them a person remains in a state of anxiety and fear for a long time. It seems that something terrible has happened and you need to be very careful not to make the wrong move, which will lead to a new attack. If the pain in the lower back is accompanied by pain in the leg, anxiety grows as the threat of a herniated disc and, accordingly, the operation begins to loom on the horizon. Most middle-aged people have heard of such hernias and are afraid of them. This fear increases the pain. If a herniated disc is indeed found during the medical examination, the fear increases. A person feels numbness or tingling in the lower leg or foot, or weakness in the leg (these sensations accompany SMN and are actually the result of growing fear). Next, we'll talk more about CHAPTER A B A 1. MANIFESTATIONS OF MUSCLE TENSION SYNDROME 31 that a herniated disc rarely causes pain. Unfortunately, there are not many remedies to get rid of such pain. If, fortunately, a person understands that this is just a muscle spasm and nothing terrible happens at the physiological level, the attack will soon pass. But this happens very rarely. I advise my patients not to panic about what is happening, go to bed and maybe take a strong pain reliever. Next, they should test their motor abilities a little, without trying to remain still for many days or weeks. If a person can overcome their own prejudices, the duration of the pain attack will be significantly reduced. Chronic pain However, in most cases, pain in MNS develops gradually - without acute attacks. In some cases, it is impossible to explain the appearance of pain at all. In other cases, discomfort appeared and increased hours, days and even weeks after any incidents. It can be an accident when another car crashes into your car from behind and your head is thrown back sharply. The x-ray does not show any fractures or displacement of the cervical vertebrae, but for some reason, pain appears over time - usually in the neck and shoulders, and sometimes in the middle or lower back. Sometimes the pain starts in the neck and shoulders, and then goes down, covering the back. If you know it's SMN, chances are the pain will go away fairly quickly. If you are taken by doctors, pain symptoms can persist for many months. 32 HOW TO CURE BACK PAIN DURATION OF ATTACK Is it an acute attack or a gradual increase in pain - where does it all come from? Remember: an incident, no matter how dramatic, is most likely just a trigger. The true cause of pain should be sought in the psychological state of the patient. Sometimes the reason is obvious - for example, a financial crisis or an event that is usually considered joyful - a wedding or the birth of a child. I know many professional athletes who suddenly start to feel pain during a competition, such as a tennis tournament. Naturally, they were sure that the cause of the pain was trauma. However, upon learning that they had SMI, these people recalled how much g they were worried about the outcome of the match. Apparently, the real cause of SMN should be considered not so much a source of anxiety that overcomes a person, but a hidden psycho-emotional reaction to it - anxiety or anger. It is from its intensity that the strength of the manifestation of pain symptoms depends. In other words, MNS is caused by repressed emotions. We prefer not to let out our unpleasant and painful experiences. It is as if a program is sewn into us that keeps them in the backyard of the subconscious. Finding no way out, they make themselves felt in the form of SMN. We will discuss this topic in more detail in the chapter on psychology. But it also happens that a person says: "When this started, nothing special happened in my life." As a result, it usually turns out that he is in a state of anxiety constantly. It seems to me that such people have a gradual accumulation of GL A B A 1 . MANIFESTATIONS OF THE MUSCLE TENSION SYNDROME 33 internal "garbage", and when the "container" overflows, physical symptoms appear. When this is brought to the attention of patients, he quickly admits his perfectionism, forcing him to respond to daily stress with repressed anger and anxiety. Delayed attack There is another fairly common variant of SMN. In such cases, patients experience a rather long period of nervous tension - for example, during a serious and prolonged illness of one of the family members. They themselves seem to be quite healthy, but after one or two weeks after the “black streak” in their life ends, suddenly there is an attack of back pain - acute or gradually increasing. While these people had to act, they, one might say, kept themselves in control, but as soon as the danger passed, the accumulated anxiety spilled out, provoking pain. The same situation can be explained as follows: a stressful situation provokes a surge of emotional pain and despair of such strength that physical pain is simply not needed. In other words, the function of the pain syndrome is to distract the person's attention from repressed unwanted emotions such as anxiety and anger. And when a person is going through a crisis, it makes no sense to be distracted from it. Whatever the psycho-emotional component of MNS, it is a pattern that must be taken into account if we are to make a correct diagnosis of back pain. 34 HOW TO CURE BACK PAIN Vacation or Weekend Syndrome How a person's anxiety manifests itself largely depends on its nature. It is not uncommon for patients to report that they have an attack of pain during every vacation, or that chronic mild pain that bothers them worsens on weekends. The reasons for such problems are quite obvious - these people are extremely anxious about work or business when they are out of work. Here there is a kind of delayed reaction: while they are at work, their anxiety can be said to “burn out”, and during rest, anxiety and fear increase. A tense, tense person often hears the advice: "Relax", as if he could do it arbitrarily, at his own request. There are many relaxation techniques, including meditation, but until a person learns to get rid of repressed anger and anxiety, no amount of relaxation will help him - he will suffer from SMN and spasmodic headaches. Some do not even know how to switch off from everyday worries and think about something pleasant. I remember a patient who always got back pain when she sat down at the table and poured herself something to drink, hoping to relax. Recently, I spoke with a young man whose example would serve as a perfect illustration of the "vacation" muscle tension syndrome (TSS). He told me that he had been in a state of intense nervous tension for a long time and did not feel any pain in his back. Until he went on his honeymoon. And then one day CHAPTER A B A 1 . MANIFESTATIONS OF MUSCLE TENSION SYNDROME 35 he awoke from a nightmare and immediately felt a violent spasm in his back. This case could be explained by the experiences, however pleasant, associated with marriage, but, given that my patient belonged to the category of extremely obliging people, I connected his illness with his attitude to work. I met this young man again three months after we met. His back still hurt, especially since magnetic resonance imaging showed a displacement of the intervertebral disc in the lumbar spine and the doctors insisted on an operation. (Magnetic resonance imaging is a diagnostic test that can take a picture of the soft tissue, which means you can see abnormalities like displaced discs or swelling.) It turned out that he came to see me after reading my article on SMN. After examining him, I came to the conclusion that his symptoms could not develop due to the existing displacement of the intervertebral disc. Such a neurological picture could only occur with inflammation of the sciatic nerve, a typical manifestation of SMN. Be that as it may, when he learned that SMN was the cause of his suffering, the young man was delighted and quickly recovered. Another fact that many people find extremely difficult to accept is that very often the source of their repressed anger and anxiety, and therefore SMI, is their personal life - an unhappy marriage, problems with children, or the need to take care of elderly parents. I could give many examples to support this: women who are bound in hateful marriages that they are unable to end due to emotional or financial dependence on their husbands; people who are competent and successful in business, but completely incapable of solving problems with spouses or children. I remember one woman who suffered from back pain. She lived with her brother, who had a very difficult character. Despite the treatment, the pain that tormented her only intensified. And then one day she did something absolutely out of the ordinary - splashed out the accumulated rage on her brother. The woman screamed and cursed, and then ran out of the house. And - oh, a miracle! - the pain is gone. Unfortunately, my patient was unable to maintain her fortitude and soon the pain returned. The Holiday Syndrome It's not uncommon to hear or read about the stress people go through during holiday events. What should be fun and relaxation turns into torment. I have repeatedly encountered situations where patients experienced accompanying attacks of pain before, during, or immediately after big holidays. The reason for such attacks is obvious: significant events require considerable effort, especially from women who traditionally take on the responsibility of preparing and holding festive events. In addition, according to the general opinion, such events should be fun and relaxed. Usually in such cases, women do not even realize how strong their internal tension is, so a sudden attack of pain becomes a complete surprise for them. CHAPTER 1 . MANIFESTATIONS OF MUSCLE TENSION SYNDROME 37 NATURAL HISTORY OF SMN What are the characteristic manifestations of SMN? And what happens when a person is in the grip of this syndrome for a long time? Conditioning One of the most important concepts necessary for understanding the topic discussed here is the so-called conditionality. Conditioning also has a new and more popular synonym: programming. We can say that all living beings, including people, have their own built-in programs. This phenomenon was discovered and further studied by the Russian scientist Ivan Pavlov. His experiments showed that, in response to certain stimuli, animals form associations that cause repetitive physical reactions. For example, Pavlov rang the bell every time he fed the test dogs. After several repetitions of this procedure, the dogs began to salivate after a familiar call, even if there was no food. That is, salivation turned out to be caused not only by food, as it was before, but also by a call - in response to a certain sound, the expected physiological reaction arose. It seems that the process of conditioning or programming comes first when a person is experiencing an SMN-related pain attack. Curiously, people suffering from SMN most often start to experience pain when they sit. Surprisingly, such a gentle posture can provoke pain. Conditioning occurs when two things happen at the same time, and it's reasonable to assume that at some point the person with SMN felt pain while sitting. His brain connected this body position with painful sensations, and the program was born: "it hurts when I sit." Subsequently, the pain appears due to a subconscious association with sitting, and not because such a posture is harmful to the back. This is one way of forming conditioning, there are probably others that I don't know about yet, since most people with "problem" lower backs complain about pain in the sitting position. Car seats have a bad reputation, so getting into a car automatically prepares you for pain. Often people are programmed to feel pain because someone told them about it. You hear: “Try not to bend at the waist” - and after a while you feel pain when you bend over, although nothing like this has happened before. Another authority tells you that sitting puts more pressure on your lower back - obviously you are bound to experience pain when you sit. Standing in one place, lifting and carrying weights - all these supposedly dangerous actions can serve as a basis for the formation of more and more new conditions. Some people say that when walking the pain that torments them goes away, others say that it gets worse. Someone gets worse during the day, and someone - at night. One man lifted weights all day without even thinking about his back. But at night (at about three o'clock) he woke up from a violent attack of pain that forced him to get out of bed. An illustrative example of formed conditioning. CHAPTER 1 . MANIFESTATIONS OF MUSCLE TENSION SYNDROME 39 And someone complains that as soon as he wakes up and gets out of bed when his back starts to hurt. In such people, the pain usually intensifies in the evening. Judging by the stories of all these people and the results of examinations, I tell them with confidence that they have SMN, but internal programs make them believe that the cause of the excruciating pain is different. However, a few weeks after they complete my treatment program, the pain subsides, proving that the pain attacks were conditioned. Agree, if the pain was caused by tissue damage, it would not disappear after rehabilitation, consisting mainly of lectures and seminars. And so it turns out that the old subconscious programs are destroyed due to new knowledge. In MNS, the importance of conditioning cannot be underestimated, since it is this that provokes reactions that remain incomprehensible to patients. When someone says: "I can only lift light objects, their weight should not exceed three kilograms, otherwise my back starts to hurt," this means; that the pain is psychosomatic in nature. Another similar example: a woman complains that she is in pain, bending over to fasten her shoes, while she can easily bend at the waist and touch the floor with her palms. The cause of many of these conditioned responses is the fear that occurs in people who experience back pain, especially in the lower back. These people have often heard and read a lot about how fragile and vulnerable part of the body is their back, how easy it is to injure it during such heavy loads as running, swimming or cleaning the apartment with a vacuum cleaner. And they are accustomed to associate physical activity with pain, which is sure to appear if you wait for it. That's what conditioning is. Neither the specific posture nor the type of activity is of particular importance when it comes to pain in MNS. It is important to remember about the subconscious program that triggers a pain attack, that is, the main role is played by the psycho-emotional, and not the physiological component of pain. SMN Patterns Probably the most common pattern of SMN is the repetitive pain attacks discussed earlier. They can last for days, weeks and even months, and then the pain begins to subside little by little. Usually, medical treatment includes bed rest, painkillers, and anti-inflammatory drugs in the form of tablets or injections. I do not instruct my patients on what to do during an attack of acute pain, because the goal of my program is not to treat attacks, but to prevent them. But sometimes they call me and ask for advice - what to do in case of an acute attack. As I said earlier in this chapter, it is extremely important to wait until the pain subsides. I can prescribe a strong analgesic, but by no means an anti-inflammatory, because there is no inflammation. The irony is that during the pain attacks of SMN, it would be better not to seek medical advice at all. But such behavior cannot be called absolutely correct either, since in some cases pain can be associated with real patho- MANIFESTATION OF THE SYNDROME OF MUSCLE TENSION 41 and then consultation of the therapist is necessary. But, even if we are not talking about any really serious pathology, the diagnoses made by doctors sound threatening: degenerative changes in the intervertebral discs, arthritis, spinal stenosis, traumatic arthritis, and so on. Combined with dire warnings about what will happen if the patient does not begin to comply with the prescribed bed rest or try to run, vacuum the apartment and play tennis and bowling at some other time in their life, the perfect combination for further recurring pain attacks. But the human spirit is not so easily broken, and in the end the pains subside. The person feels relieved, the physical pain goes away, but the fear remains. With the exception of the rare desperate daredevils, most people who have experienced bouts of acute pain never again attempt any of the dangerous activities listed above. People become extremely attentive to their feelings and are constantly in a state of anxiety. They are afraid of a new attack, and that inevitably comes. Six months or a year may pass, but in the end the prophecy comes true and a terrible event occurs. As before, the person associates the pain with some incident. This time, along with the back, the leg may ache, and then frightening talk begins about the prospect of surgical intervention if computed or magnetic resonance imaging (MRI) shows an intervertebral hernia (computed tomography, like MRI, provides information about the condition of bones and soft tissues) . As a result, anxiety increases and pain intensifies. 42 HOW TO CURE BACK PAIN This pattern of recurring acute pain attacks is quite common. Over time, pain attacks happen more often, become stronger and last longer. And with each new attack, fear grows, which makes people avoid physical activity. Some patients gradually bring themselves to a state of complete immobility. In my opinion, fear-based movement restrictions represent the worst part of the pain syndrome. Despite attempts to give up "excessive movements", the pain will still come back and go, affecting all aspects of a person's life - his work, family relationships and leisure. I have seen patients with SMN who seemed to be more disabled than people who were paralyzed in both legs. The latter lived a full life, raised children and worked, while moving around in a wheelchair. Some patients with severe manifestations of SMN spend most of their lives in bed because of pain. Over time, many people develop SMN into a chronic stage. Now they feel pain not periodically and paroxysmal, but constantly, usually not very strong, but aggravated by certain types of physical activity or in certain positions, which, as we remember, indicates its conditionality: “I can only lie on my left side”; “When I lie down, I definitely need to put a pillow between my knees”; "I never go anywhere without my little back cushion"; “If I sit for more than five minutes, my back will start to hurt”; "I can only sit on hard chairs with a straight back" and the like. CHAPTER 1 . MANIFESTATIONS OF MUSCLE TENSION SYNDROME 43 For some, pain becomes the central theme of their lives. It's not uncommon to hear people say, "Back pain is the first thing I think about when I wake up in the morning and the last thing I think about when I fall asleep." It becomes an obsession. SMN has many different manifestations. Some people constantly experience mild pain and try to avoid physical exertion. Others, despite periodic acute attacks, live in a normal rhythm with little or no restrictions. I've talked quite a bit about both relatively mild and more severe manifestations of SMN, where pain is felt in the lower back and leg. But the sensations in the neck, shoulders and arms can also be very painful and interfere with a normal life. I will give a typical example. My patient is a middle-aged man who has been suffering from attacks of pain in the neck and shoulders, accompanied by numbness and tingling in the arms, for three years. He came to see me after experiencing pain in his left arm eight months ago. The man had previously seen two neurologists, underwent several examinations, and was told that the pain was due to a "problem in the intervertebral discs in the cervical region." He was faced with a dilemma - whether he needed to go to the operation immediately, or whether he could wait for a while. He was warned that without surgery he was in danger of paralysis. Not surprisingly, after such a diagnosis, the pain spread from his neck and shoulders to his entire back - he could no longer play his favorite sports - play tennis and ski. The man was very scared. 44 HOW TO CURE BACK PAIN After examining him, I found that he had SMN and there were no pathologies in the cervical spine. Fortunately, the third neurologist he consulted confirmed that his spine was in perfect order. As a result, the man with a light soul accepted my diagnosis - muscle tension syndrome (MSS). After completing my program, he got rid of pain in a few weeks and was able to return to his favorite activities. The episodes didn't recur. Sometimes, he said, he only “felt a little” in the shoulder or knee. For anyone who is actively involved in sports, knee pain is an extremely annoying factor. I was convinced of this from my own experience and I can confirm that it gets on your nerves, worries and generally interferes with a normal life. And here we must remember that any ligament or tendon in the arms and legs, any muscle or nerve in the neck, shoulder, back and buttocks can suffer from SMN. Although in the case of each new patient one should try to clearly identify the areas of the body affected by MNS, this part of the consultation is the least significant. A conversation with a person about the pain he experiences is essentially an excursion into his personal life. After we understand where he feels pain, this information can be put aside, since we are not working directly with muscles, nerves and ligaments. The main thing is to find out which episode in the patient's emotional life played a fatal role and caused the onset of pain symptoms. I recall the case of a man who decided he was financially secure enough to leave the business to his children at a young enough age. Soon he developed back pain, CHAPTER A B A 1 . MANIFESTATIONS OF THE SYNDROME OF MUSCLE TENSION 45 because of which, in fact, we met. During the conversation, it became obvious that, having retired, he was so preoccupied with numerous family problems (caused by the death of several relatives) that he began to seriously worry about the business he had left. In addition, the prospect of supposedly approaching old age and death began to frighten him. All these experiences on the conscious and subconscious levels caused increased anxiety (and anger), which led to the appearance of SMN. Traditional medicine attributed his condition to early aging of the spine. It is clear that the treatment prescribed on the basis of such a diagnosis did not bring any results - in fact, the problem was not in the back, but in relation to life. SMN can affect the muscles that surround and pierce their nerves, as well as the ligaments and tendons of the arms and legs. At the same time, a person feels pain, tingling, weakness or numbness in various parts of the body, and the intensity of the sensations he experiences also varies - from slight discomfort to excruciating pain, which actually makes him disabled. Recurrent pain attacks, accompanied by fear of them and their intensification during physical exertion, are the main characteristics of SMN. Pain, numbness, tingling and weakness are nothing but ways to get your attention. This is how the brain tries to tell you that something is wrong. For most people - both doctors and their patients - this "out of order" means the pathology and the resulting injury - individually or in combination. And the deeper this conviction, the more pain is associated with physical activity. The patient cannot help concluding that he has been injured somewhere or that there is some disturbance in his system. Then the program begins to lead him, due to the fear of such simple postures and movements as sitting, standing, bending over or lifting weights. The complex of symptoms of SMN fears and mobility restrictions attracts a person's increased attention to his body. As we will see in the following chapters, this is precisely the main purpose of the muscle tension syndrome (TSS) - to create physical discomfort that diverts attention from unwanted emotions. It seems that such a price is too high, but no one knows exactly how the inner workings of the mind take place, we only assume that fear and pain are undesirable for him. CHAPTER 2 THE PSYCHOLOGY OF SMN Pain in the neck, shoulders, and back is usually not the result of mechanical disorders, and therefore cannot be cured by mechanical means. They are associated with human emotions, personal fulfillment and the vicissitudes of life. Conventional medicine's attempts to deal with such pains are like a parody of healing. Doctors diagnose various structural pathologies, although in fact the problem lies in what makes the structures of the body work, namely, in the mind. SMN is expressed in the form of physical pains, but they are provoked by psychological difficulties, and not bodily pathologies. This is an extremely important aspect of the described syndrome, which we will discuss in the following pages. But first of all, I want to give a few definitions so that there is no confusion in words. VOLTAGE Voltage is a widely used term with different meanings for different people; in my work and in 48 HOW TO CURE BACK PAIN in this book, this word is included in the name of TMS - muscle tension syndrome. I use it to describe a state that arises involuntarily in response to certain experiences, so it will often occur in the future. It can be said that experiences are the result of a complex interaction between different areas of the mind, as well as the mind and the external world. Some of them are accompanied by discomfort, provoke mental pain, or simply cause embarrassment. Such experiences do not meet with approval in society and are considered unacceptable. Therefore, we suppress them. I'm talking primarily about anxiety, anger and low self-esteem (inferiority complex). These experiences are driven deep, because our mind does not want us to experience them and demonstrate them to the outside world. Probably, if people had a choice, most would prefer to become aware of their own negative experiences and deal with them, but the human mind functions in such a way that they are instantly and automatically suppressed - so there is nothing to choose. Such suppression is inevitably accompanied by tension. So, using the word "tension" here, we will be talking about repressed, unwanted experiences. STRESS The concept of "stress" is often confused with the concept of "tension" and evaluated negatively. I prefer to use it to refer to any factor that puts any kind of pressure on a person. We may be in a state of physical or emotional stress. Heat and cold are types of physical stress, while responsible work or family problems are emotional. The stress associated with MNS leads to an emotional response and suppression of the experience. Hans Selye was the first to draw attention to how stress affects the body, and his in-depth study of this problem has become one of the most striking achievements of medical science of the twentieth century. Selye defined stress as "the non-specific response of the body to any challenge addressed to it." Stress can be both external and internal. Examples of external stress are responsibility at work, financial problems, a change in profession or place of residence, worries about children and parents. But the significance of internal stress in terms of causing tension is much greater. In this case, we are talking about all kinds of perfectionism, the need to surpass others at any cost, and similar things. People often say that they are stressed at work, hence the tension. But if they did not feel a certain sense of hyper-responsibility towards their work, they would not feel tension. Usually such individuals are prone to rivalry and strive to get ahead at all costs. As a rule, they are extremely self-critical and put forward increased demands on themselves. A housewife and mother with a similar character “presses” herself no less than some manager, although the center of her worries and experiences is not work, but family. She worries about her children, husband, parents, wants her family to have all the best, and spends all her strength on this. A woman of this type 50 HOW TO CURE BACK PAIN will be very upset if she feels that one of the family members is dissatisfied with her (the desire to please loved ones is not unique to women, recently one of my patients, a middle-aged man, while sitting in my office, confessed to same). Thus, stress is the outer shell of a certain emotional structure, consisting of the experiences of everyday life, superimposed on the character of a person. Stress causes tension (a consequence of the suppression of unacceptable experiences). Now let's take a closer look at what a person is. THE CONSCIOUS MIND The conscious mind is that part of your personality that you are aware of. About this part of yourself, you can definitely say what feelings you are currently experiencing, such as joy or sadness, and you are sure that you know yourself. You know that you are a conscientious, hardworking and, perhaps, suspicious person, and perhaps even a perfectionist. It seems to you that it is these personality traits that determine your behavior. But is it really so? Often there are subconscious motives behind our actions that we are not aware of. That is why it is important to look into your subconscious mind, which we will soon do. Many people with SMI admit to being overly conscientious. We can say that they themselves classify themselves as "type A" people, according to the classification of doctors Meyer Friedman and Ray Rosenman, presented in their book "The Core of Behavior Type". CHAPTER 2. PSYCHOLOGY OF SMN 51 A person of this type is a workaholic. He can work eighteen hours a day without noticing fatigue. But even the most hardworking people should remember that human strength is not unlimited and prolonged overexertion is fraught with cardiovascular diseases, as well as other diseases. In addition, such people should pay attention to their own feelings. Most often, a “type A” person tries not to pay attention to his experiences, because they seem to him a manifestation of weakness. However, according to my observations, there is a certain difference between patients suffering from MSN and people "type A", because coronary artery disease is quite rare in MSN. Yes, I have seen several such cases, but their number cannot be compared with the number of patients with such accompanying SMN diagnoses as colitis, hay fever, migraine, acne, urticaria, and so on. It appears that these diseases, apart from back pain, are the most common and characteristic manifestations of SMN, reflecting a lower level of impulsivity than in Type A individuals. Be that as it may, our own personal characteristics and everything connected with them are only a drop in the ocean compared to what is hidden in our subconscious. SUBCONSCIOUS In psychological literature, the term "subconscious" indicates that part of a person's mental activity that he is not aware of. It is in this sense that we use it when discussing emotions. 52 HOW TO CURE BACK PAIN The subconscious is a deep, mystical and unsolved area of ​​the human psyche, a place where a wide variety of feelings live, not always pleasant, not subject to logic and sometimes simply frightening. We get some idea of ​​what is happening in our subconscious when we remember and evaluate our dreams, manifesting themselves without any supervision from the waking conscious mind. The subconscious is the repository of all our experiences, no matter how pleasant or socially acceptable they are. Knowing what is happening in our subconscious is extremely important, since it is it that often dictates our behavior after waking up. And it is in the subconscious that the roots of SMN are hidden. An interesting fact: the predominant part of the emotional and mental activity of the human psyche passes below the level of consciousness. Our mind is like an iceberg - its conscious tip is much smaller than what we are not aware of. And it is precisely in the subconscious that complex processes take place that allow us to think, remember, write, speak and think logically, that is, to do everything that allows a person to consider himself a rational being. Our ability to make sense of what we see, recognize faces, and perform dozens of different actions, which we take for granted, is also the result of subconscious brain activity. Probably most of the emotional reactions are born in the subconscious. Experiences that do not find a way out remain there in a suppressed state and provide conditions favorable for the emergence of SMN. The structures described here of the human psyche, subdivided into consciousness and subconsciousness, as well as the content of its “lower floors” that we are unconscious of (which, under certain conditions, can be raised up and realized) were discovered more than a hundred years ago by Sigmund Freud. To better understand where muscle tension syndrome (MSS) comes from, it is necessary to understand the processes taking place in the subconscious mind. Low Self-Esteem It was a shocking revelation to me to realize how many people live with low self-esteem. For this, there must be some cultural prerequisites and general trends in the upbringing of children that cause this phenomenon. The feeling of inferiority is deeply hidden, but it still manifests itself in one way or another in human behavior. As a rule, we strive to compensate for unpleasant experiences, therefore, feeling weak, we demonstrate strength. Many years ago, in my practice, there was a case that served as the clearest illustration of this statement: a kind of macho came to me for treatment, who was twisted by pain in the lower back. The nurses said that he boasted to them of his toughness in fights, business and amorous affairs. In my office, he inconsolably complained of unbearable pain. Emotionally, this man was a little boy, desperately trying to prove to himself and to the world how big he was. Most likely, the obsessive need to succeed, reach the goal and win, inherent in most of us, is a reflection of a deeply hidden inferiority complex. Wherever the desire to live up to a certain ideal of being the best parent, the best student, or the best worker comes from, it is characteristic of people with SMN. A typical example is a man who has worked selflessly for many years, created a very successful business and is surrounded by children and grandchildren, whom he patronizes. He always liked this role, but the responsibility that lay on him was always extremely high. For many years he suffered from lower back pain, despite the fact that he tried a variety of therapies. By the time I met him, pain had long been a part of his life. He accepted the concept of tension as the cause of pain, but could not get rid of the internal patterns that generated it. Our hero considered himself too old to resort to psychotherapy, which is often necessary in such cases. However, it was now clear to him that there was no pathology behind the pain he experienced, and this was the main result of our treatment. My next patient is a young man in his early twenties who had his first child shortly after he started a branch of the family business. At the same time, new areas of responsibility appeared in his life, and he, as an extremely conscientious person, took them seriously. Soon this young man developed low back pain due to SMN. As soon as he realized that the source of the pain symptoms was internal tension, the pain disappeared. We will discuss later that this mindfulness is a key factor in the treatment of SMN. These two men, old and young, had one thing in common, namely: a heightened sense of responsibility and a strong intrinsic motivation to succeed in business and family life. Such people do not need to be controlled and forced to work, they are already super-disciplined and super-responsible. Those who develop SMN are usually extremely goal-oriented. They strive to achieve results by all means and set themselves difficult tasks. In our culture, success comes from competition, and these people have the necessary fighting qualities. They are accustomed to making increased demands on themselves, it always seems to them that more could be done than has been done. Often their perfectionism manifests itself in unexpected ways. I remember one young man who grew up on a farm who confessed to me that after he learned what SMP was, he understood why during haymaking he had an irresistible desire to stack hay in perfectly even shocks. You are probably now thinking: why such excellent qualities as hard work, responsibility, dedication to work and striving for excellence often cause SMN. It is quite obvious that there is a direct relationship between such personality characteristics and SMI, but how does it arise? To understand this, you need to remember about anger and anxiety. Anger and anxiety I have no special psychological and psychiatric education, and I am aware that my descriptions of psychophysiological processes in the human body are simplified and may seem naive to professionals. But since this book is intended for the general public, a minimum of specific words and complex concepts is just right here. Be that as it may, we are dealing with an almost unexplored border territory located between the psyche and the human body. Alas, modern medical science actually ignores this territory (with rare exceptions). The reasons for this inattention are discussed in chapter seven, Mind and Body. For me, my experience with the diagnosis and treatment of SMN sheds some light on what is going on in the unknown realm where emotions and physiological processes meet. We will talk about anger and anxiety in one section, because I consider these feelings to be related and most often repressed, and therefore provoking the development of MNS. From the very beginning of my work with SMI, it became clear to me that most people suffering from this syndrome suppress anger and anxiety in themselves. Even those who initially deny this, eventually agree that they still have it, they just "tried not to think about anything like that." Considering the personality characteristics characteristic of SMN, listed above, it is not difficult to conclude that it is anxiety that causes this syndrome in the first place, since a person is always in a state of anxiety: “What will happen next?” Anxiety is an exclusively human phenomenon, somewhere near fear, but of a higher level, since it is due to a quality that animals do not possess, namely, the ability to anticipate and anticipate. Anxiety arises in response to the assumption of danger and carries a certain logic, unless the very expectation of danger is not illogical, as is often the case. An anxious person sees a threat in everything, even where there is none. Such is the nature of homo sapiens. But it often happens that the individual himself is unaware of his anxiety, since it remains hidden in his subconscious as a result of the operation of the suppression mechanism. As we shall see later, the SMN takes an active part in the process of suppression. Narcissism We have already spoken about the role of low self-esteem. Next to this feeling hidden in the subconscious, there is another, no less curious phenomenon - narcissism, which implies excessive concentration on one's own person. It originates in a person's tendency to love himself. The evolution of society in the United States of America has led to the emergence of an "I"-oriented society, excluding any collectivism. It is said that in many Indian vernaculars, the pronouns “I,” “me,” and “me” simply do not exist, because Indians associate themselves with something more than a single individual and feel they are an integral part of the tribe. Today's white Americans, on the contrary, profess extreme individualism and admire those who "made themselves." This medal has a second side - a person who is entirely focused on his own selfish interests and does not have true ideals inevitably becomes greedy. We are occasionally shocked by the news that respected members of the American business community or government officials are convicted of crimes, but in fact there is nothing to be surprised at, such a trend is just a logical extension of society's favorable attitude towards narcissistic selfishness. Anger Narcissism is present to some degree in all people. When this personal characteristic is hypertrophied, a person may have problems with social adaptation, since he tends to get annoyed over trifles, especially when dealing with people who do not want to obey his will. As a result, anger is born, and if the degree of narcissism of the individual rolls over, he can be in an angry state almost constantly, without even realizing it, since anger, like anxiety, is suppressed in the subconscious. This may seem paradoxical: on the one hand, we suffer from low self-esteem, and on the other hand, our narcissism provokes us to play royalty. Remember the tale of the prince and the pauper? These diametrically opposed feelings are two sides of the same coin, and although such a statement sounds strange, we usually experience them at the same time. This situation is quite typical for the human psyche. It contains many conflicting emotions, most of which we are not even aware of. Why do people feel angry? In fact, everything that causes anxiety (unconscious) in a person makes him angry. You try to do your best work and hope that everything will be all right (anxiety), but you are afraid of problems when communicating with colleagues (anger). CHAPTER 2. THE PSYCHOLOGY OF SMN 59 Although work is the most common source of anxiety and anger, personal relationships are also a common source of repressed negative emotions. In family life, quite serious problems often arise that are ignored because they seem insignificant. One of my patients was a forty-eight-year-old woman who grew up in an orphanage. She married early and devoted herself entirely to her family and home. This woman coped well with her household duties, because she was smart, diligent and conscientious. But the moment came when it began to bother her that she did not receive a decent education and did not even have a driver's license - after all, her life was dominated by the interests of the family. She did not realize this inner resentment, and gradually she developed back pain, from which she was treated for a long time and unsuccessfully, including by surgical methods. When this woman came to me, it was difficult for her to perform even the simplest actions, since the pain in her back became permanent. My program helped her become aware of her repressed feelings, and as a result, her pains disappeared. The healing process was not easy, and she had to go through a lot of emotional pain. But this is quite natural in such a situation, and certainly much better than the unbearable physical pain that turned her into a helpless victim. An important source of anger and resentment, which we usually do not realize, is our sense of responsibility towards loved ones - parents, spouses and children. Although we sincerely love them, they often complicate our lives, and gradually an inner anger grows in us 60 HOW TO CURE BACK PAIN. But is it possible to deliberately be angry with an elderly parent or a small child? Here is a good example: a man in his forties went to another city to visit his elderly parents. The weekend was not over yet, and our hero developed back pain for the first time in a year after the successful completion of the SMN therapy program. When we met, I assumed that the pain had returned due to some subconscious anxiety, but the man maintained that the weekend had been wonderful. True, later he admitted that his mother was very weak and he had to take care of her all this time, and in general he was worried about his elderly parents. The situation was aggravated by the fact that they lived far away and in order to visit them, he had to fly to them by plane. My patient is a good, decent person, and, of course, he would by no means blame his parents for getting old. Therefore, he subconsciously suppressed the irritation that was accumulating in him, which, for reasons that we will discuss a little later, caused a new attack of pain. Now let's look at another case. My patient, a young father whose first child barely slept, suffered from sleep deprivation, as did his wife. In his free time, he tried to help her take care of the child, and if earlier their life together was like a solid honeymoon, now only memories remain from that time. Soon, the young father began to have back pain due to repressed anger at his own child (absurd, isn't it) and at his wife, because she could no longer satisfy his emotional and physical needs in the way she used to (agree, absurd). Because the emotions he experienced were unacceptable to him, he developed SMI. Many doctors would interpret the situation described differently. They would say that his back ached from the fact that he often carried a child in his arms, slept little, and even did unusual housework. A familiar explanation, isn't it? Another common explanation for such cases is the so-called "secondary benefit" beloved by behavioral psychologists - supposedly it is not uncommon for a person to get sick in order to gain some benefits. However, in this case, both of these explanations should be considered untenable. On the one hand, our young father was in great physical shape, having played college football in high school and college. It is hard to believe that under any circumstances it was contraindicated for him to take a small child in his arms. On the other hand, the concept of a benefit that a person receives from illness is also very dubious - I find it hard to believe that such a benefit exists in nature. Behavioral psychologists, however, like the concept because it's simple and the weight of what needs to be done to fix the situation is to reward yourself for behavior that excludes "secondary gain" and punish yourself for the opposite. And no fussing with such unpleasant subconscious feelings as anxiety and anger. Many years ago, before I even knew about the SMN, I tried this approach and found it ineffective. All family relationships are emotionally burdened to some extent. 62 HOW TO CURE BACK PAIN in the first place, when a person suddenly and for no apparent reason begins to have an attack of MNS. The combination of anxiety, love for a loved one, and internal resistance to the responsibility associated with close relationships is a source of deep conflict from which SMN grows. Here is another, one might say classic, case of the manifestation of SMN. My patient was a thirty-nine-year-old married man who ran a family business that his father had once started. He told me that his father was still active in the business, but had lately become more of a nuisance than a help. The man admitted that on this basis he had a conflict with his father and he felt guilty. The pains appeared about two and a half years ago, and four months after they began, he came across information about SMN. He decided that this was complete nonsense and it was better to trust traditional medicine. He went to many doctors, tried on himself all possible methods of treatment, but to no avail. Two years later, the man still suffered from pain, the thought of which haunted him constantly, and could no longer move as freely as before. He was afraid of any physical activity and did not even dare to bend over. He eventually completed my program successfully and was soon pain free. During the next consultation, I saw a person who was set up to cooperate, ready to accept any information, and I simply could not believe that at first he completely rejected the obvious diagnosis. This case was a lesson for me: when working with SMI, one has to admit an unpleasant fact: people tend to deny the idea of ​​SMI in every possible way until their situation becomes critical. It is quite obvious that the cause of the pain syndrome in this man was hidden in his relationship with his father. I will give one more clear example of the role of family relations in the development of SMN. One day I received a call from a woman who had recovered from her lower back pain two years earlier with my program and said that she now had pain in her neck, shoulder, and arm. She was sure that the relationship with her husband and teenage stepdaughter was the cause of the pain. I advised her to try to do without conventional medical treatment, but the pain progressed. The woman had difficulty moving both shoulders, a common manifestation of SMN in the neck and shoulders. And then one day she decided to look the problem in the face and told her husband everything she thought. As a result, as soon as they managed to unravel the tangle of family problems, the pain disappeared. After all, its cause was repressed resentment. In the chapter on treating MNS, I will go into more detail about how to deal with these situations. One of the main conflicts of the subconscious and consciousness is the battle of the negative feelings we experience and the desires generated by narcissism with that part of our mind that is preoccupied with issues of decency and compliance of our actions with social norms. The well-known psychoanalyst Karen Horney described the so-called "tyranny of duty" that often dominates a person's life. Patients often report being rigidly driven by certain behavioral imperatives. One woman who refused to acknowledge her perfectionist cravings told me that she was born into a family with a cult of strong character and intransigence. Obviously, since she herself was by nature a rather mild person, the attitudes dominant in her family gave rise to internal conflict in her. Often it is the pressure of cultural traditions that makes us behave in one way or another. I remember one of my patients - a very beautiful woman, a member of a religious group that welcomed large families - six or eight children were common among them. I suggested that her pains were due to internal resistance to the responsibility of raising so many children. For a long time she did not want to agree with this, insisting that she did not feel any resistance. In the end, I managed to explain to her that it is very difficult to become aware of such feelings, because they are suppressed and become locked in the subconscious. In the end, she admitted that somewhere deep in her resistance still exists, and soon the painful symptoms began to subside. The more I work with MNS, the more I am impressed with the impact of anger on the human body. We have all become so good at suppressing it that in most situations we are completely unaware of its existence. I had the following idea: Compared to anxiety, anger plays a more important role in the development of MNS symptoms; perhaps anxiety is a reaction to repressed anger. The following story made a very strong impression on me. A forty-five to fifty-year-old man suffered from panic attacks in addition to many other health problems. After the examination, I diagnosed him with MNS and told him that the cause of his panic was most likely not increased anxiety, but repressed anger. Then he told me about one incident in his life, which confirmed my assumption. Once he got very angry with someone and was ready to get into a squabble, but remembered that it was indecent, and preferred to restrain himself. A moment later, he had a panic attack! Probably, my patient was not only angry at that moment, he was beside himself with anger, and the need to suppress such strong emotions turned into a panic for him. We will soon see that such situations often cause SMN. But first, let's deal with the phenomenon of repression. Where does it come from? Suppression I remember a woman proudly telling me how she was able to overcome her fifteen month old baby's temper tantrums. A "smart" family doctor advised her to splash ice-cold water in the child's face when he got angry. The effect was amazing - the baby was no longer angry. At such a tender age, he learned to suppress his emotions. He was programmed to suppress anger, and now he will be guided by this subconscious program all his life. Faced with the many irritating, upsetting, and infuriating situations that happen every day in the lives of any of us, he will automatically begin to suppress the natural reaction of anger, and when the level of accumulated anger goes beyond a critical point, he will develop SMN. This story is a perfect illustration of one of the sources of the need for suppression: the blessings of intentional parental influence. This is perhaps the most common reason we learn to suppress our emotions. Trying to raise their children, parents unknowingly create psychological problems for them that will make themselves felt in adulthood. Just imagine how many reasons there are for suppressing anger - both logically justified and unconscious. Everyone wants to be loved, and no one likes the disapproval of other people. Therefore, we suppress the urge to asocial behavior. We are afraid of punishment, although we do not want to admit it to ourselves. According to the views of society, the manifestation of anger is a variant of unacceptable behavior. We learn this in early childhood and know that it is not good to be angry (especially when this feeling arises in response to an external stimulus to which we should not react negatively), and therefore we suppress our own anger. At the same time, we are not even aware of our own need to suppress anger. As a result, out of nowhere, we have SMN or any problems in terms of gastroenterology. Personally, I already know: if I get heartburn, it means that I got angry at something, although I myself don’t know what. Then I start thinking about the possible source of my heartburn, and when I find it, it goes away. After seventeen years of working with SMN, it is clear to me that we are all angry and anxious, regardless of cultural traditions and upbringing, and we all suppress our negative emotions. On the other hand, the psychological conditions leading to psychophysiological reactions like SMN, stomach ulcers and colitis are universal and differ only in the degree of manifestation. In serious cases, we call these reactions neurotic, but in fact we are all neurotic in one way or another, so such a definition loses its meaning. The concept of repression is closely related to the concept of the unconscious. Both of these concepts were first stated in the language of science by Sigmund Freud. Peter Gay's excellent biography of Freud, Freud: A Life in Our Time, provides a wonderful metaphor for the unconscious: “The unconscious is like a maximum security prison for antisocial elements who have been languishing there for years or who have just arrived; Prisoners are treated harshly and guarded vigilantly, but it is not possible to completely establish control over them, and besides, they are constantly trying to escape. It is these "anti-social elements" imprisoned in the subconscious that are described in this chapter. They strive to break out of prison into our consciousness, but the subconscious mind resists and surrounds them with walls of oblivion. I recently heard a most curious story from a patient. After examining her, I diagnosed her with MN and explained what it meant. The patient said that the pain started after she invited her older sister on a trip to Europe. From that moment on, her concern did not leave her: would her sister like the trip? Then she began to get angry at herself for such experiences. Soon she began to dream about her sister and mother, and long-standing teenage grievances against them surfaced, which became especially painful after her father died (the girl was eleven years old). This set of emotions - anxiety, anger and resentment rooted in childhood - is a breeding ground for 68 HOW TO CURE BACK PAIN SMN. I was amazed when, after my little prompting, the woman was able to bring such important psychological material to the surface of her consciousness. Interestingly, over eighty percent of Americans suffer from pain, which I consider to be symptoms of muscle tension syndrome (TSS), and this number has grown exponentially over the past thirty years. Back and neck pain, judging by the number of sick days, is the number one reason for absenteeism in the US. And about fifty-six billion dollars are spent annually to combat these pains. In other words, we are talking about a real epidemic! PHYSICAL PROTECTION AGAINST SUPPRESSED EMOTIONS For many years, I have been convinced that MND is, so to speak, a physiological outburst of repressed negative emotions. But in the early 1970s, it became clear to me that back and neck pain, which affects a significant part of the population of our country, is the result of their suppression. This is evidenced by the following fact: eighty-eight percent of people with MNS suffer from the obvious consequences of chronic nervous tension - colitis, stomach ulcers, asthma or migraines. The idea that the pain syndrome does not express repressed emotions, but, on the contrary, prevents them from passing into consciousness, was given to me by my colleague Dr. Stanley Cohen during our joint work on the article. He said that in psychological language it is called protection. That is, the pains of MNS (or stomach ulcers, colitis, and migraines), as well as asthmatic attacks, arise in order to distract a person from the real source of his suffering, hidden in the realm of emotions. At the same time, attention willy-nilly switches to physical sensations. This means that SMN is not a physiological pathology at all, but part of a psycho-emotional process. Pain syndromes in the neck, shoulders, and back have become epidemic over the past thirty years precisely because they have become the most common type of defense against repressed emotions. A sign of a good disguise: no one knows what she is hiding. As a consequence, no person suffering from back pain even tries to relate it to emotional factors. On the contrary, almost everyone begins to look for the cause in some kind of injury or degenerative tissue changes. Yes, there are diagnoses that indicate real pathologies - fibromyalgia, fibrositis, myofasciitis, and the like. These pathologies can indeed occur due to injuries and muscle failure, but they are also an excellent disguise for psycho-emotional problems. As long as a person's attention is focused on physical pain, repressed emotions will not be able to get out into consciousness. I have repeatedly noticed that the more painful the hidden emotion, the stronger the SMP. For example, in a patient who suppresses rage caused by childhood bullying, the pain usually becomes unbearable. They literally immobilize him and disappear only when he has the opportunity to throw out the terrible, painful anger that has languished in the subconscious for years - this is another example of how anger becomes the cause of SMN. 70 HOW TO CURE BACK PAIN MNS EQUIVALENTS As I said, there are other diseases that perform the same task as MNS. Here is a list of the most common ones: Pre-ulcerative conditions Stomach ulcer Hiatal hernia (hiatal hernia) Irritable bowel syndrome (mucosal colitis) Hay fever Asthma Prostatitis Tension headache Migraine Eczema Psoriasis Acne, urticaria Dizziness Tinnitus Ringing in the ears Frequent urination All these diseases can serve one purpose - the suppression of emotions. And the longer a person is deluded, considering them “only diseases,” the more he suffers from them. As long as these diseases have something to suppress, they will not go anywhere. In addition, some symptoms may be replaced by others. For example, new generation drugs for the treatment of stomach ulcers help get rid of it, but some other disease comes to replace it. A man in his forties told me that ten years CHAPTER 2. PSYCHOLOGY SMN 71 ago he developed back pain and underwent spinal surgery. Five months after this operation, he developed a stomach ulcer that tormented him for almost two years. The doctor prescribed various medicines for him, but they did not help. Then the ulcer stopped making itself felt, but instead his shoulders and neck ached. The operation and treatment of the ulcer did not relieve him of the problem, but simply forced out some of its symptoms, giving way to others. History of gastric ulcer treatment The history of gastric ulcer treatment is quite interesting. The decrease in the number of cases of this disease in the United States of America and Canada over the past twenty years is attributed to the emergence of new highly effective drugs. I, thanks to journalist Russell Baker, have a better explanation. In one of his Sunday articles in The New York Times (August 16, 1981), he raised the question, "Where did the stomach ulcer go?" Mr. Baker drew readers' attention to the fact that people have become less likely to suffer from this disease. This article gave me an idea: since everyone - both doctors and their patients - understood that the ulcer is associated with stress, it means that it has ceased to be a good means of masking repressed emotions. That is why the incidence of stomach ulcers is decreasing. And maybe this explains where so many sick backs, shoulders and necks come from? MIND AND BODY I believe that almost any organ of the body can be used to mask repressed emotions. Examples include hay fever, frequent respiratory problems, and urogenital problems. A PhD urologist friend of mine told me that more than ninety percent of prostatitis cases are due to nervous tension. I have a patient who suffers from constant dryness of the mouth due to reflex contraction of the salivary ducts caused by nervous tension. Suppressed emotions can trigger laryngitis. Ophthalmologists talk about common visual disturbances associated with nervous tension, and so on. However, I remind you that the above is by no means a substitute for medical examinations, which are necessary to rule out degenerative, infectious, and neoplastic diseases as causes of symptoms (we will discuss this topic in more detail in the chapter on mind and body). The final verdict of the specialist should sound in the affirmative. Vague diagnoses like “I don’t know exactly what it is, therefore, most likely, psychosomatics is to blame for everything” are unacceptable. The doctor should say, for example, the following: "Now that we have ruled out the variant of the tumor, I can continue the treatment with confidence, knowing that the cause of the disease is psychological." It is rare that this is done, as most medical practitioners are either ignorant of the psychosomatic nature of many common illnesses, or prefer not to think about such topics and continue to treat the symptoms.

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Some patients react very angrily and sometimes violently when told that their pain is in the interplay of mind and body. They become enraged, start spitting, scattering things and trampling them under their feet. They hear only one thing: "Your pain is only in your head." But it is not so. Nobody says pain is unreal. No, it's very real. It just happens because of what's called muscle tension syndrome, not because most doctors tell their patients.

The reason patients react so emotionally is because they put their pain first so they don't have to face their other problems. Rejecting the truth that the symptoms of their disease are created by internal forces, they fall for the deception created by their own cunning brain, and their problems continue.

1. Pass a medical examination. Make sure you are not seriously ill. Be responsible for your health.
2. Look at your physical exam results with a grain of salt. If your physical exam reveals nothing but a herniated disc, arthritis, a spur, a curvature of the back, a narrowing of the spinal canal (stenosis), or any other normal change, then you have nothing to worry about. All of these disorders do not cause back pain. No matter how many doctors have confused patients on this issue, experience shows that most people have these anatomical changes. For some it causes pain, for others it is painless. Pain occurs due to limited oxygen supply. Regardless of the location of the pain, be it in the back, limbs, or some other place, its origin is rarely local. Most often, pain occurs due to myoneural tension syndrome.
3. Reject the one-size-fits-all approach. This approach consists in the following words: "We do not know the cause of your pain, so let's try all kinds of methods, one of them will definitely work." These methods include manual therapy, acupuncture, surgical methods, injections, muscle strengthening, weight loss and so on. Almost all of them have the same effect as placebo. Paradoxically, these methods will leave you with your pain. If they help the patient, it is only because he believed in them. But the relief does not last long, and this approach must be continued indefinitely, since the pain does not go away from the lower back. It is this approach that is the main cause of pain epidemics. Never try to relieve the pain - just eliminate it!
4. Beware of misdiagnosis. A herniated disc does not cause back pain. This myth was debunked decades ago in the seminal work of pain pioneer John E. Sarno, MD. He coined the term "muscle tension syndrome". Spinal surgeons are only now beginning to realize that Dr. Sarno was right. You cannot compress the nerve, as there will be instant paralysis and the pain will disappear. A dead nerve cannot transmit signals. You cannot "dislocate" your back. The vertebral discs are firmly attached to both sides of the spine and cannot be removed and reinserted. You don't have to strengthen your core muscles to heal, and scoliosis doesn't hurt. The proof of this is the fact that almost everyone is cured if they can get rid of these outdated myths. Any part of the body can be damaged, which will naturally cause pain. But then the body quickly recovers. Pain does not become chronic if it is not supported by emotional processes and/or conditioned reflexes.
5. Understand the cause of your pain. With the help of almost any pain, the brain redirects the patient's attention to the affected part of his body. Pain arises from hidden emotional processes such as anger, fear, sadness, and frustration. When these powerful emotions cross a certain threshold, the brain will reduce the oxygen supply to the damaged area of ​​the body to divert attention from it and prevent emotional pain. Pain is never imaginary or fake, it is always very real and palpable.
6. Look at what is happening in your life differently. Nearly everyone I have helped heal has been able to trace their back pain back to a specific event or period in their lives. Is your marriage going through hard times? Are you dissatisfied with your job? Is it very unnerving? Has someone close to you died or is sick? Have you recently retired? Are you a complete perfectionist and trying to please everyone? Are you unable to show your emotions? Feeling abandoned like a child? Are you too responsible and restless person? Just reached a transitional age? Connect all the facts about your pain and heal. Awareness of what is happening at the unconscious level has an amazing healing power. Once you change your behavior, pain will no longer be a big distraction for you.
7. Try to understand why you need to believe that you have a bad back. When I declare to someone that there is a real way to get rid of back pain, most often they tell me: “No! My pain is real! Yes, the pain is always real. The question is why don't you ask how to be cured when you are offered a prescription. Why does anyone have to fight the pain and still stay with it? This is critical to understanding the purpose of pain. The most common task of pain is to hide those emotions that are too powerful or dangerous. The brain creates a terrible sensation of pain in order to firmly convince the patient that he has more serious structural problems than existing worries and unresolved issues. And the patient, of course, will believe that there are problems, because his brain says so.

Modern science, in its unsuccessful efforts to outsmart Mother Nature, is at the root of the ongoing epidemic of pain from fibromyalgia to chronic fatigue. The truth about the cure doesn't benefit the all-powerful monster called the "medical industry" obsessed with endless pain management without concrete results.

Any message about how to be cured is blocked every time by people in this industry profiting from such treatment and articles that are published with money from advertising products of this industry. Thus, the pain epidemic is on the rise, despite the fact that humanity now has the most advanced technology in its history.

Everyone can be cured if they overcome the outdated understanding of pain and begin treatment anew, applying a deeper knowledge of the root of the problem. An open question remains whether the sick really want to be cured or just treat their body? These two goals are always in conflict with each other.

Ecology of health: A psychophysiological illness is any illness in which the physical symptoms ...

A psychophysiological illness is any illness in which the physical symptoms are thought to be the direct result of psychological or emotional factors. This diagnosis means that psychological factors either initiated or contributed to back pain, or both.

It should be emphasized that although psychological factors may be the cause of physical symptoms, but, however, the symptoms are not argued using imaging techniques. However, real physical problems (such as back pain) can be triggered by emotional factors.

History of "stress back pain"

Dr. John Sarno, MD, professor in the Department of Physical Medicine and Rehabilitation at New York University, recently popularized the idea of ​​"stress back pain", which he calls "Tension Muscle Syndrome" (TSS), although such a concept was formulated as early as the 1820s. year.

Dr. Edward Shorter's book Paralysis to Fatigue details the history of psychosomatic illness. And back in the 1820s, the diagnosis of "irritable spine" was made, and it's essentially equivalent to the modern idea of ​​stress back pain. The diagnosis of "irritated spine" was quite popular and spread around the world at that time.

Interestingly, Dr. Shorter opined that many doctors and patients of that era began to firmly believe in this diagnosis, although there was no obvious pathology. Dr. Shorter noted that doctors planted this diagnosis in the patient's head, increasing the fear that there was a serious illness, and recommended bed rest for patients.

The diagnosis of spinal irritation remained fairly common until the early 1900s. Dr. Shorter believes that the diagnosis served "the need to remain competitive with other medical clinics by 'medicalizing' patients with certain subjective complaints. It also served the needs of patients by providing an opportunity to 'save face' and have a medical diagnosis, instead of focusing on possible psychological and emotional factors, since most patients did not want to admit the presence of psychological problems.

The history of the diagnosis of spinal irritation is useful in understanding current medical approaches to back pain. Even today, some doctors pay attention primarily to structural "explanations" for back pain, and convince their patient that "diagnostic findings" are the cause of the pain, thereby instilling fear in the patient, and then advise "justified" treatment. However, if stress is the true cause of back pain, then active treatment with physical methods may not be effective and cause even more stress for the patient.

And if you go back to Dr. John Sarno's conceptualization of "stress-related pain", you can see the similarity with the concept of "spinal irritation". The most important difference is that Dr. Sarno places the primary causal factors (psychological and emotional) first in the treatment plan; while some physicians continue to use only "physical" treatments.

In particular, Dr. Sarno's theory is that the majority of back pain treated by the medical community using "organic" approaches is actually stress related. It is important to note that this theory and treatment approaches are ambiguously accepted in the medical and psychological community, and have not yet been clearly supported by scientific research.

How does stress cause back pain?

There are many theories about the causes of stress-related back pain. It is important to note that the paramount principle of all these theories is that psychological and emotional factors cause certain physical changes, and as a result, back pain appears.

In most theories of stress back pain, the cyclical pain gets worse as it continues, leading the patient to restlessness and problems performing daily activities.

Cyclic pain is characterized by:

• The patient becomes unnecessarily limited in the performance of many functions of daily life.
• This decrease in activity is due to the patient's fear of pain or injury.
• This fear may be exacerbated by advice from a doctor (relatives) to calm down due to the presence of diagnosed small structural changes (which may actually have nothing to do with back pain).
• Restrictions in movement and activity contribute to impaired physical condition and weakening of the muscles, which in turn leads to increased back pain.

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Of course, such a cycle provokes an increase in pain, an increase in fear, and even more physical maladjustment, along with other reactions such as social isolation, depression and anxiety.

Dr. Sarno's theory

In the formulation of Dr. Sarno SNM, back pain is not associated with mechanical or physical factors, but is due to the patient's feelings, personality and subconscious problems. Key emotions include unconscious anger and rage. In addition, he describes people who may develop muscle strain syndrome as personality type with the following characteristics:

• Has strong intrinsic motivation to succeed.
• Has a great sense of responsibility.
• Purposeful and disciplined.
• Self-critical.
• Perfectionist and compulsive.

Dr. Sarno's theory argues that these personality characteristics interact with stressful life situations and this leads to back pain. It is also noted that the source of psychological and emotional stress is not always obvious.

Dr. Sarno's theory of TMS describes the mechanism by which emotional tension is pushed out of awareness by the mind into the unconscious. This unconscious tension causes changes in the nervous system. The changes lead to narrowing of blood vessels and reduced blood flow to various soft tissues, including muscles, tendons, ligaments, and spinal nerves. This leads to a decrease in oxygen supply, as well as the accumulation of biochemical waste in the muscles. In turn, this leads to muscle tension, spasms and back pain experienced by the patient.

Diagnosis of "stress pain" in the back

The diagnosis of "stress back pain" is often based on a careful history and physical examination. But patients should be careful when attempting to self-diagnose "stress back pain" as the pain may be due to a serious medical condition (such as a spinal tumor or infection). A thorough physical examination using imaging techniques will usually rule out more serious structural causes of back pain in most patients.

In situations where back pain is stress related, the history of back pain is often quite variable. Pain may appear after a specific incident or come on suddenly. For example, often pain begins with an incident of muscle and ligament sprain, but does not disappear due to the influence of emotional factors, although the muscles and ligaments have already recovered from the injury.

In many cases, an MRI examination can reveal disc protrusions or osteochondrosis, although stress is actually the cause of back pain. In these cases, MRI findings are not clinically significant and ultimately these changes are not considered to be the cause of the pain.

Common characteristics of stress back pain include symptoms such as:

• Back pain and/or neck pain
• Diffuse muscle pain
• Painful points in the muscles
• Sleep disturbance and fatigue
• In many cases, with stress back pain, patients complain of pain migration

In general, the symptoms of stress back pain are similar to those seen in fibromyalgia.

According to Dr. Sarno, the diagnosis of SNM is made only when the organic causes of pain are completely ruled out, and at the same time there are characteristic features of SNM.

Treatment of back pain associated with stress

Just as there are many theories about how stress and other emotional or psychological factors can cause back pain, there are many treatment approaches. But the main approach can be distinguished - complex.

With a comprehensive approach, the treatment of stress back pain is carried out in a more advanced way than defined by the concept of Dr. Sarno's SNM.

In an integrated approach, clinicians do not always see the clear personality characteristics that Dr. Sarno says are important, and do not focus on unconscious anger as a focal psychological problem.

An integrated approach to treatment takes into account various factors: physical, emotional, cognitive and environmental factors, and aims to influence all aspects. Thus, The impact of treatment is carried out on the following aspects:

• physical, including weakened muscles, nerve irritation, etc.
• emotional, including depression, anxiety, anger, etc.
• cognitive, such as negative thoughts, pessimism, despair, etc.
• environmental factors, such as job loss, financial problems, etc.

A comprehensive treatment program may include procedures such as:

• Treatment of physical factors with physiotherapy, analgesics and exercise therapy.
• Treatment of physical and emotional factors through the use of appropriate drugs (antidepressants or muscle relaxants).
• Treating emotional and cognitive factors with psychological pain management techniques and biofeedback.
• Treatment of environmental factors through consultations.

Such a complex therapy for the treatment of back pain has been used for more than 25 years and has proven to be effective, although a key factor in the outcome of treatment is the patient's motivation to complete the course of treatment and rehabilitation. published