Back-pain is a real and frustrating challenge for many people.

For most, back pain is not a clear-cut mechanical problem that can be fixed with surgery. Instead, it’s multi-faceted, largely misunderstood, and approached in harmful ways ways that lead to a range of compounding issues that include less movement, more fear and confusion, greater pain sensitivity, less self-confidence and self-efficacy, and more depression and/or anxiety.

The good news is that more people are starting to recognize and share this reality with others as they shift towards new strategies and more movement. Some of these self-motivated people find themselves in an Alexander Technique lesson ready for change.

Interestingly, the Alexander Technique doesn’t treat back-pain (or anything else) directly. Instead, it’s an education and practice in awareness, posture, and movement applied directly to the activities and movements of your life. All benefits are a byproduct of this process.

It teaches how movement, posture, self-perception, and thinking all interact in real time to produce how we use ourselves in the activities our lives. You become a student of yourself in activity - and learn to use your awareness and intention to positively shape movement, postural tone, musculoskeletal use/ posture, reactions to internal and external stimuli, and more - such that you can reduce or rebalance excess tension and better self-organize yourself into more dynamically balanced and easeful movement as you go about your life.

In doing this, you learn to understand what you’re doing that may be contributing to your own back pain. You then learn to stop doing or ‘undo’ these things that may be limiting you, and to encourage natural responses that underlie health posture, ease, and freedom of movement instead. It’s through this practical, applied self-education that you decode, better self-manage, and overcome your back-pain.

This process is very different than receiving a treatment or performing a prescribed set of movements (even if helpful), but still not really knowing how or why things changed. Instead, it’s an education and practice that requires clear self-discovery, self-responsibility, and self-empowerment - understanding what you’re doing with yourself that may be contributing to or causing the issue, then changing this for the better, with the result of moving better, feeling better, and gaining greater self-knowledge along the way.

In the fascinating blog post below you can read from a student of mine who took a analytical look to into their own experience and approach to back-pain. I wrote some responses (in quotes) to further learning and practice. Much thanks to my student who was wonderfully generous to share this to help others.

I Have A Complex Relationship With My Back

Author: C. Camman
In quote responses - Mark

I hurt my back last week.

This is not news. I’ve been hurting my back since 2013.

About six months after I finished grad school, toward the end of my work-day, I noticed that my lower back was feeling sore. I hadn’t done anything in particular to it and I assumed that when I got home I’d put some heat on it, rest, and feel better the next day, the way I always had before. Except that it didn’t feel better the next day. If anything it felt worse.

It was a couple of months of constant pain and stiffness before I accepted that resting and heat and gentle stretching on my own was not going to fix the problem. I sought out a massage therapist (made it worse at the time) and then a chiropractor (made it better) and finally a physiotherapist who assessed my whole body and how it moved and gently broke it to me that nothing was working the way it was meant to. All the parts that should be strong and hold me up were weak and shaky. All the parts that should be supple and flexible had become rigid and stiff to compensate. I’d spent my entire life up to that point working my body into a pattern of habits that was unsustainable, culminating in two-and-a-half years of grad school where I poured every waking hour into my studies and research, often sitting in the same chair without moving for hours at a time, working ten- to twelve-hour days and six or seven-day weeks, with the occasional exhausted flop of curling up in bed for a couple weeks in between major deadlines.

Oops.

So last week, when I started to feel a nagging stiffness and ache in my lower back as I tried to move around the house and get my day going, I thought I knew exactly what to do. I popped my ibuprofen, grabbed both a heat pad and an ice pack to see which worked best, tried to improve my posture throughout the day, and got in to see my RMT and chiro as soon as possible. I’ve been coping with this for over six years now (making incremental strides toward fewer and less severe flare-ups as I go) so I’ve been getting to be quite the expert in the way my body is now. What I’m not an expert in is the way I’d like my body to be.

Every time I hurt my back like this, I worry that this time it’ll be permanent. That the pain won’t gradually fade away and function return. And every time I get injured, it’s a little bit different. The things that worked the time before don’t work the same. At one point, a couple of quick adjustments from the chiropractor would bring immense relief. All I needed was to get a seized-up joint to release. This time it seemed to be an inflamed disc, something that massage and chiro can’t really touch, except to try to get the rest of my body to calm down while the disc sorts itself out.

After a couple of days of waking up in pain and struggling to stand first thing in the morning (the chiro tells me that the disc fills with fluid overnight, making it most painful in the morning and better throughout the day as I get blood flow through the area), I make a decision. I decide to accept this moment as a gift. The universe is once again offering me both opportunity and motivation to make a significant change in my life, and I’m going to take it.

I’ve been playing with the idea of evaluating my progress to recovery since the first twinge of pain. It’s impossible to avoid. I’m in a novel situation (new iteration of back pain) and I need to adapt. Therefore, I must evaluate. While I go about my day, I take stock of my physical experience, identifying indicators, running experiments, and assessing my progress toward restored well-being. The indicators are easy: how much pain do I feel, what type, and in association with which attempts to function? Walking around is fine and sitting isn’t too bad (until I try to stand up again), but reaching forward, bending down, and getting up and down are where it really hurts. After each of the interventions I try (heat, ice, lying flat on a hard surface, stretches, etc.), I go through a repertoire of movements and classify each experience under ‘worse’, ‘better’, or ‘no change’.

(In persistent pain/ longterm/ chronic pain issues (back pain being one of these) it’s common for the location, intensity, triggers, and feeling of the pain to change and move around throughout the body. This can be really scary and frustrating. This also leads to a negative process in which we narrow our attention onto the pain which causes our awareness/ nervous systems’ sensitivity to get turned way up in a protective fashion. Each time we ‘chase the sensation’ we actually change the internal neural connections that make up our perception of our pain and movement - in this case in a way that creates a negative cycle of more protection through less movement, which leads to higher sensitivity and more narrowed focus, which leads to more protection and less movement etc…)

What I learn from this is that I can’t tell what’s really helping and what’s not. It keeps changing. One day ice is better than heat. The next day heat is better and ice is terrible. About midweek, I go grocery shopping (a few blocks of walking away) and by the time I come back, the pain is almost completely gone (though it reappears by the evening after I’ve been sitting for too long again). I’d been out on a walk the day before without so much relief and, when I wake up the next day in the same amount of pain as before, the walk I take that day doesn’t help nearly as much. Was it something about slowly pushing the grocery cart around while I picked up arugula and milk with Sarah McLachlan playing softly in the background that was the real solution? Who knows. There were too many variables to pin it down. My body is a complex system with pain as an emergent property.

For many of us, part of the issue lies in an artificial (cartesian) division in which we see ourselves made up of our brain - apart from our body: We imagine we live in our head, and our body (the darn thing!) is separate from us and not cooperating. Instead, just as the brain is constantly sending information to the body, the body is constantly sending information to the brain. Even more so, in real life activity and movement the whole system acts as one integrated process (head to toe/ mind/ body/ emotion/ spirit/balance). It works like this whether we’re consciously aware of these connections or not. ‘Nature doesn’t work in parts’, and problems in how we use and experience ourselves can start to emerge when we isolate into parts.

Instead, what happens when we start to replace the word body with the word ‘self’? (i.e Self = how the brain/body/mind/emotions/nervous system interact to produce our actions, movements, tension, and feelings). The practice is then to develop and refine our ability to observe and shape shape how these aspects of us work as one unified process in action (Note: we learn to first understand and organize these aspects of ourselves via how we use our head-neck-and back relationship in relation to gravity/balance and stimuli). This gives us a way to understand and cultivate the conditions for new movement, actions, and sensations to arise, all as emergent properties of a change in the way we use or embody our whole self - head to toe, mind/body - in action.

At this point, I’ve tried the obvious things. I’ve consulted the experts. Now it’s time to change the way I’m thinking about what’s happening.

That’s great! Alexander himself came to the same conclusion when he first started developing the technique to overcome his own issue. See: Chapter 1, The Use of the Self

Since the first time I found myself wincing through a familiar movement, my strategy has been the same: identify the source of problem, intervene, return the system to previous state of comfort and function.

This strategy is really common. The issue is we ignore ourselves until some pain nags at us, which then shifts our attention back into ourselves, to the painful part of our body… we then try to shift around to move the pain away…then the pain/tension temporarily shifts so we move our attention back out of our bodies and again ignore ourselves until the pain nags us again…and the cycle continues. An alternative strategy is to use pain signal as a reminder to include more of ourselves (our postural supports in relation to balance/gravity) in our activity. Through this practice we become more ‘embodied’ in action and more skilled in how we balance and use ourselves in action.

Then, after the desired equilibrium has been restored, identify root causes of problem and implement preventative procedures (honestly, get a gym membership already, Carolyn). I’ve been pursuing that strategy for six years. I’ve had some modest successes in terms of reducing the overall number of days and hours per year I spend in debilitating physical agony (now there’s a metric), so I could chalk that up as a sign of success with room for improvement and continue to pursue the original strategy, placing renewed emphasis on the prevention component, which, despite six years of intention, I’ve barely moved the needle on. Or I could try something different, since I’m getting bored with fruitlessly nagging myself toward self-improvement while living under the threat of inevitable future pain.

There are several problems with trying to restore the system of my body to its previous state. For one, it’s impossible. If I accept my body as a complex, fluid system, then I’m not driving back down a road to correct a missed turn, I’m steering through rapids on a kayak. I can’t go back. Also, even if I could, my previous state was a precursor to my current state, with all its flaws already present if not actively raging. Better to keep moving forward. In this case, the entire strategy of intervene-stabilize-prevent is suspect. Not to mention ineffective, since I’ve demonstrated time and again that when I do return to “normal” (a new normal, at least), I’m terrible at the prevention side of things, shifting the pattern that put me here in the first place. And, no wonder, because at that point I’ve killed off the feedback loop (pain) that was giving me insight into the progress I was making, leaving nothing in its place to inform the next stage, and my only option then is to follow prescriptive advice about what I ought to be doing with my body and hope it takes. (It hasn’t. Still no gym membership.)

So instead of investing the bulk of my effort into restoring myself to a pain-free state, I have accepted pain as my indicator, not my outcome. My goal is not to be pain-free, my goal is to change my physical habits.

Truly amazing insight…Yes! Now expand that goal beyond changing physical habits to changing psychophysical habits (changing and refining the way you embody yourself in the movements and activities of your life - i.e how you develop and refine your ability to include more of yourself (your postural supports in relation to balance/gravity) into more of our activities in daily life. The end result being your bring more ease and poise to everything you do which changes how you function, your physical habits, and a whole lot more along the way.

Aside from a minimum of pain management tactics to keep myself functional enough to get by, I stopped experimenting with ways to make my back stop hurting and began experimenting with ways to introduce sustainable changes of habit in my daily life, trying to live the way I would want to be as if I were already pain-free. (The indicators for this are harder to come by and still emerging.)

One of the most common indicators, ‘does this hurt?” and ‘where exactly does it hurt’ easily narrows our attention (like seeing a tiger in the room we block out everything else and narrow down on the tiger!). This narrowed attention is very useful for acute pain such as when you cut yourself, but poorly adaptive for long term persistent pain such as back-pain.

Some new indicators could include:

Did I have any awareness of myself before the pain showed up, or was I unaware of myself until the pain brought me back in touch with my body/self?

What am I doing with my neck-head-back relationship right now? Especially in relation to my base of support). Compressed? Collapsed? Balanced and opening upwards?

Is my attention narrowing… or expanding to include more of myself, my directions, the environment around me etc..?

If I lie down in semi-supine what is my contact like with the floor? How does this change over time? 

What am I doing with my breath? (i.e where am I placing my breath? Is my breath moving or not moving?)

This opened up a whole new horizon of opportunities. And since I’m already in a state of general disruption, interrupting old habits and substituting new ones has never been easier.

Great observations. In order to cultivate something new for ourselves and our movement (outside of habit) we have to simultaneously disrupt (or stop off) the old habit from happening while allowing for a new expression of movement to occur. In other words we inhibit the old neural path, and a new pathways is directed/ activated. Overtime this creates a new pathway (that strengthens with practice) and gradually unlearns the old pattern/pathway through non-use. This learning process is usually easier when we’re ‘in a state of disruption’ because we’re slightly out of habit so the ‘pull’ or ‘itch’ to do the old habit isn’t as strong.

I literally can’t sit the way that I normally would sink into without thinking, so I get to practice a new way of sitting (informed by my newly-renewed Alexander Technique practice, which is all about shifting sensorimotor habits). I can’t get up in the morning and go straight into emails for the next hour or more, so it’s a chance to stretch out while listening to a podcast or walk up to the pool for a swim instead. These are all things I’ve tried to implement before, with variable success and always as a struggle and a chore to remember and keep on top of myself to do it. The difference in what this feels like is subtle to measure and there are still too many factors to pin anything down with absolute certainty. That my back pain substantially subsided as of this morning could be a total coincidence and is most likely a partial one. It’s only been a week (less since I made this shift), I’m not going to claim miracle breakthroughs. It remains to be seen if new patterns settle or old ones re-emerge like acid reflux after midnight.

Perfect. As much as I sometimes wish it was a miracle cure for my students, the Alexander Technique isn’t a magic pill; it’s a skill, a practical education, and a practice. Sometimes it truly does cause a rapid positive shift in feelings of health, pain relief, and well being, but the strongest way to approach it, especially for self-motivated students who love the chance at taking on the responsibility for their lives and actions, is as a practice to continually grow your connection to yourself and skill in the way you use yourself as you engage in the world….and through this, to continually develop your ability to feel better, move better, and to positively shape many aspects of your life in the process.

But, if nothing else, I’m enjoying the freedom of the cognitive shift. To have stopped waiting until I got better in order to get well, to have moved right on to the good stuff, the place where change happens.

The ‘rest and wait’ strategy is only useful for the most acute period of back-pain. Beyond this very minimal time frame ‘rest and wait’ is a very harmful strategy to use when it comes to back pain. Unfortunately, it’s probably the most commonly adopted strategy even though it easily leads to less movement - a downwards spiral of loss of muscle mass - psychological depression or downwards mood and helplessness - the nervous system increasing sensitivity to pain signals - leading to less movement etc..- this cycles downwards fast and is hard to break out of. Instead, we can all use the reminder to…”get started with good stuff, the place where change happens!”

*To read the the original article please visit:
https://www.camman-evaluation.com/blog/2019/2/12/i-have-a-complex-relationship-with-my-back