Like father, like son
I’ll have to start with my usual disclaimer that I’m not a doctor, nor do play one on the internet. This post is lengthy, but it is one of the most important discoveries of my life. This story starts near the time of my birth. My earliest memories of my father involve his back pain. The restricted activities, the special chairs, ointments, gadgets and all the corrective stretches. Oh, and the professional care. The doctors, chiropractors, surgeons, massage therapists, osteopaths, energy workers and acupuncturists. For him, it started in 1970, when he was 28 years old. My mother was pregnant with me, and against his wishes, his very controlling mother decided it best to move in with both of them. He experienced a low back spasm and sciatica so intense that he passed out from the pain. By the time I was a year old, the pain had become chronic and the multitude of treatments began. In 1987, he had a back surgery after a MRI showed a disc protrusion. Then, as often happens with back surgery, things got even worse. Today, at the age of 73, the chronic back pain still controls a large portion his everyday life.
I was never exposed to any team sports as a child, which I’m sure had quite a lot to do with my father’s chronic pain. By the time I was in middle school, team sports were mandatory for PE and the previous lack of exposure made for a horrible experience. Any kid who has been subject to intense bullying knows the dread of PE. It’s no surprise that I became obsessed with weight training as a young adult. My biggest fear? Hurting my lower back. For good reason, I held a belief system that the human spine is poorly designed and inherently fragile.
I always warmed up judiciously and wore my lumbar support belt without fail. Yet I hurt my low back over and over again. Sometimes it would hurt for a couple of days and other times for a couple of weeks. Heavy squats were my nemesis but I also hurt it in random indirect ways, like on a 45 degree leg-press sled or just racking dumbbells. In 1994, when I was 24 years old, I had a life-altering event. On a cold and rainy San Francisco morning, I was training my back and began with heavy bent-over barbell rows like I had so many times before. I felt an intense pop in my lower back and immediately fell to the floor. I spent most of the next two months lying down and contemplating how I’d get through the following day, let alone continue my career as personal trainer. I felt as though I had fulfilled my father’s legacy.
My father was quick to recommend several of the specialists he was seeing. I saw chiropractors of half a dozen different disciplines, massage therapists, acupuncturists and energy workers. Nothing made it better. After two years of treatments and continued symptoms that ranged from needles in my feet to sub-scapular spasms, I finally got a MRI. It revealed a disc herniation between L4 and L5. Three of my other discs showed severe degeneration and I also had degenerative osteoarthritis. The orthopedic surgeon recommended immediate surgery and flatly stated that I could no longer lift weights nor engage in any strenuous activity without risk of becoming crippled. Based on the outcome of my father’s back surgery, I wasn’t eager to follow in his footsteps. There were also things that just didn’t make any sense about the injury. Sometimes the pain would vanish for a day or two at a time. I also didn’t understand why I was getting all of these other weird physical symptoms in places that had nothing to do with the nerves that were exposed to this specific disc protrusion. Every professional care provider had a different but equally vague answer. “The human spine is very complicated and we’re still learning a lot about how to treat it.” This wasn’t a very comforting explanation when considering letting one of these guys cut me open.
Pulling the veil back
About a year later, I was still in constant pain, but against the surgeon’s advice, I continued to exercise. I was just very, very careful. Most of it was seated, I always wore my lumbar support belt and had also added a variety of salves, ointments and anit-inflammatories. It seemed that I was rarely in pain when I was actually exercising, though I’d intuitively expect the opposite. My life was much different. I was no longer training people and instead wore a suit and tie, commuting to an office every day with my special carseat for added lumbar support. On one of these drives, I was listening to a guest named Dr. John Sarno on The Howard Stern Show. Evidently, this wasn’t he first time he’d been on since he had “cured" Howard’s chronic low back pain. I didn’t understand quite how he did it, but person after person called into the show with stories about how Sarno had also fixed their back pain.
Figuring anything was worth a try, I ordered his book "Healing Back Pain" and read through it in under a week. In about two weeks, I was about 80% better. A couple of months later, I was completely symptom free. Yes, you read that correctly. After years of pain, I was symptom free in 21 days because I read a book. Here’s where I will now humbly attempt to summarize a man’s life work in a blog post. Dr. Sarno earned his medical degree from Columbia University's College of Physicians and Surgeons in 1950 and later became board certified in Rehabilitation Medicine. By the early 70’s, he realized that his patients rarely improved. Here were some of the questions he began to ask about chronic back and neck pain:
- Why has lower back pain quickly reached epidemic proportions, ranking only second to the common cold as the reason for missed work?
- Why, after millions of years of evolution where humans have continually endured physical hardship, would we suddenly become unable to preform basic day-to day-functions without pain?
- If there are structural evolutionary inadequacies in our bodies, why is it that they have started causing chronic pain in only the last fifty years?
- Why would directly working the affected area with ultrasound, massage therapy and exercise often provide temporary relief for a structural injury as opposed to further aggravate it?
- Why is chronic back pain only prevalent in industrialized nations and why have the numbers climbed so dramatically in the last twenty years?
- How could the physiological structure responsible for protecting your central nervous system be completely devastated by something as innocuous as picking up a child or sleeping on a soft or hard surface?
- If your spine is injured, why would only very specific activities like sitting in a chair or standing cause pain in that area, but not other actions that involved the same area such as riding a bike or cooking? Or vice versa?
- When a MRI shows identical spine abnormalities in different patients (such as the exact same disc protrusion between L4 and L5), why are the symptoms so wildly different? They might include sciatica in the left leg and in others the right. Some might have local pain while others get cramps in their calfs. Some have shooting pain in the buttocks and others have no symptoms at all.
- Why do most patients’ pain get considerably worse after a diagnosis supported by a X-Ray or MRI?
What Dr. Sarno discovered is a phenomenon called Tension Myositis Syndrome (TMS). Myositis simply means a physiological alteration of muscles. While this alteration is often incredibly painful, it is also harmless. The way TMS works physiologically is by acting out through the body’s autonomic nervous system. This is the part of the central nervous system responsible for all those involuntary functions of organs like your heart, stomach, lungs and liver. It also controls the circulation of blood. Most TMS manifestations are a mild restriction of blood flow to a target tissue, resulting in a lack of oxygen to that area. If that tissue is a muscle or tendon, this will cause mild pain to severe spasming. If a nerve is involved in the oxygen deprivation, in addition to pain, there may also be numbness, tingling and weakness. That’s why exercise usually helps as opposed to hurts. It is temporarily forcing oxygen rich blood to the target areas that are being deprived. In the case of an actual structural injury, say a torn ligament, this would not be the case.
So why would the autonomic nervous system do such a horrible thing to us? Well, that’s where things get really interesting. Believe it or not, it’s our unconscious mind trying to protect us through the art of distraction. Over the accumulative years of our everyday lives, there are many things that make us angry- most of which we are never consciously aware of. Like a well that is slowly filled over time but never emptied, this anger accumulates and eventually turns to rage. When the amount of rage in that well reaches a critical level and threatens to spill over into consciousness, the brain might create this diversion of pain. Read Part II to discover the personality types subject to this syndrome and how to implement the cure.