My path to a massage career began with recurring bouts of severe low-back pain many years ago. I would routinely get clobbered by episodes of pain that would put me in bed for days at a time.
One of the reasons I ended up in bed is because that’s what my doctor recommended. Back then, the conventional wisdom was to treat severe back pain with bed rest.
Orthopedists and other health-care experts now know that that’s probably the last thing you want to do. In most cases, when your back is aching it makes more sense to get moving as much as you can.
(IMPORTANT: Some conditions and injuries that can cause low-back pain definitely do call for bed rest and limited movement; check with your doctor if you have any concerns about how you should care for your back pain.)
A Reminder of the Bad Old Days
A few weeks ago I awoke with stiff hips and an all-too-familiar ache in my low back. At breakfast, I squirmed at the table trying to find a comfortable position. When I put on my socks and tied my shoes, I felt pangs of pain deep in the middle of my low back. Bending forward was very uncomfortable and reminded me of the bad old days, raising danger flags in my mind.
Twenty years ago, I might have just popped a handful of ibuprofen and crawled back into bed.
I know better now.
I started moving as much as I could, and in ways that I knew were likely to moderate the pain. I made several gratuitous trips up and down the stairs. Did several body-weight squats. Adopted a half-squatting horse stance at my standing desk. Got down on all fours and did some gentle cat-cow yoga moves and some light leg extension exercises. Did some lateral stretches to open up the space between my hips and rib cage.
I also played with several body-awareness techniques that I have learned and developed over the years, scanning my body from top to bottom. Swaying a little at the ankles. Locking and unlocking my knees. Tilting my pelvis forward and backward. Flexing and extending each pair of vertebrae in my spine. Retracting my shoulders. Making sure my head was tucked back over the center of my torso.
Throughout all of this, I tried to be as curious and objective as possible as I assessed my pain levels and movement restrictions.
There’s a natural temptation to clamp down and stop moving a body part that aches, to flinch and recoil when a movement or position hurts. By staying non-attached to, and curious about, my discomfort, I found that could move more than I might have thought at first and that I could almost always squirm or wiggle or otherwise reposition myself in a way that reduced the pain.
What Caused This Back Pain?
Sometimes back pain is set off by an obvious cause – picking up a box awkwardly or slipping on an icy sidewalk. But just as often it is triggered by some seemingly benign event, like a sneeze or simply standing up from a chair. Sometimes it just comes out of nowhere.
I don’t know what caused this episode.
Earlier in the week I had returned from a trip to Nashville. The flights were about as comfortable as they can be nowadays. My AirBnB had a firm-enough mattress. I was at a conference moving around and standing most of the time. I had intentionally booked a room about a mile and half from the conference center so I could take a nice walk each day. So that trip probably wasn’t the cause.
It’s the holiday season, so I’ve been eating a lot more sugary treats and junk food than usual. One likely factor in low-back pain onset is inflammation. Your body can get systemically touchy when it’s in an inflammatory-response mode, and there appear to be links between sweets and carbs and inflammation. So maybe that was a factor.
I’ve also been less active lately. “Motion is lotion,” as they say, and I haven’t been keeping my back and hips and legs as lubricated with movement as usual. So that may have played into it, too.
Still, as if often the case with low-back pain, there was no obvious cause.
Nor do I know exactly what was going on pathologically. It’s hard to ever know. With back-pain episodes like this, even if you could watch real-time fMRI results and peruse on-the-spot CT scans, you’d be unlikely to discern the exact injury or dysfunction that set off a low-back pain pattern. There are just too many possibilities.
About ten years ago, I took a continuing-ed course on low-back pain with the late, great massage educator Bob King. At the start of the class, Bob rattled off a long list of possible causes of low-back pain, including intervertebral disk bulging or herniation, strains to muscles like the multifidi and erector spinae, sprains of spinal ligaments, “suppressed infantile rage” (a reference to John Sarno’s hypothesis that most low-back pain originates in the psyche), and a host of other possible sources. Most of these sources are hard to identify.
Even if you could identify the strain or sprain or inflammation that set off your low-back pain, there’s not a whole lot you could do with that information.
The Pain-Spasm-Pain Cycle
As soon as any injury or irritation occurs in the low back, your body goes into a protective mode that tries to prevent further injury. Muscles around the injured area clamp down, splinting and supporting the injured area, but also reducing local blood flow (ischemia).
But you still need to move.
So nearby muscles are recruited to do the work that the clamped-down muscles usually do. These recruits, being less adept at those motions and being undernourished due to ischemia, can then be strained and injured as they try to pick up the slack. Each instance of pain can cause another group of muscles to clamp down, which causes more pain, which causes other muscles to clamp down. And on and on.
This dynamic is sometimes called the pain-spasm-pain cycle. It’s the best model I’ve found for understanding low-back pain. This cycle can also explain that unnerving sensation of your low-back pain spreading out beyond its original location.
Breaking the Cycle with the Self-Healing Mind Trick
That approach I describe above –
- calm, detached curiosity about your pain
- mindful inquiry into what the heck is going on
- pain-free movement to maintain/restore range of motion, and
- body-awareness practices to reconnect with your body
– is the foundation for what I call the “Self-Healing Mind Trick for Low-Back Pain.”
Calm, Detached Curiosity
When your back is out and the simplest movements set off excruciating pain, it can be difficult to stay calmly curious about your situation. Difficult, but not impossible.
Try to take one little baby step away from your pain for a moment. Then look back at it and regard it as objectively as possible. Try to identify the details of the pain, where it is exactly, what sets it off, what calms it down.
This can be a moment-by-moment observation, hour-by-hour, or day-by-day. Whatever the time span, stay cool, calm, and collected as you curiously observe what aggravates your pain and what eases it.
If you have chronic, ongoing low-back pain, keeping a pain journal can help. Journaling can both help you identify patterns that cause or prevent further pain. And it lets you give your doctor a detailed account of your pain pattern over time, which can help guide their treatment plan.
Another benefit of keeping a pain journal is that it can make you more mindful of your situation, which brings us to the next point.
Detached curiosity is a good start, but non-judgmental acceptance of your situation can take you to the next stage of self-healing.
At any one point in time, you just have to accept that your pain is there. It’s not malevolent pain that’s out to get you. You’re not a bad person for experiencing it. It’s just pain. Paradoxically, over time, this calm acceptance can help ease your pain.
To grossly over-simplify the complex psycho-neurological stuff that’s happening as you practice mindfulness: the more you worry, the more you hurt. Being consciously mindful of your situation helps you worry less, reducing your pain, or maybe just your perception of your pain. Either way you feel better, and your opportunities increase to break the pain-spasm-pain cycle.
At first, it makes sense to stop moving when your back goes out. You need a moment to collect yourself and to assess what’s going on.
As soon as possible, though, you should get moving again, but only if you can do so without creating more pain.
That pain-spasm-pain cycle works at a number of levels, from tiny individual muscle fibers all the way up to the big muscle groups that propel you through the world. Finding ways to get moving keeps your blood and lymph flowing, nourishing your achey muscles and removing the waste products associated with healing. I suspect there’s also a psychological benefit as you reassert control over your situation.
My favorite healing movement is walking. It’s our most natural form form of movement. And it naturally and gently engages many of the muscles associated with low-back pain. If you can walk without exacerbating your back pain, do as much of it as you can.
Light exercise can also help. The list below includes some of the most-often-recommended exercises to address low-back pain. You can try these exercises during a bout of of low-back pain, but only if they don’t aggravate it. Better yet, do these exercises regularly as a preventive measure when you’re not in pain.
The links take you to YouTube videos that show each exercise. Start with the least intense version of these exercises and gradually increase the amount of effort you exert. If you feel any pain, stop the exercise right away.
- quadruped (or “bird dog”)
- cat stretch
- back extensions
- pelvic tilt
- torso rotation
- lateral leg raise
Staying curious, being as mindful as possible, and doing pain-free movement are all good first steps toward cultivating body awareness.
But to really reconnect with your body, you’ll want to specifically activate the systems that report to you how your body is situated in the world.
The main systems that do this are your sense of touch, your vestibular system, and your proprioception system.
Your skin is your body’s largest organ, the place that physically connects you with the rest of the world. So it is no surprise that your sense of touch figures prominently in body awareness. It’s easy to activate this system: hug a friend, get a massage, or cuddle up with your pet. Every time you are touched or touch someone or something, you can enhance your sense of body awareness.
The best way to activate your vestibular system, which is largely concerned with balance, is to disrupt it. Simply standing with a narrow stance, standing on one leg, or standing with your eyes closed can make you more aware of your physical position in the world. So can walking on sand or hiking on uneven terrain. Anything you can do to discombobulate your balance, and then regain it, stimulates your vestibular system.
Sometimes called the “sixth sense,” your proprioception system consists of receptors in your muscles and joints that report to your nervous system how your body is situated in space. It’s hard to directly affect or access this system, but you can begin to get a sense of if with almost any kind of intentional, deliberate movement: dance, tai chi, and yoga are all good starting points.
I truly wish I could bottle this self-healing trick and give it to you right now. It has brought me – and many of my massage clients – a lot of relief. The pain episode I describe at the start of this story had calmed down within a couple of days as I used this trick.
A couple of final notes.
Can Massage Help When I Am in Acute Low-Back Pain?
I didn’t have time to get a massage over that weekend of my back episode, nor would I have been likely to (more on this below).
However, in a fortuitous turn of events, I was registered for a professional continuing-ed class on treating low-back ligaments the following weekend. Luckily, my back had calmed down by then. But there was still a little ache. So I was delighted to find that even the choppy, uneven treatment you get in a classroom setting helped soothe my last little nagging back aches.
So, yes, massage can definitely help. I have many clients who benefit greatly from regular massage to help keep their backs healthy and from treatment massage when their backs are acting up.
But if you are in the midst of a fresh and acute episode of low-back pain, you may get more relief from a self-healing coaching session than from a conventional massage session.
How Massage and Self-Care Work Together
Massage is great for getting tight muscles to relax, but when your body is in crisis mode due to pain in your low pack, loosening tight muscles may not always be the best approach.
Nowadays I am very cautious and conservative in my care of folks who show up in my massage office with acute low-back pain. Even with that approach, about once every other year or so someone will get off of my table in more pain than when they arrived.
I feel horrible when that happens. And I do all that I can to ensure that happens as infrequently as possible.
So, if you come in for an appointment while your back is locked down, don’t be surprised if I spend as much time on getting you moving as I do on massaging the achy spots.
If you have any questions about how massage can help your low-back pain, or if you’d like to learn more about my “Self-Healing Mind Trick for Low-Back Pain,” please let me know.