So, while it may seem natural to protect your back, this response actually contributes to the pain, rather than relieving it.

In response to a stressor, the ‘fight or flight’ response is initiated, part of which is to send signals to the muscles to contract. It’s as if the body is actually preparing to engage in a physical fight or to flee as fast as possible and in this automatic mode cannot distinguish whether this is the appropriate response.

I was also reminded that, while my brain reflexively sends signals to my muscles to contract, I can choose to override this response by deliberately relaxing my muscles. While this knowledge did not make the stressor itself go away, at least my back was not in pain as I dealt with it.

And after a day like yesterday, I was very glad to know this.

by Mary Williams, Founder, BACKCoach

Nearly all of us began our lives with naturally balanced posture. Yet, along the way, we modeled the posture of others, spent too many of our days inactive and, over time, transformed our beautifully designed musculoskeletal systems into an imbalanced, overworked and often painful body framework.

When our bodies are not properly balanced, there are several consequences:

• Our joints don’t move fluidly, may lose some of their natural range of motion and suffer needless wear and tear because our bones don’t track properly. This can lead to a reduction in function as well as pain or debilitating conditions such as osteoarthritis.
• Our muscles become overworked as they are recruited to compensate for the imbalance. Instead of healthy muscle pairs that are relaxed, healthy and ready to be called upon for movement, they become overstretched or shortened due to the imbalanced orientation of the joints.
• Impaired breathing if the ribs – and lungs – are not allowed to fully expand.
• Compressed vertebral discs if the spine is not properly aligned.
• Restricted blood flow or nerve conduction if pathways are altered from their proper orientation.

Many of us believe that how we age is due to the luck of the draw, but more important is what we do and how we carry ourselves as we go through life. Cultures that maintain their balanced postures and whose daily lives require physical activity remain active and healthy throughout their lives, while many developed countries, with all of the conveniences, report “epidemic” levels of back pain and other musculoskeletal disorders.

It is often said that in order to be healthy throughout our lives, we must remain active. While this is very true, we must go a step further and understand that in order to remain active, we must regain the natural, balanced posture that we were born with. For most of us, this means re-learning how to sit, stand and move as we were designed.

This process can take some time – generally from a month to a year – because our muscles have adjusted to imbalance and may be tight, short or deconditioned due to over- or underuse. When our bones are in natural alignment, our muscles can relax until called upon for movement.

The human body is strong, flexible and remarkably designed. Our bodies do not suffer from faulty design or evolution gone awry. Our spines are not delicate or fragile, but impeccably designed, strong and capable.

We can regain the balance, fluidity and ease that we had as children and be active and healthy throughout our lives if we simply get to the root cause of musculoskeletal pain and injury by properly aligning and balancing our skeletal system.

Unfortunately, if you search further you will discover that many of the techniques designed to provide relief have instead been found to provide either temporary, little or no relief, often leaving back pain sufferers feeling frustrated and financially drained.

I’ve often been asked about my use of the term root cause and my response is this: If you haven’t gotten to the true, underlying origin, you haven’t gone far enough. For example, one highly-marketed online entity claims that trigger points are the root cause of back pain. My response would be that while it is good that they go further than diagnosis and are looking at what is happening in the body at a deeper level, I challenge the assertion that trigger points are the root cause of back pain, and are, instead, a result of the primary and secondary contributing factors as noted in The BACKCoach Model of Chronic Back Pain. Further questions must be asked, such as,

• Why has the muscle tightened into a trigger point?
• What is the person doing that has resulted in this response?
• Is there more than one factor in the development of trigger points?

So, what are the true, underlying root causes of chronic back pain? At BACKCoach, we refer to these as the Contributing Factors. Thorough investigation has led me to uncover that there are three primary contributing factors that lead to chronic back pain and several other, secondary, contributing factors. The three primary contributing factors are so prevalent in developed countries that they explain the relationship between these countries and their according prevalence of chronic back pain. The three primary contributing factors for chronic back pain, in no particular order, follow.

1. Primary Contributing Factor #1: Imbalanced Posture. Beginning in the 1920’s, our postures significantly changed. We no longer carry ourselves with a properly balanced and stacked spine, rather, typically beginning in adolescence, we observe others and mimic their out-of-balance spines. In other countries where this change of posture does not occur, there is virtually no back pain.
2. Primary Contributing Factor #2: Stress. The chronic stress that is part of daily life for so many of us results in many physical changes in the body, including muscle contraction. In a healthy situation, when stressors occur, the situation is dealt with or we do something physical, then and our bodies go back to normal. Unfortunately, today’s stressors are typically chronic, and, in combination with Contributing Factor 3, below, lead to chronic muscle tension, which, in turn, results in pain.
3. Primary Contributing Factor #3: Inadequate Physical Activity. In addition to #1 and #2 above, we have become a society that is overwhelmingly sedentary. For most of us, even if we engage in regular exercise, a large portion of our day is spent sitting. This leads to deconditioned muscles, slouching, and a build-up of stress instead of the relief that exercise and movement provides.

What you’re unlikely to hear from providers, but is supported by study after study, is that long-term back pain is rarely the result of an injury, but of the underlying contributing factors that led to the ‘triggering event’. If we want to have long-term relief, we have to dig a little deeper, to the fundamental, underlying reasons for the pain itself.

It is at this fundamental, critical, root-cause level that we must focus if we want to achieve lasting relief and a return to a full, active, limitless life. Each contributing factor must be addressed. Let BACKCoach show you how.

While not a primary contributing factor for chronic back pain, ‘pseudostressors’ in the diet can lead to involuntary muscle tightness, and it is this mechanism that can influence back pain. We know that muscle tightness can be quite painful, that much of the underlying source of back pain is muscle tightness and that people with chronic back pain tend to have a strong muscle contraction in the back muscles in response to stress, compared with people who do not have back pain or recover quickly when they do experience back pain.

So, it is important to consider all of the sources of muscle tightness, including those in the diet, referred to as ‘pseudostressors’. The name comes from the fact that these substances result in a physiological stress response not related to typical stressors such as a hectic schedule, life changes, etc.

Pseudostressors in the diet include:

• Any food or beverage that contains caffeine. Caffeine is the predominant pseudostressor for most of us and can come from our coffee, tea, soda or energy drink, but may also be added to foods and medications. Chocolate and products that contain chocolate also contain caffeine – the darker the chocolate, the more caffeine.
• There is a host of new ‘energy’ products that contain caffeine – Perky Jerky beef jerky, Morning Spark Instant Oatmeal, SumSeeds Energized Sunflower Seeds, alcoholic energy drinks, and energy water, to name a few in this rapidly-expanding category.
• Some medications, such as weight-loss pills and pain relievers, also have caffeine in them, so be sure to check your labels.
• Jolt, maker of the highly-caffeinated Jolt soda, now makes other products with added caffeine: caffeinated gum, mints, and breath fresheners.
• An often overlooked category of pseudostressor is substances that are foreign to the body that can cause a stress response. Processed foods and foods or drinks that contain sugar can cause a stress response in your body, as well as having an effect on blood sugar regulation and imbalances in brain chemistry.

So, if you want complete relief from back pain, first lay a solid foundation of challenging your beliefs about back pain, reversing the cycle of pain, addressing the three primary contributing factors, and then look at everything else that can cause a stress response in your body, particularly food and drinks that are processed or contain caffeine.

The word ‘comfort’ is key, because when you are comfortable at work, you are less likely to experience pain or injury, while, conversely, if you are uncomfortable it may be an indication that pain or injury may be coming your way.

If you feel uncomfortable at work, the first thing to do (assuming there is not an injury that is the source of the pain) is to learn how to balance your posture, as your body is designed. By building this solid foundation of balanced body mechanics, you can apply the principles to everything you do, from loading your dishwasher and playing tennis to sitting at your computer for hours at a time.

If you still experience discomfort, or your work environment does not allow you to sit in a balanced posture (and, believe me, there are many chairs and car seats that are in this category), you can then shift the focus to ergonomics.

Ergonomics abatements, as industry likes to call them, generally fit into one of three categories – work practices, work environment, or administrative controls. Work practices refer to how you sit, stand and move in your work environment. The work environment refers to the physical components around you, such as the orientation of your desk, chair and computer, a factory assembly line or a patient room in a hospital.

Administrative controls are looked at as the avenue of last resort. While rare, there are jobs where there is little that can be done in terms of how you move or modifying the physical layout. Two jobs that I’ve analyzed in this category are tank welders and surgeons, as well as select manufacturing jobs. Examples of administrative controls include job rotation, enlargement and taking regularly scheduled breaks.

Whether you’re looking at a few minor workstation modifications, or a complete redesign of a work area, ergonomics can help you to feel more comfortable, to be more productive, and to be less likely to suffer a potentially career-altering injury.

It’s important to first understand that the source of most back pain is muscular tightness. In this example, she slept in an uncomfortable position (muscles got imbalanced into tight:stretched pairs), then she played tennis (strong, asymmetrical muscle contractions), which left her with a muscle or muscles that ‘knotted up’, resulting in the pain she was experiencing.

The second pertinent aspect is that the central nervous system is responsible for muscle contractions. The brain sends messages to the muscles via nerves, telling them to contract, and – this is the important part – it can instead send a signal to the muscles telling them to relax.

Try this simple technique:

Take a deep, diaphragmatic breath, and as you exhale, tell your brain to send a signal to the affected muscle telling it to relax. Inhale, notice the tight muscle, and consciously relax it.

Another complementary technique is to expand on the above by doing a full body scan.

Inhale, and as you exhale, slowly scan the body from head to toe, locating areas of tightness and consciously relaxing any tight muscles.

If the pain persists, consider practicing a relaxation technique such as meditation, progressive muscle relaxation, or visualization/guided imagery.

And remember, most back pain is due to tight muscles, which your brain controls. Your brain initiated the muscle contractions but you can take control by overriding this response and letting your brain tell the muscles to relax.

In many instances back pain resolves on its own within three days to two weeks. Try these techniques to see if they help relieve the pain and/or shorten its duration. And be sure to see your healthcare provider when appropriate.

In 2002, I undertook a study to understand the origin of back pain and the most effective ways to recover from it, and was surprised at what I learned. I had spent my career working with back pain experts, developing back injury prevention programs for businesses and teaching people how to apply ergonomic principles in their work and home environments, and had no reason to question the standard approaches to preventing and treating back pain until, I was in an automobile accident and spent the following fourteen years with significant back pain. Since I could not find relief through standard channels, I set out to learn everything that I could about back pain – it’s origin, its mechanism and the most effective ways to achieve lifelong relief.

There were pieces of information I had recalled from the many conferences I’d attended that weren’t reflected in the treatment approaches I’d encountered. For example, there was the landmark “Boeing Study”, a longitudinal study in which researchers measured many, many variables of healthy employees in hopes of discovering the attributes that would predict which of their employees would ultimately develop chronic back pain.

The results were quite astounding. After measuring and tracking things like height-to-weight ratios, arm length, strength and flexibility, the only factor they found that correlated with chronic back pain was how well they got along with their boss. It seems that, if you are an industrial employee, you are less likely to have chronic back pain if, when challenges arise at work, you can discuss and resolve them with your supervisor.

With this and other studies in mind, I undertook further investigation. In one study, investigators took MRI’s of people with no history of back pain and found that 64% of healthy subjects showed disc findings such as herniated, protruded or bulging discs or degenerative disc disease. Thirty-eight per cent of these non-symptomatic subjects showed findings on more than one disk!

For as many as two thirds of people with chronic back pain, there was no initial incident and diagnostic tests did not indicate any abnormal findings.

Regarding surgery, the reports are also intriguing. For example, many people continue to report back pain after the identified ‘structural defect’ is corrected, while, in an interesting study, 50% of people who underwent exploratory back surgery to determine the source of the pain and were merely sewed up when no defects were found were relieved of the pain.

Other studies report that, for an estimated 99.5% of people with back pain, the origin of the pain is muscular tightness. So, the question then should be, “What is the cause of the tightness?”

Beliefs often play a role in back pain. Many of us hold a belief in something we commonly refer to as a ‘bad back’. We believe that, essentially, there are two groups of people: the general population and those with a ‘bad back’. Further, as a culture we tend to believe that once our back ‘goes out’ we become permanent members of the latter group.

Another belief and natural body response that can contribute to prolonging back pain is the tendency to want to ‘protect’ our backs. We’ve all heard people say things like, “she can’t do that because she has a bad back.” Or, we may brace ourselves or limit activity in an effort to ‘protect’ our backs. Unfortunately, these actions can make things worse.

So, if we are experiencing back pain we must consider our beliefs and entertain the possibility that some of these beliefs may not be true and may, in fact, be impeding recovery. It is essential that we understand the cause and mechanism of back pain and address it at this root cause level if we wish to achieve long-term relief, full resumption of activity and a return to a full, active life.

- Mary Williams, MSEd, CPE, is the founder of BACKCoach™, a comprehensive, wellness-based system that helps people with back pain to return to a full, active and limitless life. www.BACKCoach.net

Having started running in Converse All-Stars, tube socks and a cotton shirt, I love the Running Fashionista trend in running!

• How did your back feel at the beginning of the year and how does it feel today?
• Does it feel better, worse, or the same?
• What did you do to try to help your back in 2010?
• How much money did you spend?
• Did it help?
• Does it feel today like you never had back pain, or does it feel like you ‘have a bad back’?
• What do you now believe about your back?
• What part have you played in your recovery?

Next consider the following additional questions. Are you pleased with how the year went? Have you progressed, remained stagnant or retreated?

Many people with chronic back pain find that they flit from one approach to another, trying this, then that, in hopes of a magic bullet or a quick fix that will make the pain go away, if only briefly. They may struggle with their beliefs about the pain, possibly deepening initial beliefs such as, “This is really serious”, “It’s never going to get better”, or “I have a bad back”.

This year, consider something different. Consider a slow fix, one that takes some effort on your part but one that results in lifelong relief. You see, most approaches to addressing chronic back pain are reactionary. They may address something found on an MRI, a tight muscle or a symptom. This year, please consider a system that gets to the root cause of back pain and is comprehensive in scope. Please consider giving BACKCoach a try if you continue to struggle with chronic back pain, you have had enough and you are ready to take back your life.

I have a confession to make… As I look back on 2010, I have to admit that I’ve been sloppy with BACKCoach. I haven’t been writing as many articles or doing as many workshops. And I finally realized why: I just don’t think about my back any more. After 14 years of constant pain followed by years of exploring, implementing and improving, I now live a pain-free, active life. BACKCoach began with the excitement of discovery and a need to share what I’ve learned with my fellow back pain sufferers. While I clearly remember the pain and frustration of those days, they are completely behind me.

One of the concepts we talk about in BACKCoach is ‘living above the line’. When you are suffering from chronic back pain, you live below the line, and if it’s been long enough, you may not even consider that life can be lived again in the way that you had expected prior to the onset of the pain. When I was living ‘below the line’, I only remotely hoped to reach the line again and did not even consider a life lived above the line. Now that my back is no longer an issue for me, limitations and restrictions are simply not on my radar.

However, while this has been great for my personal life, when I developed BACKCoach, my goal was to reach as many people as possible who suffer from chronic back pain, share with them what I’ve learned and provide them with the information and tools they need to completely recover and get back to their lives.

I’ve gotten away from this focus, and I apologize.

The good news is that, in 2010, I spent a lot of time developing BACKCoach into various options and now BACKCoach is accessible to anyone interested in full recovery, regardless of time or financial constraints. BACKCoach is now available in the following formats.

• The full 9-session BACKCoach program. This private coaching series includes 9 individual sessions plus The BACKCoach Workbook. We’ll begin by creating your own personal wellness vision and continue with eight weekly sessions. Each time we ‘meet’ (by phone) you will learn a new component of the BACKCoach Model, and, week-by-week, take steps towards achieving your goals and realizing your wellness vision . By the end of this 3-month series, clients report that back pain is no longer a factor for them.
• The BACKCoach System. Designed for the do-it-yourselfer, the BACKCoach System walks you through the BACKCoach Model of Chronic Back Pain and the steps toward full recovery. The BACKCoach System includes a workbook (information, worksheets, coaching questions, exercises, goal forms and more), an audio CD by BACKCoach founder Mary Williams and a journal to record your progress, thoughts and experiences in an easy-to follow format with inspirational quotes. Purchase of The BACKCoach System also includes quarterly teleclasses and a quick-start guide so that you can begin the very first day.
• BACKCoach Group Series. Designed for those who prefer personal attention, group interaction and a savings over individual BACKCoaching. Contact me if you are interested in group BACKCoaching.
• Practitioner Training. This year, BACKCoach will expand to reach practitioners who work with people with chronic back pain.

This year, please know that things can be different. It can be better. My wish for you is that a year from now you will look back on 2011 as the year you got to the root cause of back pain and reflect on it as something that you used to have.

Happy 2011!

Useful Links:

The BACKCoach System

Nine-sesion BACKCoach Series