Back Pain, Therapeutics, and Somatics

Because people resort to what they know, and what they know for back pain and lifting injuries consists of drugs, surgery, or manipulative techniques, and because there is something better, clinical somatic education, I have written this brief blog.


COMMENTS ON EACH MODALITY

First, I'll comment on drugs, then manipulative techniques in general, then surgery, then clinical somatic education.

At the bottom of this page, there exists a link to a page comparing a major manipulative technique used for back pain, chiropractic, with the newly available method, clinical somatic education.

These three approaches are best for temporary relief or for relief of new or momentary muscle spasms (cramp), not for long-term or severe problems.

The third, surgery, is a last resort with a poor track record (estimated by one physical therapist at 15% success rate).

You can get a comparison chart of common modalities here.


DRUGS

Drugs can provide temporary relief or for relief of new or momentary muscle spasms (cramp), but can't provide a satisfactory solution for long-term or severe problems. They generally consist of muscle relaxants, anti-inflammatories, and analgesics (pain meds).

Muscle relaxants have the side-effect of inducing stupor, as you have found if you've used them; they're a temporary measure because as soon as one discontinues use, muscular contractions return.

Anti-inflammatories (such as cortisone or "NSAIDS" -- non-steroidal anti-inflammatory drugs) reduce pain, swelling and redness, and they have their proper applications (tissue damage). Cortizone, in particular, has a side effect of breaking down collagen (of which all tissues of the body are made). When pain results from muscular contractions (muscle fatigue/soreness) or nerve impingement (generally caused by muscular contractions), anti-inflammatories are the wrong approach because these conditions are not cases of tissue damage. Nonetheless, people confuse pain with inflammation, or assume that if there's pain, there's inflammation or tissue damage, and use anti-inflammatories to combat the wrong problem.

Analgesics tend to be inadequate to relieve back pain or the pain of trapped nerves and, in any case, only hide that something is going on, something that needs correction to avoid more serious spine damage.


MANIPULATIVE TECHNIQUES

Manipulative techniques consist of chiropractic, massage, stretching and strengthening (which includes most yoga and Pilates), most physical therapy, inversion, and other forms of traction such as DRS Spine Decompression.

Most back pain consists of muscular contractions maintained reflexively by the brain, the master control center for muscular activity and movement (except for momentary reflexes like the stretch reflex or Golgi Tendon Organ inhibitory response, which are spinal reflexes). I put the last comment in for people who are more technically versed in these matters; if these terms are unfamiliar to you, don't worry. My point is that manipulative techniques can be only temporarily effective (as you have probably already found) because they don't change muscular function at the level of brain conditioning, which controls tension and movement, and which causes the back muscle spasms.

Nonetheless, people commonly resort to manipulative techniques because it's what they know -- and they think they're getting the best available help.


SURGERY

Surgery includes laminectomy, discectomy, implantation of Harrington Rods, and surgical spine stabilization (spinal fusion).

Surgery is the resort of the desperate, and although surgery has a poor track record for back pain, people resort to it in desperation. There are situations where surgery is necessary -- torn or ruptured discs, fractures, spinal stenosis; situations where surgery is inappropriate -- bulging discs, undiagnosable pain, muscular nerve impingement; and situations where surgery is sometimes appropriate -- rare cases of congenital scoliosis. (scoliosis -- curvature of the spine -- is more commonly a functional scoliosis, the consequence of muscular tensions around the ribs and spine, rather than the result of deformed growth).

Again, the point: most back disorders are of muscular (neuromuscular) origin — and correctable by clinical somatic education (which is not about convincing people that ‘things are not so bad, and live with it’ or ‘understanding their condition better’ — but a procedure for eliminating symptoms and their underlying causes, and for improving function). Severity of pain is not the proper criterion for determining which approach to take. The proper criterion is recognition of the underlying cause of the problem.


CLINICAL SOMATIC EDUCATION

Clinical somatic education is a system of mind-brain-body-training with used to overcome health problems often referred for osteopathy, physical therapy, chiropractic, massage therapy, and other modalities.

The specific advantage seen in clinical somatic education by referring physicians is that, while being effective in the relief of muscular pain and spasticity, it has the specific virtue of teaching the client an ability so to control the muscular complaint that there is little chance of a future return of the problem.

For a technical comparison between somatic education and chiropractic (as an example of a manipulative approach), click the following link: back pain information in Santa Fe. The page links to more detailed articles.

You can get a comparison chart of common modalities here.

View the video, below, for a candid, two minute view of a client's first moments after completing a session (about one hour) of clinical somatic education.