How Physical Dysfunctions Create Conditions and Pain

A physical dysfunction occurs when your body posture and/or mechanics are no longer optimal, or “normal,” and are now creating excessive wear and tear on your muscles, ligaments, bones, and joints. This can show up simply as pain, or it can develop into a medical condition, such as scoliosis, a joint condition, disc herniation, and more.

Imagine a puppet. If you pull one string up tight and leave the others loose, the body will change posture. The same is true of your muscles. The tighter, shorter ones will pull your body out of its normal position and the result will be a curved or crooked posture.

This is what’s happening to our bodies when the muscles are out of balance. The changes may be subtle, but we’re walking around in twisted ways and, eventually, we’ll experience pain and/or suffer an outright condition, such as a herniated disc or sciatica. Vertebrae are pulled to the right or left, straining the spine. Hips are pitched forward or backward, forcing the lower back into an unnatural position. Shoulders round, pulling on the upper back and neck. These joints and bones are then forced to move every day in these strange, tilted positions.

When you have a physical dysfunction, your body will try to compensate. In other words, it “works around” whatever the dysfunction is in order to do what you want it to do, whether that be a particular exercise or a particular task. For example, if you sit for many hours of the day (like many people do), your hip flexors—those muscles on the front of your hips that pull your knees up—become short and tight.

This tightness can “pull” the top of the pelvis on one or both sides downward, which creates excessive curvature in your lower back. Then you have constant strain placed on the muscles of the lower back, but that’s nothing compared to the uneven compression placed on your discs as a result of the excess curvature.
This is just one example of how physical dysfunctions develop and wreak havoc on our bodies. As someone with back, neck, or sciatic pain, it is critical that you understand this process, as it holds the key to you getting lasting relief and also knowing how to prevent or better deal with future flare-ups.

How Physical Dysfunctions Create “Conditions” and Pain 

If you regularly carry a wallet, cell phone, or other object in your pants pocket, try the following exercise. Put on a pair of fairly snug-fitting jeans that have a back pocket and sit in a chair. Notice your body position. Then stand up, put the wallet or cell phone in the back pocket and sit back down again. See how your body position shifts ever so slightly? The hip on the same side as the wallet or phone will rise up a little bit, and your shoulders and neck will adapt to compensate.

This is the same thing your body does when lifting a heavy bag, though the effect is a bit subtler.

Here’s another demonstration you should do in front of a full-length mirror or with a friend who can take a photograph of you. Stand with your side to the mirror (or camera). Next, place your hands on your hips. Notice how your index finger and thumb rest on your hips.

If you were to put a carpenter’s bubble level on the area covered by your index finger and thumb, would you be “level”? Ideally, you want to be. But if your index finger and thumb lean toward the front of your body, your hips lean too far forward. This puts you at much greater risk for back pain. Similarly, if your finger and index finger lean toward the back of your body, your hips lean too far backward, which also can lead to back pain.

Or try this. Face the mirror, or the camera, with your hands at your sides and then stand to the side. Look at yourself in the mirror or in the photos. Do your fingers rest on the side of your leg or do they rest more toward the front, on the big leg muscles called the quadriceps?

If someone looking at the front of your body can see your knuckles, this is a problem. The correct position is for your hands and knuckles to rest at the sides of your body—clearly visible to someone to your right or left, but not to someone who is facing you.

If your hands rest in the forward-rotated position, also known as “forward-rolled shoulders,” it means many of the muscles in the front of the upper body are much shorter and tighter (not always, but typically stronger) than the corresponding muscles in the back. People who spend a lot of time driving and have to reach for the steering wheel, or who sit in front of a computer where the keyboard is too far away, often show this type of imbalanced pattern.

The Slippery Slope Toward Back Pain 

When a physical condition isn’t corrected, the body starts to break down. Usually the result is pain, which can exist on its own without signaling any particular condition. However, conditions also arise as a result of the same lengthy wear and tear.

Tight muscles can pull the vertebrae out of alignment, pinching a nerve or creating a herniated disc. Physical dysfunctions can pressure joints and, over time, stress them to the maximum until they develop inflammation and injury.

Overworked muscles can go into spasm, causing pain and forcing the body into physical dysfunction.
The pain from these conditions is often triggered by some sort of activity, such as heavy lifting, gardening, cleaning, or  sports. Suddenly there is pain, triggered by a muscle spasm, strain, or pull, or by a pinched nerve or inflamed joint.

That’s why most people believe they have “thrown out” their backs or suffered the injury because of a singular occurrence. The condition shows up immediately after the activity, so the belief is that the activity caused the condition. However, this isn’t the case. The activity may have triggered the pain, but it was the long months or years of uneven muscle use that actually created the condition that made the pain possible.

Back Pain Type #1:
Nerve Based Back Pain 

Once the physical dysfunction and/or condition exists, pain can be triggered suddenly and without warning at any time. When you have a muscle or bone that is a hair’s length away from a nerve, it doesn’t take much for either of them to intrude on the nerve’s space—irritating it and causing you nervebased back pain. 

Incidentally, one of the main reasons so many back treatments fail, work only temporarily, or have inconsistent results is because most treatment approaches focus on the latter steps of this process. There are many ways to make pain go away temporarily, but all such relief measures don’t address the underlying causes of the pain. 

For example, surgery may claim to “correct a herniated disc,” but it does nothing to address the physical dysfunctions and muscle imbalances that caused the disc to herniate in the first place. This is why a number of people who get back surgery end up getting repeat back surgery. One disc gets “fixed,” only to have another become damaged a year or two later as a result of the same muscle imbalances that were never corrected. And that’s if the disc was really what was causing the pain to begin with. 

Rather than get a new bucket to catch water leaking from a  roof, it makes a lot more sense to just fix the hole in the roof.  The same can be said for back pain. Find the source of the  problem and all the “downstream” issues end up disappearing  on their own—including the pain! 

Back Pain Type #2:
Tissue Based Back Pain 

When a physical dysfunction or condition persists  uncorrected, the various tissues in your body—namely your  muscles, tendons, and ligaments—get overworked incredibly  quickly. Normally, these tissues are strained only when you  use them. Under these kinds of conditions, your soft tissues  can tolerate enormous usage completely pain free. 

But if you have a physical dysfunction, you’re actually  straining those soft tissues virtually every second of your  waking day. 

For example, if your hips are misaligned due to a muscle  imbalance or trigger point, the muscles surrounding your  misaligned hips get overworked and abused. If you’re sitting  in a chair under these conditions, your muscles, tendons, and  ligaments have to work overtime to compensate for your  physical dysfunction. This quickly becomes excess usage (the  “too much” problem we mentioned previously) and your  body rebels by making you feel pain. 

Why Didn’t My Doctor Tell Me About This? 

You may be wondering why your doctor never told you  about muscle imbalances; trigger points; the excess,  deficiency, and stagnation; and the mindbodydiet  concepts.

Certainly he or she is an educated person. Do doctors not  know about them? And how can that be? 

The fact is, in the United States, and most other “modern”  countries, the medical schools tend to focus on treating the  symptoms, and the solutions they favor usually include  pharmaceuticals or surgery.

If you suffer a heart attack, for instance, because of a  blocked artery, doctors will focus on opening that artery  (either with surgery or medication) and give little attention to  why the artery became blocked in the first place. Then, to  help you avoid another blocked artery, they’ll prescribe drugs,  rather than investigate the “why” behind your condition. 

Most of our medical professionals work very hard for their  credentials, and they tend to work equally as hard in their  practices. It takes an enormous amount of time and effort just  to stay current with all the advances in the medical world,  including new drugs, new treatments, and new technologies. 

Unfortunately, insurance companies put enormous time- management pressures on doctors. They only have a few  minutes to make you feel better—and a few minutes are  nowhere near enough to identify the underlying causes of  your pain, let alone develop a comprehensive treatment plan. 

At the same time, pharmaceutical companies are creating  billions of dollars’ worth of profit each year, and so the focus  is not on prevention, but instead on how to sell more drugs  and what new drugs can be developed. 

And while the typical doctor’s visit isn’t long enough to  really solve a back-pain problem, it is long enough to  prescribe the latest and greatest pill—a pill that may  temporarily reduce pain but doesn’t get rid of the underlying  causes of the pain, and that is usually not without serious  negative side effects. 

Unfortunately, this sets up a vicious cycle. When the  underlying causes of back pain aren’t addressed, you end up  right back in the doctor’s office a few months later with the  exact same problem you had previously. And the whole  process repeats itself. 

The drug companies continue to make money with each  back-pain episode you experience. In a misguided attempt to  save money, insurance companies feel like they’ve succeeded  because they’ve kept doctors’ visits very brief—so they can  pay them less. 

Of course, when you don’t actually solve what’s causing  your back pain, you end up having to go back to your doctor  repeatedly. This costs insurance companies more in the long  run, but they’re so used to thinking about short-term profits  that they often don’t look at it from any other perspective.  Fortunately for you, there are other approaches to  resolving back pain that do not rely on surgery or potentially  harmful medications. 

Keep in mind that muscle imbalances and trigger points  are not technically diseases. Most doctors and the medical  schools that train them focus only on eliminating diseases.  And since most forms of back pain aren’t technically diseases,  many medical doctors aren’t familiar with these alternative  approaches. 

It’s Not Your Fault 

If you’re thinking, “What’s the matter with me? Why  didn’t I notice this was happening?,” stop. Don’t be hard on  yourself. You didn’t notice because your body made the  changes without you being aware of them. You may have  experienced some aches and pains, but who hasn’t, right? 

Besides, most of us are hard-pressed to find the time to really  focus on our health until our bodies literally demand it.  It isn’t your fault that you’ve suffered back pain. The good  news is now that you’re taking a proactive approach to your  condition, you’re going to learn what you need to know to  take better care of your own body, get rid of the pain, and finally get your life back. This knowledge will last the rest of  your life, helping you make adjustments when you need to, so  you’ll reduce your chances of ever having to experience back  pain again. 

Remember, we all have these imbalances, and the sooner  you identify and address them, the sooner you’ll be on your  way to freedom from pain. Later in this book I’ll teach you  exactly how you can do just that. 

Your Mind and Your Diet:
Two Other Potential Sources of Back Pain 

While problems in the body tend to be the ones most doctors and health care professionals focus on, the mind and the diet play a much bigger role than most realize. In fact, I personally feel, and more and more research is suggesting, that these other areas may be keys to improving back pain. It’s quite easy to have issues with “too much,” “too little,” and blood circulation or body energy that’s “too slow” because of 

your emotional and dietary life.

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Physical Causes of Pain

In the previous chapter, we talked about how the causes of back pain are “too much” (excess) of something, “too little” (deficiency) of something, or blood circulation that’s “too slow” (stagnation). Also, it’s important to remember that you often will find a combination of several causes that are all working together to keep you in pain.

In this chapter, we’ll focus on how these key concepts are related to your physical body. For most people, it all starts the same way. You use your body in an unbalanced manner, likely without being aware of it. For example, you may sit in a chair or car seat 10 hours a day, but stand or walk only an hour or two.

Next, one of two things happens.

Some people develop tissue-based pain, which originates in the muscles, tendons, ligaments, or joints. Others suffer from nerve-based pain, a result of taut muscles pressuring a nerve or pulling the body out of alignment so the bones in the spinal column (or a joint) compress or pinch a nerve or force a disc to bulge or herniate. Often, people suffer from both types of pain at the same time.
Let’s examine how these situations can develop.

Muscle Imbalances:
The Tug of War Inside Your Body 

Human beings are born with well-balanced bodies, but rarely do they stay that way. Throughout our lives we learn to use our muscles to master various activities, but because we tend to favor one side, or do some activities over and over again, we work some muscles too much and others too little.

Take our modern-day sedentary lifestyles, for example.

Most of us sit far more than we stand or engage in activity.

We sit at the computer, in a plane, in meetings, while watching TV, and while eating, driving, and visiting. If we were to log the hours we spend sitting, as opposed to other activities, we’d probably find that sitting takes up the majority of our time. We’re a society of “too much” sitting—especially compared to 50 or 100 years ago.

Sitting, however, isn’t the only way we use our muscles too little or too much. Consider the course of your own typical day. Most likely you use one hand more than the other to brush your teeth, style your hair, write, and eat. That hand and arm also are probably more prominent in activities such as cleaning, cooking, and doing laundry.

When you drive, you use the right leg for both pedals, while your left does nothing, unless you’re operating a manual transmission. Since you do these activities most every day, these muscles are used over and over again, while others—like your left leg when driving—are hardly ever worked. You can imagine how the stronger muscles on one side of your body—with little counterbalancing resistance from the weaker ones on the other side—can pull your spine, hips, and other joints slightly out of alignment.

The same thing can happen with your forward and backward movements. Many people tend to lean forward more than backward for activities such as driving, reading, mowing the lawn, woodwork, crafts, playing games, and, of course, working at the computer. You lift heavy items by leaning forward, not backward. For sports such as skiing, running, cycling, soccer, and baseball, you’re almost always leaning forward.

If you’re not performing backward-type stretches and exercises to counteract these “bending forward” habits, the muscles in the front of your body will become stronger and shorter, while the muscles in the back may weaken and stretch out. Again, when the front of your body is much stronger than the back, you can imagine how such unbalanced forces can subtly distort the natural curve of your spine.

There are many more examples of how we use our muscles unevenly. You may prop a telephone on one ear while doing other tasks, using just one side of your neck. Carrying a heavy purse, laptop bag, or backpack on one shoulder may cause you to lean to one side to support the weight while sticking your hip out on the other side to counterbalance it.

A similar thing happens if you have young children or grandchildren and carry them on one hip. You jut out that hip to support the extra weight—without copying the action on the opposite side.

Another example: If you have a wallet or cell phone in your back pocket all the time, it tends to tilt your hip and the rest of your body to one side whenever you’re sitting. The result of all this uneven body use is that certain parts of the body grow strong while other parts weaken, creating a literal tug of war—where both sides lose.

Common Muscle Imbalance Examples 

One of the most common examples of a muscle imbalance that causes back pain occurs in many people today who work in sedentary positions. We call it “forward-tipped pelvis.” All that sitting tightens the hip flexors (fronts of hips).

Meanwhile, the stomach (abdominal), hamstring, and buttock muscles become weak from being underused.

The tight muscles pull the pelvis down and forward, creating an excessive curve in the lower torso and causing the abdomen to protrude forward. The resulting pressure on the lower spine can eventually cause dysfunction and injury, such as sciatica, a herniated disc, or a muscle spasm.

Another widespread muscle imbalance is one we like to call “forward head and shoulders.”

This occurs frequently because people spend so much time hunched over computers, steering wheels, office desks, stoves—almost every activity we do requires us to lean forward.

This causes the muscles in the chest and at the base of the neck to tighten up, while the muscles in the upper back and shoulders weaken and stretch out, putting pressure on the upper spine and causing upper back and neck pain.

There are other common muscle imbalances, but perhaps you can begin to see how our everyday routines work our muscles unevenly, create bad posture, and eventually lead to pain.

Your Muscle Strength: Use It or Lose It 

The body is truly an amazing machine. The more you work it, the stronger it gets. In contrast, if you drive your car for thousands of miles, it’s not going to drive any faster or get better gas mileage. If you play your upright piano for years, it’s never going to grow into a grand piano. The human body, on the other hand, responds to work by becoming stronger and more efficient—especially in the muscles.

As you go about your daily routine, using one hand, arm, or leg more than the other, that part of the body becomes stronger. Imagine if you lifted weights with only your left arm for several months and did very little with your right arm.

Pretty soon you would notice a definite difference between the two.

When you exercise or use a muscle, the fibers are stimulated, stressed, or slightly “damaged.” This is why you may feel sore after a particular activity. During rest, the body repairs the muscle, building it back up to withstand similar work in the future. The fascinating thing is that the body goes the extra mile in reconstruction, building the muscle up stronger than it was before, so you can handle the same
activity with greater ease.

However, the opposite also is true: When you don’t work a muscle, it not only doesn’t grow stronger, it actually grows weaker, sort of like a basketball that isn’t inflated regularly. If you’ve ever had an operation on one leg or arm and had to build the muscles back up again, you know this fact well! Or, if you’ve ever been confined to bed for a week or two due to a medical condition, you’ll remember how wobbly you felt when you tried to get up again. This is because your muscles had already started to weaken from inactivity.
So, how do these uneven muscles result in a tug-of-war inside your body?

Striving for Balance 

When we think of balance, we often imagine two things working in opposition to one another. We may visualize two children on a teeter-totter, for instance, or the two ropes that lift and lower a flag on a pulley. Muscles work much the same way—in twos. In order for you to be able to move forward and back and side to side, each muscle needs a partner muscle to pull the opposite way.

If you bend your elbow to touch your neck, your biceps (the muscles on the front of the upper arm) pull, or contract and shorten, and the triceps (the muscles on the back of the upper arm) relax and go into a stretched position. If you didn’t have the triceps muscles to pull your arm back out, it would remain bent. Fortunately, when you’re ready, the triceps contract while the biceps relax to straighten your arm again. This is why it’s so important to keep both muscles in an opposing muscle group balanced.

I’m not saying here that both muscles need to be of equal strength, as some muscles are naturally designed to be stronger than others.

Rather, each muscle should maintain the state of strength and flexibility that keeps the nearby joints functioning optimally. This allows you to move easily in all directions in the way the body was designed to move.

When it comes to eliminating and preventing back pain, the goal isn’t necessarily to have muscles as strong and flexible as possible—though that certainly helps. The goal, as we said in Chapter 3, is balance: Your muscle pairs need balanced strength and flexibility to support your body height and weight and allow for normal movement.

Unfortunately, for most of us, keeping all the muscle pairs equally balanced is a tall order. Not only do we suffer from working some too much and others too little, we suffer from stretching some too much and others too little. But the even bigger challenge is that most people aren’t even aware of this. While this basic understanding of how our bodies work should be common knowledge, it isn’t, and that’s why so many people struggle with nagging aches and pains.

“I Can’t Touch My Toes Anymore!” 

Many of us, as we get older, become less flexible. When we were children we could probably touch our toes, do somersaults, and even perform splits. But as we get older, our muscles seem to tighten up like boards. You may be surprised to hear that age isn’t the main culprit.

A muscle’s natural reaction is to contract. Just like a roly- poly bug that curls up when you touch it, the muscle—when you ask it to work—will tighten.

Think of what happens when you touch a hot burner by mistake. The muscle contracts to pull your hand away, sometimes before you even realize what’s happened.

Similarly, when you perform an activity, the muscle contracts to help you perform it. That means for every activity you do, some muscle, somewhere, is pulling or contracting.

Do the activity frequently and for extended periods of time, and the muscle is required to stay in that short, contracted state.

If the muscle is stretched during a resting and healing period, it most likely will return to its relaxed, elongated, and more flexible state. (This is why most fitness trainers, like me, recommend stretching after exercising, to elongate the muscle again after it’s been tightened from physical activity.) If it’s not stretched, it will stay tight, and at the end of the healing process it will remain a little shorter than it was before. For most of us who do certain activities over and over again, but fail to adopt a regular stretching routine, this is how we lose flexibility.

Gradually, our muscles get so used to being in a contracted, tightened state that they tend to stay that way. Suddenly, we can no longer touch our toes—or for some folks, even our knees!

Muscle Flexibility: Stretch It or Lose It 

If you’re a woman who wears high heels, most likely you’ve heard the warnings: Wear them too much and the muscles in the backs of your lower legs—the calf muscles— will shorten. And if you haven’t, here it is now: Wearing high heels is asking for problems, and it’s one of the worst things you can do to your feet and body. You can visualize this effect.

Just imagine your calf muscle as a rubber band that extends from the back of your knee to your heel. When you wear high heels, the rubber band contracts (or gets shorter) to accommodate the shorter distance between your heel and your knee. Over time—particularly if you wear these shoes up to eight hours a day, five days a week—the muscle adapts to this shorter position, so that when you take the high heels off,
 you feel a pull as the calf muscle tries to lengthen again to set your heel on the floor.

The same thing can happen to the muscles in the backs of your thighs, called the hamstrings. Visually, you can imagine the hamstring “rubber band” at a certain length when you’re standing. What happens when you sit down? The rubber band—in this case, the muscle in the back of the leg— shortens to allow you to sit.

If you sit too much, the muscle will adapt itself to that position as normal and become permanently shortened, again, reducing your flexibility and causing pain when you stand or need to bend over. This shortening of the muscles happens throughout the body, with any muscle that is required to remain in a shortened position for a long time—and is stretched too little.

Lack of stretching and overwork of muscles are a couple of reasons why we lose flexibility. But there is another reason, which you never hear health care professionals talk about: excess fibrin. A more common term for it is “scar tissue.” I’ll talk more about fibrin in Chapter 6, but for now, understand that when you work a muscle, some of the fibers are damaged. This is a good thing, because when the body goes into repair mode, it typically builds the muscle back stronger than it was before.

However, part of that rebuilding process involves producing fibrin or “scar tissue,” which forms a sort of latticework on which the body can build new tissue. (Picture the crisscross framework on a building undergoing remodeling.) To provide maximum structural integrity for your injured tissues and joints, fibrin is a naturally stiff and inflexible material. The more fibrin that builds up in your body, the more inflexible you become.

Typically, once the repair work is finished, a special type of enzymes called proteolytic enzymes come in to complete the job by breaking down the fibrin and whisking it away.

Unfortunately, as we get older, our bodies don’t produce as much of these critical enzymes as when we were younger.

Without these enzymes doing the cleanup job, fibrin builds up in our connecting tissues. This is why, when you turn 40, 50, or 60, you begin to feel stiff all over and less springy than when you were younger.
You can see how our tug-of-war is getting worse. Not only is it going on between strong versus weak muscle pairs, it’s happening between flexible versus inflexible muscle pairs. And guess what’s in the middle of the battle? Your spine— specifically your neck, back, and hips.

Trigger Points 

Muscle imbalances are not the only physical causes of back pain. Another source is something known as trigger points or “knots” in one or more of your muscles.

When you use your muscles, your body tells them to contract. Long, hairlike muscle fibers lock together, shorten, and draw in. For example, when you lift your coffee cup, all the muscle fibers in your bicep contract, allowing your arm to lift. When you’re done lifting, your body tells these muscle fibers to relax. The fibers “unlock” and allow your muscle to elongate.

When a muscle is overworked (contracted “too much”), it may simply radiate pain, but oftentimes a knot also will develop. (In the case of a tendon or ligament, inflammation or injury may occur.) These knots are really small tangles in the fibers of your muscles.

If you’ve ever had a massage, you’re probably familiar with this. Knots are tender, feel hard to the touch, and can require a lot of pressure to release. If you think of the muscle as a length of hair—since muscles are made of up fibers similar to hair strands—a normal muscle would look like healthy, combed hair, whereas a muscle suffering from a knot would look like you took the hair and twisted it.

This knot slows blood flow through the muscle, causing several problems. First, the waste products produced by your muscle cells aren’t removed quickly, so they settle into the fibers.

Second, the cells in those areas aren’t getting as much oxygen as they’re used to getting—so they’re mildly oxygen deprived.

Third, your blood transports the fuel that powers the “unlocking” mechanism within those last few muscle fibers that are “stuck” together. Without ample blood circulation, these muscle fibers never unlock. This creates a vicious self- reinforcing cycle where a knot causes slow blood circulation, which prevents the knot from releasing itself, which causes the knot to persist even further. (This is a classic situation of your blood circulation moving “too slow” in that specific part of your body.)

These three conditions combine to cause inflammation, tenderness, and pain in that part of the muscle. The result is a trigger point, or what most people think of as a knot, in their muscle.

It’s also important to note that trigger points can develop in tendons, and because tendons are so much less vascular, meaning they get so much less blood flow, they often are much harder to treat effectively.

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The Three Hidden Causes of All Back Pain

Let me introduce to you to the three hidden causes of all  back pain (really all health conditions, for that matter). I’ll  begin with terms that are slightly technical, and then explain  what they mean in plain English. Once you understand these  key concepts, you’ll probably never look at your own back  pain the same way again.

All back pain is ultimately caused by one (or more) of the
following three issues:

1. Excess (“too much”)
2. Deficiency (“too little”)
3. Stagnation (“too slow”)

All these terms revolve around the idea that to live pain  free, you need to maintain a delicate balance in your body,  mind, and diet. It’s important to avoid too much (i.e., excess)  of anything that causes you pain or too little (i.e., deficiency)  of something in order to prevent pain from occurring.

For example, if you do too much weightlifting, causing  your muscles to get shorter and less flexible, and you do too  little stretching to lengthen and increase the flexibility of your muscles, you create a condition that is ripe for back pain.

Similarly, if you have too much negative emotional stress  and too little downtime to process and deal with that stress,  you’ll be creating conditions in your body that are ripe for pain while limiting your ability to heal.

Let’s look at each of these three concepts in more detail.

Excess: Too Much of Something 

When we talk about excess, we’re talking about too much  of something. If you drink too much soda, coffee, or  caffeinated drinks, you’ll have too much caffeine in your  system (as well as other junk). Since caffeine is a diuretic that  causes you to urinate a lot, you’ll have too little water left in  your body. The discs in the spine need water to stay healthy  and function optimally. Too little water and they degenerate,  bulge, or herniate, making you vulnerable to nerve  compression and pain.

If you eat too much of the wrong kinds of fats—such as  hydrogenated (partially or fully) vegetable oils; fried foods;  and foods such as chips, crackers, and the like—you’ll likely  carry too much fat on your body, potentially straining your  muscles and putting extra pressure on your back. In addition,  since the body requires a delicate balance of different kinds of  fats to avoid inflammation, too much of these “bad” fats will  tip the scales in favor of inflammation and pain. (I’ll explain  more about diet and inflammation in a later chapter.)

We can have too much of just about anything in any area  of our lives. I’ve touched on diet, but what about the physical  body? Too much running, cycling, or weightlifting—without  cross-training with other types of exercise, sports, or  activities—can lead to uneven muscle strength and flexibility.
 
Too much sitting at the computer can lead to shortened  muscles in the backs of the legs, which creates back pain. Too  much stretching, without strength training, can lead to weak  and flabby muscles that no longer support the body properly.

We can expand this concept to our mental lives. Too  much stress can weaken the body’s defenses and lead to  sickness. Too much anxiety can lead to tension headaches and  irritable bowels—even panic attacks. Too much self-judgment  can lead to depression and low self-esteem, which decreases  blood flow in the body and robs the tissues of adequate  oxygen supply.

All these excesses throw the body and mind out of balance,  tipping the scales toward back pain—not to mention other  kinds of pain and/or disease.

Deficiency: Too Little of Something 

When we talk about deficiency, we’re talking about too  little of something. If you drink too little water, you run the  risk of dehydration and toxic buildup in the body, as well as  constipation and back pain. Eat too little fruits and  vegetables, and your body doesn’t get enough of the vitamins  and minerals it needs to stay healthy, fight off stress, and  lower your risk of experiencing back pain.
As with “too much,” we can have “too little” of just about  anything in any area of our lives. If we consider the physical  body, the first deficiency that comes to mind is too little  exercise. In America, we’re suffering from an obesity  epidemic.

I talked about too much of the same kind of  exercise a moment ago, but for many people, the problem is  too little exercise. We’re moving around a lot less than we  used to and performing far fewer manual tasks, which is  creating all kinds of aches and pains, to say nothing of the  increase in such weight-related disorders as diabetes and heart  disease.

If we consider our emotional lives, we can see how too  little quiet time is a problem for many of us. We’re  bombarded by stimulation from all corners of our existence— televisions, cell phones, traffic noises, loud voices, radios,  stereos, text messages, e-mails, and more. Rarely do we take  the time to go to a quiet place and reflect. This constant  stimulation leaves us anxious and unable to relax, causing too  little oxygen to reach the muscles and creating blood  circulation that’s too slow.

These deficiencies create an imbalance in the mind, body,  and diet—again, setting us up to suffer because of some  upcoming disorder or pain condition.

Stagnation: Something Is Moving Too Slow 

Stagnation can be caused by too much or too little of  something in your life—or by both. Simply put, it’s the  slowdown of blood flow and body energy.

In a healthy body, the blood flows freely throughout the  veins and arteries, supplying all organs and tissues with the  oxygen and nutrients they need while carrying waste away.  However, if that blood flow is restricted somehow, say, in a  trigger point within one of your back muscles, it slows down  and clogs up the system.

Imagine one side of a two-lane highway. As long as those  two lanes stay open, traffic flows freely (usually!). However,  during times of construction, one lane often is closed, which  narrows the passageway and forces all the cars into the  remaining lane. The flow slows down.

There are many causes of stagnation. Too much anxiety,  tension, and fear all restrict blood vessels, as evidenced by the  feeling of “cold hands.” Too much sitting for long periods of  time, whether at the computer or on an airplane, restricts the  blood flow in your legs, and can even result in a clot. Too  much “bad fat” in the diet can slow down blood flow and leave you fatigued. Too much strain on a muscle can cause a muscle spasm, which can restrict blood flow. Too little activity, too little stress relief, too little water, and too little stretching to elongate the muscle fibers all can lead to low energy and poor circulation. And poor circulation can lead to muscle soreness, toxin buildup, and back pain.

A Dangerous Cycle 

It’s easy to understand how these three points—too much,  too little, and too slow—can all interact and feed each other.  You can see how too much of one thing often prompts too  little of something else—with the entire chain of too much  and too little resulting in energy and blood flow that is too  slow, creating back pain.

Suddenly it becomes clear why the more common  approaches to treating back pain—those that focus strictly on  pain—don’t address the underlying conditions.
It’s a dangerous and self-reinforcing cycle.

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Pain is only a symptom

Pain.

It’s a powerful word that creates strong feelings.

Think back to the last time you experienced pain. If you’re  like most people, you probably remember some event that  caused it—a paper cut, a sprained ankle, or a skinned knee.  Most people believe that back pain operates the same  way—that it’s caused by some isolated event. They “throw  out” their backs, for instance, experience pain, and then have  a back-pain problem. Since the pain happened rather  suddenly, they imagine that if they can get rid of the pain,  they’ll get rid of the problem.

Like many things in life, the real story is more  complicated. Back pain is just a symptom that can be caused  by many different things.

Two people can feel the exact same type of back pain for  two entirely different reasons. If they were both to undergo  the same treatment, one may start to feel better but the other  may not. It all depends on why the pain exists in the first  place.

Let’s say you have a dog, and one night that dog comes in  whining. You know he’s in pain, but you don’t know why.  Pain is just a sign that something is wrong.

Next, you may notice he’s limping, which is a good sign  that the pain is probably in his leg somewhere, but you still  don’t know what’s causing it. To find out, you need to do  some investigating.

Most likely, you would call your veterinarian and work  toward finding a solution. You would not, in most cases, give  the dog a pain reliever or a massage and then forget about it.  Even if your dog felt better the next day, most likely you  would still want to be sure his leg was all right. Unfortunately,  you might not treat yourself with the same care.

Many traditional back-pain treatments focus primarily—if  not exclusively—on just getting rid of the pain.  In the process, they fail to identify the underlying cause of  that pain. Of course, it’s great to have pain erased or, at least,  diminished. But easing the pain without solving the problem  means one thing—the pain comes back. That’s why a lot of  people seem to frequently “throw out” their backs and  experience persistent, recurring back pain.

Pain Is a Message…So Listen!

Pain is your body’s way of telling you that something is  out of balance, or “messed up” in some way. That may not be  the technical term doctors use, but it’s the most accurate one I  can think of!
Through pain, your body is trying to send a message that  something is wrong and it needs help. When the message is  silenced but the underlying problem is ignored, the  communication has failed. Consequently, your body starts to  “yell” louder by giving you more pain—recurring and more  severe pain.

Your body is trying to tell you something, but you aren’t  listening!

The Three Big Myths About Back Pain 
What I want to emphasize here is that we can’t just focus  on symptoms like pain. Instead, we must turn our efforts  toward figuring out and fixing the underlying problem  causing the pain. Before I explain the primary causes,  however, let me start by dispelling a few popular myths.

Myth #1:
You “Throw Out” Your Back 

In the course of my work, I’ve taught hundreds of  thousands of people my back-pain treatment approach. When  I ask them what’s wrong, they almost always say something  like, “I was doing X when I ‘threw out’ my back.”

Usually, some physical activity precedes the back pain, like  picking up a heavy object, sneezing, bending over, or getting  out of bed. The thinking goes, “Well, since I didn’t have pain  before the activity, the activity must have caused the pain.”  As you’ll see in the next few chapters, the reality is a bit  more complicated. In many cases, a physical activity can  trigger a pain episode, but by itself, it isn’t the underlying  cause.

Consider this example: Let’s say you fill a room with  natural gas and then toss a match inside. You could say that  the match caused the explosion, but it would be more  accurate to say the match “triggered” or ignited the explosion.  The better question to focus on is “Where did all that gas  come from in the first place?”

It’s very similar with back pain. A physical activity can  trigger a pain episode, but it’s not the “fuel” behind it. If you  don’t get rid of the underlying problem, then any number of  things can “trigger” the pain.

Myth #2:
Back Pain Means Something Is Wrong with the Back 

People usually think that if they have back pain, their  bodies are suffering from some mechanical dysfunction.

“Since my body hurts,” they say, “it must mean something is  wrong with my body—something with the bones, the  muscles, or the soft tissue that connects them.”

While this is sometimes, if not often, the case, it’s not the  only underlying cause of back pain. Other factors that  originate in your mind (e.g., stress levels) as well as your diet  (unhealthy foods) can cause severe back-pain episodes, even  when there’s nothing wrong with your spine, discs, joints,  muscles, or ligaments. These factors also can exacerbate  physically caused back pain, making it many times more  painful.

Myth #3:
The Current Pain Isn’t Related to Previous Bouts  

If you experienced a back-pain episode two months ago  and another today, you’re likely to think these episodes are  unrelated. Perhaps the last time it happened because you  sneezed. This time you were moving furniture.

For most people, the trigger that causes their pain episode  is different on different occasions. Naturally, they associate  the “cause” to the trigger and believe the episodes are  unrelated.
In fact, in the vast majority of cases, multiple back-pain  episodes are usually caused by the same underlying problem— even if each pain episode had a different trigger.

Let’s consider again the room filled with natural gas—a  dangerous situation, no doubt. But the gas is the source of the  danger, not the match, static cling, or a cell-phone ring that  might create a spark to trigger the explosion.
 
The same is true when it comes to back pain. Once you’ve  created conditions in your body, inadvertently or otherwise,  that are ripe for an explosive bout of back pain, any number  of things can set off a pain episode. Different activities that  may trigger pain are only sparks igniting the gas that was there  all along.

There Are Two Types of Pain: 
Which Are You Suffering From?
Though there are many back-pain conditions, such as  sciatica, scoliosis, and a herniated disc, we can narrow them  down to two basic categories: nerve-based pain and tissue- based pain.
You may have one or the other, or you may have both.  Some treatments will ease nerve pain, others improve tissue  pain. Some might, in some cases, work for both. But  determining the right treatment for your particular case can  require some investigation. This is, incidentally, why so many  back-pain sufferers find inconsistent relief.

Let me explain the differences between the two types of  pain.
As the name suggests, nerve-based back pain is caused by a  nerve that’s not happy for some reason. Typically, it’s being  pressured, pinched, compressed, or injured in some way— usually by a nearby muscle or bone.

For example, if a nerve is surrounded by or next to a  muscle that’s unusually tight and inflexible, that muscle  presses on the nerve, causing it to hurt. This is common in  sciatica.
If a nearby piece of bone, such as a vertebra in your spinal  column, is out of position, it also might press on the nerve,  causing pain. These bones themselves may be out of position  due to an overly tight or inflexible muscle nearby. In other words, the whole process may start with a tight muscle but end with a nerve that’s irritated by a bone.

Nerve pain often, but not always, is felt as a burning,  tingling, sharp, shooting, electrical, or numb sensation, or like  “pins and needles.”

Tissue-based pain, on the other hand, originates in the  muscles, tendons, ligaments, or other connective tissues in the  body. (Most commonly, the pain originates in the muscles.)  Think back to the last time you gave someone a neck or back  massage. You may recall feeling one or more “knots” in the  muscles. These knots are one of the main causes of tissue- based pain. One way to tell if a knot is really a knot, or just a  bone, is to see if it exists on both sides of the body in the exact  same position. If it appears on both sides, it might be a bone  or part of a joint. If it only appears on one side, it’s more  likely a knot.

This knot is more formally known as a “trigger point.” I  don’t know why it’s called this, but I suspect it’s because if  you press firmly on it, it triggers pain. Trigger points also are  known to trigger pain in areas of the body other than where  they’re located, and this is called “referred pain.”

A trigger point is caused in part by a pooling of toxins in  your muscle tissue—which, in turn, is usually caused by  imbalances in your diet, excess negative stress, and/or damage  to the actual muscle fibers as a result of an injury and/or  excessive exercise or physical activity.

If you’re under a lot of stress, for example, your body’s  natural tendency is to shift to more shallow breathing and to  “freeze” parts of your upper body (clenched jaws and tense  shoulders are a few examples). This “freezing” reduces the  amount of oxygen in your body and slows the circulation of  blood in certain areas—such as your back. Without the  optimal level of oxygen from deep breathing and without  natural body movement to keep the blood flowing, toxins get  “stuck” within tight muscle tissue. If this is allowed to continue for a long enough period of time, a trigger point develops, causing pain.

Trigger points also might be caused by an imbalance in the  diet. For instance, many people who have been led to believe  they aren’t getting enough calcium may, in fact, be deficient  in magnesium. Without magnesium, the body can’t process  calcium as it should. Magnesium also is involved in the  muscle-relaxation response, so if the body doesn’t have  enough of it, trigger points are more likely to develop. Since  proper muscle function depends on both of calcium and  magnesium—and since they depend on each other for  absorption into the body’s cells—an adequate, balanced  supply (along with potassium and other trace minerals) is  necessary for healthy, pain-free muscles. Studies have shown  that supplementing with these nutrients can help ease trigger  points.

Another way to really aggravate trigger points is to drink  too little water. When you’re dehydrated, your blood doesn’t  have enough fluid to flush out all the toxins and other  biological waste that your body produces. Under normal  conditions, the blood washes away all these waste products,  moving them to the liver and kidneys, where they are  eliminated from the body.

But if you’re even slightly dehydrated, there isn’t enough  water in your blood to do a good cleaning job in the little  spaces between the cells that make up your muscles. When  this happens, you’re much more likely to develop trigger  points—or if you already have them, they increase in size,  severity, and pain.
Other types of tissue-based pain, such as pulled or strained  tendons or ligaments, also can be caused by overuse. While a  sudden trauma or injury can pull a ligament—a very extreme  form of overuse—doing the same type of moderate-intensity  activity too many times can strain a tendon or ligament, too.

There is a fine line between using and overusing your tendons and ligaments.

Notice how similar types of sharp, shooting pain—a  trigger point in the muscle, an inflamed tendon, or a  compressed nerve—can be caused by entirely different  reasons. As you’ll see in the next chapter, this is quite  common. You also will see that if you don’t know what’s  causing your pain, you could very easily choose the wrong  treatment approach!

You may already have an idea which type of pain you have.  If not, you’ll figure it out as you go through this book. For  now, just remember that you need to know what’s causing the  pain before you can reasonably expect to get rid of it.

The Three Causes of All Back Pain  As I mentioned earlier, most people think they “throw  out” their backs and then experience back pain. While you  now know that this isn’t the case, let’s look at what does cause  back pain.
All back pain comes from one of three sources—and  these are almost always overlooked by doctors and other  health care professionals.

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The Seven Back Pain Mistakes

If you’re reading this blog, most likely you—or a loved  one—is experiencing, or has experienced, back pain. Maybe  you’ve tried some of the treatments out there but haven’t found any lasting relief. At this point, you may be wondering why you haven’t had greater success. Through my practice, I’ve found that the reasons back-pain sufferers continue to suffer are usually because they make one or more of the following seven common mistakes.

Mistake #1: 

Continuing a Treatment That Doesn’t Work 

I’ve talked to a number of back-pain sufferers who have  amazing stories of how long they tried a particular type of  treatment before giving it up. Prior to enlisting our help, one  of our clients actually went through 70 treatments with a  chiropractor—and experienced no relief at all.
I know of several other clients who spent a lot of money on  massage therapists and acupuncturists, only to get temporary  relief that disappeared within a few days.

This doesn’t make any sense. If you’re using a back-pain  solution that doesn’t work or hasn’t worked permanently, it’s  worth trying a different approach. Some treatments work for  some people, but if a treatment isn’t working for you, that’s  what’s important.
Here’s a general rule to follow: Once you’ve gone through  a three-month period of treatment, if you see no  improvement, consider making a change. It’s not so much  that you should have only X amount of treatments, but that  you should notice steady progress in your pain relief. This  relief should be of the long-lasting variety—not the kind that  wears off in a few hours.

Mistake #2: Failing to Solve the Problem the First Time 

Many people experience back pain that lasts a few days and  then subsides. When the pain disappears, rather than make an  effort to identify and address the cause of it, they simply  forget about it.

Here’s an example: About 10 years ago, my mother had  her first bout with back pain. She suffered back spasms for a  few days, then the pain went away and she went on with her  life. Two years later, it came back—much worse than before.  It got so bad, she couldn’t work. If she had taken that first  round of pain more seriously, I doubt she would have had to  go through the second one. Even if she did, it wouldn’t have  been nearly as bad and she’d have known exactly what to do  to get rid of the pain again, but this time much more quickly.  I understand why this happens. Most people believe that  when the pain goes away, the problem does, too. This is a  common misconception that I hope will be corrected as you read this blog.

The truth is, even though the pain may ease up for a while,  if you haven’t figured out what caused it in the first place,  that cause is still there, lurking, waiting to flare up again. Of  course, figuring out what causes back pain isn’t always easy.

If you have a fall or some other sudden accident, it’s not  difficult to figure out why your back hurts. But in nearly all  cases, the pain is caused by any number of things, things you  may not have even thought about. You need to investigate  what unhealthy conditions may be developing in your body  and, more important, what’s creating those conditions. I like  to call these “hidden causes,” and you’ll discover them later in  this blog.

Mistake #3: Thinking You’re Too “Healthy” or “Fit” to Have Back Pain 

You may eat right, exercise regularly, and enjoy good  health, but that doesn’t mean you can’t experience back pain.  Having been a personal trainer for many years, I’ve seen a lot  of people in excellent shape who suddenly find themselves  with lower-back trouble. The reality is that people who  exercise frequently are just as likely—if not more so—to  develop back pain. Certain groups of athletes—including  runners, cyclists, swimmers, dancers, gymnasts, and  bodybuilders—are prime candidates for back problems.

Cyclists, for example, spend hours in a hunched  position—a position that’s not natural for the body to  maintain over long periods of time. This causes a number of  problems, as you’ll discover shortly. In addition, the constant  repetitive motion of peddling a bicycle overworks one set of  muscles while underworking another. These imbalanced  behaviors are very common in many people, and frequently  they create conditions in the body that lead to back pain.

The same thing can happen to nonathletes. Even if you  don’t do any of the above-mentioned activities, your workout  program can create problems if you’re concentrating too  heavily on certain areas of your body—making the pain  worse—while neglecting others. Being fit doesn’t necessarily  mean that your body is well-balanced or devoid of other causes that could lead to back pain.

Mistake #4:
Treating Only the Symptoms 

The majority of the treatments people receive—including  cortisone shots, anti-inflammatory drugs, ultrasound,  electrical stimulation, and the like—address only the  symptoms of pain. You must understand that pain is merely a  signal that something is wrong. Even if you get rid of the  pain, the problem is still going to be there.

Here’s an illustration: Suppose the oil light comes on in  your car. You could put a piece of duct tape over the light,  which would eliminate the aggravation, but it won’t solve the  problem. Your engine is still going to need attention. And  unless you do something about it, it’s only a matter of time  before it will break down.

It’s the same with pain. You’re hurting because your body  is suffering some sort of stress or strain. If you don’t address  it, you’ll continue on with your “oil light” lit, so to speak,  until something breaks down. Unfortunately, such a  breakdown is usually very painful.

Mistake #5:
Not Understanding That Back Pain Is a Process 

Most of the time, back pain, neck pain, and sciatica take  weeks, months, or even years to develop. Usually, you’re not  aware of a problem until something starts to hurt. But rarely  is back pain the result of a one-time incident. Barring an  injury like a car accident, back pain typically doesn’t happen  overnight. And even if a fall or an accident did trigger pain for  you, the fact is that before the event you likely had several  “hidden causes” placing unnecessary strain on your body.

Consider this example. Many of us sit for hours a day,  especially if we’re required to work at a computer or be in the  driver’s seat of a car or truck. The body wasn’t made to sit  that long. (That’s why we’re seeing so many cases of back pain  now as compared to several decades ago.)
Sitting puts extra pressure on the spine. It also shortens the  muscles in the front of our hips and the backs of our legs  while weakening others, like the ones in the rear end and the  abdomen. To make matters worse, most of us adopt poor  posture when we’re sitting. The shoulders round, the head  juts forward, and the back curves like a “C.” When we stand  up again, we feel that tightness in the backs of our legs and in  our hips, and most of us retain that stooped posture even  when in the upright position.

Imagine that the front end of your car is out of alignment,  which causes the tires to wear unevenly. This also can happen  to your muscles. Doing one thing over and over (such as  sitting with bad posture) can throw the body out of its proper  alignment, forcing it to adapt and work at strange angles.

After a long period of operating this way, certain muscles,  tendons, ligaments, and joints wear down, while others that  are barely used become stiff and weak. The end result of this  long process is often a condition like back pain, but it also can  manifest itself as many other conditions, such as foot pain,  knee pain, hip pain, shoulder problems, carpal tunnel  syndrome, and dozens of others.
Unfortunately, X-rays, MRIs, and CAT scans don’t reveal  much of the uneven wear and tear we’re talking about here, so  many people are unaware of what has caused their pain. Even  after undergoing treatment that may give them some relief,  they have failed to address the underlying causes, setting them  up to likely have to deal with this problem for a very long  time.
 

Mistake #6:
Believing There Are No More Options Left 

After suffering back pain for a while, and trying various  treatments, you may tell yourself that surgery is the only  option left or—even worse—that you’ll just have to learn to  live with the pain.
If you’ve experienced little success, you may  understandably feel tired of trying. My “message of hope,” so  to speak, is that pain is not your problem. Determining what  is causing the pain is the problem. When you can get to the  underlying, often hidden cause of your back pain, it becomes  much easier to treat successfully.

Most practitioners try to get rid of back pain without ever  really trying to figure out what’s causing it. For example, two  people can experience the exact same level and location of  back pain, but for wildly different reasons.

Let’s say you’ve tried physical therapy, but it didn’t work  for you. It’s not that physical therapy doesn’t work; the  problem is that the therapist didn’t have you doing the right  combination of things to address the specific causes of your  pain. Remember: Pain isn’t the problem. It’s just a message  that you have a problem.

Forget about treatments that try to make the message go  away. Until you’ve attempted to figure out what’s causing the  pain, you haven’t come close to exhausting your treatment  options. In fact, I’m willing to bet that there are several  treatments you likely have not tried (maybe never even heard  of) and I’ll tell you about these later in this blog.

Mistake #7:
Failing to Take Control 

Many back-pain sufferers look to others to make them  well. The problem with this is that no one cares more about  your body and health than you do, and in the end, you have  to take the steps necessary to allow and assist your body to  heal.

A medical doctor looks at back pain as a muscular  problem. Prescribe the right drugs, he believes, and the  problem goes away.

The surgeon sees it as a disc or vertebrae problem—a  bulging disc is putting pressure on a nerve. She thinks that by  cutting away the problem, it will go away.

The acupuncturist feels that back pain is related to poor  circulation within the body. By using acupuncture treatments,  he encourages better circulation and believes that it will  stimulate the body’s natural self-healing powers to kick in.  The chiropractor sees back pain as a misalignment of the  spinal column. She thinks that by manipulating the spinal  column into alignment, she will fix the problem.
These treatment approaches are all partially right.

The challenge with back pain is that the cause is different  for each person—and often involves a combination of factors.  Because no back pain practitioner is well-versed in all these  areas—nor overly knowledgeable about matching conditions  with treatments—nobody other than you will ever consider  the “big picture,” or holistic aspect, of what’s causing your  pain.

This is why I found relief only when I took charge of my  own care. I certainly called on others when appropriate, but I  was personally responsible and determined to get rid of the  problem once and for all.

I encourage you to adopt the same attitude. As you read  the chapters that follow, you’ll come to understand what’s  going on with your body and learn how to finally get the  lasting relief you’ve been looking for.

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