Category Archives: back pain relief

Think Your Pain Symptoms are Caused by a Structural Problem? Think Again.

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Have you or a loved one ever been in that uncomfortable position of asking a health provider:

“What is the cause of my back pain?

“…shoulder pain?”

“…neck pain?”

or some other painful condition? And your well-meaning nurse, doctor, or physical therapist was kind enough to do a “diagnosis” with an MRI or X-Ray, solemnly telling you afterward that the cause was:

a torn rotator cuff

degenerative disc disease

disc protrusion

or some other scary and official sounding “cause”? And those explanations sound convincing, do they not? If a person has intense and recurring back pain and someone shows them an x-ray with a “herniated disk” that disk must be the cause, right? After all, SOMETHING must be causing the pain. It is difficult to not associate pain that with some type of structural abnormality…especially when someone who is supposed to be an authority on pain tells you so.

But do structural anomalies cause pain?

Is it true that disk protrusions, torn rotator cuffs, herniated disks and the like actually cause pain? It’s not a trivial question. If a surgeon believes a spinal problem is causing a pain symptom, he or she may want to conduct an expensive and invasive surgery to “fix” the structural “problem.” The “cure” could cost tens of thousands of dollars and require months of recuperation. It might be nice to know if structural abnormalities are a necessary and sufficient cause of pain.

I’m not going to directly answer the question of whether so-called structural problems cause pain symptoms. You will have to be the judge. I will give you some information from several studies that demonstrate how many people with structural issues are, in fact, pain-free. In other words, the research shows that some people have pain “causes” and yet do not report pain symptoms. Let’s begin.

Pain and the Lower (Lumbar) Spine

The first research I will cite was conducted in 1991 and reported in the Journal of Neuroimaging (cited in PubMed). The researchers used magnetic resonance imaging (MRI) to examine the lumbar spine (the lower part of the spine) of 66 asymptomatic people. Asymptomatic means they had no back pain.

Given that they had no back pain, they had structurally perfect lower backs, right?

Not so fast.

Twelve of the people in the study (18%) had either a disc protrusion or a herniated disk of some kind. Twenty-six of the people in the study (39%) had a bulge that could associated with degenerative disc disease. In addition, there were many other structural issues found, including spinal stenosis, and narrowed nerve root canals. The researcher’s conclusion? “Degenerative disc disease is a common finding in asymptomatic [pain-free] adults…”

Pain and the Cervical Spine (Neck Region)

Next up, a more recent study, reported in 2005 in the European Journal of Radiology (PubMed). This study examined the cervical spine of 30 pain-free individuals. The cervical spine is the seven vertabrae at the top of your spine, beginning at the base of the skull and ending near the top of your shoulders. Again, 30 people who have no reports or history of pain near the cervical spine likely have no structural problems in that area, right?

Au contraire.

An astounding 73% of the sample (22 of 30) had a “bulging disk”! Fifty percent of the sample had a “disk protrusion”. The thought occurs to me that if the majority of the sample had a bulging disk perhaps having a bulging disk is normal? In that particular sample it certainly was not out of the ordinary. Let’s do one more.

Shoulder Pain and the Rotator Cuff

This one is from the Annals of The Royal College of Surgeons of England and was published in 2006 (Full-text online: Dead Men, and Radiologists Don’t Lie). This study is a review study, meaning they did a review of many different studies that had already been conducted. They reviewed the prevalence of rotator cuff tears in people who had reported pain and people who had not. Interestingly, they reported on studies of living people as well as cadaver studies of people who had died. In the cadaver studies, on average, people who had pain symptoms in the shoulder area had rotator cuff tears at a rate of 42%. Meaning that only 42% of those who were in pain had a rotator cuff injury. And for those without any pain? About the same: 39% of them had injuries.

The study of living people was a bit different. According the the studies 26% of pain-free people had rotator cuff injuries and 49% of those in pain had injuries. The researchers concluded that “rotator cuff tears demonstrated radiologically during investigation of the shoulder may well not be responsible for the presenting symptoms.” In plain english, rotator cuff injuries might not be the cause of pain symptoms.

You’ve got the take home message by now? According to the research, pain and structural problems are not necessarily related. Be wary when someone tells you that they are, even if they have an X-Ray or MRI scan to “prove” it. Get a second opinion. Look for other factors.

I am not a medical doctor, nor am I giving medical device. I am merely reporting on the literature that has been produced. Do not make any medical decisions based on my opinions.

Some Common Delusions of Physical Therapists

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I would like to give a nod to Barrett Dorko and his article: The Matrix and Me, where he lists some common illusions of therapists (I assume physical therapists). Dorko is provocative writer and I recommend taking a look at his work.

From his article:

Traditional Therapeutic Illusions

In my experience most therapists (this occasionally includes me) practice clinically as if certain things were true despite the fact that researchers have learned that they are not. Here’s a short list of what I call “therapeutic illusions”:

Strength and posture are related

Pain and posture are commonly related

Strength and pain are related

You can stretch connective tissue with your hands

You can reliably palpate vertebral joint movement”

I have no idea what “palpate verbal joint movement” means nor do I think about “connective tissue” when I work. But I agree with Dorko on the first two illusions . Do you agree that the beliefs above are illusions?

Are pain symptoms and posture unrelated?
Are strength and pain unrelated?
Are they completely unrelated or just occasionally unrelated?
Or occasionally related?

I believe what Dorko is talking about above is the medical model idea that pain is the result of dysfunction or structural problems in the spine, nerves, joints or elsewhere. That is, if a person has chronic back pain, there MUST be a pinched nerve, degenerated disk, herniated disks (etc.) that is causing the pain. This type of thinking can lead to drastic interventions such as invasive surgery to “fix” the spine. But is the thinking correct and does the research bear this out? (I believe the answer is “No.” But it has been several years since I have read research in that area.)

Does your own experience as a Feldenkrais practitioner match what Dorko is saying?

Let me know your thoughts.

(A special thanks to Robbie Ofir for mentioning Dorko on the FeldyForum several months ago. I learned about him there. Dorko has some interesting essays that are well worth a read: Dorko’s Desk. )

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Free Feldenkrais-Based Back Pain Relief Workshop

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Ready for some more open-source, share-and-share-alike Feldenkrais resources? Good!

Back Pain Relief Transcripts Based on the Work of Dr. Moshe Feldenkrais

A group of open-source, Self-Awareness Through Movement lessons, designed to reduce and eliminate back pain, as well as improve the movement of your entire spine.

Based on the work of Dr. Moshe Feldenkrais, these sessions are also available for sale as audio downloads: Feldenkrais Back Pain Relief.

The session names are:
1) Primary Movements of the Back
2) Turning Through the Spine
3) Relax and Move the Back
4) Moving Through the Spine:

All transcripts are in word document (doc and docx) and pdf format. Click to Download:

Back Pain Relief Transcripts

Creative Commons License

Do you now one other person who could use these? Please consider clicking the button below to send them an email.

Eliminate Back Pain Workshop Audio + Transcripts

My “Eliminate Back Pain” series has recently been updated, with 4 new sessions to help eliminate back pain while sitting.

For practitioners who want to teach their own back pain workshops, I have also added an option that includes transcripts of the 11 Feldenkrais-based sessions. You could be up and running and teaching your own back pain workshops in just a couple of days.

Full details at my Feldenkrais mp3 (downloads) store. These products come with an unconditional money-back guarantee. And I will keep a back-up copy for you in case you have a hard drive crash or otherwise need them replaced.

cheers! – Ryan

Feldenkrais: Free Your Ankles, Free Your Back

I’m taking some time to do Ruthy Alon’s Feldenkrais, Awareness Through Movement series, called “Free Your Back.” (I don’t know where you can buy the series, I bought mine at the FGNA conference in Portland last year.) I’m doing the series for a number of reasons, not the least of which is research – I am readying a follow-up volume to my Feldenkrais Back Pain Relief mp3 download series, called “Eliminate Back Pain Now.” It’s always good to see what other practitioners have done already.

I discovered a fascinating thing while doing the series. It was something that made me feel like a rank beginner. Somehow, over the last few years (or decades?) I had lost a great deal of movement in my ankles. Doing a particular lesson in the series, dropping down into the ground while standing, bending my knees, keeping a soft back and flexing my ankles so that I could drop down further…at some point…I realized that there was an additional amount…a HUGE amount…that I could easily and safely flex my ankles. The movement reverberated through my entire system, evoking ease and flexibility throughout.

I’ve done similar movements on my own, in trainings, in workshops, but somehow this time, it really “clicked” and I perceived the pattern.

A few minutes later, I went into my kitchen to get some soup. The soup is in the lowest cupboard, just a few inches off the ground. When I bent down to get it, I rode down into the crouching posture as if my joints had been oiled with warm butter. Hmmm. Love it.