George Russell, M.A., D.C.
GR3The Mysterious Case of Sam
"Why do I have this pain?"  It's a question we often ask our doctors.  And yet, as often, we aren't really interested in gaining a deeper understanding of the dynamics of the pain.  We want the pain to simply go away and never come back. 
When it's possible for me to make a patient's pain go away, never to return, I'm happy to do so.  But my real interest, my deep desire is not in fixing-it is in the transformation of the patient.
Each one of us has completely different underlying dynamics, and therefore we have different issues to resolve in order to find wellness.  In my years of working with people and pain, I've found that no two "low back pains" are alike.  While pain may exist in the same place on each person's body, the cause of the pain varies from person to person.  The thoughts and feelings connected to the pain, triggered by the pain, vary as well. 
The path to healing, then, must to be adapted to each individual.   
Sam's Rib
Sam is a new father and a member of a delightful and brilliant family that I have been treating for several years.  He came to me last year with ribcage pain that only occurred at night while he was sleeping.  Invariably, the pain would wake him.  Sam and I discussed his physical regime (he is an athlete), the type of bed he sleeps on, and his sleeping position.  Through movement analysis, I discovered a postural problem that was putting stress on his back.  I fitted him for orthotics to help correct his posture, and coached him on how to stand, lie, and stretch the tight areas of his back.  After that initial visit, Sam checked in with me by phone or e-mail every once in a while to discuss his on-going problem as he changed jobs...and diapers.  Sam was paying attention to his posture, and was very open to thinking in larger ways about what might be causing his pain, but his pain mysteriously persisted.
Our habits can be mental, emotional or physical.  Habits of posture and behavior, even habits of thought come from and create sensations, pleasurable and painful.  We may be able to co-exist with our habits for decades without an awareness of them, and therefore without feeling the need to change them.  But when a long-held habit crosses paths with an event-whether it be a happy event, such as the birth of a child or a new challenging job, or an unhappy event, such as an accident or an illness-injury, and then pain, can occur.
We all now know that psychological pain can lead to physical pain.  Feelings are called "feelings" because they have a physical component to them.  But that doesn't mean that our pain always and only is "in our minds."  Any person with chronic physical pain will carry around psychological pain, and the words and actions of this person can often-to the frustration of friends, partners and doctors-seem to come from "psychological problems."  Conversely, the patient who has the desire for deeper understanding of the dynamics of his or her pain will question and examine all the corners.  The thoughtful patient will not only search for a structural solution but will examine job and leisure activities, the way he or she walks, sits, and sleeps, and, of course, the thoughts and feelings that come from and give rise to action and feeling.
Diagnosis is not merely a conclusive definition of the patient's problem.  While Sam did indeed suffer from "rib misalignment" and "muscle spasm," we both understood the limitations of that description.  Rather, diagnosis is a creative and collaborative art.  It is a dialogue that begins in the doctor's office and continues on in the mind and body of the patient.  It is a hunch that leads you to try a remedy.  Then you evaluate the result and make your next move.  And the process continues.
A few weeks ago, I received a most rewarding e-mail (abridged, here) from Sam:
Dear George,
I want to give you an exciting update on my back pain.  As you may remember, the pain started early last summer.  It only occurred after I had been sleeping for awhile.  Sometimes it would be so painful that it would wake me, and I'd have to get up for awhile.  When it was really bad I felt like my torso was in a vice grip.  I saw you and had insoles made for me, and I used some of the exercises you prescribed for awhile.  Things seemed to get better, though the pain never went away completely.
Something made me think that the remedy had to be mental more than physical.  I knew back pain is often the effect of stress and tension, but I didn't know what to do with that.  But at the same time, at some point I just thought, this is ridiculous.  It did not feel like any physical work was going to help.  Even when I did yoga regularly it had no impact.
I decided to order one of John Sarno's books; a friend had told me about him a few years ago.  I got "Mind Over Back Pain" and skimmed through it in a day.  I couldn't really relate to the patients in the book, I wasn't much interested in his medical explanation, and the message about back pain stemming from tension was pretty simple and easy to grasp.  The thing is that I feel like I'm a pretty self-expressed guy, so it was hard for me to imagine that I was holding onto some tension that needed expression.  But the book did get me to start turning that question over in my head.  Where was I holding onto tension?
Then a night or two later as I was experiencing back pain at around 3am, the thought occurred to me that the impact that the back pain was having on me was to wake me up at night--just like Naima does every night to feed Gabriel.  Don't get me wrong, I'm not a guy who just lets his wife do all the night time work.  After Gabriel was born I'd get up to change his diaper and keep her company a few times each night.  But lately we'd fallen into a pattern where he was feeding just once or twice a night, and I was sleeping through it.  I began to think that it was okay for me not to get up. 
I realized though, that the pain had started during Naima's pregnancy, when her own discomfort was keeping her up.  Classic case of sympathy symptoms, I thought.  Looking back, it was around when she got more comfortable that the pain lessened.  And it was only lately, when I'd started to sleep through Gabriel's nighttime wakings, that my pain got stronger.  And while Naima was willing to get up on her own at night, she was clear with me that she appreciated the "moral support" when I got up at night, even if for a moment or two.
So, I thought, I get it.  This pain is a reminder to me to wake up at night.  That's what it does to me in actuality anyway: causes me to wake up.  And so this week I decided that I would wake up when Gabriel woke up.  I told Naima, "When he gets up, I'll get up."  

And then I started talking to the pain.  I'd feel it and say, "Thank you for the reminder, but I've got this."  In other words, I've got it taken care of.  On Wednesday night, I noticed that the pain had shrunk to a specific spot in my ribs.  Still strong, but not all over my side.  And then last pain!  A little tightness, but not the sharp pain I felt before.
I hope I'm not writing you too soon (knock on wood), but I think I figured this out.  I'm very excited.  I'm trading dealing with the back pain for soothing Gabriel or helping Naima--a great trade by any measure. 

Sam is the patient's real name.  He was happy to be the subject of this newsletter, and to have his e-mail reprinted.

Have you heard of gyrotonic?  It's a fitness technique that creates strength, length and freedom in the spine with simple movements that just about anybody can do.  I've been doing it myself for some time, but this winter I had a  painful right shoulder injury, and now it's gone, due mostly to gyrokinesis, which is a form of gyrotonic done without equipment.  My teacher is Aviva Geismar, a brilliant teacher who assists many of the classes I teach.  I'm taking Aviva's weekly class on Fridays 1:30-2:30 PM , right near my office.  To learn more about  this class, or about Aviva and her teaching, email me or click here.
Got resilience?  This is from the Tao te Ching, translated by Stephen Mitchell.  It was brought to my attention by the acupuncturist in my office, Corey DiStasio:
Men are born soft and supple;
dead, they are brittle and hard.
Plants are tender and pliant;
dead, they are brittle and dry.
Thus whoever is stiff and inflexible
is a disciple of death.
Whoever is soft and yielding
is a disciple of life.
The hard and stiff will be broken.

The soft and supple will prevail.
Four week resilience group this summer!  Thursdays, June 18 - July 9th.  Sign up in advance; space is limited!
George Russell, M.A., D.C. | 101 Fifth Avenue, Suite 10C | between 17th and 18th Street | New York, NY | NY | 10003