The first thing to consider is, "What is the origin of the sharp or sudden pain of a back injury?" To some, it feels like a sharp, stabbing pain; to others, a seizing grip that interferes with breathing. Perhaps it is just that: the seizing grip of muscles going into spasm, causing stabbing back pain and interfering with breathing, nothing more.

Back Pain Treatment and Physical Therapy

Medical practitioners, including physical therapists, face a peculiar quandary with regard to back pain and muscle spasms in general: so often, the pain they encounter in their patients comes from muscular spasticity, so much of their effort goes into ending muscular spasms, and yet so many of their patients return with the same muscle spasms and back pain for which they have been treated in the past. According to one physical therapist, the likelihood of a patient who has had back pain returning again with the same problem is about 80%.

Let's take another look at back pain, in particular.

Overview Of Back Pain And Muscle Spasms

Unless you have had a violent accident, your back pain, whether sudden or chronic, has been coming for a very long time. Muscular tension builds up for a long time before crossing the point of no return and becoming a back spasm. Then, like the straw that broke the camel's back, a small movement is sufficient to trigger a crisis.

We return to the quandary of back spasms. What causes the build-up of tension? What controls muscular tension?

The answer may be obvious to you: your brain controls your muscular tension; your brain causes your muscles to go into spasm.

Why?

Muscle Spasms -- Usually a Brain-Conditioning Problem

Here, the answer may not seem so obvious -- but obvious it is when you think about it: brain conditioning. Your brain, the master control organ of your muscles, is an organ of conditioning (learning). People acquire their tensions through conditioning: repeated overuse, repeated overstrain, repeated stress. Repetition leads to habit formation and habit formation leads to involuntary habits of tension. Back pain is a nervous tension habit conditioned into you through the repetitive strains of life. At that point, your nervous tension is no longer a reflection of a momentary emotional state, but set in the habituation operation of your brain and muscular system.

So the problem is simpler than you might expect. You probably do not have a medical problem; you probably have a conditioning problem. With tingling or numbness, the muscles of your back are so tight that they are pulling your vertebrae (the small bones of your spine) so close that they are pinching nerves. By relaxing those muscles, you can take the pinch off the nerves.

Fortunately for those using the right methods, a muscular conditioning problem can often be cleared up fairly quickly -- past experience notwithstanding.

Perspective on Therapeutic Methods to End Back Pain

The problem with most methods used to relax muscles -- mental methods, manipulative methods, therapeutic methods in general --is that they may not adequately teach muscular control. Muscular control has two parts: the ability to create muscular tension and the ability to relax muscular tension. Both abilities are needed; otherwise, you are either musclebound (and prone to cramping) or weak. Such methods also often neglect an important part of control: sensory awareness. Too often, people are given therapeutic exercises but no instructions in how to do them; they're told, "These are strengthening exercises," so people go for strength instead of control; they go for effort instead of sensory awareness. If you can't feel how to regulate your muscular tension, you can't feel how to relax your muscular tension. You feel pain with no connection to the sense of contracting those muscles to the point of fatigue. Progress comes slowly, at best, from working too fast and too mechanically.

So you need to improve both muscular control and the ability to feel your muscles.

Then, you develop freedom of movement, and then, you can relax more completely than you ordinarily do and stay more relaxed without thinking about it. "Freedom of movement" means it's your natural state.

To, show you how do-able this is, I'll present some coordinated movements that can often restore your comfort. Before I do, read and understand the following instructions:

(NOTE: If your problem is severe, (numbness or tingling in your extremities) see your doctor to rule out a medical emergency. That done, find a Hanna Somatic Educator (for fastest results) or use the procedure shown below or other self-help resources found below.)

Simple Somatic Coordination Exercises to Help End Back Pain

• Do these movements as a way of creating sensations of movement.
• Move slowly and smoothly.
• Be gentle, working within the range of sensations you're willing to experience. Done gently, they are safe to do even with disk problems. If in doubt, consult your physical therapist before proceeding.
• Always separate repetitions of a movement with complete relaxation.

If you do these movements mechanically (for example, by counting repetitions instead of feeling movement), if you do them too quickly or too hard, you deprive yourself of the sensations needed to discover your own control over yourself. You may make yourself tighter, instead of looser. You will get better results by doing too little than by doing too much. You will have an easier time if you have somebody read these instructions to you. The movements should feel comfortable to do; if they create pain, do a smaller amount of movement. Move more slowly, more gently.

A: STARTING POSITION:

• on your belly
• face turned to the right
• right hand under your left cheek (like a pillow, palm down)
• left arm loosely by your side

1. Slowly lift just your left leg.

   Feel the first sensations of muscular effort. Go slowly.

2. Slowly lower your left leg.

   Feel the last sensation of relaxation, as it happens. Take a deep breath and let everything go.

   REPEAT THIS LEG LIFT FOUR (4) TIMES AT DECREASING LEVELS OF EFFORT.

3. Simultaneously lift your left leg, head, and right arm.

4. Slowly lower yourself down, take a deep breath and relax all the way.

   REPEAT 4 TIMES AT DECREASING LEVELS OF EFFORT, THEN SWITCH SIDES.

B: STARTING POSITION:

• On your back
• knees up
• feet near your buttocks
• Fingers interlaced behind your head.
• Elbows out flat on the floor

1. Arch:
   • Inhale.
   • Gently, gradually turn your tailbone down into the surface (arch your low back).
   • Gently press your elbows down.
   • Tug your heels toward your buttocks and hold.

2. Curl:
   • Begin to exhale.

   • When you can feel your back tighten, relax your back and gradually press your back onto the surface.
   • Bring your elbows together. (pause)
   • Press down on your feet.

   • Continue to exhale.

     Use equal strength to curl as you did to arch.

   • Point your elbows at your knees.
   • Curl forward and look at your knees.
   • Exhale completely.

   REPEAT THIS "ARCH AND CURL" MOVEMENT FOUR TIMES MORE AT DECREASING LEVELS OF EFFORT.

Dr. Hanna's definitive article on clinical somatic education: "Clinical Somatic Education - a New Discipline in the Field of Health Care," by Thomas Hanna, Ph.D.

See also: "The Psoas Muscles and Abdominal Exercises for Back Pain"

Lawrence Gold served for two years on staff at the Wellness and Rehabilitation Center of Watsonville Community Hospital, California and for two years as part of the Novato Institute training team for new practitioners. As part of the team, he presented Hanna Somatic Education at Esalen Institute, Big Sur, California.

He has published books for professional practitioners and movement therapists, and self-care instructional programs on back pain and movement health, for the general public.

Click for a preview of the self-help program, Free Yourself from Back Spasms.