Degenerative Disc Disease – Neck and Back Pain

Is Degenerative Disc Disease Causing My Neck & Back Pain?

At the age of 42, after an MRI, I was diagnosed with Degenerative Disc Disease. I also had two bulging and one herniated disk. I went home, crawled into bed and cried, convinced that my body was aging beyond repair, and it would be all downhill from there. That was fear. Not fact.

What I now¬†know and want to share with you is that degenerative disc disease may just be a normal part of aging, not a disease at all! “Consider the results of a major 2014 review by Brinjikji¬†et¬†al: signs of degeneration are present in very high percentages of healthy people with no problem at all. ‘Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.*'”

The Bad News    

Yes, your neck or back hurts and your doctor just told you that you have a condition with the word¬†‚Äúdegenerative‚ÄĚ in it. You can‚Äôt even bend down to feed the cat in the morning because your back is so stiff and painful. Or¬†maybe your problem isn’t so much having¬†back pain, but your foot is numb. Or you have pain, numbness or tingling in your buttocks, knee or calf. It‚Äôs been going on longer than you care to admit and nothing seems to make it better.

The Good News

Remember:¬†that MRI is not the whole story. In fact studies show that there is a low correlation between a scary MRI and low back pain. “Low back pain experts have long understood that you simply cannot reliably diagnose low back pain either with MRI, or with X-ray.

Okay fine, you say, but¬†you still have¬†back pain, which is why you got the MRI in the first place. Here’s where the good news comes in.¬†You can get better. More likely than not, you can return to a completely pain-free life. With the right treatment and a few targeted exercises, you can restore¬†flexibility to your spine and become stronger than you‚Äôve ever been. You will probably need to learn a few postural adaptations, especially at your computer, along the way.

The other good news is that this is a wake-up call while you’re still fairly young. Treatment might include gentle back and hip flexibility exercises using¬†a gentle, healing¬†breath to ease your body and mind. You might learn¬†a few¬†postural tips¬†and¬†appropriate core strengthening exercises. Later your treatment might include yoga back strengthening with other exercises to make your hips and legs stronger. You might find that not only do these exercises¬†make your back feel better, you look better, too. And who doesn’t want that? With a stronger core, you might find you have more energy. (P.S. the core refers not only your belly muscles, but all of the muscles surrounding your pelvis – side hip muscles – glutei medii and minimi, the glutei maximii (your glutes), your pelvic floor and efficient, coordinated use of your breath with movement.) The strengthening usually comes after we’ve got a handle on your pain. (Beware treatments that load you up with weights for strengthening from the get go – I’ve had too many patients come to me after that kind of therapy. Their pain didn’t improve or sometimes it got worse.) Continue reading “Degenerative Disc Disease – Neck and Back Pain”

The Role of Posture in Back Pain

Part I – Coming to the Floor

Image from Gray’s Anatomy 1932

Yoga can be an excellent modality for managing and healing low back pain. Just as many poses in Yoga are ideal for healing certain kinds of back pain, other poses may make back pain worse. It depends on the nature and cause of your back pain.

I agree with Robin McKenzie, a New Zealand Physiotherapist, that poor postural habits play a big role in most back pain. McKenzie has developed a body of work that successfully treats back pain. Many of the exercises that are prescribed by the McKenzie are the same postures that can be found in many gentle or beginning Yoga classes. (Unfortunately, many of these same postures have been dropped from more advanced Yoga classes today.)

We live in a world in which we are sitting — at our desks, in front of the television, at our computers — for many hours of the day and night. We sit in slouched postures, with our spines rounded forward, our heads jutting forward (check out your posture right now). The position of the spine in this curved forward “C” position is called flexion. We have four natural spinal curves, at the neck, the thorax, the lumbar and the sacral spines which form a gentle S from the top down. However, with the demands placed on us from early childhood, when we begin to sit at uncomfortable desks, we begin to alter our natural spinal curves. We begin to lose our ability to find a neutral, or comfortable, position. We begin to slouch. We slouch when we’re sitting. We slouch when we’re standing up.

We slouch because we can’t find a comfortable position in which to counter gravity, a constant force pulling on our bodies. When we give into dysfunctional postural habits, then we end up fighting gravity, one of the strongest forces in the Newtonian universe. What happens next is that the anti-gravity/postural muscles in our necks, extending to the entire length of our spines begin to overwork. As they overwork, they fatigue. As they fatigue, they begin to hurt. It’s not that we don’t try to sit up straight, but we end up slouching because we don’t have the strength to maintain an upright position anymore. It becomes a vicious cycle.

These long muscles, the erector-spinae muscles, extend in series from the base of the skull to the sacrum. In a slouched posture, not only do they overwork and become tense, but at the same time they become over-lengthened, weak and painful. They are not able to do their jobs in holding the trunk upright against gravity. Once these muscles become weak and over-lengthened, other muscles in the hips try to compensate. The hip muscles, working to keep the body upright against gravity, depending on their placement and your anatomy, become short, tight, weak and painful.

At the same time, the Core muscles, the deep abdominal and pelvic stabilizing muscles surrounding the hips, become weak and flabby. Breathing is often shallow. With a slouched posture, the ribs are compressed in the anterior body and the diaphragm, the primary muscle in breathing, is placed in a disadvantageous position.

The body may feel tense and tired. Trying to sit or stand erectly becomes more and more difficult. Our bodies are out of balance and out of sync with gravitational pulls. The body ends up fighting gravity rather than working efficiently within the gravitational field.

How do we restore balance to our bodies?

The best way is to go to the mat, to the floor, where the body can rest into gravity, without having to fight it. The flat surface of the floor provides maximum support and feedback to a body out of sync. Once lying on the floor, you can begin to realign yourself, front-to-back, right-to-left, head-to-toe. The four spinal curves are supported. Where the spine is rotated, a common occurrence in people who suffer from back pain, it can begin to unwind.

The body craves balance. Coming into the floor, embracing gravity and relaxing into it, combined with breathing mindfully, is the beginning of healing your back pain.

 

Mindful Advice for a Painful Shoulder

This was written to a patient after I had seen her for an initial treatment. She had developed a painful shoulder from shoveling snow earlier in the Winter.

You may want to notice your shoulder at different points during the day, or at night, or in the morning when you’re still in bed. Just quietly become aware of extra tension or holding in that shoulder. Then, breathe into it gently a couple of times.

It may relax, or it might not. What’s important is to gently become aware of what’s going on with an accepting mind and then to breathe WITH the tension, discomfort or pain. It isn’t necessary to have a goal to change the feeling, but simply to notice it and to breathe into and with it.

I’m passing this along because when I woke up this morning, I became aware that I was holding my left shoulder, one with a chronic & old injury, in a tense and elevated position. Then, I took a quiet, mindful breath into my shoulder and watched it unwind from the tense holding pattern that had crept into it.¬†Amazingly, it felt much better once I noticed the feeling of tension and holding in the shoulder.

Sometimes we hold our hurt wings with tension, in anticipation of pain. This can set up a pain, holding/spasm, pain cycle just like an injury can. But the tools of awareness and breathing mindfully can help relieve the fear of anticipation to derail the tension/holding/spasm before it gets going.

Try this the next time you wake up with pain: Notice it. Accept it. Breathe with it. Then see what happens and get on with the day.

How Yoga Physical Therapy Works With Pain

Day 2. I started this blog because I want to get the word out about NY Yoga Physical Therapy. Sometimes I come home after working with a patient who has chronic pain with a great idea that we discovered during our session, and I want to share it. So this is a way to get me started writing about the work, to explain what it is that we do in Yoga Physical Therapy.

First and foremost, I look at the body with the eyes of a Physical Therapist. The training was the best I could find for understanding the components of the human body and how it moves in space. From my background in dance and yoga, I became a Physical Therapist because I was hungry to know about muscles, joints, the nervous system, and how it all fits together. Then, by studying the pathology of injury and disease, I learned what happens when something goes wrong. My job as a Physical Therapist is to find a way to help the injured body in pain recover. These 20 plus years of working with injuries and disease have only increased my understanding and intuitive approach.

Yet as great as the Physical Therapy training was, it didn’t give me a way to deal with the whole person. Often I would find people were tense, upset and holding tension in their bodies, especially those with low back pain, upper back pain, neck pain and those with frozen and painful shoulders. (I also see people holding tension in their feet, knees and hips.) At first, I didn’t know what to do with this growing observation. I wasn’t trained in how to deal with stress and the psychological components of pain, disease and injury.

Once I consciously started practicing holistically, incorporating Yoga, mindful breath work and other holistic practices into the sessions, I began to be able to help people help themselves with the effects of stress held in their bodies Рphysically, emotionally and psychologically. The introduction of the breath, not only into the exercises, but as a separate activity in itself, began to transform the effectiveness of the therapy sessions, especially in those with chronic neck pain, upper back pain, middle back pain and low back pain.

By helping you learn how to breathe into area injury and pain, you become aware of your own experience of feelings, holding, tension and tightness in that area of the body. On a physical level, getting breath into a tight or tense area literally begins to open up the area. As the muscles relax, they loosen their hold on the bones. The affected bone(s), pulled out of line by an overactive muscle, can begin to relax back into place. When the muscle, then the bone(s), release back into a relaxed state, then the affected joint can begin to realign itself. Yes, you can learn to breathe into targeted areas of the body. As the body relaxes, or disinhibits from tension and pain, then the breath can freely move the trunk.

Secondly, blood does not flow freely through tense muscles. So another result of using a mindful breath is that it helps muscles to relax. Relaxed muscles allow blood to freely circulate through these affected muscles. With more blood flow, more oxygen gets into the area. More oxygen equals more healing. The molecules and chemicals for healing can now get to get to the injured, painful area. Not only that, but the byproducts and waste molecules from cellular respiration Рor cleaning up the debris from the injury Р is now able to move out of the area more quickly. This aids in decreased swelling, inflammation and therefore improved healing.

On the psychological level, mindful, meditative breathing is documented to lessen the effects of stress, including lowering blood pressure and decreasing heart rate. It lessens¬†the effects of cortisol, the stress hormone of the fight-or-flight reaction. As a person becomes more aware of ¬†bodily tension and learns to breathe into it, often the emotions or thinking that contributes to that tension begin to loosen their hold as well. As the mind begins to relax, so too does the body. Once the body begins to relax, so do the mind and emotions. It’s a dynamic, interactive process.

I’ve had patients thank me for helping them to identify and learn to work with the stress that is contributing to their pain and injury. Once they developed an awareness that they were holding tension in their backs, necks, feet or hips, they were able to begin working with, and begin lessening, that tension. Their pain started to go down, too.

For one patient with chronic back pain and neck pain, a sudden¬†awareness and acceptance¬†of how he held¬†tension in these areas was the turning point in his treatment. He said, “I thought about what you said last week about accepting the discomfort. And over the weekend, I got it. It was weird, but my experience of the pain changed.” He stopped therapy shortly after.

Awareness is key. So is acceptance. With aware breathing into an injury, combined with specifically targeted positioning or stretching of the body, the healing process is powerfully supported. Using a gentle and mindful breath also gives us an effective tool to support the entire healing process, body and mind. Paradoxically, acceptance of pain can reduce the anxiety and fear surrounding it, which then contributes to the relaxation of the tension that we hold because these feelings.

Sharon Gary of Yoga Physical Therapy in mid-town Manhattan can help you with this holistic, integrative approach to healing.