Herniated Disc, Chronic Back Pain and Yin Yoga as the new Therapy
A herniated disc is a tear in the fascia ring of the disc, which surrounds the gelatine core. This tear can occur from degeneration or overexertion. Over time the gelatine core can leak out causing the disc to become thinner up to a point where the disc “dries out”. The vertebral bodies come closer together and there will be less mobility in this area. The possibility of friction and inflammation is higher, as well as the possibility that the nerve channel will be compromised and/or that the facet joints become fixated.
When the gelatine core leaks out, a nerve in the area could be irritated and could lead to back pain and/or a pain which emanates down into the leg/s.
At least, that is what we have believed until now - that this is the origin, development and cause of back pain.
However, experts in back pain know that abnormal vertebral bodies or discs, herniated discs as well as bulging discs have almost nothing to do with a person having back pain-chronic or not.
In 1994, a study into the cause of back pain was published in the reputable New England Journal of Medicine, showed fascinating results:
MRIs were taken of 98 test patients, who had never experienced more than 48 hours of back pain at one time in their lives.
Of the 98 participants who experienced no noticeable back problems
- 64% had an abnormal disc
- 52% had a bulging disc
- 28% had a herniated disc
- 38% had more than one abnormal disc
- In addition to this, they discovered many different “abnormal” structures in the vertebral bodies
The result: No back pain despite herniated discs!
Conclusion of the study was that in most cases, back pain and the diagnosis of an abnormal disc have no correlation.
Back Pain without a herniated disc!
In another study, a group of patients suffering from chronic back pain with emanation of pain down into the leg were tested. After a CT scan, MRI, blood tests and EMG there were no abnormalities found in either the spine or the nerves.
How can this be?
Back pain despite a disc operation!
In yet a third study, a group of patients who had undergone successful disc operations were studied. The disc operation involved shaving the gelatine core and fusing the “problematic” vertebral bodies together. Despite the fact that there was no more friction possible, the patients still experienced the same back pain after the operation as they had prior to the surgery.
How can this be?
No back pain after a fake disc operation!
In early medicine practice, if a patient had extreme back problems, the surgeon had to go in blind, in that he/she had to open the patient up to see what the issue was. At that time, they didn’t have the technology of CT scans or MRIs to diagnose the patient.
Many of these such cases were put together for a study.
In a large number of the patients, there was no structural damage to be found on cutting open the patient. In these cases, the surgeon closed the patient up without having surgically intervened.
Surprisingly, despite the surgeon not having done anything, beyond cutting open the patient, the researchers discovered that many of the patients became pain free post-operation.
How can this be?
No back pain in Asia and developing countries?
Back pain is public health problem Nr. 1 in Germany as with many other western countries.
In Asia, I was witness to the typical working days of the locals and what I saw would shock most of us in the west - 8 hours working in the rise fields bending over, sitting and sleeping on thin mattresses and hard floors. Their standard footwear – flip flops or sandals.
In addition to this, in developing countries the medical service is very often far away and not up to most modern western standards.
And despite this, very few people suffer from back pain.
It is said, that in these countries the attitude to pain is different. There is no fear of pain and to have pain every now and then is accepted as a normal part of life. In most cases, instead of taking a break when they have pain, the people just continue doing whatever they normally do despite the pain. These people generally know that the pain will go away by itself in it’s own time.
Could perhaps our beliefs and psychological fear of pain be possible reasons for continuing chronic back pain?
The book - Back Sense - from Ronald D. Siegel, Psy.D., Michael H. Urdang and Douglas R. Johnson, M.D.
The authors not only make a strong case that chronic back pain is created by stress, they also have great reasoning.
Stress creates muscle tension and muscle tension creates pain!
In most back pain cases, doctors look for a structural reason for the pain and will almost every time find something structurally “out” in the average person over 35 years in age. In this age group 4-5 bulging discs are normal. The state of mind and the environment of the patient are most often not considered in the diagnosis.
An injury normally heals itself within 6 weeks. If pain continues after 6 weeks, it could be due to too much tension, hardening or matting/felting of the tissues or adhesions, thickening of the muscular or fascial tissue.
Tension, hardening or felting of the tissue, adhesions, thickening of the muscular or fascial tissue can be produced by what? Right! STRESS!
Lets go back one step
80% of the diagnoses of back pain are unspecific, even if a bulging or herniated disc is diagnosed.
Despite this, in the minds of society the old belief still holds:
herniated disc = a severe problem and pain.
In the eyes of the book “Back Sense” this belief is fatal, because beliefs can exasperate pain and become a part of a viscous cycle of pain =
- Back pain
- Fear, frustration, limited life quality, fear of movement and to live life, fear of working again, fear to lift anything including one’s own children, fear of life without any movement = stress
- (fascia) tissue contracts – (fascia) tissue tension increases
- Back pain
We can call this cycle - chronic back pain. Out of my subjective experience of 10 years of suffering with chronic back pain, I can 100% confirm this viscous cycle.
Most of the times, the diagnosis has nothing to do with the pain.
Why do so many people hold on to these old beliefs?
It is like the example of spinach.
The story goes that in 1870, German chemist Erich von Wolf was researching the amount of iron in spinach and other green vegetables. His research showed that spinach contained vastly greater amounts of iron compared to other vegetables. This discovery went on to become widely known and popularised by the famous cartoon character Popeye and his love for spinach.
Some 67 years later, Professor Schupan repeated the analyses of spinach, only to discover that the decimal point had been misplaced in the original findings making spinach ten times higher in iron content than in reality. Spinach was suddenly relegated back to being a “normal leafy green”.
Despite this discovery some 80 years ago, the myth that spinach is particularly iron-rich still continues to this day (albeit with no help from Popeye).
When a doctor tells a patient with back pain that he/she has a herniated disc, they usually don’t hear anything else the doctor has to say after that. The panic alarm bells are ringing and all they can think of is their miserable fate. But if the person would actually listen, he/she would hear the doctor using the words – “maybe, possibly, potentially” in reference to the pain caused by the herniated disc and no definitives. Instead, all the person hears is “the pain comes from a herniated disc”.
Where does the pain come from?
Even after the latest scientific research it is still unclear which tissue is responsible for the pain.
There are several different theories out there:
1) In the minority of the cases the disc or the pressure on the nerves surrounding the disc could be responsible.
2) Another possibility for the pain could be hydrostatic pressure. When a tissue gets injured, there is a build up of fluid in the region, which is called hydrostatic pressure. This can compress or irritate nerves in the area.
3) It could be the trigger points of the muscle tissue, which lead to nerve irritation.
4) Friction causing the possibility of inflammation which in turn irritates nerve endings.
5) “Back Sense” brings stress into the discussion. Stress can lead to higher tension in the muscles, leading to irritation in the nerves in the back, resulting in chronic back pain.
There are so many possibilities of how chronic back pain starts.
Fascia could also be the root of the pain!
Dr. Dittrich, an American doctor and scientist, conducted a study where he exposed the large lumbar fascia of patients, during disc operations. In 93% of the patients he discovered micro tears of the fascia, lesions and scar tissue in the lumbar fascia. Ironically, in most of the cases the disc was completely intact, despite complaints of chronic back pain.
His supposition was that back pain may come from these old and new micro injuries in the lumbar fascia, rather then from the disc.
Another theory (that we discussed in an earlier article), is that pain could come from stiff, felted, thickened fascia tissue.
This stiffening of the tissue could come from an uneven strain (e.g. an uneven stress on the body), unilateral strain (e.g. carrying uneven loads) or repetitive strain (e.g. working on an assembly line) or a combination of all three eg. professional sportspersons or office workers. This stiffening of the fascia tissue could also come about from a sedentary lifestyle. Last but not least, mental stress could be the cause of stiffened tissue.
Incidentally, for men suffering from back pain, there is a distinctive, measurable thickening of the lumbar fascia. For women, however, it works a little differently.
“Glued” or “felted” fascia tissue is drier, stiffer, more brittle and susceptible to injuries. Fascia tissue with little elasticity, can pull on nerves possibly causing pain. This also happens when layers of fascia tissue are unable to glide smoothly over one another anymore. This friction leads to inflammation which in turn could lead to pain.
As with frozen shoulder syndrome, back pain patients have a higher density of fibroblasts and myofibroblasts. We might like to call this “frozen back syndrome” and from a subjective standpoint, it feels exactly like a frozen back when one has chronic back pain. It feels like a constant shortening, hardening and restriction within the tissue.
Fascia and muscle are like brother and sister!
When the body is cold, the fascia sheath around the muscle becomes more tense, relieving the muscle of work in order to save energy.
When the body is warm, the muscle becomes stiffer allowing the fascia to relax.
Muscle and fascia are like brother and sister, working in tandem.
If fascia tissue is inflamed, the muscle becomes hyper sensitive, contracts and attempts to protect the fascia, like a brother would protect its sister.
If the muscle is inflamed, the fascia reacts like a protector, it contracts and attempts to take over the strain/work load of the muscle.
It’s as if the body says “Something is injured here! Hold this position so that the injury doesn’t get worse.”
Unfortunately, these protective mechanisms do not always work in favour of the injured person, especially when other tissues, other then the inflamed tissue signals pain. When fascia tissue is inflamed, the muscle may begin working overtime to protect the inflamed tissue and then itself becomes overworked and also signals pain. These muscles are connected to other muscles and fascia chains that run through the entire body, which can then lead to a pain transfer to other areas of the body.
For example, let’s look at pain in the lumbar area. Most people with pain and/or inflammation in the lumbar area have enormous tension in the muscle and fascia, especially around the sacrum, the sacroiliac joint, the gluteus group, down to the knee and other near by areas. This tension alone can create pain.
This pain is often described as an emanating pain travelling down into the leg/s.
But what if the inflammation is gone and the pain is still there?
The first thing a physiotherapist will do to relieve tension, is to work on the sacrum - releasing the compression and shortening of the fascia within the capsule of the sacroiliac joint which usually occurs with chronic back pain. This release of tension through manual therapy signals the tissue above and below the sacroiliac joint to relax.
Other methods could also restore stiff, felted or tense tissue to it’s relaxed healthy, such as an encouraging word from the doctor, a positive prognosis of the healing process or a belief in an alternative therapy.
We believe, as long there is a level of trust and belief in healing, healing occurs by itself.
Endorphins are released, the tissue relaxes, the pain reduces.
Chronic back pain through stress?!
Through emotional mental stress fascia tissue becomes stiffer.
In the short term, this is a positive reaction because we ideally want the fascia to be tighter, more stable and to boost the efficiency of storing kinetic energy. Why? Because in stressful situations, we want to be in an optimum fight or flight mode.
This reaction, called “doping” is vital for the short term fight or flight mode but is very unhealthy if endured over a long term.
We can imagine how a tissue reacts in difficult times eg. stress in the work place or at home, burn out, grief, depression etc.
Our body becomes more tense. Our stance becomes droopy – back, shoulders, head, eyes. We move lethargically. Our organs, muscles, fascia are no longer being supplied with the nutrients it requires for optimum health - all of which leads to more stress within our bodies.
Which Therapy?
In 1997, a controlled long term trial was conducted to assess the benefit of an educational program to prevent lower back pain. 4000 post office workers in England were recruited for the trial. One half received instruction on how to sit and get out of bed “correctly”. They were issued ergonomic chairs and beds and learnt functional lifting of weights, back training etc. The other half received no training, instruction or specially designed equipment. At the end of the 5 year study, there was no difference in the number of workers suffering from back pain between the two groups.
Despite all the training and equipment designed to relieve back pain, it did not make a noticeable difference in the number of workers of both groups who suffered from back pain, nor did the relief or recovery time from back pain differ from one group to the other.
What is the solution to back pain?
Create a healthy mind set - a happy, stress free life - at work, in relationships and friendships, to make peace with people and circumstances, to make peace and accept one’s self. These are all more significant factors then an ergonomic chair or bed could ever be.
And of course, a healthy diet and environment will help as well.
How can we support a healthy life through movement?
A life full of movement appropriate to age - doing neither too much, nor too little helps the fascia tissue to stay hydrated, the joints mobile, and the body to function optimally to flush out the toxins, the fascia and cells to be replenished with fresh nutrients for rejuvenation.
Fascia tissue can be likened to a wet sponge in so far as when we “squeeze” fascia through stretching, compression and/or pressure, we flush out the toxins. However, unlike a sponge, when we release the fascia, it takes time for this tissue to become rehydrated (and rejuvenated). After the fascia has been “squeezed”, it takes up to one hour for it to rehydrated to the same level as beforehand and after approximate three hours the fascia will be more hydration then before the stimulation.
Cells are more receptive if you “bathe” them in fluid, rather then just “stretching" the cell. In certain massage techniques we move water around the cell. We hope to achieve the same or similar effect with very slow stretching and compression. The speed in which we stretch our tissues, seems to be key in the successful stimulation of the cells.
4 hours after a massage treatment or class, the fibroblasts (in the fascia) create an enzyme to expel overproduced collagen fibres.
This is how we can eliminate stiff, matted tissue and hopefully relieve pain.
Does this possible solution sound like Yin Yoga? YES!
When we practice Yin Yoga, our focus should be on the slow pace while practicing and transitioning from one pose to another, giving our body time to rejuvenate and heal.
Our mental attitude is equally as important. Is our approach to life positive or negative? Do we tend to become stressed or worried quickly or do we rather trust in the course of life? All these factors make us more or less resilient to pain, illness and injury.
Yin Yoga and meditation are powerful practices to reflect, feel, listen, improve the senses and recognise where we have stress in our lives. Our bodies mirror the state of our mental, emotional and physical lives. When we take the time to tune in to our bodies, we can initiate conscious changes in our lives.
Above all, don’t allow yourself to become “paralysed” by pain or a scary diagnosis.
We become self responsible. We actively do what we can to get out of the pain cycle. If there is irreparable damage, we accept the pain, rather then fight it, with the knowledge that fighting the pain, will only make matters worse.
As I myself have experienced after 10 years of living with chronic back pain, Yin Yoga, Yang Yoga and meditation relaxes the body and mind. These practices are profound and can lead to a pain free life.
Yin Yoga teacher - the new therapist?
For centuries, physiotherapists have very successful treated people using conservative methods of therapy to assist the body’s own healing, rather then operating, as I experienced myself. One technique used for the treatment of herniated discs was long held traction (stretches) - to decompress the spine. With this treatment, the muscles and of course the large fascia of the lumbar region are pulled apart.
In the latest approach, physiotherapy works with long held traction and compression to stimulate the tissues e.g. joint capsule.
All of this, we could say as well about Yin Yoga. So, is Yin Yoga also a therapy?
In Yin Therapy’s opinion, Yin Yoga could be used as a complementary and profound therapy in it’s self, especially if science is able to prove what we yinsters already experience and feel for ourselves = more flexibility, more “space” in the body, more calmness, pain relief in many cases to being completely healed of chronic back pain.
Currently a research team is testing the theory that long held traction has an anti-inflammatory effect and can relieve pain. An anti-inflammatory effect has already been proven with laboratory rats after 10 days of long held static stretching for 10-15 minutes at a time.
We see that it works. We just don’t know yet, how or why it works.
While we wait for science to come up with the how and why, let’s just keep on enjoying the benefits of Yin Yoga.
Namasté