Nagging Aches and Pains: An Introduction

When I first tried yoga two decades ago, I was coming off a back injury. Well, not an injury per se. Just inexplicable, transient discomfort in my lower back.

At work, sitting at my computer, I’d feel restless and just plain achy. My employer was very accommodating about ergonomics. My chair was well made and supportive—although I wondered if I should try a balance ball. My industrial-strength keyboard tray was infinitely adjustable. Although not debilitated, I was leery of prolonged sitting on long plane rides, in movie theaters, and especially at my workplace.

I mentioned predicament to my yoga classmate Peter. The next week, he handed me a slim paperback, Mind Over Back Pain, by John Sarno. “I’ve lent this book to so many people,” he said. “I keep buying more copies because sometimes I don’t get it back!”

Published in 1984, the book was already 15 years post publication, but it was new to me. Similar in size to Strunk and White’s The Elements of Style and it was likewise concise and informative. Sarno’s ideas weren’t generally accepted by his medical peers, but he got his MD from Columbia and practiced at NYU—legit enough for a read, I figured.

John Sarno’s Mind Over Back Pain

Sarno made an impression on me for two reasons: First, he pointed out that structural abnormalities don’t necessarily cause pain. The same condition—shown by x-ray or MRI—might be debilitating to one person and unremarkable to another.

Second, he proposed that bodily pain is often caused by emotional pain. When you’re anxious or angry, he hypothesized, your brain distracts you from these emotions by creating bodily pain—in your back, neck, shoulders, hips. His remedy: address your emotions, whether by journaling, confiding in a friend, seeing a therapist.

I found these points somehow reassuring. It was reassuring to think that bodily pain correlated with emotional pain because no emotion would last forever, right? (I was rather stressed at the time, at crossroads in my career and in a bad relationship. I also observed that my back pain was situational. At home I could sit—at my desk, at the dining table—with relative ease.)

There’s no big drama to relate. I can’t recall if I tried journaling ala Sarno. Whether from my newfound yoga or from facing my emotions or from the simple passage of time, my back discomfort resolved and never recurred.

Mind-Body Connection Now Mainstream

A few years later, I checked out one of Sarno’s subsequent books. I didn’t like it nearly as much. Sarno had expanded his hypotheses; he was now applying his mind-body connection to the gamut of illnesses—and attributing all of them to emotional state. He had gone overboard.

I more or less forgot about Sarno until last fall, when a New York Times article sparked my memory of Mind Over Back Pain. I had to laugh at the reporter’s “I swear I’m not woo-woo” disclaimer; I could relate. But, nowadays, no one disputes the mind-body connection in the experience of pain.

Pain is now recognized to be a complex phenomenon with wide-ranging causes. For an overview on current thinking about pain, here are three informative websites:

The Pain Brain This New York Times series comprises articles, including the one on Sarno linked earlier, on chronic pain. It’s a good introduction.

Mind Over Pain Paul Ingraham’s PainScience website is a favorite of mine. I like his thorough research, including citations, and his rational, skeptical perspective. He covers a range of conditions and treatments—and debunks some popular strategies that even I’ve considered via wishful thinking. Regarding Sarno in particular, Ingraham’s “A Cranky Review of Dr. John Sarno’s Books & Ideas” articulates my own reaction.

Living Well with Pain I stumbled on Tina Price’s impressive website detailing her own experience with debilitating sciatica and making sense of pain theories. I appreciate her honesty and her logical application of theory to personal experience.

“Tool Kit” To Address Pain

To address chronic pain, we must consider both physical and mental causes. Here’s my step-by-step approach:

Movement When in pain, people wonder if it’s safe to move. For non-acute pain, movement is generally beneficial. Not moving essentially causes bone loss and soft tissue (muscles, tendons, ligaments, cartilage) atrophy. That said, movement intensity must be adjusted to day-to-day circumstances.

Wide-ranging movement is ideal. Walking, running, swimming, and other repetitive aerobic exercise complement yoga and weight training. For me, yoga has been invaluable in keeping my body mobile in “all” directions. When I injured my right shoulder 15 years ago, physiotherapy was initially essential, but only with yoga did I restore full range of motion (beyond basic “reaching for the top shelf” mobility).

Posture Although poor posture doesn’t necessarily cause pain, ideal posture is nevertheless a worthy starting point. It’s important to work on posture while healthy and pain free. It’s difficult to align the body while injured. Yoga can be a practical starting point to improve posture—if the type of yoga emphasizes good alignment (e.g., Iyengar yoga) and if the teacher is knowledgeable. Practitioners must be wise enough to modify (or to forgo) poses potentially risky for their bodies.

It can be useful to study posture on its own. In California Jean Couch’s Balance Center and Esther Gokhale’s Gokhale Method focus on optimal spinal alignment—in standing, walking, sitting, lying down. I have Gokhale’s 8 Steps to a Pain-Free Back and, although she includes too many testimonials, her step-by-step instructions are clear and sensible. The photos alone—comparing posture in different cultures and eras—are revelatory.

Physiotherapy / Chiropractic If you see your doctor about back pain, chances are, they’ll recommend first seeing a physiotherapist. Unless you have an acute injury, most doctors lack enough time (and, sometimes, enough expertise) to manipulate your body or to recommend home exercises. Note: By “physiotherapy” I’m referring to various methods of bodywork. An equivalent professional might be a chiropractor or fitness trainer.

If I trust the person, it can make a difference just to get the green light to move or bear weight on the injured body part. Sometimes, just the confidence that I’m not exacerbating the injury can be enough to reduce pain.

Massage Not everyone likes massage (believe it or not). If you, like me, have high resting muscle tone, you might feel “tight.” I have functional flexibility, but my muscles, especially in my neck and upper back, often feel tense. While short of painful, this excess tension feels uncomfortable. Therefore, I love deep-tissue massage. Just the anticipation of a massage cheers me up!

Emotional Factors What about Sarno’s theory that most back pain is “in the mind,” never mind herniated discs and slouched posture? For chronic pain without apparent cause, Sarno’s theory is worth considering. His suggestions are simple and doable. Just write down those nagging thoughts in an emotional purge or confide in a friend—anything that forces you to address what’s on your mind.

Even if stress or anxiety isn’t the root cause of your pain, it probably exacerbates it. When I’m gloomy about one thing, everything is colored by that dark cloud. So, even if Sarno’s theory is not quite on point, I doubt that his advice can worsen your situation.

In my title, “an introduction” is meant to emphasize that chronic pain is a wide-ranging phenomenon, beyond the scope of this blog post*. If you’re in chronic pain, don’t assume direct cause and effect. A multipronged approach is probably best. Do yoga, improve your posture, consult a physiotherapist or chiropractor, get a massage—and, maybe, just maybe, deal with your emotions.

Images: Cats epitomize ease in movement, repose, and quiet contemplation. I never tire of watching the feline species. This is Tilly, a senior calico and purring machine who lives in Santa Cruz, California. I caught these moments in 2018 and in 2021.

*In case you’re wondering, yes, my title is a copycat of JD Salinger’s Seymour: An Introduction.