Therapeutics and Somatics

This entry contrasts standard therapeutics for pain with clinical somatic education, for relief of pain. It explains the origins of pain and how therapeutic approaches work (or don't work).

To begin, I'll state my bias: I am a clinical somatic educator trained in methods of mind-brain-body training that addresses chronic, non-malignant, musculo-skeletal pain (e.g., back pain) and stress-related disorders (breathing difficulty, headaches).

When pain from injuries lingers beyond the expected few weeks of tissue healing, it generally comes from residual muscular tension triggered by the injury. Tight muscles cause muscle pain, joint compression (leading to osteoarthritis) and nerve impingement (e.g., sciatica, Thoracic Outlet Syndrome).

Conventional therapeutics and alternative therapies (e.g., bodywork of all kinds) generally produce temporary and partial relief from moderate-to-severe injuries and may be slow to produce durable improvements.

Clinical somatic education, in the tradition of Thomas Hanna, generally produces rapid, durable, and complete relief from moderate-to-severe injuries. That distinction makes it a better choice, in general, than both conventional and other manipulative therapies.

This article contrasts those methods to an approach that deals with many musculo-skeletal problems, including back pain, more effectively.
Click above for the self-relief program for back pain and for other conditions.

How Chronic Muscular Tension Forms

In the viewpoint of somatic education, muscular activity comes either from voluntary behavior, from habitual (involuntary) learned behavior, or from involuntary reflexes. That means that movement, posture, and muscular tension come conditioning of our nervous system.

It seems obvious that stress and trauma leave impressions in memory and that those impressions might be associated with tension of one sort or another. The piece I'm adding, here, is that the memory of injury, if intense enough, can displace the familiar, healthy awareness of movement, position and self-control. That displacement creates a kind of amnesia of the body; we forget how we were before injury and get trapped in tension.

It's this kind of tension that conventional medicine tries to "cure" by means of manipulative therapeutics (including chiropractic, bodywork and acupuncture), drugs, and surgery.

That this approach works better than the methods this article critiques remains for you, the reader, to see for yourself. I can't convince you, here (any more than I could be convinced before seeing for myself), but can only offer you a line of reasoning and ... at the bottom of this page, a bit of evidence -- a link to a candid, two-minute video clip that shows the first moments of a client after a one-hour session of clinical somatic education.

So, I must appeal to your capacity to reason and to your intelligence and you must seek out the experience, for yourself.

We begin.

OVERVIEW OF THERAPEUTIC MODALITIES FOR BACK PAIN

First, I'll comment on drugs, then manipulative techniques in general, then surgery, then clinical somatic education.

Two of these three approaches, drugs and manipulation, are best for temporary relief or for relief of new or momentary muscle spasms (cramp), not for long-term or severe problems.

The third, surgery, is a last resort and is appropriate for only the most severe of degenerative conditions beyond the reach of therapy.

You can get a comparison chart of common modalities here.

DRUGS

Drugs can provide temporary relief or for relief of new or momentary muscle spasms (cramp), but can't provide a satisfactory solution for long-term or severe problems. They generally consist of muscle relaxants, anti-inflammatories, and analgesics (pain meds).

Muscle relaxants have the side-effect of inducing stupor, as you have found if you've used them; they're a temporary measure because as soon as one discontinues use, muscular contractions return.

Anti-inflammatories (such as cortisone or "NSAIDS" - non-steroidal anti-inflammatory drugs) reduce pain, swelling and redness, and they have their proper applications (tissue damage). Cortizone, in particular, has a side effect of breaking down collagen (of which all tissues of the body are made). When pain results from muscular contractions (muscle fatigue/soreness) or nerve impingement (generally caused by muscular contractions), anti-inflammatories are the wrong approach because these conditions are not cases of tissue damage. Nonetheless, people confuse pain with inflammation, or assume that if there's pain, there's inflammation or tissue damage, and use anti-inflammatories to combat the wrong problem.

Analgesics tend to be inadequate to relieve back pain or the pain of trapped nerves and, in any case, only hide that something is going on, something that needs correction to avoid more serious spine damage.

MANIPULATIVE TECHNIQUES

Manipulative techniques consist of chiropractic, massage, stretching and strengthening (which includes most yoga and Pilates), most physical therapy, inversion, and other forms of traction such as DRS Spine Decompression.

Most back pain consists of muscular contractions maintained reflexively by the brain, the master control center for muscular activity and movement (except for momentary reflexes like the stretch reflex or Golgi Tendon Organ inhibitory response, which are spinal reflexes). I put the last comment in for people who are more technically versed in these matters; if these terms are unfamiliar to you, don't worry. My point is that manipulative techniques can be only temporarily effective (as you have probably already found) because they don't change muscular function at the level of brain conditioning, which controls tension and movement, and which causes the back muscle spasms.

Nonetheless, people commonly resort to manipulative techniques because it's what they know -- and manipulation is the most common approach, other than muscle relaxant drugs or analgesics, to pain of muscular origin.

SURGERY

Surgery includes laminectomy, discectomy, implantation of Harrington Rods, and surgical spine stabilization (spinal fusion).

Surgery is the resort of the desperate, although surgery has a poor track record for back pain.

There are situations where surgery is necessary and appropriate -- torn or ruptured discs, fractures, spinal stenosis, rare cases of congenital scoliosis. There are situations where surgery is inappropriate -- bulging discs, undiagnosable pain, muscular nerve impingement.

Severity of pain is not the proper criterion for determining which approach to take. The proper criterion is recognition of the underlying cause of the problem and dealing with that.

A NON-MANIPULATION APPROACH THAT FREQUENTLY GETS RESULTS WHEN THERAPY HAS FAILED: CLINICAL SOMATIC EDUCATION
Working with Brain-Level Control

Most back disorders are conditioning problems - correctable by clinical somatic education.

Clinical somatic education is not about convincing people that 'things are not so bad, and live with it' or 'understanding their condition better' or instructions for maintaining good posture. It's a procedure to eliminate the underlying cause of pain symptoms and to improve function.

In the case of back pain, the underlying cause -- chronic back tension -- causes muscular pain (fatigue), disc compression, nerve root compression, facet joint irritation, and the catch-all term, arthritis -- all through strictly mechanical means.

Degenerative Disc Disease, for example, though called a disease, is no more a disease of the discs than is excessive wear of tires on an overloaded vehicle with wheels out of alignment. Over a long period of time, accelerated wear accumulates. With discs, they call that a disease. There is no such thing as Degenerative Disc "Disease"; it's breakdown caused by bad conditioning.

Clinical Somatic Education

Clinical somatic education is a discipline distinct from osteopathy, physical therapy, chiropractic, massage therapy, and other similar modalities.

It isn't a "brand" of therapy or treatment, but a category or discipline within which various somatic "brands" or approaches exist. Examples of "brands" include Trager Psychophysical Integration, Aston Patterning, Rolfing Movement, Orthobionomy, Somatic Experiencing, The Alexander Technique, Feldenkrais Functional Integration, Hanna Somatic Education and others.

The prime approach of somatic education, through whatever method or "school", is to retrain the nervous system to free muscles from an excessively contracted state and to enhance control of movement, function, and physical comfort.

One key difference of clinical somatic education from manipulative practices is the active participation in learning by the client. It's not just strengthening or stretching, but gaining the ability to relax completely, to exercise full strength, and control of every strength level in between. The added freedom and control that a client learns during sessions, and not what a practitioner does to the client, per se, causes the improvements. In clinical somatic education, the instruction comes from outside; the improvement comes from within.

As education, clinical somatic education deals with memory patterns -- the memories of incidents of injury, of stressful situations and of how to move and how to relax. Memory patterns show up as habitual muscular tension and changes of movement (e.g., limping) and posture (e.g., uneven hips or shoulders).

Deeper-acting somatic disciplines, such as Feldenkrais Functional Integration and Hanna somatic education, deal with more deeply ingrained and unconscious habit patterns formed by injuries and stress.

How it Works

Clinical somatic education uses movement and positioning to enable the client, by combining sensation and improving control of movement, to recapture control of out-of-control muscles. As muscles come under voluntary control, they relax and become responsive, again.

The Distinction: Clinical vs. Enriching Somatic Education

Most forms of somatic education are not "clinical" somatic education; they are "enriching" somatic education that gradually improves movement and sensory awareness. They have limited predictability about when a specific outcome, such as pain-free movement, will occur.

The distinction of a clinical approach to somatic education is the speed with which improvements occur and the ability of its practitioners to predict with a high degree of reliability how many sessions will be required to resolve a specific malady, without further need for medication or treatment by a health professional -- "how long before I can have my lifestyle back".

Even "enriching" somatic education (such as Feldenkrais Somatic Integration or Aston Patterning) alleviates pain, given enough time -- even where more conventional therapeutic methods -- manipulation, adjustments, stretching, strengthening, drugs, acupuncture, surgery -- are less successful or fail altogether.

The specific advantage seen in clinical somatic education by referring physicians is that clinical somatic education, while being effective in the relief of muscular pain and spasticity, has the specific virtue of teaching the client an ability to improve control the muscular complaint (i.e., pain) to the point that there is little chance of a future return of the problem.

For a technical comparison between somatic education and chiropractic (as an example of a manipulative approach), you may click here

For a discussion of back pain and clinical somatic education, you may click here. For a discussion of clinical somatic education and recovery from injury, in general, you may click here.

a candid, two minute video of a back pain client's first moments after completing a one-hour session of clinical somatic education
Click above for the self-relief program for back pain and for other conditions.





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