22. BACK-PAIN and CALF-TENSION

16 Jun

Postural muscles are those that help maintain standing and other positions. Important examples are in the lower back, calves, and hip. Since these muscles must be tensed for long periods to maintain our balance, they are often strained and become painful. My experience with very severe back pain and calf tension has inspired me to do a considerable amount of research. I suspect that most people really do not understand these disorders and that doctors often avoid explanations and/or do not fully understand the physiology. I have listed below some of my observations in this area.   Since this information is not presented as a substitute for medical advice, it may best serve to stimulate beneficial discussion. This information was developed from writings by reputable doctors, physiological psychologists, and other therapists. Some of it may be speculative.

It is often the case that tension in a muscle may persist long after necessary for its function. Sometime postural muscles are tensed when the tension is not necessary for support, or greatly tensed when only moderate tension is needed. Inflammation often results from excessive muscle tension, and may build up slowly. In my case, I suspect that the build-up has taken several days or maybe weeks. There is no pain during the build-up, but after a certain threshold is reached, a sudden sharp pain may appear after an ordinary movement. Perhaps at some point, the inflammation is so great that a ligament or tendon slips out of position triggering pain receptors.

Tension may be prolonged by psychological stress factors, chronic anxiety, and/or other reasons. There is tendency for medical doctors to ignore psychological factors, and more specifically, to attribute lower back pain to the spine rather than to muscle.  (This happened to me with disastrous consequences.)

One of my muscle-tension cases is instructive in this area.   I was referred by a doctor, a lady patient with right leg pain.  She had consulted with several physicians to no avail.  After an extensive interview and some tentative relaxation work, it became apparent that her pain was caused by the stress of driving many hours a day for her business.  We worked on a program of general and specific-muscle relaxation and her pain problem was quickly solved.

Prolonged tension in a muscle can lead to pain and in the worst case, cramping. Cramping can be identified by sharp pains, hard muscles, and often a brief collapse. If you have experienced a common calf cramp while playing tennis or other sports, you know what this feels like. What I find interesting is that you can also get similar cramps in the back muscle.

Sometimes the pain prevents beneficial stretching, as this temporarily makes the pain worse. For example, working with a computer for long periods, can lead to calf tension and if not relaxed can strain or damage the achilles tendon. If you are making precise computer mouse movements or are writing about something upsetting, many muscles may be over-tensed.

With regard to back-pain,  it is noted by experienced physicians that CT   and MRI scans may indicate serious spinal defects, but these may not be   the cause of the pain.  The source of pain must be determined by also considering physical examination,  history, and interview.

Treatments. There are a variety of treatments for postural muscle pains, including surgery, nerve blocks, physical therapy, etc. Since my education and practice is in physiological psychology, I am emphasizing that aspect.

If the cause of pain is excessive muscle tension, then the following is helpful. Awareness of tension often leads to a natural regulation. Awareness can be developed by focusing on a muscle, then repeatedly tensing and loosening it. What does it feel like when it is tense and loose? The simplest procedure to directly reduce tension is stretching. For back pain,  my personal experience is that bending over and touching the toes 30 or more times per day, is the single most effective action. For tension in the calf, standing and pushing against a wall to stretch the gastrocnemius muscle (like before running track) is best. You can also get benefit from massage, vibration, heat or cold, and inversion (hanging by feet) for backache. Biofeedback equipment can help with general and specific relaxation. I have successfully used this method with many patients.

Since inflammation is often involved in the pain, NSAID drugs, such as Naproxin can help, but may not be necessary. Inflammation itself can cause damage so it must be reduced.  If you use medication, you may need to consult with a doctor regarding drug interactions. If you use any medication it’s best to terminate when when the pain has abated — and you should terminate gradually.  If the pain has a cramp-like characteristic, one could consider taking mineral supplements, such as calcium and magnesium.

Generally,  it is important to avoid situations that promote inappropriate muscle tension. For example,  immobilization for a long period should be avoided. Just moving around is helpful. If you are sitting in a chair working with a computer you could get up periodically (say, every half hour or less) and walk around, or just sit there and do some arm, leg and back stretching movements. If anxiety or nervousness contributes to the tension, then psychotherapy could also be helpful.

Final thought: I am most concerned because some doctors over complicate a common pain problem and do not recommend an effective simple solution.  For lower back-pain, the patient could be instructed to stretch the back muscles (carefully) many times per day — and to be aware of what the muscles feel like and what activities may be causing tension.  For knowledgeable patients, scans and/or PT may not be necessary.  Many years ago, I went to an orthopeadic doctor at Henry Ford Hospital, for a severe achilles-tendon pain problem.  After an examination, his only recommendation was to stretch my calf muscles many times per day — a perfect and correct simple solution. How many doctors today would provide this simple answer?

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