Not so laid back

Not so laid back

Reflections on the root and meaning of spinal pain

Tzivia Bieler smiles at a grandson’s bar mitzvah in Israel.
Tzivia Bieler smiles at a grandson’s bar mitzvah in Israel.

My back pain began in 1993.

I did not sit wrong, turn wrong, lay wrong, bend wrong, step wrong. It was not some random physical activity that propelled me onto the back pain path. Rather, I believe it was life’s turns going wrong, and as that reality became a part of my life, my back joined the global ABC family — the Aching Back Club.

After my mother-in-law passed away in December 1985, my father-in-law continued to live alone in their Washington Heights apartment until the summer of 1993. When that was no longer an option, we began the process of moving him into a nursing home. Before giving up the apartment, my husband, children, and I sadly but lovingly selected those items we wanted to keep. We then arranged a two-day moving sale for the building tenants — many of whom had been friendly neighbors of my in-laws — with the hope they would purchase some of the used items.

Watching the parade of inquisitive “lookers” and buyers, I sadly thought how one person’s treasure is another person’s trinket. Every object had special meaning for my in-laws. But the neighbors didn’t view those items as fond or unique mementos of the Bielers; the purchases were nothing more than good, cheap deals. It was painful to watch. I cried for two days. Two whole days. And I felt my mother-in-law’s tears dropping from heaven.

After those two emotional days, back pain became my constant companion. I visited different orthopedists, orthopedic surgeons, chiropractors, and physical therapists; I tried special corsets, exercises, acupuncture, acupressure. An MRI revealed two thoracic herniated discs. Yet the pain would disappear without explanation, sometimes for days, sometimes for weeks, sometimes for months, then return with a vengeance. The hard wood floor was my happy place. When pain overwhelmed me, that is where you would find me, lying on the floor in my workplace behind a closed door, desperate for a 10-minute reprieve, or at home, or during a doctor’s appointment, or even a celebratory meal in someone else’s house. I was never embarrassed by my preferred horizontal position. The hard floor was my only relief.

Thirty years of on-and-off back pain. Remarkably, I have lots of company in this basic ABC group, for the list of people I know who had or have various degrees of back pain is endless. And I am still at the very top of that long list. Now I fully recognize that for some people, the physical problems with their backs are so serious and so debilitating that the only — and I say that quite definitively — the only solution is surgery. My back pain, however, was elusive, a trickster, a phantom that came and went at its own pleasure. And I was helpless to escape its punishment.

“The Egyptians enslaved the Children of Israel with crushing harshness — be’farech,” we read in the first chapter of Shemotzw (Exodus 1:14). Some commentators view the crushing harshness as backbreaking work. How remarkable that the Torah reflects the idea that difficult physical activity could put so much strain on the body that Hashem uses a word suggesting the familiar image of a person’s back breaking from work. Certainly, we all can relate to such a phenomenon.

And yet, while the work of these Jewish slaves surely was difficult enough to break a back, nothing hints at the possibility that a slave’s back gave in or gave up or gave out in any way. Definitely no complaints as far as I can see about backs aching or “killing.” The “killing” was literal. When Pharoah decrees that no straw will be given to the slaves who must continue to produce their quota of bricks, the Jewish people complain to Moses and Aaron not specifically about their backs breaking, but rather “. . . you have made our very scent abhorrent in the eyes of Pharaoh and the eyes of his servants, to place a sword in their hands to murder us!”

In Psalms 38, King David writes of man’s own foolishness, and remarks: “I am bent and bowed down greatly; I go mourning all the day.” One commentator notes that “bent and bowed” would be due to enormous pain. But are we talking about physical pain, or do a man’s painful thoughts reflect emotional pain? In either case, I am no stranger to the position described. And perhaps what I mourned the most during those difficult times was the loss of a clear head and the blessed gift of a painless straight back.

I began to view my back pain from a different perspective around the beginning of 1997, when a colleague at work, watching me struggle, loaned me a book titled “Healing Back Pain” by Dr. John Sarno. Dr. Sarno was a professor of rehabilitation medicine at New York University School of Medicine and an attending physician at the Rusk Institute. He believed that there are well-functioning people around the world who have issues that are raging (Dr. Sarno’s word, not mine) in their heads. Herniated discs were not part of the equation. Half the world has herniated discs, Dr. Sarno asserted, and many have no back pain whatsoever.

The human brain, Dr. Sarno explained, is eager to protect us. It recognizes that a physical pain is easier to manage than an emotional one. When stressful issues begin to surface, your brain, in its desire to protect you from thinking about them, sends less oxygen to a specific line of the body — neck, back, buttocks, legs. Less oxygen causes pain. He calls this theory Tension Myositis Syndrome. Thanks to your brain, the diminished oxygen moving down your spine causes back pain. You can focus only on your physical pain, while the angry or upsetting thoughts and feelings temporarily fall by the wayside. Often you welcome the distraction. Oh,” people would say. “So it’s all in your head.” “No,” I always responded. “The pain is real, but it is not caused by a physical problem.”

Don’t do anything that sends a message to your brain that you think there is something wrong with your back, Dr. Sarno warned. Forget special shoes, chairs, beds, exercises, heating pads, corsets. Seek out those things for your general well-being, not because of your herniated discs.

These are some treasures from Ms. Bieler’s in-laws’ apartment; giving them away caused her physical pain. (Tzivia Bieler)

I wanted desperately to believe that this was the solution to my back pain, and so I became Dr. Sarno’s patient in the summer of 1997. I paid him $700, which covered a good many things: my long visit with him (with MRI in hand), where he determined that I had this syndrome; a three-hour class explaining the process in detail, and the opportunity to attend his weekly group sessions at the Rusk Institute for as many weeks as I wanted.

The moment I sat down on the chair in the circle, my pain disappeared. Once the session ended, I was outside no more than five minutes when it returned.

But sitting in that circle was an eye-opening experience. It became clear to me that suppressed angers or worries are the culprits, not my spine. People who had surgery but still experienced pain became my ABC buddies. One young man married to a woman from Argentina wondered why, when his wife and baby son traveled to see family in South America, back pain disappeared, only to return when they returned! (All of us understood what was going on with his back!)

Another woman shared how it took her a good two hours from the time she awoke to reach the point where she could be functioning in her kitchen. But how did she function in the kitchen? She tied a heating pad around her body, which was connected to the outlet via many extension cords. “Wow,” I remember thinking, “I’m not as bad as I thought I was. It never occurred to me to do anything like that!” We listened to the man whose child had died, to the mother whose son was an addict, to the woman whose husband wanted a divorce. We shared our frustrations, our challenges, our angers.

I actually know people with back pain who simply read Dr. Sarno’s book, believed fully in his techniques, and were quickly free of pain. I wasn’t that lucky. It took me quite some time, reading his book over and over again and being a part of his group and individual therapy sessions before I realized, sometime in January or February 1999, what? My back pain was gone.

It was a complicated year, a year filled with difficult episodes related to my husband’s health. But the pain stayed away. It was as though my brain was saying, “You have lots on your plate. I will keep all those other issues quiet while you take care of and spend good times with your husband.” And then, my husband died on November 29. “Be satisfied. I’ve given you the time you needed to manage his illness and to spend some peaceful time together,” my brain seemed to say. “It’s time to get back to the business of you healing.” On the third day of shiva, my back pain returned.

From that day in December 1999 until this very moment, my brain and my back have shared the unusual dance of my life, a dance that balances the simple physical cause of pain due to standing too long in the kitchen as I cook with the more complicated emotional issues that surface and must ultimately be addressed.

Put simply — life.

I do not automatically dismiss other approaches to healing back pain. Esther Gokhale, a licensed acupuncturist, created the Gokhale Method, an unusual perspective that can help people return to postures that build strength and resilience. Certainly Dr. Sarno would approve of correct posture and strengthening your core muscles. Ms. Gokhale also found that there are a few cultures in the world — villagers in Ecuador, Portugal, and West Africa — who enjoy pain-free lives. She claims they work long hours and carry heavy objects, thus developing strong backs and muscles. And, she asserts, they have j-shaped rather than s-shaped spines.

Can I accept a full Sarno, with some of the Gokhale approach? Possibly. The Almighty has created a complicated human machine, and while there are purely physical techniques that improve and benefit our backs, I have full faith in Dr. Sarno’s solution, which recognizes the mind/body connection. Let go or be dragged, goes the saying. Acknowledge the difficult thoughts and move forward.

Perhaps the Jews in Egypt had more of a j-shaped spine, strengthened by the crushing physical harshness of slavery. Slaves, I would imagine, have no emotional strength or time for “raging” issues that must remain suppressed, and their only thoughts were likely their focus to survive each day. And survive they did, for 210 years.

Ultimately realizing they could not free themselves from this horrible “pain” on their own, they finally called out to God for help. Their salvation was at hand. What had begun as a manageable life in Goshen ultimately became a terrible life of slavery. There it was: a very dramatic version of life turned wrong.

On a personal and far more simplistic level, I sought help through Dr. Sarno in facing the realities of my life’s emotional turns. After all these years, I do my best to face such thoughts every day and to let go. Above all, of course, is the knowledge that the Almighty watches over us and helps us find the path. We face the difficult turns and savor life’s good turns. It’s a happier ABC: the Always Believe Club. And in the end, dayenu.

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