It is estimated that up to 80% of adults will experience back pain in their lifetimes. Back pain is one of our culture’s most debilitating and costly health problems. All you have to do is look up the statistics to see for yourself. And women are more likely than men to experience low back pain.

Given that our backs are designed to support us for a lifetime, I find these statistics staggering. More shocking is that mainstream medicine fails to treat back pain successfully and increases disability and reliance on opiates.

Why is Back Pain Misunderstood? 

The cause of most chronic back pain is generally misunderstood by the medical community. Although we’ve been taught that back pain results from damaged or defective tissues in the back, a great deal of scientific research has shown that this simply is not true.

For example, a landmark study reported in the New England Journal of Medicine pointed out that a full 64 percent of normal people with no back pain whatsoever had evidence of abnormal disks including bulge, herniation, or some other abnormality. And what’s even more interesting is, extensive testing on many chronic back pain sufferers fails to reveal any abnormalities whatsoever! 

While the evidence is clear that these findings are common and not evidence of injury or disease, unfortunately they are regularly presented to back pain sufferers as the “cause” of their back pain. Risk factors that traditional medicine often cites as the primary causes for back pain include advancing age, lack of exercise, being overweight, having poor sleep quality, sitting too much, and lifting heavy objects. While acute physical injuries or strains can certainly begin the cycle of back pain, they tend to heal quickly on their own or with minimal intervention. So if abnormalities are not the primary cause of chronic back pain, what is? What keeps the pain going? 

True Causes of Back Pain

In my New York Times bestseller, Women’s Bodies, Women’s Wisdom, I shared the pioneering work of John Sarno, M.D. who identified the role of muscle tension and suppressed emotions in triggering the chronic pain cycle. Dr. Sarno, a Columbia-trained physician who passed away in 2017 at the age of 93, Dr. Sarno believed that the brain uses pain to distract us from feeling negative emotions. He taught that most cases of back pain and sciatica are related to Tension Myoneural Syndrome (TMS)—also known as Tension Myositis Syndrome, a condition in which the back muscles become painfully tense.

I’ve long been an advocate of Dr. Sarno’s groundbreaking work because where mainstream medicine fails to treat chronic pain successfully (and increases disability and reliance on opiates), his approach recognized that the pain cycle is often triggered by unrecognized or unresolved emotions such as anger and anxiety.

These emotions, along with rage—specifically called out by Dr. Sarno—cause physiological changes and symptoms.

This makes perfect sense and explains why treating merely the physical symptoms with bedrest, medications and often surgery does not work. In his practice Dr. Sarno worked with people to overcome their back pain by acknowledging their psychosomatic origins. And upwards of 80% of his patients felt better after being treated with Dr. Sarno’s method.

The Muscle Tension–Stress Connection in Chronic Pain Syndromes

Because of mainstream medicine most people assume that pain and illness are purely physical. And that’s a difficult belief to give up. But, if you have ever suffered from chronic pain and then taken a vacation only to notice your pain is gone, you may have some clue that something else is going one. That “something else” is stress!

One of the first things that happens to all of us when we’re under stress is that we tense up—preparing to take action as part of the ancient fight-or-flight pathway in our body. When we can’t run or express our distress, and that distress is chronic, we tense even further.

Chronic muscle tension is the direct result of emotional stress that is not consciously acknowledged. Stress over the pain, worries about the future, the stress of living with a difficult spouse or family member, financial worries, and more all add up to chronic muscular tension. This pain is not “all in your head.” It’s real. Chronic muscle tension hurts a great deal.

Interestingly, we use the same word “tension” to describe both emotional and physical conditions. We feel “tense” emotionally and our muscles also “tense up.” And this is painful. Remember the last time you had a muscle cramp? You can’t move or think of anything else until that muscle relaxes. It’s not surprising that exactly the same class of drugs—the benzodiazepines such as Valium and Ativan— can relax both muscles and anxiety. But these drugs don’t solve the problem; they merely mask it, and worse yet, they are highly addictive.

Going to physicians, chiropractors, physical therapists, and other experts can help temporarily with the physical pain caused by chronic muscle tension. This is why chiropractors and others are in business. However, until you address the true underlying cause of your chronic muscle tension and pain, it will continue to flare up—often at the most inopportune times.

This is not easy work! We are conditioned to downplay stress and many people are unaware of how specific events can be stressful. The truth is ordinary everyday emotions and circumstances can result in muscle tension that we’re not even aware of.

Here is a list of life events that researchers have found to be the most stressful.

• Death of a friend or loved one.
• Getting married, marital separation, divorce, or reconciliation.
• Personal injury or illness.
• Changing jobs, being fired, or retiring.
• Pregnancy, sexual difficulties.
• Moving, getting a mortgage.
• Child leaving home.
• Trouble with relatives.
• Beginning or ending school.
• Changes in daily routines, taking a vacation, holidays (particularly Christmas!)

Natural Ways to Help Heal Chronic Back Pain

While not everyone with back pain will be able to avoid using traditional therapies and surgery, everyone can still be helped by addressing emotional and psychological factors that can contribute to chronic pain and affect pain perception. And it just may be the key to returning to normal functioning!

Here are some of the ways you can help yourself if you suffer from back pain:

1. Get a thorough medical evaluation. See a doctor to rule out any serious condition. Once you’ve gotten the medical “all clear,” work with an expert who will support you in resuming exercise and activity. You can do this even if your tests show evidence of a bulging disc or other common “abnormality.” The best way to do this is to go to a physiatrist—a physician who specializes in rehabilitation and understands the role of activity in recovering from back pain.

2. Work consciously with your stressors. Identifying your everyday stressors is a starting place for healing back pain. When you notice pain, ask yourself, “What happened?” “How did I feel when it happened?” If you can’t trace your pain to a specific event, ask yourself “what was going on around that time?” “Who else was there or involved?” Then try to drill down to the emotions these events bring up. Once you are able to connect the dots, allow yourself to fully feel the emotions. 

3. Keep moving. This is critical to full recovery because chronic back pain is often due to muscular tension and disuse. The keys to regaining freedom of movement include flexibility (stretching), strength (weight training), and endurance (aerobic) training. There’s also an ingenious at-home program anyone can do called The Core Program, developed by physical therapist Peggy Brill. The Core Program is a series of exercises that can be done in a small space with only a mat and some ankle weights.

4. Express negative emotions. Expressing negative emotions associated with your pain can help your lesson physical pain. When you let go of something you’ve held onto that is causing tension, you will often feel a physical release as well. It won’t happen all at once. It’s more like peeling an onion. If you are not sure how to express negative emotions (as many women aren’t!) you can start by saying something like, “I choose to release all anger and hurt (or another emotion) associated with my pain.” You can also use Divine Love petitions to assist with release of both emotional and physical pain. 

5. Listen to your dialogue. There is immense power in words! If you find yourself saying things like, “my back is killing me,” or “I feel backed into a corner,” or I don’t get any support,” you may be unconsciously reinforcing beliefs that don’t serve you. Practice listening to your own dialogue. If you hear any implications of outmoded belief systems work to revise these internally, and then in your external conversations. You can also ask your friends and family help. You can say, “I’m really working on strengthening my back and my life in every way. Please don’t treat me as if I’m special or remind me that I have a bad back.” 

6. Don’t blame yourself. Emotional and psychological factors are present with any dis-ease. This means that in order to effectively manage dis-ease, including pain, you need to address the underlying emotions. However, this does not mean you are to blame for your emotions or your pain. It simply means that you acknowledge them. When we accept and experience emotions more directly, it helps trigger our bodies into relaxation and ultimately relief from pain.

7. Be mindful. Mindfulness is simply the practice of bringing your attention into the present. So if you are walking, notice how the ground feels under your feet. Notice what your surroundings look like. Notice the weather. When your thoughts wander, gently bring them back to the present. This practice works because anxiety about back pain (or any other pain) is usually connected to thoughts about the future—fear of loss of normal function and activities or imagining the worst-case scenario. By keeping yourself tuned in to the present, you take your attention off your sore back and neutralize negative thoughts about the future.

8. Keep a journal. Set aside 15 minutes per day to write in a diary. Write about your emotions, including fear, hurt, sadness, anger—whatever shows up for you. Don’t hold back. Try writing every day for the first several days, then once per week. Write continuously without self-editing, and let it flow. Studies have shown that writing about your emotional “hot buttons” enhances immune function and health and reduces stress. In fact, journal writing has long been part of my core program for creating health daily. I recommend it for every woman, regardless of whether you are experiencing back pain. 

Psychological and emotional stressors are contributing factors in every illness. And excessive emotional stress that goes unexpressed or unreleased generates further stress. But stress is a part of life. Turn these easy techniques into healthy rituals to release stress and put the mind-body connection to work for healing back pain and other pain syndromes.

Do you have back pain or chronic pain? What have you done to heal?

Learn More — Additional Resources

• Back Sense, by Ronald D. Siegel, Psy.D., Michael H. Urdang, and Douglas R. Johnson, M.D.
• Healing Back Pain: The Mind–Body Connection by Dr. John Sarno
• The Core Program: Fifteen Minutes a Day That Can Change Your Life, by Peggy W. Brill
• Healing Mind, Healthy Woman: Using the Mind-Body Connection to Manage Stress and Take Control of Your Life, by Alice D Domar & Henry Dreher
• The Relaxation Response, by Herbert Benson, M.D., president of the Mind/Body Medical Institute.
• Women’s Bodies, Women’s Wisdom, by Christiane Northrup, M.D., Chapter 15, “Steps for Creating Vibrant Health”
• The Wisdom of Menopause, by Christiane Northrup, M.D., Chapter 12, “Standing Tall for Life: Building Healthy Bones”
• The audiotape program Anger Releasing by Louise Hay