Tiger Woods just had his fourth back surgery last month; Steve Kerr has had two back surgeries, and, due to severe back pain, is currently unable to coach his Golden State Warriors in the NBA play-offs. Though most men have not won a Masters like Tiger, or hit a championship-winning shot like Kerr, many of us have had a bout, or persistent bouts, of excruciating back pain. Where does it come from? The medical doctors invariably diagnose something disc-related—bulging, herniated, ruptured; and their treatment: often, surgery. But are they right? Could our back pain be connected to how we go through the world as men, with emotional rather than physical roots? If so, how do we heal?
His recommended treatment: not surgery, but knowledge.
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I was hospitalized at 16 with pain in my back and running down my left leg, caused, my orthopedic surgeon diagnosed, by a bulging disc. He prescribed two weeks of traction, one girdle-to-go. When I was still in pain one year later, my uncle, a writer at the time for Sports Illustrated, hooked me up with an appointment with the New York Giant’s orthopedic surgeon: “Juvenile disc,” he called it. “Let’s operate.” I was 17; my dad and I looked at him like he was crazy. Thankfully, we were wise enough to follow the advice Steve Kerr has recently offered: “I can tell you if you’re listening out there, stay away from back surgery.”
But if not surgery, how to break what became a regular cycle of back pain? A recent article by Cindy Boren in the The Washington Post notes, Kerr himself “has tried everything, including conventional medicine, yoga, meditation, marijuana, exercise and sheer willpower. Nothing has worked.” Like Kerr, I too tried everything (minus the marijuana): a streak of ten years without missing a nightly regime of back exercises, innumerable preventative trips to the chiropractor, running on a golf course, physical therapy, massage, acupressure… And still, inevitably, at least once a year—usually somewhere between Christmas and New Year’s—I would endure a terrible week of pain where, wracked with severe spasms, I crawled-on-all-fours around the house, literally unable to stand up. For years on end this painful pattern persisted.
Until, at 32, a colleague handed me Dr. John Sarno’s Healing Back Pain: The Mind-Body Connection.
“Read it,” Gary said.
“I’ve tried everything. What’s his treatment?”
“Read it—that’s it. That’s the treatment.”
Sarno’s premise: 98% of the back cases he sees as a doctor of orthopedic medicine have nothing to do with disc problems, or pinched nerves, or physical trauma; rather, the back pain is a manifestation of unexamined, unacknowledged anger and anxiety. More precisely, our back pain is a defense mechanism against repressed emotional pain: we become fixated on the physical pain and what we believe are its physical causes, and therefore avoid having to deal with the underlying anger and anxiety. The physical back pain, in other words, serves to distract us from what we subconsciously perceive would be even more horrific emotional pain.
So does Sarno deny the pain is real? No, the pain is absolutely real—and must be, if it is to camouflage the repressed emotional pain. But the pain is finally harmless, the result, Saro speculates, of local mild oxygen deprivation to certain muscles, nerves, tendons, and ligaments. Sarno calls his diagnosis TMS (Tension Myositis Syndrome), and he suggests that back pain is just one of a host of similar disorders that may serve the same function of distracting us from our anger and anxiety; his list of “equivalents” include: peptic ulcer, tension headache, migraines, irritable bowel syndrome, hay fever, prostatitis, and eczema (58).
And who is prone to TMS? Believe it or not, perfectionists, hyper-responsibles, achievers, copers, “goodists” (those of us working hard to be good sons/fathers/husbands). In short, people who don’t allow pain to get in the way of accomplishing what they feel they must accomplish—until it does.
His recommended treatment: not surgery, but knowledge. For it is Sarno’s contention that it is the knowledge, once accepted, of this mind-body-emotions-pain connection that severs the connection, thereby freeing the person from pain. With that in mind, the essence of his treatment is to “Think psychological, not physical”:
I suggest to patients that when they find themselves being aware of the pain they must consciously and forcefully shift their attention to something psychological, like something they are worried about, a chronic family or financial problem, a recurrent source of irritation, anything in the psychological realm, for that sends a message to the brain that they’re no longer deceived by the pain. When that message reaches the depths of the mind, the subconscious, the pain ceases. (91)
Was I skeptical? Damn right I was! Part of me held tight to the idea that my pain was caused by a physical event—that fall I took sophomore year, my “narrow spinal column,” my slight scoliosis—and that it could only be corrected by physical means: back exercises, correct posture, chiropractic adjustments, heel lifts. After all, we men pride ourselves on the physical. I was even willing to concede, given the post-semester/Christmas pattern of severe lower back spasms, that my back pain had something to do with “stress.” But to fully accept the idea that the cause of my physical pain was, ultimately, emotional pain — from repressed anger, fear, anxiety? Ouch! !
Still, Gary was right—in simply reading the book, I immediately sensed Sarno was onto something, and for the first time in a long time, I felt a twinge of hope. Although I wasn’t, at first, prepared to acknowledge the depth and intensity of my repressed emotions, I had always been open to some kind of mind-body connection. And I clearly fit his personality profile of the hyper-responsible “goodist.” So, gingerly, I tried it.
Most men will endure almost anything to avoid dealing with our anger and anxiety.
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When I felt a twitch of spasm, I asked myself, “OK, what am I angry about, or sad about, or fearful about?” Or sometimes, as also recommended by Sarno, I got angry at my brain, called it out, exposed its well-meaning deception: “Hey, I know what’s going on here now! Stop it!” Sometimes I got immediate relief; sometimes I had to persist, to stay focused on my emotions, before the pain eased; sometimes, no matter how much I zeroed in on my anger or anxiety, the pain won.
I can report this, however: in the twenty-five years since reading (and re-reading) Sarno’s book, I’ve had only one incident of lower back spasms. And to be honest, even that one time was comparatively mild—spasms, yes, but not severe enough to reduce me to baby crawl. Do I still have some back pain? Yep. Mostly mild shoulder and neck stuff—and I’ve found, as Sarno predicts, that this too is directly linked to whatever emotions I’m currently out-of-touch with.
In addition to Sarno’s book (he’s written four; I recommend starting with Healing Back Pain: The Mind-Body Connection), the following Sarno-related link will provide dozens of testimonies—some from famous folk, most from ordinary back pain-sufferers—of the success of Sarno’s way of treating back pain: http://www.tmswiki.org. This 20/20 segment on Sarno is also a vivid demonstration of Sarno’s treatment…and his pain-free results: https://www.youtube.com/watch?v=QUEQHXaMnx0.
As for Tiger and Steve Kerr, Sarno writes, “Most athletes would reject the [TMS] diagnosis, since psychological syndromes are equated with weakness, and athletes have an image of strength and indomitability to preserve”(67). Furthermore, I am not a psychiatrist, so I cannot speak to their inner emotional state. However, it is clear both Tiger and Steve are immensely competitive men, and in my experience, their kind of game-time intensity is often channeled from a deeper anger. The truth of that can only be determined by Tiger and Steve themselves—with the pay-off possibly being a reduction or elimination of their pain.
Like most athletes, most men will endure almost anything to avoid dealing with our anger and anxiety. Even severe back pain. And sometimes, it is only after we have we have exhausted every other option, including surgery, that we have the courage — and now, thanks to Sarno, the knowledge —to face the emotions at the root of our pain.
Check out the best inversion tables for back pain.
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Photo: Getty Images
Nicely written and provocative, Peter. Thank you for yet another reason to examine my anger and suppressed emotional well-being.
Thanks to Pete for this clear and concise summary of Sarno’s approach, which has also helped me immensely. The comments at the end about our cultural biases against accepting Sarno’s approach are right on. It also took me years of failed traditional medicine to eventually accept Sarno’s wisdom.
Wow. What a revelation. What I wouldn’t give to see a documentary of Tiger working with Sarno’s treatment plan. I almost wish I had back pain (not really) just so I could “think psychological, not physical.”