Everyone knows what back pain feels like, but what causes it? Common sense says back pain is caused by a pulled or strained muscle or a damaged or misaligned spinal vertebra, and common sense is often right, just not always. Back pain specialists within the field of alternative medicine have a host of other theories-and the clinical proof, in the form of healed patients, to support them. According to these practitioners, while back pain may of course be precipitated by a physical strain, back pain also may be caused by chronic constipation, old surgical scars, and imbalances in the body’s vital energy flow.

So if you’re one of the 70% to 85% of adults who experience back pain, before agreeing to anti-inflammatory drugs or back surgery, consider the alternatives, such as massage therapy, chiropractic, herbal and dietary therapy, neural therapy, and acupuncture. Any of these approaches, as the following case histories show, can get you back to your life without pain recurrence or toxic drug side effects. Back Pain Caused by Untreated Physical Injury Elliot Greene, N.C.T.M.B., a nationally certified massage therapist, based in Silver Spring, Maryland, sees a lot of back pain cases which are the result of initial physical injuries left unaddressed, sometimes for years.

Consider the case of Lytton, 48, who came to Greene’s office complaining of painful shoulder pain and spasms. They were sufficiently severe as to prevent him from playing tennis; even writing became nearly impossible as his arm and shoulder would be seized with cramps. Six months earlier, while chopping firewood, Lytton had felt a muscle pull around his right shoulder blade. The pain and disability progressed steadily from that point, he told Greene. He’d start playing tennis, then his right arm would freeze up with pain. Lytton went the usual round of standard consultations, getting steroid shots from one doctor, physical therapy from another, but his condition did not improve. “He came to see me as a last resort,” says Greene.

When he first touched Lytton’s shoulder blade muscles, Greene found them to be as hard as rock-“extensively contracted, as nearly all the muscle fibers had been ‘recruited’ to produce the chronic spasm. The spasm made it difficult and painful for Lytton to move his shoulder and arm.”

In a serious strain, such as Lytton’s, many of the fibers of muscles and connective tissue rupture and tear. Then the body attempts to heal this by growing scar tissue in the area. Trouble occurs when the site, without proper intervention, never gets fully healed and remains a little inflamed, painful, and in spasm, Greene explains. “Further complications can result if the scar tissue has grown so it interferes with the normal functioning of the muscle fibers. This can lead to painful movement and less range of motion.”

In Greene’s professional perspective, Lytton’s case was perfect for deep-tissue, hand-delivered massage therapy. He explains that the massage has to focus on “restoring circulation, reducing chronic muscle tension, and influencing how the scar tissue has formed so that it doesn’t interfere with the ability of the muscle fibers to contract and lengthen properly nor adhere to adjoining structures.” To do this safely and effectively, a thorough knowledge of human musculoskeletal anatomy is required, which happens to be a massage therapist’s specialty.

Greene treated Lytton weekly for ten months, working the muscles around the painful shoulder blade and the rest of his back. With this type of injury, improvement is dependable, although gradual. After about four weeks, Lytton felt a marked improvement. He started taking stretching and yoga classes to promote greater flexibility.

Lytton, when younger, had been more physically active, but as his forties progressed, he tended to minimize the role of exercise in his life. After his initial injury, he ignored the signals his body was sending, thinking the problem would “go away,” until he could barely move his arm without pain.

Now, as he recovered from this disability, “he saw he needed to take a more active approach to his physical fitness,” comments Greene. At the end of the treatment, Lytton had regained full use of his shoulder with completely pain-free range of motion. He also started to understand that the next time he had a physical strain, “getting the treatment started sooner rather than later would be a much better idea,” says Greene.

In his second case study, Greene shows what happens when you let a serious back injury go for 15 years before getting correct treatment for it. Neville, 40, a former soldier, had, when he was 25, fallen seven feet out of a hovering helicopter and landed square on his shoulder with all the weight of his equipment on it as well. He received emergency first aid, enough to suppress the pain, and was sent back into battle.

“Neville never really had any therapy for his shoulder injury,” Greene notes and, over the next 15 years, his shoulder became painful and steadily lost its range of motion.

When he examined Neville’s shoulder, Greene found that the tissue scarring was so extensive that it had adhered to the outermost layer of bone (producing stabbing pain) and was starting to calcify. As Greene explains, sometimes a very deep tear in a muscle disturbs the tissue covering the bone, which leads to new bone being laid down on the muscle wound. “This area of calcified scar tissue was about the size of a 25¢ coin and felt like bone,” says Greene.

The goal of treatment, then, was to loosen this adhesion, break up the scar tissue, increase blood circulation through it, let the body absorb the bony part of the muscle wound, and restore the muscle’s normal range of motion. It took about a year of regular massage treatments, but at the end of it Neville was able to move his arm again without pain. In fact, he was so impressed with Greene’s therapy, that afterwards he became a massage therapist himself.

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