Blue Beryl Blog
Back Care Basics
Yesterday, the American College of Physicians amended its guidelines of care for the treatment of low back pain. This statement echoes many a concern voiced over the years – that an over reliance upon muscle relaxants and opioid painkillers as a primary approach to care, simply masks an issue.
Acute or subacute pain tend to resolve, provided more serious injury is not the cause. In fact, the determination clarifies that for nonspecific pain with an occurrence of under 12 weeks generally improves through acupuncture, physical therapy, heat and other mindbody modalities.
Strain and sprain are common. There are things we can do to take care.
Clearly bodily usage, the connection between stress and muscle tension and routine, safe and therapeutic exercise are important factors in back care. Evaluation and discussion of history can often rule out more serious circumstances. Among them, manual palpation of the muscles can provide a significant degree of insight for best care.
Nondrug therapies (non-pharmacological) are now to be observed as the first line of care, which puts self-care strategies at the forefront. Acupuncture is no longer the safe alternative, and will perhaps be one of the routes your doctor may recommend.
Cupping, Moxibustion, heat therapy, electro-stimulation, manual therapy, therapeutic exercise, herbal medicine, compress - these combine to reveal just how comprehensive Asian medical care can be with respect to the treatment of back pain.
How do we express our greatest potential? How can we experience the utmost satisfaction?
Mihaly Csikszentmihalyi's research on optimal experience reveals something about the paradox of attention. In various areas of human activity – art, philosophy, athletics, dance and work – we can experience enjoyment and a sense of creativity, involvement and connection that stands apart from ordinary moments.
These experiences of “flow” can contribute to overall happiness and wellbeing. They also share something in common with processes of change, in relation to attention.
In order to shift less optimal behaviors, we often have to curb impulses and employ what McGonical called the “muscle of willpower.” Healthy choices require self-control. Long term changes require a certain amount of discipline.
In addition, replacing certain behaviors with others more healthful benefits greatly when we enjoy them.
Optimal experiences of flow that visit us through disciplined engagement are said to mirror greater complexity and organization. It is as if our energy and faculties find themselves in moments of alignment that somehow promote the type of ease, contentment and relaxed concentration that characterize such experiences.
Therein lies the paradox of attention. It must be consolidated, in a meaningful and often goal-oriented focus such that attention itself is consummated and released. In such moments, many of our impulses or “wants,” as well as the energy of mentation come together in apparently seamless experience of presence – even amidst stress, as many an athlete or performer will attest to.
Humanitarian Matthieu Ricard, in conversation with a neuroscientist, also came up with the notion that meditation, in its peak moments, is similar to the peak experience, or the experience of flow except it is one in which stillness predominates, rather than the active state of a mountain climber, or when things click on a family vacation after struggles with the luggage, when two lovers state at the perfect sunset – when we arrive.
The paradox of attention in relation to change again is that self-control becomes a resource when we recognize that the struggle between parts of the brain, or the self, sometimes requires a willful deployment of our discrimination to choose for the longterm. These same impulses, and their short term reserve, often related to reactiveness and the fear/flight response, are the basis of impulses and related to emotional patterns that also have to be brought into line when we attempt to master any art, or engage the body in crossfit, or perhaps running – which many experience flow.
The point here is that whether it is specific change or greater health and enjoyment, it’s often valuable that we dedicate some of our time and energy towards something that is meaningful, pleasurable and that can challenge us.
Some of them can be more physical such as gardening or hiking. Writing or painting, too, share this context for flow experience.
As we say in Chinese medicine, where there is free flow of vital energy, there is no pain. Where there blockage or obstruction, pain is concomitant. A previous mentor expressed health in terms of rhythm and flow, as central to the worldview and experience of the bodymind in integrity, wholeness and complexity.
Is happiness contingent upon relative circumstances?
It’s actually a complex question. Mindfulness often reveals that our perceptions and stories are quite constructed and not so solid. The things we might not feel jazzed about, can change.
And so, something that can be draining in one period of life – even a person, or relationship – can be a source of happiness, and much of that has to do with perspective.
This holiday period I reflected upon the cultural, rather than religious aspects, of the festivities. With all of the gift-giving I focused upon generosity, and how it contributes to happiness.
I felt gratitude for being able to share time with family and friends, and mostly, to have my daughter connect with the joy of giving. We made many inexpensive gifts to offer to our extended community. In the long run, I’d like myself to foster a nourishing relationship with the holiday experience.
If we take at face value contemplative wisdom, we might assume that trying really hard to be happy will only contribute to a vicious cycle. Chasing for happiness can be a drag. It’s what we do in a consumerist society and can lend not to compassion fatigue, but wallet fatigue and perhaps a well of inadequacy. Perhaps we wish we could give more, or had more basic facility – financially or otherwise – to do things, and even be of great service with our lives.
Pretty quickly we undoubtedly realize that yes, material circumstances do provide a foundation for happiness to flourish. So that’s not what the samsaric clamor is all about, but rather our stance on life and moreso, how or how not, we are promoting happiness or suffering based upon our motivations and take on things – our relationship to experience.
Neuroscientist Rick Hanson emphasizes that happiness is experience dependent, and that to cultivate the embodied foundations of happiness, it’s important to understand the brain-based underpinnings of how our experience is shaped and has come to evolve.
One of the main things Hanson is known for is highlighting the negativity bias, which undermines our ability to be open-minded about experience. Evolutionarily speaking, we are prone to seek safety and security, in relationships and to the environment and so our nervous system records and orients to the world, based upon our early experience. That’s called the saliency system, we have mentioned in previous posts.
Strangely, we’re wired to recognize pain and danger – a species’ survival mechanism that reads the environment for mishap. Like a scrooge or ghost of Christmas past, the implicit stores of memory can override our ability to assimilate the good, to see possibility and have hope, even in relationships or work, because we can remain conditioned to believe that all circumstances are destined to failure or have preconceived notions about everyone and everything.
This negativity bias is important to understand, and if there is a science of happiness we must regard the value of integrating positive experiences, to note the saliency of happiness. That’s one of the buzzes in the neuroscience field regarding rewiring the brain with respect to neuroplasticity. Hanson suggests deeply imbibing nourishing experiences so that the neural patterning around those circuits register, and over time, can be a mainstay, establish a network or habit of happiness.
These are the types of structural brain change that are the relative or embodied foundations of happiness and psychological health.
So if you’re having some great holiday time, take a moment to let it sink in. Perhaps not fretting that you’ll be back at work soon is the contemplative wisdom bit – nonattachment. From a brain-based perspective, we might just have so much past as fodder for positive change and by letting the joyful experience seep in, they can imprint.
If not, there are equally powerful ways to till the field such that our difficult emotions and challenging relationships can be sources of inner nourishment or happiness. Again, that all depends upon perspective and our capacity to engage such tools.
An analogy before parting here is found in traditional medicine around emotional and physical healing, toxicity and medicine, suits.
If we are strong than we can apply strong measures. We can also use poisons as medicines, in the right dosages. If we apply a strong measure, and our body resists, it becomes toxic even if it were a hundred year-old ginseng. If our body is in a deficient state, it must be propped up – supported – with minimal intervention such that we can register a gentle nudge toward self-regulation.
Similarly, if we want to change, we don’t always need drastic measures. A spoonful of sugar will do. Sometimes sweet is needed, and not only bitter. We can focus on the positive and implement small changes – dietary or otherwise. Some rest and encouragement.
If we’re feeling robust and want to work away at behaviors or even feelings that have shaped our emotional lives, our immune response, ways that we engage work and the world that are obscuring rather than vitalizing, we go at it with an axe, and fell the tree – or certain branches of experience – at their root. Some prefer cold turkey. Others a purgation. Something demonstrative.
These are applications of medicine, and they relate to personal change, as well . One of the great things about healing is the capacity for change and of each of us becoming skillful with our experience, learning skills of nourishment – how to build up, break down and genuinely create more optimal experiences that contribute to happiness. This will make us better parents, teachers, lovers and friends.
To cultivate happiness, we often speak of generating equanimity, kindness and care, and a mind bent to prosocial emotions because they allow us to flourish. Of lesser note are the strategies of self-healing and care that support our reworking of experience or rewiring of the brain. As we come towards New Year’s we’ll again share some thoughts about how to find nourishment in our experience.
We usually think of this process in terms of digestive capacity and immunological function, but clearly all of these functions - social, interpersonal, regulation with the environment - are all intertwined
Obviously, when we are doing a dietary overhaul it might just be helpful to stock only those foods whose sources we are aware of, and ingredients that are explicit and which we know we won't respond poorly to. Omitting overtly problematic items such as the sugary foods, pro-inflammatory goodies - excess coffee, alcohol and the like - will quickly begin to streamline our diet. One of the upsetting realities we might be familiar with is that food can transform from a great source of pleasure to something we have to be cautious of.
Lets not forget the intrinsic role the sensitive digestive system plays in relationship to our mood, immune function and vitality - not to speak of providing fuel for our bodies. The metabolites of these gut microbes can be a cause for serious health detriment, relative to inflammatory processes, and maybe also our mood, as emphasized here.
With all this in place, we begin to see how integrally related our mood is in relationship to the types of foods we grab for, how well we digest them, and what our bodies can make out of what we put in it.
The dark story of the belly's unconscious unfolds.
Our human microbiome encompasses a variety of bacteria that populate key areas of the body. These include the skin (eg. staphylococcus), orifices and mouth (streptococcus), the gut system (bacteroides)– it’s different stretches -as well as the vagina (lactobacillus). Like the Big Island of Hawaii, these stretches contain site specific bacteria like bioregions and their given micro-climates.
In terms of gut and vaginal microflora, fermented foods and drinks - those rich with probiotics – and probiotic supplements may aid in rebiosis, or fostering a better balance, or reboot.
Probiotics (such as Bifidobacterium and lactobicilus) are fostered by prebiotics, which directly feed them. Probiotics need to be able to be introduced into the system, and not be broken down by gastric acid, adhere and colonize.
Metabolites from gut bacteria influence mood, energy, behavior and are involved in epigenetic regulation, as well as the immune response – positively or negatively. Some bacteria contribute to vitamin synthesis. Many chronic health concerns may involve gut dysbiosis, or microbial imbalance (including asthma, diabetes, obesity, cancer and autism; Yong, 2016). Overuse of antibiotics, medications and other factors can disrupt this balance.
The microbiome is in contact with several environmental agents, known as xenobiotics, or foreign chemical substances that are often registered as toxic. We respond to them, often negatively, or cumulatively. Begin to look around the house, the environment, check water quality and what’s in the food. It’s often a good starting point.
Raised in a medical culture where vaccines and antibiotics are often life-saving but also over-used, we can benefit from limiting them and knowing when to implement a safe alternative. Some medical conditions benefit greatly from antibiotic use, but many may indeed may cause or exacerbate chronic issues.
The microbiome has become a fashionable area of research. Many traditional medicine enthusiasts have been quick to state that Ayurveda and Asian medicine maintained these same ideas between digestion, the immune system and the enteric nervous system. As with the neurosciences, it’s important to acknowledge the differences and to highlight the cultural and historical differences, and most importantly the health practices and strategies relevant to each.
In following posts, we’ll be unpacking key immunological concepts and mechanisms to show what each medical system is focusing upon, to better understand the analogous relationships and divergences.
Dietert (2015). The Human Super Organism.
Yong (2016). I Contain Multitudes.
Appropriate words are not always found when friends, family members and coworkers experience loss. We have so many natural responses to loss, and it is one of the universal feelings that connects us together. There is a wisdom in loss and sanity in grieving.
We are not always meant to counsel, but to connect, be a partner in presence, reflect. We don't always understand, but we can be with one another.
Some experiences of loss allow for new growth. Many are confounding, and in some case grieving merely has its own time and is not linear.
Often, when we bottom out from a job loss, relationship breakup, or that of any dream – chaotic breakdowns can reveal the lack of ground, with the hysteria of grasping and holding on. Anger and disbelief do not sequentially give way to acceptance and integration. Our lives are not organized in one way, nor is a process of resolution.
Growth and wisdom underlying change is a highly personal process. I learn a great deal from some of the elders, and even senior patients, I know and work with. I recognize the role of reflection and the tone of understanding that is imparted in their contact - often empathetic and accepting. Life is filled often with what we least expect; our paths are hardly ever fully carved out, in so much as walked.
Knowing is often a solitude in itself. There are many things we know, and don’t have the words for, or can’t share publicly. Can’t speak of because others won’t relate, or it won’t help a situation. In those cases, creative work can regenerate, and can open us up to dreams, in the way that dreams help us digest experience. The relationship between knowing, feeling and embodying - all underlie how we heal and integrate the past and bring it onto the trail.
Not knowing what to say is common, pointing to the solitude of grieving and letting go. For that reason, I took a detour here to address something a bit more personal – that of pregnancy loss – as such conversations require sensitivity. We don't need to rush words when they'll fumble undoubtedly. We can get to the point indirectly, like a sidelong glance, or when washing dishes while another is watching tv, or while shopping, because such distraction can also allow for softening, acting as a buffer, and also allow people to occupy the same space... then the same heart space.
Indirectness can be a cultural way, but also something I’ve learned from moms, counselors and children.
One of the loneliest forms of loss is pregnancy loss, and can be equally shared by couples trying to conceive, but often weighs more on the mother, regardless of how far along a pregnancy was from the time of conception. While Asian medicine posits some notions of when life, consciousness and sentience is aroused, often aligning with the feeling connection a mother may develop with the fetus, it is this experience alone – biological, emotional, maternal, social and spiritual – that can evade others understanding.
There are several causes of miscarriage, including: Abnormalities, uterine, immunological, hormonal and environmental. The last of these has come to include more interpersonal and social reflections, aside from toxic exposure, and now we are beginning to look more at this facet of the supportive environment of a couple or family system, the epigenetic factors that influence growth and pregnancy outcome. We can now openly discuss our experience and not see something so magic as something so mechanical or sterile. We can look at our lives, frustrations and feelings as confluences as well.
This should expand the concept of maternal and paternal factors in reproductive physiology and psychology, in Asian medicine. Chinese medicine etiologies have a way of couching these psychobiological contexts – some of kidney weakness, lack of nourishment from deficiency of qi and blood, the compounding of stress and emotions causing stagnation, heat, as well as traumatic falls and injuries. We may be diagnosed with incompetent cervix, a structural/functional condition which modern medicine, addresses.
These are all presentations that are important in cases of threatened or habitual miscarriage, described according to traditional medicine etiology. Chinese medicine also utilizes herbs and strategies for ‘calming a restless fetus,’ to secure a pregnancy, noting the distinct psychobiological connection between mother and fetus, and dual focuses on both, from early on.
It’s quite difficult to write about these things. Clinicians share many private conversations, even in the case of abortions. In some instances, miscarriages are seen as blessings, preparations. Everyone reacts uniquely, with understanding, perseverance, resilience - or despair and confusion. Sometimes a loss will inform us of where we are. Only the individual can make sense of these narratives.
The holding environment of our lives – which in a previous post I mentioned as the garbha – is metaphorically personal and social, but also more importantly personal, individual, embodied and in some senses private. To nourish at these depths often requires that our commitments focus on this primary goal, and even with all the dedication, metaphors switch and we can be confounded by not achieving outcomes, right away, or of missed opportunities. Or the sense of failure.
For those who are not trying to achieve pregnancy, we can relate to the wider experience of wanting and missing, or of hopes and dreams in general.
Chinese medicine offers treatment for the inner experience of health processes – change. Many formulas are restorative not only for our physiological status, but also our hearts and minds. We experience glaringly obvious bodily metaphors when we are going through rough experiences – the holding – weight gain, shifts in bowel regularity, social/emotional withdrawal, pauses and silences.
Following pregnancy loss, it’s important to allow for processing, restoration – noting fertility as an experience, as part of psychobiological process, and to only consider the reproductive window as a concern of timing.
The reproductive body is linked to several key organ systems, each of which ties into our everyday biological functioning – nervous, autonomic, immunological, sensory. Whether it’s flirting and coupling, deeper emotional intimacy or coming together for children, Chinese medicine acknowledges many interwoven matrices of connection within each of us that align and open - reservoirs of energy, experience and impulses we awaken to that may be as startling, or natural, but often powerful.
We can be deeply impacted by our sexuality, intimacy and reproduction, which involve both conscious and unconscious parts of our experience. These come into vivid play, full swing especially when trying to get pregnant and dealing with medical information, costs and relational needs. Things get complex.
This whole discussion revolves around compassion, empathy, self-care and love, whether we are talking about love and loss, reproductive medicine or resonances of autumn upon our bodies and minds.
So yes, there are treatments for the body, but there is also therapy for experience, and the magical medicine potion of experience.
As I am writing a book, and living life day to day, I am profoundly moved by what wisdom Asian medicine has offered me. We’ll address some dietary and behavioral considerations at another time, but I hope you are similarly benefitted by the wisdom and knowledge that is there in these ‘nourishing traditions.’