Back Pain, Cultural Conditioning , and Unasked Questions

Cultural pressures cause us to sit for far longer  than we are comfortable doing, work more than we want to and say yes to things we want to say no to. 

Back pain of course has many causes. Pain can be complex and there are anatomical as well as psychosocial factors involved. Most causes are discussed at length in any physical therapy clinic. But there are also more subtle factors that aren’t  discussed as much, yet could make a big impact on the frequency and intensity of back pain. 

We live in a culture that starts conditioning us from a VERY young age to sit still.

Sit for hours. Hide how you feel if you don’t want the teacher on your back. Hurry up. Get your work done. Pay attention. Learn information you have no interest in learning and do things that you have no interest in doing.

Do it for the grade, or the money. In some cases (like mine), do it (“it” being ANY kind of activity that I either don’t want to do at all or that I want to do less of or take a break from) so that I can prove  how hard working I am.

This is not always a conscious choice on my part. It’s this underlying sense of “I better get this done, or else….” Or else what? The productivity police will rappel down from the ceiling and arrest me?  I’m only worthy if I’m productive? 

We excel at abandoning ourselves on a consistent basis .

I’ve had people finally confess to me during their physical therapy evaluation that they sit at their desk for 12 hours, will skip meals and water, and will wait so long to go to the bathroom that they have to make a mad sprint for the restroom.

As most  people with back pain can attest to, sitting for long periods of time causes a worsening of symptoms. But we ignore our impulses and needs over and over again because it’s what we were taught to do. 

We spend hours in our cars commuting and for many parents, shuffling kids from one activity to another. Very often feeling tense and rushed. But most of us don’t ask ourselves “Is this what I really WANT to do?” I’m not asking your children to start hitchhiking, I’m asking these questions so that we can maybe admit that there are some strong cultural pressures going on. 

 At this point, you are probably thinking to yourself, “Umm.. I was just looking for a simple stretch that I could do in my living room”  

After all, I'm a physical therapist and I'm expected  to teach movements, posture and habits to relieve back pain and promote better movement. I've done that and can humbly tell you I've been successful at it. And although helping people find relief from pain could be considered a job completed, something was missing. 

One could argue that I convinced them to get up from their desks and go for a walk. Got them to  cut back on their driving. Put more time and effort into their breath work and mobility drills during their warm ups and their workouts. Influenced them into implementing more variety into their movements.

But I missed out on the opportunity to get them to question why they were ignoring those things to begin with.

Where do you abandon yourself?

To quote my favorite physician Gabor Mate of “The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture””, ask yourself “In my life’s important areas, what am I not saying no to?”

This question asks you to look at the patterns that show up in your work and your personal relationships. The extra work that you take home for the weekend, the chronic pattern of staying late, the volunteer work that you felt pressured to say yes to. All the times you go along to get along.

I’m not talking about the person bleeding on your doorstep, or your young child asking you to wash his favorite t-shirt.

It’s the pattern of saying yes when your body is clearly telling you no. The times that you knew you had to rest but didn’t want to cancel your plans lest you hurt someone’s feelings or God forbid, disappoint someone..

It was easier to notice these things in my patients before I noticed them in myself.  It took a coach and a therapist to point these things out to me. That I had become so inauthentic, saying yes to things that my body was clearly saying no to, that I didn’t know which way was up. 

These patterns chip away at our health. We now have several studies to point to the links between chronic stress, trauma, pain, inflammation and the immune system. . Dr. Mate creates meaning from these studies as well as from his own clinical experience.

"Medicine often fails to treat the whole person, ignoring how today's culture burdens our bodies and our immune systems and undermines emotional balance." His book is a work of art. It is a must read for anyone with chronic pain.

Personally, as I started to spend more time looking inward over the past few years I started to pay attention to my bouts of insomnia, occasional dizziness and back pain. To be clear, nothing serious but they did indeed become patterns. And although I did at times seek medical help or an assessment, I did so IN ADDITION TO asking myself, what else could these physical issues be telling me?

When I started looking at my back pain not as an outcome but as a symptom, I could ask myself “What is this a symptom OF?”

In my case it was a deep dive into all the ways that I was so hard on myself. Being hard on myself, with very little self compassion, resulted in many times working past the point of fatigue and persistently ignoring what my body was telling me.

Thus my journey into learning about how emotions contribute to our wellbeing, and if stuffed down and ignored, our demise. More importantly, asking myself these questions gave me the space to determine what I actually WANTED, not what the culture dictated for me.

This made it easier (easier not easy) to say no even if I was disappointing someone who I respected and cared about. And I can’t help but ask that if I, a white heterosexual woman, has felt the impact of cultural pressures, how must the added stressors of racism, homophobia or poverty impact a person?

 I am convinced that if all of my patients and clients were able to pay attention to how they feel, and were able to  give space to those feelings, I would be out of work. For real.

If people got really honest with themselves and pushed themselves away from their desks, got up when they had the impulse to do so, and said no when they really felt it, I would have to, oh I don’t know, become a dog walker or something. But we also know that saying no and getting up from the desk is a luxury for a lot of people. Many people don’t have that autonomy.

 As you might imagine, I get a lot of push back with these views even from people who actually DO have the autonomy to make changes. “Well, Heather” they say, “Someone has to do the work around here! This budget isn’t going to write itself!”

And they are right. We do have to make a living and feed our children.  And there is something fulfilling to being productive and tackling our to do list. And there are times that I'm actually really fulfilled by  a project, get into a flow state, lose track of time and forget to eat.

I’m not talking about those times. It’s the chronic, persistent patterns of saying yes when we want to say no. It’s the cultural pressures of putting others' needs before our own. Of being dishonest with ourselves and others while building resentment or at the very least fatigue. 

The good news? You don’t have to take any action right now. You don’t have to change a darn thing. You can actually start by paying attention to how you feel.

Notice how it feels to ignore your own boundaries. Notice what happens when you really want to get up from your desk but you stay seated. Notice when you are really thirsty and you think “just a few more minutes” and 3 minutes turns into 60. And notice all the no’s that you swallow. 

 And then? Have compassion for yourself. Be kind. This is not one more thing to beat yourself up for. We are products of our environment. We have been conditioned by our culture. Be curious about this. Lighthearted if you can. Think to yourself “Huh, what could this back pain be telling me?”

Over and over again when people take the time to ask themselves these questions, they notice their impulses. They still might ignore them (these are some ingrained habits) but they do start to notice them and slowly but surely start to make easy changes. The ones that make the most sense to them.

Many of my patients and clients, when looking for solutions beyond the traditional treatment plan,  have been helped by using all kinds of modalities including meditation, breathwork, counseling, coaching, getting out in nature. There is no one action that everyone can take. But we can all pay attention to the ways that we abandon ourselves and reach out for help from there.

Thank you for reading. If this post resonates with you, please share