Sometimes Pain is the Sum of Many Factors

By Douglas Nelson

This article first appeared in the May/June 2013 issue of Massage & Bodywork.

“I can’t believe how much my back hurts,” said Mr. M., an active young man in his mid-30s. “If I bend over—even a little—it really grabs. At its worst, it can take my breath away. My doctor said it is a muscle spasm, but man, this feels like a lot more than that.”

“I understand why you think that, but actually a spasm can be one of the worst pains you can experience,” I assured him.

“But this hurts so much,” Mr. M. asserted. “I’m afraid something is seriously wrong.”

“That’s the funny thing about pain,” I responded. “We would like to think serious problems hurt worse than less serious ones, but that just isn’t true. A paper cut on your tongue can be devastating, yet a deadly cancer may have no symptoms at all. There just isn’t a linear relationship between the danger and severity of pain.”

“Well, if you and the doc are right that this pain is muscular, I don’t ever want to feel it again. You have to tell me what movement to avoid. Whatever the trigger was, I don’t want to do it again.”

“Have you been doing anything out of the ordinary?” I asked.

“Not really. I did carry big boxes of tax receipts up into the attic, but that was a week ago. I also helped my friends move into their new house, but just for one day last week. Oh yeah, then I changed the plumbing under our bathroom sink, which was a nightmare—a two-hour job turned into a whole weekend of work. I was fine until yesterday when I bent over to put on my socks and my back seized up.”

“I think I know the remedy,” I answered thoughtfully. “You need lighter socks.”

Mr. M. just stared at me for a second, not knowing whether to grimace at a bad joke or if I was actually serious.

“Lighter socks, really?” Mr. M. questioned.

“OK, not really. What you’re searching for is a singular movement that caused your back spasm. In reality, there wasn’t one event, but a perfect storm, where bending over to put on your socks was simply the last straw.”

“I get your point, but there must be some particular movement I should avoid. I don’t want to live in fear of moving the wrong way and being in pain again.”

Thinking of a way to get my point across, I offered up a crazy idea. “Here is the deal: I am going to see you for two to three sessions in the coming days. In less than two weeks, your back will feel substantially better. In about a month or so, you will have forgotten all about this pain episode. Sometime in the next six months, I am going to inform you that your task on that day will be to recreate this back pain within a 24-hour period. If you can do that, I will pay you $750. If you can’t, then you owe me $750. Sound like a plan?”

“No way,” Mr. M. responded. “I don’t think I could do that.”

“I’m pretty sure you couldn’t,” I replied. “That’s why I’d bet $750 on it. My point is that you couldn’t recreate this back pain even if you were paid to. There is no need to live in fear of possibly repeating some mysterious motion that will send your back into a spasm. A more reasonable approach is to resume your normal daily activities as much as possible.

“The overwhelming odds are that your back pain is the sum total of multiple factors: carting heavy boxes into the attic, helping your friends move, then wrestling with plumbing under the sink for hours on end. The act of bending over to put on your socks was simply the straw that broke the camel’s back, so to speak. In all probability, if you took out any one of those events, your back would not have spasmed.

“When you are dancing on the edge, even a slight breeze can topple you. It takes all those factors to create your present circumstance—that’s not likely to happen again anytime soon. Overprotective guarding of your back may actually do more harm than good.”

I could see Mr. M.’s face soften as his fear eased. Three sessions later, his back was doing just fine, and I haven’t seen him for weeks. And I haven’t made that $750 phone call; I don’t think I need to!

Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars and president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois. His clinic, seminars, and research endeavors explore the science behind this work. Visit or email him at