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Anxiety and the Body: Case Study

LukeNotes, January 2024

Father Joe got right to the point and described his back pain as “going on for years” and rated it an 8 out of 10 on the pain scale. He had tried different doctors and pain specialists as well as medications, but nothing seemed to work. He described his work hours as 24/7, 365 days of the year and felt burned out. “At the end of the day I don’t have the energy to shop or cook healthy food, or exercise or even do things I love like seeing friends or hiking.” When asked to describe the behavior of his pain, he gave a blank look and said, “It just hurts.”

The behavior of pain is the “when, where, how long, intensity, irritability, recovery, and personal feelings about the pain” that helps a therapist categorize it: muscular, nerve, visceral, acute, or chronic, and/or emotional. This information guides the treatment. For example, when someone has a burning or numb feeling down the back of the leg, it is likely a nerve is getting “pinched” in the spine. Treatment would be for the back, not the leg, even though the leg is where the pain is being felt.

Father Joe was able to tease out some details of his pain, “It is in the center of my lower back; it feels like I am locked up. Sometimes I’ll get a sharp pain out of nowhere that makes me tense up and not want to move. It is the worst in the morning and at the end of the day. It is better while standing and worse when sitting, and awful in car rides. The pain is 6 out of 10 most of the time. It scares me. I can’t stop thinking about it. I feel like I will have to live like this for the rest of my life.” When asked if he had tried any treatments he said, “No, I’m too scared. I’m just resting and trying not to do anything to aggravate it.”

It is not uncommon for pain to cause fear, but unfortunately, fear will activate the “Fight or Flight” response. Father Joe thought he was helping his body heal by resting, but he was prolonging the misery. In Physical Therapy the mantra is, “Motion is Lotion.” However, if someone is fearful of movement, they will not move normally. Father Joe’s first goal was to learn to let his muscles relax safely.

There are many methods for relaxing the body: massage, yoga, stretching, and hot tub or hot shower. For Father Joe, guided muscle relaxation using a hold-relax technique gave him a sense of control that helped to decrease his fear. Lying in a recliner, Father Joe listened to a guided relaxation that helped him focus on different muscles, hold each muscle in a gentle contraction for a few seconds, and then fully relax the muscle. He did this for all the major muscle groups for thirty minutes. Afterward, Father Joe reported his pain was a 1 out of 10. He couldn’t believe that something so simple could have made such a difference. He also realized that he had a tool to help his body heal.

After a week of practicing the guided relaxation, Father Joe started practicing light mobilizations and gentle rocking movements for all the actions of the spine and pelvis: forward and backward rocking, side-to-side, and rotation to help keep those muscles relaxed. He started in a hands and knees position and moved to lying on his back and then standing. The routine of gentle repetitive movement, like a swing or a rocking chair, helps relax tight muscles and eases the fear of movement that causes pain. It also increases the Relaxation Response, decreases systemic inflammation, and increases endorphins. Once Father Joe was able to see that he could move in many ways without pain, he was able to let go of guarding his back and breathed more slowly and deeply, which helped lower his fear and his “Fight or Flight” response. Once the fear was gone, Father Joe began to move into the Relaxation Response and begin the healing process.

For confidentiality reasons, names, identifying data, and other details of treatment have been altered.

Read the article related to this case study here.