How Muscular Learning Leads to Pain and Degeneration
Chronic pain is invisible, and can be all too easily ignored by people who haven’t experienced it. But if you suffer from chronic pain, you understand the stress, helplessness, depression, and fatigue that accompany it. You might deal with financial hardship as a result of missed work or healthcare costs. You may struggle with having to use addictive pain medication to keep your pain under control. And if your experience is like that of most Americans, your doctor is of little help in getting to the root cause of your pain.
Large-scale surveys estimate that between 50 million and 100 million Americans, and 1.5 billion people worldwide, have chronic pain that negatively impacts their life. These people suffer on a daily basis because the medical community simply does not know how to address the underlying cause of most chronic musculoskeletal pain. And sadly, two of the most common pain treatments—medication and surgery—are expensive, can lead to other health problems, and usually don’t address the cause of the pain.
The growing problem of chronic pain has fueled other large-scale public health issues, the most tragic of which is the opioid epidemic. In 2011, a whopping 238 million prescriptions for narcotic pain medications were filled in the United States. As of 2017, the number of people abusing prescription painkillers was more than double the number of people addicted to heroin and almost double the number of people addicted to cocaine. There are now more overdose deaths involving prescription opioids than there are deaths involving cocaine and heroin combined.
Many Americans also turn to surgery to find some relief from their pain. Blue Cross Blue Shield reported that spending on elective orthopedic procedures increased by 44% between 2010 and 2017. Many of these surgeries are being performed on younger patients; the National Center for Health Statistics found that between 2000 and 2010, the number of hip replacement surgeries in people ages 45–54 more than doubled.
As more elective surgeries are performed each year, health insurance costs are driven higher. And unfortunately, orthopedic surgeries have inconsistent outcomes. They also pose the added health risks of persistent pain, reduced long-term mobility, repeat surgeries, infection, and abuse of prescription pain medication.
Chronic pain is a big contributor to our global mental health crisis. People who suffer from pain for at least 6 months are more than 4 times more likely than non-sufferers to be diagnosed with depression. And as pain becomes more severe or complex, symptoms of depression worsen. Pain and depression share biological pathways and neurotransmitters in the brain, so they often coexist and exacerbate one another.
Up to 90% of pain sufferers are unable to get a good night’s sleep. This lack of sleep contributes to a state often referred to as the “terrible triad” of suffering, sleeplessness, and sadness. For people with chronic pain, the combination of fatigue, depression, and unrelenting pain becomes a vicious downward cycle that can lead some to desperately resort to overuse of painkillers, unnecessary elective surgeries, and even suicide.
Chronic pain has also created a huge financial drain on our economy. The CDC estimates that the total cost of disability from all types of pain is $300 billion annually. And while we typically think about the effects of pain on a personal level, the cost to the U.S. government is immense. In 2008, federal and state programs (including Medicare, Medicaid, the Department of Veterans Affairs, TRICARE, workers’ compensation, and others) paid out $99 billion in medical expenditures attributable to pain.
Western medicine works miracles on a daily basis, but it is way behind when it comes to addressing the underlying cause of chronic muscle and joint pain. Since most pain is functional—created by the way our nervous system is functioning—the traditional outside-in approach of using medication and surgery simply doesn’t work.
How Muscle Memory Causes Chronic Pain
The idea that your body will inevitably break down as you age is a myth perpetuated by the medical community. As a result, many people experience muscle and joint pain and never ask why—or if it might be avoidable.
While there are many causes of pain, including autoimmune diseases, cancer, and neuropathy, most pain and degeneration occurs because of the way that we habitually use our bodies. For example, in the case of back pain—the most common type of chronic pain, experienced by up to 80% of Americans at some point in their lives—it’s estimated that 97% of cases are mechanical in nature. The way we sit, stand, and move makes our muscles chronically tight and sore, compresses our joints and nerves, and puts stress on our bones and connective tissue, often to the point of causing significant pain and damage to the structure of our bodies.
All of these painful problems are the result of muscle memory: your nervous system’s way of making movements automatic and efficient. You may not be aware of it, but your nervous system is constantly reinforcing old movement patterns and learning new ones.
For the most part, acquiring muscle memory is enormously beneficial. Without muscle memory, you’d spend all day figuring out how to brush your teeth and get dressed for work.
Unfortunately, this automatic learning process allows you to develop unnatural and damaging muscular habits too. For example, if you choose to sit slouched forward at the computer every day, your nervous system will start keeping you in that posture by subconsciously contracting your abdominal and pectoral muscles. Soon you’ll be sitting and standing with slouched posture all the time, even when you’re not at the computer. For most people, this slouched posture is not a genetic condition or an inevitability of the aging process; it’s simple muscle memory.
Functional magnetic resonance imaging (fMRI) shows that when we first learn a movement, our prefrontal cortex (an area of the cerebral cortex that plans complex behavior, makes decisions, and focuses attention) is highly interactive with other brain regions. As we practice the movement over and over, the prefrontal cortex becomes less involved, and activity increases in the motor cortex and basal ganglia (a subcortical cluster of neurons that plays a role in learning, memory, voluntary motor control, and habit formation). This shift correlates with decreased need for conscious attention as we master the movement. Ultimately, our long-term motor memories are stored in the vestibular nuclei in the brainstem.
When repeated muscle contraction is signaled by the brain, muscles retain excess tension. A sensorimotor feedback loop in the nervous system called the gamma loop automatically regulates the level of tension in our muscles. As the brain continues to send the same messages to contract, the baseline level of muscle tension being set by the gamma loop gradually increases. Our proprioception (our internal sense of our posture and body position in space) adapts so that the increased level of muscle tension feels normal.
We’re usually not aware of this gradual tightening until our muscles become stiff, then sore, then downright painful. Tight muscles also pull our skeleton out of alignment, causing poor posture and issues like functional leg length discrepancy, idiopathic scoliosis, movement limitations, and recurring injuries in athletes. The misalignment and pressure caused by tight muscles also leads to joint degeneration and nerve impingement, like sciatica.
We each develop unique patterns of muscle use and tension throughout our body as a result of our repetitive daily activities, our reactions to stress, our personality, the injuries we sustain, the sports we play, and any physical training we engage in. No other human being on the planet stands and moves quite like you.
A study published in the Journal of Applied Physiology in October 2019 calls these muscular patterns our “individual muscle activation signatures.” The study found them to be so predictable that a computer program could recognize patterns of muscle activation in individuals 99% of the time.
The study authors recognize recognize that the concept of individual muscle activation signatures has implications for understanding why people experience musculoskeletal pain and degeneration:
“This would open new research perspectives in which individual differences are considered relevant information for addressing fundamental questions about the control of movement in health, aging, and disease…It is known that even small differences in activation level can have a large effect on movement. It is, therefore, possible that each individual muscle activation signature has specific mechanical effects on the musculoskeletal system. As such, some strategies may place some individuals at greater risk of developing musculoskeletal disorders than others.”
Athletes, dancers, and other trained movers have long understood the uniqueness of our muscular patterns. Many of the comments to the New York Times article on the study agreed that the finding was old news. However, while the fact that we all stand and move differently is obvious to most of us, knowing how to change these deeply learned muscular patterns is not widely known—and this is why so many people suffer in pain.
The Answer Lies Within Our Nervous System
We evolved to survive, so our nervous system does have a built-in way to avoid developing chronic muscle tension—it’s called the pandicular response. This reflexive response exhibited by vertebrate animals is automatically triggered when the nervous system senses increased muscle tension or loss of sensation in inactive muscles.
If you’ve ever seen a dog or cat arch their back when they get up from a nap, or watched a baby stretch their arms and legs as they wake up, you’ve witnessed the pandicular response. The response contracts and releases muscles, sending feedback about the level of muscle tension to the brain. This resets the level of baseline muscle tension and restores voluntary control of the muscles. Essentially, pandiculation “wakes up” the sensorimotor system.
Fetuses have been observed pandiculating in the womb, showing how deeply ingrained the response is and how critical it is to our musculoskeletal functioning. Unfortunately, repetitive activities, stress, and athletic training tend to build up muscle tension faster than our pandicular response can counteract it. And as tension increases and muscular patterns become more deeply learned, the pandicular response can even become inhibited.
Thomas Hanna, a student of Moshe Feldenkrais, learned about the pandicular response while studying neurology at the University of Florida Medical School. Hanna developed hands-on movements and self-care exercises that work in the same way as the pandicular response. These voluntary pandiculations are highly specialized eccentric contractions, which must be performed very slowly and consciously so that the nervous system is able to sense and integrate the biofeedback that the movement provides.
Hanna’s voluntary pandiculations proved to be groundbreaking. The movements quickly reduced muscular tension, and since it was accomplished through retraining the nervous system rather than manipulation (like massage or stretching), the effects were typically long-lasting.
A group of physicians, osteopaths, chiropractors, and physical therapists who studied Hanna’s technique said: “You have shown us what we thought we should learn during our training but never did. It is the missing link in health care.”
And a cardiologist who attended one of Hanna’s classes wrote that what he had learned “has as much potential for understanding the mind-body relationship as Einstein’s theory of relativity had for physics.”
In 1990, after years of requests to teach his methods, Hanna began his first professional training program. Tragically, after teaching the first semester of the three-semester program, he was killed in a car accident. His students worked with the clients who were on his long waiting list, and some went on to create training programs for future students.
Hanna had an enormous following—hundreds of people attended his large workshops, and many traveled across the country to work with him. He helped thousands of people release the muscle tension and change the learned muscular patterns that were the cause of their chronic pain and musculoskeletal disorders. But when he suddenly passed away, the momentum of his work came to an abrupt halt. There are still only a few hundred people in the world trained in Hanna’s method, known as Clinical Somatic Education and Hanna Somatic Education.
Hanna’s method of voluntary pandiculation is highly effective because it is not just a method of movement that someone made up—it’s part of our innate neuromuscular functioning. In a survey of 184 people who had been practicing Hanna’s self-care exercises for two months or more, 93% of respondents experienced pain relief. The recent study about muscle activation signatures shows that the medical community is beginning to recognize the functional causes of chronic pain and musculoskeletal disorders. Hopefully, it’s also a sign that doctors will soon become more open-minded to somatic education and the technique of voluntary pandiculation, which has the potential to help many of the 1.5 billion people around the world who suffer from chronic pain.