New Book Reveals the Secrets to Overcome Chronic, Nagging Neck and Back Pain Naturally
by Dr. Tamer Issa, PT, DPT
I recently published a book called Freedom From Neck & Back Pain- Learn to Live an Active Life without Fear of Pain. Writing the book was indeed a labor of love, and I'm so happy that it is now available for others to learn from. I had been thinking about writing a book for several years, and I debated several ideas of how I could help others based on my knowledge and expertise. It wasn't difficult to choose the topic of chronic, recurrent, nagging neck and back pain. Pain and functional limitations of chronic spine pain are so prevalent in our society, and there is a lot of confusion about how to solve it. Read the introduction to the book below to learn more about what led to me writing the book and whether it may help you.
Excerpt from Freedom From Neck & Back Pain
I know of no more encouraging fact than the unquestionable ability of man to elevate his life by conscious endeavor.
Henry David Thoreau
That quote by Thoreau is one of my all-time favorites. This book was born out of such an endeavor, and I hope it will elevate the life of everyone who reads it. Let me share how it came to be.
After graduating from Penn State University in 1995 with a bachelor’s degree in Exercise & Sport Science, I moved back home with my parents. I started working as a Physical Therapy Aide at Bryn Mawr Rehab in Paoli, PA. Bryn Mawr Rehab is one of Pennsylvania's most comprehensive rehabilitation centers, specializing in inpatient and outpatient physical medicine and rehabilitation for spinal cord injuries, traumatic brain injuries, strokes, amputees, neurologic, and orthopedic conditions. I witnessed every possible specialty in physical therapy there, including aquatic therapy, work hardening, driver rehab, horticultural therapy, hippotherapy (benefits from riding horses), and more. It was a remarkable place, and the therapists and patients I interacted with profoundly affected me. My plan at the time was to attend a graduate physical therapy program. That year at Bryn Mawr Rehab confirmed that physical therapy was my calling.
One of my physical therapist friends clued me in on a physical therapy program in Holland for American students, taught in English. I didn’t know how the Dutch physical therapy programs were stacked against other countries. Still, she assured me they were excellent and that learning physical therapy from a different perspective would serve me well when I returned to work in the States. I investigated the program and discovered that the Dutch program was the first foreign program accredited by the American Physical Therapy Association. I spoke to my parents about it, and they supported my decision to apply. Two weeks later, I had an interview in Boston. One month after that, I was accepted. Three months later, I was in Holland for two years!
Those two years I spent in Holland was the best thing that ever happened to me (until getting married and having kids, of course!). Living abroad in Europe was a fantastic coming-of-age experience for me. Besides the obvious benefits of traveling Europe in my free time, I received a world-class education in physical therapy. That education set the foundation for the therapist I am today.
I learned three major lessons in Holland that still influence my practice today. The first was the emphasis on hands-on therapy skills. We had massage therapy every semester of school. Some American physical therapy programs only have one semester of soft tissue work; others have none. We also learned how to use our hands to mobilize joints and strengthen muscles without equipment. All that hands-on practice developed the touch I think every therapist needs to evaluate and treat effectively.
The second was a holistic approach to care. We had several courses in psychology and were taught the importance of patient-practitioner interactions. It was stressed that you are not just treating a physical problem (the knee, the shoulder, the back); you are treating a person with a physical problem. That’s a big difference.
The third was the emphasis on clinical reasoning and critical thinking skills. This may sound obvious and necessary, but unfortunately, it often isn’t a central component of many physical therapy programs in the US. We were expected to diagnose neuromusculoskeletal problems independently rather than rely on a physician's order or diagnosis. They taught us to think rather than follow a protocol-based approach. Our Dutch professors were tough on us, and I remember multiple times being challenged as to why we were doing what we were doing or thinking what we were thinking. I’m so grateful they did because it has served me well.
Once finished, I headed back to the States, ready to start my career. I was soon enlightened about the differences between the US and Netherlands physical therapy approaches. In my first year, I worked as an inpatient and outpatient physical therapist at a community hospital in Westminster, MD. Then I transferred to the outpatient orthopedic practice to pursue my interest there. I quit after a month. That was a rude awakening. I was seeing three patients an hour and felt I was doing a quarter of what I was capable of. Even as a new grad, I knew that was a bad sign. In Holland, all the therapy is carried out by the physical therapist in a one-on-one format with no treatment or help from a physical therapy assistant or aide.
I left and took a job at a pain management and rehabilitation medical practice in Bethesda, MD. Those five years set me on a path to becoming the exceptional therapist I was striving to be. I learned the importance and underappreciated contribution of muscle pain and dysfunction in neuromusculoskeletal conditions. I also learned dry needling early in my career, which set me apart. And under the mentorship of physical therapist Jan Dommerholt and Dr. Robert Gerwin, I was fortunate enough to start on a path of teaching continuing education courses, being published in journals and book chapters, and presenting at professional conferences. During those early years, I was passionate about developing my manual therapy skills through dozens of continuing education courses.
The skills I developed served me well, especially as I started my private practice in 2005. I decided to go out-of-network, except for Medicare, because I knew I wouldn’t be able to provide the care I thought people deserved in an insurance-based model. My clinical reasoning and skills in manual therapy, dry needling, and functional exercises helped many people get out of pain and back to normal life over the years. I was grateful for that.
But there was a problem. People seemed to continually return to therapy after successful treatment, especially those suffering from recurrent, chronic neck and back issues. They would come back after three months, six months, a year, or more with similar complaints as to what brought them in to begin with. There were plenty of plausible reasons for this, mostly centered around what the patient didn’t do during their time away, not being consistent with their home exercise program, not changing their daily posture and body mechanics, and poor choices regarding exercise type and intensity. It's always easy to blame the patient, but I began to wonder whether I was doing something wrong.
In 2013, I gained clarity as to why people suffered from recurrent, chronic, nagging neck and back pain, and the ideas and concepts of this book were born. A lot of physical therapy interventions are aimed at treating symptoms. If you only treat the symptoms and don’t address the underlying causes, symptoms are bound to recur. My clinical experience led me to discover that the underlying reasons for many chronic neck and back pain sufferers were spinal instability, postural imbalance, non-optimal breathing patterns, and poor body awareness.
A stable spine can meet the demands of the compressive, tensile, and shearing forces placed on it through gravity, bending, twisting, lifting, and other movement forces over time. An unstable spine does not meet these demands adequately, resulting in wear and tear of the spinal structures and leading to muscle imbalance compensations that further add to the forces on the spine. When the load exceeds the capacity, recurrent symptoms are inevitable until the underlying spinal stability is addressed.
It’s not unusual for a physical therapist or other health and fitness professionals to recognize this phenomenon. A spine stabilization exercise program is a component of many therapists’ approaches when addressing spinal pain and mobility problems. The layperson may understand this stability work as “core stability.” The problem is that there continues to be an ongoing debate as to whether stability work is relevant in the prevalence of spine problems or the rehabilitation of spine problems. Scientific research has made strides in answering these questions. It has been clear to me that the coordination of muscles around our spine influences spinal stability, so improving this coordinated muscle activity can generate improved spinal stability. Our theories and approaches to alleviate spine problems through exercise have varied dramatically in the past 90 years, starting with the origin of Williams Flexion Exercises in the 1930s, which advocated abdominal strengthening, to the dynamic stabilization concepts in the 1990s, to the motor control concept of the late 1990s and 2000s, to the functional stability and strength concepts of the last 20 years.
This book will present a fundamental and practical approach to spinal stability mainly based on the Dynamic Neuromuscular Stabilization (DNS) concept developed by Pavel Kolář at the Rehabilitation Prague School. I have found this stabilization exercise system to be the most accurate, comprehensive, and effective approach. Throughout the book, I will use the terms “core stability,” “postural stability,” and “spinal stability” interchangeably to mean the same thing. Don’t get hung up on the semantics. Focus on the bigger picture and how it relates to chronic neck and back spine pain. I will not only review a stabilization program that may help you, but I will also explain other factors that need to be addressed for optimal spinal stability, including postural alignment, optimal breathing patterns, and body awareness.
The book's first chapter starts with addressing some common misconceptions of the “core” that introduce you to what makes up our core stability, postural stability, or spinal stability. The second chapter will address common ways people deal with chronic neck and back issues and why those may not be solving the problem. The third chapter will describe my personal experience with chronic neck and back pain and how I came to learn of the clinical approach that I describe throughout the book. The fourth chapter covers the factors contributing to spinal instability and will answer one of the most common questions I get from people when they come to see me for neck and back pain: why do I have this problem? The fifth chapter covers the critical role that posture and postural alignment play. The sixth chapter covers dysfunctional versus optimal breathing patterns and how the diaphragm affects your posture and ability to stabilize your spine. The seventh chapter is an in-depth look at spinal stability, where it comes from, and how to improve it. The eighth chapter is a practical guide to improving your awareness of postural stability in everyday life. The ninth chapter reviews possible solutions and why you should consider physical therapy. The tenth chapter is a summary and guide to help you move forward in finding a solution to your chronic neck or back pain.
This book will challenge the cultural and medical norms of how we address chronic spine issues and how to engage your core. I aim to educate as many people as possible on the concepts in this book at the heart of chronic spinal problems and, most importantly, solutions that work in addressing them.
Whether you are suffering from a chronic neck or back problem, looking to prevent possible spinal issues, or are a health or fitness professional who works with people with spinal problems, this book will have something for you.
Additional resources can be found at: www.freedomfromneckandbackpain.com