By on September 13th, 2016

I just came across a Tumblr video regarding how to overcome fear, made by Brendon Burchard, a widely followed high performance coach and personal development trainer. I felt this was very apropos for patients suffering from chronic back and neck pain, and who haven’t taken control of their condition.

I see many spine patients who come to me searching for a surgical solution, fearing their future. For the majority of patients, their condition does not require surgery.  I inquire if they have tried all they can non-operatively to heal their spines. They often quote their course of therapy or chiropractic, or their multiple injections. They dismiss my prompting about their level of activity, strength levels, or flexibility, saying that there is no way these simple interactions will cure their complicated spine diagnosis. Almost invariably, they admit that despite trying to some degree, they haven’t strengthened their spine, maximized their flexibility, or learned all there is to know about their condition.

So when I advise them to wait on surgery, and to maximize their non-operative treatment, they express fear that it won’t work. Why do they fear starting on an intensive strengthening, stretching, and postural program? They innately acknowledge that it makes sense.

This is where Brendon Burchard’s advice on overcoming fear really resonated with me for these patients. He reminds us that fear is usually not real (it’s not like we fear animals trying to kill us). Fear comes most often from negative thoughts re-running too often and associated with pain. Usually fear is bad management of our thoughts.

Brendon reminds us of the ‘competence confidence loop’: the more you understand something, the more confidence you have in that area. I have found this the arguably single best advice for back pain sufferers. If you truly understand your condition, you will most likely be slow with picking surgery and more likely to do whatever it takes to change your habits and increase your strength and flexibilty.

To understand the fear that stops you from taking control of your spine condition, it will help to divide your fear into three areas.

‘Loss pain’ – If I make this change, I will experience some loss. For back pain sufferers, it is often the loss of that ‘reason’ why you are not as active, able to do enough, or to work. Carrying that back diagnosis is a powerful crutch that is often hard to give up when you can’t function the way you would like.

‘Process pain’ – The actions necessary to get to my goal will be too difficult. This is often the case with back pain suffers since they already have been through a lot with physical therapy, chiropractic, injections, even surgery.

‘Outcome pain’ – What if I affect these changes and work hard, but don’t have the desired outcome? If we think this way, we will never change. For back pain sufferers, better to focus on what you will gain even if you don’t improve. You will gain physical fitness, which can only be positive.

You all know that strength, flexibility, understanding your spine, and optimism will help your condition. So why aren’t you committing to it? Start today by asking what you really want to change. Why are you not progressing and still in pain? If you discover loss, process, and outcome pain, flip it by focusing on the increased function, activity, and sense of well-being you will enjoy if you do commit.



Kamshad Raiszadeh, M.D.

Dr. Raiszadeh's completed medical school at UC San Francisco, orthopedic surgery residency at UC Davis and his Pediatric and Adult Spine Fellowship at the Hospital for Joint Diseases/NYU in New York City. He has 20 years of experience with the broad range of spine surgery including minimally invasive surgery, complex spinal disorders such as scoliosis and kyphosis, and cervical spine disorders. During this 20 years he has noticed a dramatic increase in patients turning to surgery for treatment of neck and low back pain, but many of them not getting their desired long-term result. He therefore became increasingly interested in improvement and standardization of non-operative treatment. By developing the best aspects of non-operative treatment in an atmosphere of empowerment to maximize the body’s own healing capacity, he noticed that many fewer patients required surgery, and the ones who underwent surgery had much better long term results.

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