3 Tips for Chronic Low Back Pain
People that experience chronic low back pain sometimes get labeled with the stigma that it’s “all in their head”. Providers don’t know how to treat it conservatively, and most patients report being bounced around from healthcare provider to healthcare provider without an answer to describe what they’re feeling. Sometimes it looks like this: You have an injury that results in low back pain such as picking something up off the floor in a funky manner. You feel your back lock up and spend the rest of that day laying on the floor for relief.
You start wondering if something is wrong and decide to rest to see if it will go away. It actually does go away, so you resume your normal activity. A little while later, it creeps back up and you’re feeling a repeat of the back pain, but maybe it is a little worse this time. So you rest again, but now you become fearful of doing something that will make it worse. You start moving your body differently and paying more attention to your back. You go to your primary care doctor or the Emergency Department to figure out what the heck is going on. They don’t know for sure, so they order some X-rays to rule out the scary stuff and give you some type of pain medication, usually an NSAID or a muscle relaxer to see if that helps. Maybe it gets better for some time, but then it flares up again. At this point you want to know what’s wrong and are willing to try more to figure it out. You go see a chiropractor, massage therapist, orthopedic doctor, and maybe try physical therapy. All or some of these relieve your pain for a time but once you stop the treatment, you’re back in the same cycle.
You can see how these reoccurring flare ups can cause you to be fearful of certain movements and end up avoiding them. Patients experiencing chronic low back pain spend hundreds, or thousands of dollars trying to find the fix for the problem, but in the end, they’re just left thinking that maybe they have a bad back and can’t do the things they used to love doing anymore. This experience happens to millions of adults in the United States not only with back pain, but knee, hip, and ankle pain as well, and jgets chalked up to “getting older”. Millions of people are giving up on the things they love to do in order to experience less pain, and I get it! But what if I told you that there is a better way?
Understanding the Pain Experience:
To understand how to manage chronic pain, you must understand how the brain perceives pain. Pain is complicated and has many contributing factors. The pain experience begins with an event that stimulates the pain receptors of the region affected (called nociceptors). In our above example, you picked up something from the ground and some tissue in your low back (muscle, ligament, disc) experienced a mechanical stress. The brain perceived that stretch, load, shear, etc. as a threat or potential for injury. You experienced pain to get your attention so you would avoid that movement for the time being. Your body is designed to do that to protect you from tissue damage and allow for healing.
Now this is where it gets complicated. When you picked up that object, your brain was processing the environment looking for other factors that could have contributed to the stress. Pretend you got terrible sleep, you were hungry and hadn’t worked out in a few days. You decided to go walk an outdoor trail to get some sunshine and exercise and when you bent down to pick up some trash, your back locked up and you hardly made it back to your car.
The next time you decide to go for a walk, maybe you decide not to go to that trail. You make sure you have a snack before you go, and if you see trash on the ground, you leave it. This is how our brain uses pain to protect us from potential threats, but sometimes it doesn’t recognize that maybe it wasn’t the trash or the trail that caused the tissue damage.
Can you see how the entirety of the “back pain situation” lead to behavior changes and caused avoidance of activities you used to love? Over time, the more attention that you give to your back, the more heightened your nervous system gets in that area, making our brain pay more and more attention to what is happening there.
This explains why things like rainy weather (which causes pressure and/or temperature changes) can make your back hurt more. It’s simply just your brain alerting you to changes in that area because it has already turned up the volume on all the signals coming from that region and muddles the interpretation.
What do we do about it?
Now that you have some background about how pain works, we can figure out how to reduce pain and stop the cycle.
1) Diaphragmatic breathing--Fully expanding the diaphragm and taking some good deep breaths provides a calming effect to the nervous system and allows for downregulation and relaxation.
2) Build strong muscles—Strength training is appropriate for EVERY body. Building a strong, resilient body helps support bones and ligaments and handle stress that may be encountered in daily life.
3) Start low and go slow—Activity is key in improving chronic pain, but it must be appropriate for the person. Starting at the right level and progressing through exercise at the right pace for your body makes the return to any activity possible with the right dosage.
In my practice, I focus on building resilient bodies and leaning on fitness to prevent and treat injuries. I have found personal value in exercise and strength training through my undergraduate and physical therapy education, and now within my career. Strength training is of benefit for every body of all types and ages, regardless of current abilities. There’s always a starting place that will provide benefit to a patient. Being a Physical Therapist and Certified Strength and Conditioning Specialist, I am able to not only provide one on one physical therapy to rehab an injury, but I have the skills to help you be able to reach your functional and fitness goals.
Resolute Physical Therapy is proud to be able to offer such specialized care to our patients. We value having the tools to bridge the gap between rehab and fitness, and love being able to offer such unique services to our patients. Please contact us with any and all questions, or to schedule a free consultation today! Contact Us
