So you've had low back pain for over 3 months?

Low back pain can be quite a terrible affliction. There are quite a few things that can go wrong in the low back but on the bright side - the treatment for it is often relatively simple if you can understand a few key concepts.

The length of time you've had low back pain can be a good predictor of the length and effort you'll need to put into recovery. Often acute low back injuries (less than a week) can be managed within a few weeks. If it's been going on for months, it's more likely to take a period of strengthening which is 8 weeks minimum (pretty straight forward). If on the other hand, it's gone on for longer than 6-12 months, the rest of this blog should cover a few important factors because there's quite a lot to consider.

The first thing you'll want to do is try and identify the structures of the low back that are your pain generators - in medicine they're called 'nociceptors'. These are parts of the sensory nervous system that process noxious stimuli. You see, the nervous system has little 'sensors' that detect if something is going to cause the body harm. This can be from chemical, thermal or from pressure and when the threshold is reached they'll send signals to the spinal cord and brain to help you get away from whatever is going on (a bit like how you'd pull your hand away from a hot stove). This is called adaptive pain as it will stop an injury from occurring to the tissues. In the short term (0-3 months) this works really well and often results in a speedy recovery. However, if these 'sensors' continue to get triggered they become more sensitive. It will take less stimuli to send those messages up to the brain. This is part of why injuries feel tender and hot after an injury. If this persists and you start to experience pain even when those parts of the body aren't under stress, it's called maladaptive pain and tends to be when things start to slide downhill. This is when there's low back pain without any associated movement or threat going on and is what happens with persistent back pain, this is often when integrative physiotherapy is helpful. I'll explain more about this shortly.

You see, the lumbar spine (low back) is quite a mobile part of the body. There's a lot of movement that goes through quite a vulnerable area. Part of this is because we evolved from quadruped animals (4 legged) to bipedal (2 legged). This great jump in evolution which allowed us to use our arms to manipulate the world happened to also create some vulnerabilities and the low back is one of the most affected. We're designed to move through our whole body from our ribcage, shoulders all the way down to our feet (the spine alone has 364 joints).

Think of the torso as a bit like load bearing suspension.

As we lift, bend, twist and move the torso should take the brunt of the load. Often things like lifestyle, old injuries or too much sitting can create stiffness and restrictions over time and rather than moving through lots of joints, all that movement starts going through a localised point which creates injury, often through the low back. This will trigger those 'sensors' I was talking about before and as it persists, the sensors will get more and more sensitive leading to persistent pain. So, if you've just been treating the low back with massage, heat, TENS or therapies aimed just at the back and those 'sensors' it will only be short lived. This is often why treatments fail.

A combination of never actually addressing the reason it's happened in the first place (often comes from looking at the whole body) and sensitisation of those 'sensor' nociceptors over time leads to maladaptive pain. Pain is now present most or all the time which stops you from moving, which makes you stiffer which then aggravates the low back further. So, can you see how this becomes a negative feedback loop?

This is often when you need a proper plan with an appropriate team. You'll likely need to see your doctor for some pain relief to calm down those sensitive 'sensors' while you work on improving your movement with a physio. Second, look at what's going on in your lifestyle and work that might be triggering things to make some temporary changes. You can do this while you work on the root cause of your issue with a good physio. This can help you start a tailored exercise program to work into making these changes to your life. Be careful not to fall for the idea of a 'quick fix' or 'crack' as it will be just that - a brief period where things feel better before returning to where you started. One key thing to walk away from this blog is that things often feel worse than they are, often the worst things you can do is listen to bad advice and pay attention to the professionals.