Managing Chronic Lower Back Pain

Ongoing low back pain can have an impact on both our physical and emotional wellbeing. Whilst back pain can be very common and something that a lot of us may have or will have experienced at some point it is still something that can be tricky to manage, but is not something that you have to suffer through and there is a lot that can be done to help. In this blog we aim to demystify some of the common myths associate with back pain and that can often lead patients feeling frustrated and defeated. Then provide some insight into the benefits exercise can have on the management of back pain.

Firstly, it is important before diving into exercise treatment for low back

pain, that we gain an understand of the basics. Whilst back pain is common, it is definitely something that should not stop you from being able to do day to day things and engage in a healthy, active lifestyle. Secondly, pain is very complex and multifaceted, so if this is something you have experienced, it is important to seek out a registered health practitioner for individual assessment, advice and treatment plan tailored to your needs as there can be many factors involved.

Low back pain can be categorised into 3 subtypes: Acute, Sub -acute and Chronic. In this blog we will be focusing on chronic low back pain, chronic is categorised by pain that has been present for 3 or more months.

The onset of back pain can come from a range of different factors. Some of these include but are not limited to:

• Injury - eg. sprain, trauma, falls

• Disease - Degeneration (eg. osteoarthritis), inflammation, nerve compression, ongoing health conditions.

• Postural/ mechanical- eg. sitting or standing for long periods, compensatory patterns, sudden increases in load without capacity to meet demand.

There can be a lot of noise and information circulating around which can make it extremely difficult to understand and manage back pain, which often leads to further worsening of symptoms, reduced exercise and physical activity and engagement in activities day to day that bring us joy, which can have large impacts on other areas of our health and wellbeing. This is why an individual tailored approach from a practitioner is important to ensure you get the most up to date evidence based advice that is tailored to your individual circumstance.

Now that we have some background, let’s breakdown some common myths associated with low back pain.

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Common Myths and Facts around low back pain

Myth 1: It is always related to tissue damage or significant trauma

Whilst pain can be a signal that there may be some sort of injury this is not always the case. Pain response can come from a number of other different factors, these may include but are not limited to:

Hypersensitivity

Can cause protective behaviours and/or guarding from either a previous injury, or beliefs that certain movements may result in damage.

Load related

Health and lifestyle factors:

Myth 2: Pain related to exercise and movement is always a warning that damage is being done and exercise needs to be stopped

Pain during exercise or movements does not always equal tissue damage. In fact pain during movement often can reflect how sensitive your back structures are to certain stressors, not how damaged they may be. Low levels of mild discomfort during exercise is okay as long as it is tolerable. We want to ensure we are applying progressive overload to build strength.

Myth 3: Flareups are always a sign of tissue damage

Pain flareups are often more related to changes in activity, stress and mood rather than structural damage. Keep moving - Exercise is safe and healthy if it is done progressively with gradual exposure to loading. Find exercise and physical activity that feels good. Some good examples may include, hydrotherapy, walking, yoga, gardening. There may be some interventions like activity modifications for periods of time that your healthcare professional might recommend but overall you should be able to find movement that you can do until you can get back to the activities you enjoy. However, strength training should always be a part of your exercise routine, to build health robust muscle strength and endurance capacity.

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Myth 4: You should brace your core and keep your back straight when bending or lifting

Weakness through these muscles does not cause pain. While being strong is important to ensure the muscles can withstand the load you are placing on them, bracing constantly is not necessary and can often result in more sensitivity and guarding around the area which can contribute to pain and movement sensitivity. Secondly to this, just like any other muscle or exercise you do in the gym, if you are constantly activating and bracing your abdominal or core muscles, this can often result in fatigue and or tightness resulting in reduced capacity to tolerate functional tasks or physical activity. Our bodies are very adaptive and resilient. Moving and loading the spine makes the back healthier and stronger. Engaging in activities like running, twisting, bending and lifting are safe as long as it is done with progressive loading.

This is where your healthcare practitioner can provide tailored guidance to allow you to continue or assist you building back up to these activities.

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Benefits of engaging and exercising for low back pain?

• Improve emotional wellbeing

• Build tissue tolerance

• Down-regulating nervous system alarm warnings

• Improve range of motion to assist with functional movements

• Increase muscular strength and endurance capacity

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Exercise management for low back pain

When getting back into exercise, there are numerous different factors we want to consider and incorporate. Firstly, incorporate regular resistance training, our muscles need to be strengthened and loaded progressively and regularly to keep them robust and enable us to continue to do the activities we enjoy. This will look different from person to person, factors that may influence this may include but aren’t limited to:

• Level of training or training history prior to pain onset or injury

• Time period that you have been out of activity or exercise

• Previous injuries or other health considerations

Just like other injuries there is a process of de-loading or adjusting your training, but it is important to remember that eventually, you want to be re- loading back into the demands. It is important to understand we don't want to just jump back into the same load and activity that we were doing prior to our injury.

With all of this information it is important to understand the goal is always to get you back into doing the things you enjoy. Your pain does not have to limit this and with the right approach, you can effectively manage pain, promote healing, and continue to live a healthy active lifestyle. If you are someone who has previously or is currently experiencing ongoing back pain and seek out allied health professional create a tailored management plan.

*Disclaimer: This is general advice only, if experiencing an injury or ongoing pain check with your allied health professional for individual advice appropriate for you and your presentation*