How To Fix Chronic Lower Back Pain

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Chronic back pain is something that we want to avoid especially if this is the first episode of lower back pain. In today’s article we’ll talk about some of the phenomena that occur when a back injury becomes chronic and the importance of avoiding this. Towards the end of the article we’ll also work on covering what is required to recover from chronic lower back pain and like many things, an understanding is always helpful.

How chronic back pain develops.

For an injury like back pain to become chronic it needs to be unresolved for a number of weeks, typically 12 weeks, or the three month mark is the point at which this classification of chronic back pain is made. There are many changes that take place physiologically as well as physically and other articles will go into more “heavy” scientific detail on the changes associated with chronic injuries or chronic pain in general. This article is focussed on trying to keep things simple, and more importantly, practically “solvable”. 

One of the big problems with back pain in general is the way in which it is approached. So often back pain is allowed to become chronic because of the way it is remedied, especially here in the UK. Certain demographics (men) are also particularly disposed to moving into this category for reasons that will shortly become obvious. That’s not to say that they have more or less difficulty with chronic back pain, we all have our own challenges and they are our own challenges to bear – and to overcome. 

Contrary to popular belief, this “12 week clock” doesn’t start when you first visit your GP (doctor). It starts when the injury takes place. So if you start struggling with back pain and decide to soldier on for 10 weeks then call the GP and book an appointment for 2 weeks time, you’ve just likely gone chronic! And that’s just to get an appointment, which frequently will result in another appointment in X weeks or months time. Even in the proactive case in the UK it is common that any meaningful treatment, advice or guidance will infrequently commence before 6 or 8 weeks. Often if you are the proactive individual and immediately seek help, you’ll be told something along the lines of “back pain will resolve itself in 6-12 weeks so just go home and take pain killers”.

You can see how easy it is to move past that 12-week period and into the “chronic” category of back pain. Part of this is due to our health system and part of it is due to our perception of back pain. It’s not approached like a broken leg, for example. Imagine walking into the hospital with a broken limb and being told that it will heal in 6-12 weeks in most cases so just go home with some pain killers.  The statement, just like with back pain, isn’t exactly wrong. Our body is always trying to heal, and will, but we know that in the leg example, if not given the appropriate support, it might not heal as well as it could and this may result in you having long standing issues to contend with. We also know that it is much easier to help the healing process occur correctly if we intervene early, as opposed to leaving you to your own devices and risk your injury becoming more problematic for the long term.

Although not identical, the theme is similar with the lower back. There is certainly guidance that can be given to help you do a better job of going through the healing process and avoiding chronicity setting in.

The problem with chronic back pain

These changes start to occur on the way to becoming chronic but they are often habitual by the time that 12-week period elapses. It is no secret that living with back pain causes you to do things differently, this could be moving in different ways, developing habits that try to alleviate the pain, it could be requirements for regular medication, it could also be avoidance of social interactions. All of these things mesh together to create a pattern of features that help you remain in pain, especially without guidance. These patterns and features also serve as an additional barrier to treatment. 

If we take some of the examples above in more detail we start to see the real issue with allowing back pain to become chronic. Firstly, movement changes. When in pain, let us suppose your back pain particularly affects your left side. You make changes in the way you walk, sit ,stand and bear weight in general. These changes result in asymmetrical systems of muscles tightening and weakening as they’re used in a peculiar manner. This happens very consciously in the acute phase when the injury has just taken place, but when you’ve been doing it for so long, weeks on end, these patterns get put into storage as autonomous programs in our brain. We start to become less aware we’re doing it. Often leading to a hardening of the habit and the consequences of these movement peculiarities begin to create secondary problems, whilst often worsening the primary back pain slowly. For example, leaning on one leg more than the other will tighten up the musculature of the hip on one side and weaken that of the other, leading to hip stiffness that has a knock on effect on the lower back.

In addition to these movement changes that become hardwired into us, we also find ourselves doing peculiar movements and often stretches to try and alleviate pain, commonly postures and movements that round the back repeatedly. These movements have the effect of further reducing the integrity of our back and trying to create more flexibility in the back as the hips become tighter and tighter. We’ve explored “tightness” being interpreted incorrectly in many of our videos in the past. Suffice to sa y, these sorts of “relief” movements, particularly the rounding of our lower back at best, get us reliant mentally on an unnecessary movement, and at worst, are reinforcing the gradual destabilisation of our lower lumbar spine.

We should also take the time to cover the longer term use of medications, both over the counter and the more severe and powerful ones; medications that have strong side effects. Not to go down a rabbit hole, but the most common of these medications often lead to abdominal discomfort and disruption of our gut. Two things happen here, firstly, when we have stomach pain, we round our back repeatedly, this is not helpful for reasons we’ve outlined over the years ad nauseam. Secondly, when working to heal, rebuild and rehabilitate, nutrition is the fuel our body uses to rebuild. With a drug laden, inflamed gut, we are going to be disadvantaged when it comes to absorbing the nutrition necessary to heal, assuming the often unlikely event we are eating sufficiently well to fuel the much needed recovery.

Finally, as a result of the difficulty with movement peculiarities and weakness that develops, the perceived need for momentary relief stretches and reduced capacity to remain upright for long periods, the possible unwanted consequences of medications digestively, and potentially the brain fog and grogginess associated with stronger pain medications, we find ourselves less likely to engage in social enterprise. This shying away from social ventures can often lead to feelings of isolation to go alongside the worsening lower back pain we are experiencing.

This is the last thing we need if we’re to face the challenge of recovering from chronic lower back pain head on. Outlook is so important with these things and it is easy to see how one with the odds stacked in this manner might be tilted towards a less than positive disposition. 

The thing is, that when you’re in the midst of chronic back pain it is hard to see the wood from the trees and a lack of an ability or knowledge necessary to identify some of the factors mentioned is a problem. Identifying parts of this problem can be difficult for those who have chronic lower back pain. It’s not just back pain, it’s all these changes that need to be considered also. Failure to recognise these additional factors, is why many with chronic back pain become disheartened when they try treatments that ”don’t work”. There are so many factors outside the treatment room that are working against you, compared to the non-chronic case, these factors cannot be ignored.

Recovering from chronic back pain

The most important thing to do first is accept that the situation is chronic and that there are going to be these factors that need to be explored, and only you can do this. As with back pain in general, you have a huge influence over the problem and its solution, or worsening. Working alongside professionals who can guide you is incredibly helpful for guidance purposes. For example, this last week or so in our #squatweek we have been commenting on members squats at home, pointing out areas that are in need of improvement, blocks that perhaps the individual is not aware of. Once enlightened however, whose job is it to make the change? Yours!

By identifying that you’re moving in erroneous ways, you can start working through exercises to make measurable and visible changes in the way in which you move. It doesn’t happen overnight though, because your back pain didn’t happen overnight. Perhaps like in the examples earlier, you have weakness and stiffness in the hips and lower limbs, perhaps asymmetrically. Working to undo this will take time and you need to know that the prospects of “bumps in the road ahead” are going to be high. At the same time, you will find that with perseverance you can make improvement in spite of these setbacks. Being prepared for a setback mentally makes it so much easier to bear when it does occur!

Then we have the “self-help” exercises or stretches, like rounding your lower back or other peculiar practices. Learning to be disciplined and cut these out, often hard to begin with, because often like Pavlov’s dogs you’re almost conditioned to feel better by doing the exercise mentally even though it is doing little to help the underlying problem. Eliminating this, for example the knee hug, will allow the ligaments in your lower back to actually start to restore their integrity, instead of being loosened off multiple times a day, only serving to enhance the problematic instability & vulnerability in the lower back.

Know that medications being reduced, often with the guidance and consultation of your prescribing physician, can be a rough process, as your body begins to readjust. This is difficult and there is no easy way through but with time and effort, you can slowly wean yourself off these with support mentioned above. As your body gets stronger and you start to recover, reduction in these kinds of medications will also help your overall system work better too, further enhancing your efforts. Again, this process will not be without flare ups along the way, but when you have support and expectation that it’s not easy, but it is worth it, you’ll be all the more armed to go through the journey to recover from this chronic back pain. 

Ultimately when it comes to recovering from chronic back pain we have to know that it is a long road, but we have to be honest with ourselves! Of the tens of thousands of patients and members alike that we’ve seen over the years, I’m yet to see or hear of an individual with chronic back pain or sciatica, that doesn’t have a multitude of areas for improvement. Dietary changes, lifestyle & movement habits, fundamental levels of strength and fitness in the body to name three core ones, excuse the pun. Those with chronic back pain, perhaps you, understandably can feel like the odds are stacked against them, especially after spending significant sums of money and trying many treatments. The thing is, you can spend all you like on others doing something to you – treatment. But all you’re doing is giving away your power.

The three simple categories mentioned in the paragraph above are all things you can, no must, do! What’s more, only you can do them. Yes, guidance and support with this endeavour is one thing. But you must put in the time and effort commensurate with the task at hand. By taking ownership of these changes, you can start to slowly undertake the rebuilding process, creating a new you and ridding yourself of chronic back pain.

You can do it 🙂

Comment of the week – Jane

” Life changing, this program works – stick at it for good results. It has reduced my pain and enabled me to have confidence in my body.”

3 Steps To Fix Chronic Lower Back Pain For Good.

  • Recognise that your back pain is chronic

This helps you put timeframes in perspective, it’s easier to see the path out of trouble if you can appreciate how you got there. Understanding that the gradual degradation of your back has taken months to years makes the recovery process being slow more reasonable. You don’t have to like it, but you will prepare for a longer road ahead. If you expect a journey to be 5 minutes down the road you’d plan and prepare very differently to a 12 hour road trip. This recognition helps you mentally prepare and improves your resilience.

  • Use support and guidance along the way

Asking for directions along the way is sensible, this is where support comes in. For those of you in the Premium Membership, we’re here for you, to act as your guide. Helping you through the bumps in the road, when you stray from the path and when you need a little support to push on. It does take time to make some of the changes, not least building strength. To build strength you’re building your body, you need time for the body to respond, but you also need to be working at the right intensity too, this can sometimes be daunting, having support to help you on this process when you’re not pushing hard enough and equally when you’re pushing yourself too hard is invaluable.

  • Take a moment to look back every so often

Sometimes with chronic back pain you’re really in a spot of bother, and climbing out of that hole can involve a longer period of work with minimal reward. This can mean progressing with exercises for a time before the benefits are reached. It’s difficult to predict at which point “enough strength” is reached, and to a certain degree this is an individual process. For most people however the ability to carry shopping bags (5-10kg), a potted plant (10-15kg) or a holiday suitcase (20-25kg) are reasonable encounters. We’re excluding the likelihood of moving furniture or other large cumbersome loads. If you’re not able to squat or hip hinge with weights approximating these, you’re likely a long way short of where you need to be as a pain free human being. Keep going until you can do these things effortlessly! That means that when you encounter these objects in everyday life, they do not thrust your body back into that downward spiral of back pain.

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