Managing Chronic Back Pain
One of the most common problems we see in the clinic, are those struggling with chronic back pain. According to the Australian Institute of Health and Welfare, approximately 4 million Australians (16%) are living with ongoing back problems. Chronic pain is defined as pain that lasts beyond 3-6 months and exceeds normal healing time post injury.
Chronic back pain can have a significant impact on quality of life, both physically and mentally. Back pain can limit us from being able to do the things we want to, whether it be sports, social participation, taking care of kids or grandchildren, or even getting dressed in the morning. If this sounds like you, you are not alone and we understand how impactful back pain can be.
What can cause chronic back pain?
Previous injury
While a prior injury may have healed from a structural perspective, pain can continue to be present.
Prolonged sitting/standing
The spine is designed to move. It does not like when we remain in sustained positions for long periods of time.
Sudden increase in activity / training load
The body does not like change. When starting out with exercise, it is important to gradually increase your training load, rather than jumping right into a high intensity exercise regime that your body has not yet adapted to.
Psychological stress
The brain plays a significant role in the way pain is perceived. Without the brain, we would not be able to perceive pain at all. An area of the brain known as the limbic system, has associations with both emotion and pain perception. Therefore, stress, anxiety, and low mood can amplify pain, even in the absence of tissue damage.
Temperature and pain science
In an acute flare up of back pain, an effective pain management strategy focuses on temperature. It is very common practice to apply an ice pack to an injured site. You may Have also been advised to apply a heat pack to the site of pain. While these two forms of treatment may sound contradictory, in actual fact they both can work well to relieve pain.
Let’s briefly talk about pain science. Pain signals are controlled by two nerve types; A-delta fibres (sharp pain) and C fibres (dull, aching pain). It is the C fibres that are typically overactive for those with chronic pain, including chronic back pain, or any chronic pain. A-beta fibres however, are responsible for controlling signals of pressure and temperature. Therefore, when an ice/heat pack is applied to an area of pain, the A-beta fibres work to “over-ride” the pain signals controlled by the C-fibres, ultimately resulting in an analgesic effect.
Pacing
Gentle movement and exercise is strongly encouraged for people with back pain, but the approach needs to be methodical. Using pacing strategies to guide your exercise is an excellent way to avoid a flare up of pain. What this means is rather than doing large blocks of exercise followed by large blocks of rest, break it up into smaller, more regular doses.
For example, rather than going for an hour-long walk, three times a week, try to do a 30 minute walk every day. The same principle applies for strenuous tasks around the house that may aggravate the pain. Rather than vacuuming the whole house in one go, do one room at a time and allow yourself a 10-minute rest in between. Yes, this may feel more time- consuming but will ultimately be more beneficial for your body.
Don’t overload. Just because you feel particularly good on a certain day, do not take that as your sign to run a marathon or complete every possible task around the house. Continue to be considerate of pacing and with consistency, you will be able to get back to doing the things that are meaningful to you.
Did you know…
Just because there is pain, it does not necessarily mean there is tissue damage. We will often see patients presenting with back pain, assuming that something must have “damaged” their back. However, this is not always the case. Due to the complexities of the brain and nervous system, it can be more than just structural damage that contributes to the body’s pain response. Nevertheless, that does not mean that the pain experience is not real.
All pain is real pain.
Key takeaways:
– The spine is designed to move. Avoid prolonged positions but also avoid sudden spikes in physical activity. Find that sweet spot!
– Try applying heat or ice during a flare up. Find which one works for you. It might be both!
– Implement pacing strategies to prevent flare-ups and support long term recovery.
– Pain does not always mean there is damage. There are many factors that can influence pain beyond what we can see on scans.
If you or someone you know is struggling with ongoing back pain, a physiotherapist can help to understand the pain, take control of the pain and develop a tailored plan to get moving with confidence again.
By Tom Koole
Physiotherapist
B.Physio (Hons)
Tom is available for consultations at our Mount Evelyn clinic on Tuesdays, Thursdays, Fridays and Saturdays.
https://www.aihw.gov.au/reports/chronic-disease/chronic-pain-in-australia/summary
https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems