Persistent lower back pain
Expert Strategies for Managing Persistent Low Back Pain
Persistent low back pain (lasting more than three months) is one of the most common reasons people experience loss of function, making it a significant challenge for many individuals. Unlike pain caused by specific structural issues, non-specific low back pain lacks a clear anatomical cause, making it harder to pinpoint and treat. For this reason, it's essential to take a comprehensive, individualized approach that addresses not only the symptoms but also the behaviors and daily movements that may be influencing the pain.
In this blog, we’ll explore effective strategies for retraining functional movements, offering key steps to help you or someone you care about take control of their back pain and get back to the activities they enjoy.
Understanding the Assessment Process
Before diving into treatment, a thorough assessment is crucial. This will help identify the behaviors, movements, and functional activities that may be contributing to the pain. Your physiotherapist will look at how you move, your posture, and even factors like stress and fatigue that might influence your condition. From there, a customized plan can be created, focusing on your specific needs and goals.
Key Approaches to Pain Management
When retraining any movement, several approaches are used to help guide patients toward recovery. These methods focus on gradually increasing awareness and improving movement patterns, without overwhelming the body or triggering more pain. Here’s a breakdown of the main strategies used in low back pain management:
1. Behavioral Awareness
A key part of retraining is increasing your awareness of behaviors that may contribute to your pain, such as excessive bracing or tightening of the muscles. By becoming more mindful of these actions, you can start to adjust and adopt healthier movement patterns.
2. Movement Modification
Sometimes, simply modifying the way you move can have a significant impact on pain levels. Through what’s called behavioral experiments, your physiotherapist will guide you to try different postures or movements and then ask for your feedback on how they feel. Over time, this helps reprogram your body to move in ways that are less painful.
3. Gradual Progression
Recovery doesn’t happen overnight, and it’s important to approach it in stages. Graded exposure to movement means slowly increasing the range of motion, load, and variability of movements you perform, all while staying within tolerable limits for pain. This gradual progression helps build confidence and resilience in your body.
4. Deconstructing Painful Movements
For particularly painful movements, such as forward bending or lifting, it can be helpful to break them down into smaller, less intense actions. By starting with a limited range of motion or lower loads, you can retrain the body step by step, eventually building up to the full movement without pain.
Practical Examples of Retraining Movements
Here’s a look at how specific functional activities are retrained:
Sitting and Sit-to-Stand
Sitting for long periods can often worsen low back pain, but the solution isn’t just about sitting “better.” Rather, it’s about experiential learning—actually feeling how different postures affect your pain. Your physiotherapist may help you explore alternative sitting positions that feel more comfortable, and over time, you’ll build new habits for sitting that reduce discomfort.
Similarly, the sit-to-stand movement (getting up from a chair) can be retrained by adjusting movement patterns and repeating the action in a pain-free way. Many people with low back pain have performed this movement in painful ways hundreds of times, so the goal is to rewire those patterns to allow for more comfortable, efficient movement.
Forward Bending
Bending forward is another movement that often triggers pain. To retrain this, physiotherapists may start by having you practice the movement in a low-impact position, such as lying on your back (hook-lying position). Gradually, you’ll work up to more challenging versions of the movement, always ensuring that pain stays within tolerable limits.
Lifting Objects
Lifting is a common trigger for back pain, but by modifying the technique and gradually adding variables like speed and direction, you can retrain your body to lift safely. This can involve learning to engage different muscles or altering your posture to reduce the strain on your lower back.
Developing a Home Program
Once these movements are retrained in the clinic, it’s important to reinforce them at home with a comprehensive program that includes:
Habit-building exercises to help integrate new movement patterns into your daily routine.
A functional exercise routine that targets the specific activities you want to get back to.
Pain education resources, such as videos or reading material, to help you better understand the nature of your condition.
Starting small and gradually increasing the intensity of your home program ensures that these changes are sustainable and effective.
Planning for Flare-Ups
Flare-ups are a normal part of the recovery process, and it’s essential to have a plan in place to manage them. Your physiotherapist will discuss strategies to handle these episodes, which may include adjusting your home program or using certain pain-relief techniques. The key is to approach flare-ups with confidence, knowing they don’t mean failure, but rather a temporary setback that can be managed.
Final message
Managing persistent low back pain is a journey, not a quick fix. By using strategies that focus on increasing awareness, modifying movements, and gradually progressing toward more challenging activities, patients can regain control over their bodies and their lives. If you’re dealing with low back pain, working with a physiotherapist who tailors treatment to your unique situation is one of the best steps you can take toward lasting relief.
For more insights into managing low back pain and other conditions, check out our back pain services or schedule a consultation today.
