Motion is Lotion: Maintaining an Active Lifestyle with Chronic Low Back Pain
As a physical therapist, I have treated hundreds of patients with low back pain, from high-level athletes to sedentary office workers. The common theme was that all of them wanted to get rid of their discomfort but felt helpless to do so. I have learned that there is a lot of anxiety and hopelessness that accompanies back pain, much of which is attributable to a poor understanding of its causative mechanisms. We have been conditioned to believe that back pain is a dangerous condition requiring delicate and constant management.
Most patients come to me with the belief that their back pain is attributable to a structural problem in their spine – herniated discs, stenosis (informally called “pinched nerves”), or arthritis, to name just a few. These structural issues account for very few instances of back pain. At least 85% of all back pain cases are attributable to non-specific causes. Non-specific means that there is nothing visible on an x-ray or MRI that can be correlated to the patient’s symptoms. This diagnosis often leads to frustration; the patient wonders what the problem could possibly be. In these cases, pain is attributable to muscular imbalances and anxiety about further injury and disability.
Many individuals with low back pain adopt a splinted or guarded posture to prevent movements that have caused pain in the past. While this may avoid discomfort, it does not address the underlying problem, which is muscle weakness and tightness. Some go as far as completely avoiding activities that have led to pain in the past, including exercise and occupational activities. Avoidance behaviors increase anxiety, which contributes to elevated pain levels and muscle guarding. The more a person with low back pain “digs in” to avoid it, the more likely he is to have onset of symptoms.
It is impossible to completely avoid aggravating movements; inevitably, we will twist, bend, or flex into the position we have been avoiding. Once muscles move out of their guarded position, the individual experiences spasms, soreness, and muscle pain. The body’s natural response is to continue to guard against further discomfort.
A key to understanding healthy management of low back pain is to understand that pain does not always mean there is tissue damage occurring, and it is not always indicating danger to the body. This is very much counter to what we know about injuries and pain. Low back discomfort that comes with certain movements is very often attributable to muscular imbalances, which are treatable with conservative measures such as physical therapy.
A physical therapist will conduct an examination to determine which muscles are contributing to painful movement and prescribe exercises to correct any imbalances that are present. She will also provide education as to why these imbalances cause pain and how to safely increase activity levels. The physical therapist may also administer manual therapy, which consists of hands-on treatments that assist in reducing pain and increasing mobility.
It is important for all patients with low back pain to understand that it is possible to reduce their symptoms by increasing activity levels and that avoidance behaviors contribute to worsening pain and reduced activity levels. Recovery requires patience, and there will be periodic regressions. Communication with a physical therapist regarding frustrations and setbacks is the most beneficial way to address this and continue to move forward.
Please reach out to Dr. Claire Kopko for help managing back pain and developing an active lifestyle.
