In this post we discuss why back pain becomes chronic and the steps you can take to begin your recovery.
Back pain is the leading cause of disability world wide. It was responsible for over 60 million disability-adjusted life years in 2015.
Most cases of back pain are self-limiting, but in a significant number of cases symptoms continue to appear sporadically or persist at a low level.
The best available evidence suggests around 33% of people will have a recurrence within one year of recovering from a previous episode.That’s a very large number of people given how common it is.
Why does back pain become chronic?
In around 85-90% of cases, no identifiable pathoanatomical source correlates reliably with the pain, so the symptoms are classified as non-specific lower back pain (NSLBP).
That means two people with identical tissue states can have completely different pain experiences.
Let me repeat that because it’s important:
Two people, the exact same scan, one with back pain, one without.
So what explains the difference?
If tissue state doesn’t reliably predict pain, the explanation has to lie somewhere else — in how the nervous system is interpreting that tissue, not just its physical condition.
Pain doesn’t necessarily correlate with damage. It’s an output your brain produces based on a prediction: how dangerous is this, right now, given everything I know?
That prediction draws on far more than the state of your spine. It draws on your past experiences of pain, your beliefs about your back, your stress levels, your sleep, your fear of movement, even what a scan report told you last time.
One of the main reasons back pain becomes chronic
As you can imagine, I meet a fair number of people who suffer with ongoing back pain. What they all have in common are false beliefs about their current condition.
These can range from the relevance of normal age-related changes they’ve seen reported on scans, to the fear that bending over may lead to a spinal disc injury.
Poor information can cause pain to linger. It maintains a level of threat that makes your nervous system more likely to signal pain, and prevents you from taking the necessary steps to get back to your activities.
It’s not an exaggeration to say that in some circumstances, inaccurate information can ruin lives.
How to resolve back pain when it becomes chronic
The first step is to gain an accurate picture of your pain and the likely influences on it. The Resolve Back Pain Handbook does an excellent job of walking you through each area and helping you make any necessary changes.
We know, for example, that psychological factors such as fear avoidance, catastrophising, and mood can have an impact.
As well as social factors like work stress, your social support network, and your beliefs about back pain.
Lifestyle factors like diet, sleep, lack of exercise, and stress, can also contribute to pain independent of any structural finding.
The main point here is not to create further stress for yourself, but to identify one or two things that you suspect are having an outsized influence.
I tend to start with the exercise piece as it can have an impact on so many other areas.
Finding a starting point is the key, exercise that you can complete without causing a significant increase in your symptoms. Not because pain is a sign of damage, but because it reinforces the connection between movement and pain. The very bond you’re trying to break.
Resistance training is extremely valuable in this regard as it enables you to isolate different areas of your body and accurately control the variables within exercise, such as load, speed, and range of motion. This means I can usually find a pain-free starting point for anybody.
Summary
Poor information is one of the most significant — and most readily treatable — drivers of chronic back pain.
Understanding what back pain actually represents can begin to reduce the threat your nervous system perceives.
This, together with a structured exercise programme that steadily changes the beliefs you may hold about your body, is the long-term solution to chronic back pain.