Low back pain is the most common cause of disability and lost work time in industrialized countries. Persistent low back pain is characterized by periods of high and low pain intensity that can persist for years. Periodic “flare-ups” are common and often result in the seeking of medical treatment. Medications and surgery are often ineffective and may be harmful in some situations.
Physical therapy is a non-invasive treatment approach that is often considered in those with persistent low back pain. However, improvements are often short-term for those with longstanding pain. Similar to surgery and medications, the long-term success of physical therapy treatments for chronic back pain is questionable.
Traditional approaches utilizing physical therapy involve a short, but intense course of treatment such as 12 visits over a 4 to 8-week period. However, this type of treatment approach is likely insufficient to positively influence a person’s beliefs and behaviors about their pain. Changing your beliefs and behaviors is crucial if you are to eventually conquer your pain.
Understand That Persistent Low Back Pain is Complex
When pain persists beyond expected time frames, changes occur within your nervous system. These changes include abnormal pain processing pathways and poor execution of movement patterns. Because the nervous system is so complex, individual “pain experiences” vary greatly among those with persistent low back pain. Diagnostic tests and scans, including MRI, are of little help because the primary problem is in the nervous system, not the lower back.
If you suffer from persistent pain, your muscles have undergone substantial changes. This is due to changes in your central nervous system. These changes include atrophy (loss of muscle) and deposits of fatty tissue in the place of your lost muscle. In particular, the lumbar multifidus muscle becomes selectively atrophied in many people with persistent back pain.
Not only does the structure of muscle change with long-standing pain but so does your nervous system’s ability to activate certain muscles. Some of your muscles may become underactive while others become overactive. These patterns differ among people with back pain making symptoms highly variable. A common strategy is when many muscles of your lower back contract simultaneously resulting in an unhelpful stiffening of your trunk.
Persistent Low Back Pain & Exercise
Altered pain processing pathways in your nervous system and changes in your back muscles lead to difficulty learning low back exercises. A long-term stimulus is likely needed to overcome the atrophy of spinal muscles and to regain proper muscle function. Performing low back exercise several times per week for 1 to 2 months is not an adequate dosage. Therefore, if you suffer from persistent pain, you need repeated practice for several months in order to master the most basic of exercises.
In order to restore normal movement patterns, exercises must match your beliefs and functional problems. Ongoing education about the science of pain is beneficial to get you back to exercising without pain. An emphasis on education and a gradual progression of physical activity then becomes your long-term treatment.
The Role of the Physical Therapist in Helping Those with Persistent Low Back Pain
A recent episode of low back pain often responds well to manual therapy treatments such as mobilization, manipulation, or massage. Sometimes, ice or hot packs can be helpful in these situations. However, passive interventions are of little help if you suffer with chronic or persistent pain. Instead, treatments that involve your active participation are most valuable. This approach emphasizes your own preferred types of physical activities that are progressed and modified over time by the physical therapist.
There is no one-size-fits-all approach to prescribing exercise for people with persistent low back pain. Core stabilization exercise receives a great deal of attention but this form of treatment is only helpful in some. The same goes for stretching, resistance exercise, and aerobic exercise. All these forms of exercise can be helpful in some people but not all. Therefore, you and your physical therapist must collaborate to develop an exercise plan that is enjoyable. This is the only way you will stick with the program for the long term.
Get Help From Your Physical Therapist for Persistent Low Back Pain
The traditional approach of attending physical therapy sessions 2 to 3 times a week for 4 to 8 weeks is not optimal. Instead, you and your physical therapist must develop a long-term working relationship. Initially, physical therapy sessions may occur multiple times a week but only for a few weeks. Sessions should then be spaced out over time. Your physical therapist helps you most by progressing or modifying your exercise program at each session.
Your physical therapist’s primary role is as a coach or guide that helps you self-manage for the long term. The ultimate goal is for you to manage and be prepared for fluctuations in your back pain.
If you would like help getting started, call our office to schedule an initial evaluation with your physical therapist.