CSA Physio Blog

Chronic episodic low back pain.

Posted on: May 21st, 2019 by Jeffrey Begg

Acute low back pain comes, then goes and is gone. Chronic low back pain is continually there for a very long time without break. What about acute episodes of low back pain that last a short while, but seem to come back every month or 2 or 3? Is it possible to finally end this frustrating cycle? Perhaps. Here’s one way I help patients with this.

Think about it: if the pain goes away and is just fine for a while, then it suddenly returns, something must have brought it on. Maybe you’ve just done way too much lifting or bending. But for some people that’s not it. It just seems to come randomly. When that’s the case, it’s not something outside of you that’s the problem (that heavy box of groceries) but rather something inside you. But what?

What about tight muscles that just need a good massage? You bet, that could be it. But if you go for a massage every 3 or 4 months whenever it flares up, that’s not really fixing the problem is it?

What about being “out of alignment” and needing an adjustment? Well, someone qualified can click your back and that often settles the pain. But if you need that on a regular basis, then it’s not fixing the problem either. Here’s where we need to think about things differently.

Here’s how a lot of the really good physiotherapists look at it:

Episodes of low back pain recur because there is something about your spine that cannot tolerate your daily life. Discovering what that is requires real craft. It takes a real thoughtful approach to examining how you move and how well prepared your back is for the demands of your life. (hint: if someone examines your back in less than 30 minutes, they’re probably missing something). Here are some of the common problems I tend to find that require attention.

Your spine is too loose.

Okay, it’s a little more complicated than that. But is essentially some spines are more bendy than is healthy, and some people even have an actual “instability” of two or more of the vertebrae in the spine (You might need an xray to decide that) . When this is the case, I will show you how to live more in the “middle zone” of what your joints can tolerate, so you can avoid going to the extremes of range of motion that cause your flareup.

Your spine is too tight.

In this scenario, I will test the range of motion of different parts of your spine and find that certain parts can’t move as much as they should. If it seems that this is the underlying issue, I will loosen those parts up for you and show you how to do the same for yourself.

Your spine just moves wrong.

Look, sometimes the issue is that your spine moves enough, and not too much, but that it just moves the wrong way. Maybe your pelvis doesn’t tilt properly when you bend. Maybe your hip doesn’t extend back far enough when you walk. Maybe the way you squat down is just wonky. In this case, what you need is some exercises to correct how you move. This sometimes means using mirrors, or lasers attached to you, but it almost always means lots of one-on-one time teaching you how to move more normally. For some people, you can’t end the cycle of back flareups until you change how you move.

Your spine is too weak.

I put this last for a reason. A lot of people think all back pain can be fixed by strengthening the stomach muscles (ie: “core strength”). In truth this is only sometimes the case. The way to find out? I will put you through a series of basic core strength tests and show you your results compared with others your age and gender. If you score “average” or above, hey, maybe you don’t need any core strengthening. We don’t know until we test.

Perhaps it’s time for you to find out what’s the cause of your episodic back pain. I’m here to help.

Jeff

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