I've got your back

Most people (70-85%) will have low back pain (LBP) at some point in their lifetime. If you’ve had LBP for over 3 months, there’s no radiating pain past your knee, and a doctor has ruled out any other serious pathology, you likely have chronic non-specific low back pain (CLBP). There’s not a magic pill or a single form of treatment which will resolve CLBP. It takes a multidisciplinary approach. Here’s some research-supported advice to manage your symptoms:

1. Shift your perspective and goal. Instead of focusing on the pain subsiding, focus on what you can do functionally and work to improve that. With CLBP, the physical cause is unknown and likely points to the central nervous system (check out central sensitization). Graded activities will help reaffirm to your nervous system that it’s safe to move again.

2. Stay active! The worst thing you can do with CLBP is rest. In fact, general exercise has been shown to be one of the most effective treatments. Recommendations include 30-60 minutes of moderate intensity cardiovascular exercise 5 days per week (walking, biking, swimming, dancing, etc.) and resistance training 2-3 times per week.

3. Motor control exercises. Seems to be superior to other methods. The goal is to improve neuromuscular control of the spinal support muscles, which include multifidus, transverse abdominis, diaphragm and the pelvic floor musculature. Progressing exercises until you’re able to incorporate muscle activation into daily movements.

4. Massage therapy, acupuncture, pilates (2 times/week), yoga (1 time/week) are all good complementary add-ons. Try one or two of these which you enjoy!

5. Cognitive behavioral therapy and a mindfulness practice such as mediation have also shown to be beneficial.

Worth noting, weight management, sleep hygiene, work life satisfaction and social support are useful areas to reexamine if you're suffering from chronic low back pain. Obesity has been linked to chronic low back pain and disability. A recent study published in 2021 found long-term poor sleep quality substantially increases risk of back-related disability. And finally, job satisfaction and social support have been strongly correlated with low back pain published in a meta analysis in 2019 (references to these studies below).

The take-away: chronic low back pain needs to be examined through a holistic lens. A good place to start is to focus on function, stay active, and find what works best for you to manage stress. A combo of these interventions which you enjoy and can incorporate into your life is ideal.

Reach out to a physical therapist if you need more individualized direction. We're here to help.

Data was taken from these sources:

1. https://www.physio-pedia.com/Chronic_Low_Back_Pain

2. https://scholar.google.com/scholar?q=central+sensitization+and+altered+central+pain+processing+in+chronic+low+back+pain&hl=en&as_sdt=0&as_vis=1&oi=scholart#d=gs_qabs&u=%23p%3D8ySXGxTvsUsJ

3. https://scholar.google.com/scholar?q=chronic+musculoskeletal+pain+nonpharmacologic+noninvasive+treatments&hl=en&as_sdt=0&as_vis=1&oi=scholart#d=gs_qabs&u=%23p%3D3nZRnBidKW4J

4. Low Back Pain: Clinical Practice Guidelines from APTA

5. https://journals.lww.com/md-journal/fulltext/2016/04120/the_association_between_obesity_and_low_back_pain.62.aspx

6. https://www.nature.com/articles/s41598-021-94845-7

7. https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-019-2826-3

8. Photo from UnSplash.