Chronic low back pain is one of the top two reasons for pain and seeking medical treatment and rehabilitation. This can result in disruption in activities of daily living, social activities, temporary cessation of sport participation and time off work. Not only does this make back pain a physical toll but also a psychological one as well, leading to increased stress and fear avoidant behaviour.
So what do you need to know?
Bones, ligaments, nerves, muscles and discs can all be injured and give rise to what is called acute mechanical back pain. However a persons’ attitudes and beliefs towards their pain is a major factor as well in chronic low back pain. Below are factors that predict progression from acute to chronic low back pain.
• The belief that back pain is harmful or potentially disabling
• Avoidance of movement and activity due to fear of back pain
• Tendancy toward low mood and isolation
• Preference of passive vs active treatment
The interrelationship between these two factors is strong, as beliefs of further injury with pain lead to avoidance of activity, resulting in reduced social interaction. As stated above this leads to delated return to sport and/or work.
A common question physiotherapists are asked is should I get a scan? It is important to know that radiology very rarely corresponds to a patient’s functional presentation. Research has shown that scans of individuals with no back pain over 35 show signs of degeneration. A scan may show normal age related process taking place which often feeds into the patient’s negative attitudes and beliefs about their back when they are experiencing pain.
So what is the best way to treat chronic low back pain?
Traditionally rest was the preference for treatment. We now know however that this is not helpful and makes things worse due to loss of muscle and increased movement avoidance activity. Other strategies such as progressive activity or exercise programs or cognitive behavioural therapy are very useful. These strategies increase your confidence with movement, and change your perception about pain respectively.
Progressive programs may include specific exercise such as yoga, pilates, walking or general strengthening programs. They may also be more specific such as rehabilitation programs for sport or graded return to work programs. These two strategies are effective as they directly improve your functional, hereby reducing movement avoidance, increase social interaction and participation in active treatment, and decrease the perception that all pain is harmful.
Finally, it is important to make the discrepancy between pain and function. It is your function, or ability to undertake everyday activities, sport and work that matters. Chronic pain very rarely equals damage. An active lifestyle, good sleep, and reduced stress are all keys to managing and improving your pain.
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