Chronic or Long-Term Back Pain
Chronic back pain is when pain persists for over 12 weeks, or “pain that extends beyond the expected period of healing”. Most long-term back injuries often require a different approach to treatment, with different expectations. Also, the emphasis is often focused not just on alleviating the pain and restoring movement in the spine, but on preventing the pain from recurring. This is different from a short-term back pain; see Acute vs Chronic Back Pain.
Common complaints with chronic back pain
“I just don’t know what keeps causing my back to ache”
“No matter what I try it, just doesn’t seem to go away”
“I get some good spells then it comes back for no reason”
“I’ve just learned to live with it but it keeps getting me down”
“I’ve seen my GP but nothing they suggest or try helps”
“I don’t want to keep living on painkillers”
Chiropractic Treatment of Chronic Back Pain
Treatment of chronic back pain commonly involves two parts: On one hand, some treatment from the Chiropractor or practitioner with realignment of the spine and release of the muscle spasm. On the other hand, an effort from clients to take a more active role in learning how to help themselves; changing lifestyle, changing ways of working, exercises and activities of daily living. Altogether, this helps keep the back healthier and avoid further strain to effect longer-lasting change and improvement. I’m passionate about this part of the treatment, and I’m never happier than when, with some treatment and lifestyle changes, the client can keep active and healthy.
Finding the cause of chronic back pain
Most of the time (85%+) patients don’t know what caused their back pain. (This is called idiopathic – ‘of unknown origin’ in medical terms). This doesn’t mean, however, that there aren’t reasons for the back pain developing; it simply that clients are unaware of them. With acute back pain, the cause is often clearer, but with chronic pain I feel I often need to be a detective to begin to understand what the causes might be. Usually, the source of chronic back pain is multi-factorial: there are several causative factors. It’s about fitting the pieces of the jigsaw together to get to the root. This requires a far more in-depth understanding of the patient’s lifestyle and detailed questioning about their work and habit patterns; the potential repetitive strains and stresses that may be causing the pain. Usually, these are the activities we spend most of our time doing in our lives.
Most common causes of Chronic back pain
Old injuries
Very often, old injuries from when we were younger or excessive over-use of our bodies can lead to stresses and strains and therefore to wear and tear in the spine (osteoarthritis).
Many people can relate their back pain to starting from either a severe injury – perhaps a car accident or a fall down the stairs – where there may or may not have been any serious injury or fracture at the time. Some clients report, for example, that they remember clearly a lifting injury at work in their 20’s, and the pain just started after that.
Repetitive strains, over-use or ‘micro-trauma’ injuring the back
We tend to use our bodies repeatedly in the same way. Simply with the repetitious excessive load on the spine, the back can weaken and start to give pain. For further information please read here about Repetitive Strain Injuries.
There may not have been one single severe trauma, but a series of smaller stresses and strains that built up over a period of time. Clients can’t remember one major injury, but might say ‘my back pain stemmed back from the days when I was playing rugby’ (or some other extreme sport) or ‘when I was lifting patients as a nurse when I was younger’. A pattern begins to form here; there is an accumulation of strains over the years.
With old trauma, long-term wear in the joints can set in, creating scar tissue and adhesions that limit full range of movement. The spine then becomes weaker and more susceptible to injury.
Bad posture and working habits causing back pain
Poor posture, and wherever we are using ourselves wrongly, inefficiently or in a way that places strain on the muscles and joints, means that injury and pain can develop.
The word ‘posture’ tends to indicate a fixed, static position, but I’m really talking about the way we move and hold ourselves whilst we are active. In Alexander Technique we call this simply our ‘use’, to mean movement as well as posture.
In my 30+ years of working as a Chiropractor, I have seen the most likely causes of aggravating or exacerbating back pain tend to be sitting too long, driving and a lack of exercise, or a combination of all three. I’m passionate about clients learning to improve their ‘posture’ or ‘use’ and my Alexander Technique and training has been invaluable in helping clients make changes to their working and living habits while improving their postural movements and work activities.
Treatment Expectations with Chronic Back Pain
A chronic back pain has been present for some time, may be months, years, or decades, so we are bound to have a different expectation about the benefits of the treatment. We may not expect the pain to stop completely and never return. There may be wear and tear (osteoarthritis) in the spine and we cannot change this wear and tear, but need to expect that it may flare up from time to time, or that more on-going treatment may be necessary. It also needs to be accepted that we are not going to be as active and flexible as when we were younger. This is a fact of life. However, that doesn’t mean that we can’t live life actively and healthily and, in large part, pain free!
Managing back pain with Chiropractic treatment
Sometimes treatment can help improve function, reduce pain and aid you to live a more active life, but with the underlying tensions, the scar tissue and tightness the joints will tend to stiffen again over time. Therefore, some ongoing treatments may be required, just as you may need to go to a dental hygienist regularly to have the teeth cleaned thoroughly, because despite however well you clean your teeth, some plaque will build up.
For some clients, ongoing treatments help with the stresses and strains that build up. Perhaps at work their back tightens again as a result of a slow accumulation of stress, for example from sitting or repetitive lifting, or because of a one-off strain. Other clients that just find by having regular treatment they feel more mobile, agile and active. To see some of my clients’ testimonials, please click here.
Reducing Medication required for back pain
Some clients that attend have lived with pain for a long time and have learnt to live with it, perhaps with the aid of medication. My aim here is about stopping the pain but also reducing the severity long-term, thereby keeping the pain to a more manageable level.
Chiropractic Treatment of Chronic Back Pain
This is commonly a combination of approaches:
- Treatment for the back pain to improve the function of the tight joints and muscles
- Advising clients to make lifestyle changes
- Perhaps some on-going maintenance treatment is required
- Introducing exercise and activity to help keep the spine as mobile and relaxed as possible.
- Learning to be more relaxed, balanced, and less tense in our movement patterns (Alexander Technique, Yoga, Pilates)
What are some of the common lifestyle changes required with chronic back pain?
I usually feel it is the activities that we spend most time doing, namely working, driving or activities around the home, that are the most likely causes of chronic back pain. I list a few of the major issues, but there are many more.
For most of my clients, sitting too long and a lack of gentle regular exercise is the main cause of back pain. I am now a huge fan of working actively, using a sit-stand desk, and many other ways of reducing the sitting in our working life.
Working from home
Working from home has many advantages, but it’s imperative to have a good ergonomic set up if you do spend any time working from home. Particularly important is not to spend too long working at the wrong height – perhaps at the dining table – or slouching on the sofa with the laptop on your knee, or lying on the bed twisting. Please read my article working from home for more detailed information.
Driving
Sitting in the fixed static position that driving enforces is a main factor in the cause of back pain. I write about more driving here.
Slouching on the sofa
Working or spending too long on the sofa is a major cause of back pain. Sometimes it is obvious when we’ve strained our backs by sitting too long or sleeping in the wrong position, as we often get up with acute pain. What many people don’t realise is that, while slouching on the sofa may not be immediately painful, the slow build up of tension is a huge hidden cause of chronic pain.
Gardening and DIY
In many ways these are much healthier activities than the aforementioned ones, and probably help our backs to keep active and flexible. I think the biggest issue here is when we over-exert ourselves! I have written more in my blog post about gardening. I must confess, however, that a few weeks ago I borrowed a jet-wash from my gardener, to clean the patio and car parks. I did a few hours and felt sore. I was going to stop but he said I could borrow it for the rest of the day, so I carried on after a short break and ended up doing 5 hours of bending over cleaning. I did an amazing job but my back was very sore and tight after, and I think I was very lucky not to have strained it worse. It did settle in a few days, but it was so utterly silly to have done so much in one go. Think about this next time it comes to gardening or housework!
Sports & Gym
Sports and gym injuries are extremely common, as are the health issues from overtraining. Most amateurs do not usually have the best of techniques and this can often lead to stresses and strains.
Unlearning bad habits of tension and stress in our movements
Sometimes with the best intentions, we can ensure we’re sitting well, keeping active, and avoiding repetitive strains. However, despite all of this, we can tense and find ourselves tightening, causing a build-up of pain. This is where Alexander Technique can be so helpful to work with our inner tensions and stresses, becoming more aware of the underlying tension patterns. Once clients begin to become more aware of those habitual stress-causing patterns of ‘misuse’, as it is called in Alexander Technique, they find they can learn to move more freely with less tension. Their back pain is then helped tremendously.
Finding the right approach to treat chronic back pain
Finally, there is no one perfect solution for treatment, prevention and management of chronic back pain. It’s a combination of approaches and sometimes this requires trial and error and learning to find what works for each of us as individuals. Please don’t give up if you feel defeated or resigned to living in pain. There are so many treatment options and if you are determined, you may be just able to find an approach that can work for you.
If you suffer from back pain, why not give us a call or pop into the clinic for some advice?