It can be helpful to understand what pain is and how it affects the lower back?
Pain is a protector, and it is important to be aware that pain does not always equate to damage. It is also important to be aware that the amount of pain in the lower back does not always reflect the size of the problem.
Sometimes, pain can occur in the lower back due to an injury to a structure (much like you might sprain your ankle or your wrist). Pain at this stage is helpful because it is protecting against further damage, and once the structure is healed, the pain should reduce and disappear. However, in people with more chronic pain, often the pain lingers far longer than it takes the structures to heal. When this happens, your pain is still trying to protect you from something that no longer needs protecting. This is usually because the area has not had enough healthy and ‘normal’ stimulus to encourage the protective pain to be stopped.
The best way to introduce healthy and normal stimulus? Appropriate and graded exercise. Initially, exercise should focus on ensuring the spine does not have any lingering stiffness- much like a sprained wrist or ankle. If the joint is not used in a healthy way after healing, you will be left with stiffness and therefore pain. It is the same with the spine- until normal and full movement is resumed, your pain is very unlikely to disappear. Once movement is improved, you will likely need to work on gaining strength in your spine. Pain inhibits muscles so any episode of pain lasting more than one week will start to affect muscle strength and function as well. Until this strength is returned, your lower back pain will usually struggle to settle completely. The other benefit of strengthening is it greatly reduces the chance of future injuries and episodes of lower back pain.
The other danger of not getting on top of your pain quickly is that the central nervous system can start to learn to be overprotective. Much like a broken car alarm that triggers with even the faintest of touches to the vehicle, your pain system can change to become overprotective as well. Movements which are normal and healthy can trigger your central nervous system into telling your brain there is pain, even if your structures have no damage. This Chronic type of pain can be confusing and very debilitating. It can lead to issues such as fibromyalgia (an issue with the sensitivity of the nervous system instead of damaged structures). Because the central nervous system is also part of the system that controls our levels of anxiety, emotions and mood, these often play a part on our pain as well. This is proven to especially be the case with lower back pain.
A Physiotherapist that has an understanding of pain science can help start your journey away from pain. The key is progressively encouraging normal and healthy movement, and therefore stimulating your nervous system in a way that starts to re-train it to become less protective.
www.tamethebeast.org explains these issues in more detail. If you have Chronic lower back pain, I would strongly recommend taking the time to read everything on the website in more detail. It is written by one of the world’s leading pain scientists Professor Lorimer Moseley and he has dedicated his life to helping people overcome their chronic pain.
Another great resource is ‘Explaining Pain’ which is a free PDF via the NHS website.
Your Physiotherapist should be aware of this new way of thinking about pain. Once you understand your pain a little better, it can make a huge difference in the way you can go about improving it. Physiotherapists are the experts who can help re-train your pain system to become less protective, but only if they understand the new way pain should be seen. Only once this is masters, can you hope to start conquering your pain.