What is it?
According to the NIH, we describe something as “chronic” when someone experiences persistent or recurrent pain for >3 months. Persistent low back pain is described when someone has consistent low back pain for >3 months. While recurrent is bouts of pain that are on and off.
Chronic Persistent Low Back Pain
When someone has persistent low back pain, it is typically caused by a build-up of repeated stimuli that is painful or one bout of an injury. Although the recovery process will look a little different depending on the cause, the guidelines of treatment remain the same.
- Calm down the pain and/or get out of the pain cycle. We need to start by getting the pain down to a tolerable level, to then be able to build back tolerance to daily activities including working, communicating, walking, and then getting back to exercise and sports. We need to find the amount that your body can tolerate, without going back into a flare-up. We will also discuss stress, sleep, and nutrition.
- Gradually build tolerance. The pain should be manageable at this time, and flare-ups are predictable. At this stage, the goal is not to be pain-free but to manage the pain enough to tolerate some loading. At this stage, I tell clients to expect a bit of soreness/pain after the session, however, it should resolve within 24-48 hours. If it does not, we need to back off on the load, volume, or intensity until we get to a point where that is the case. We will discuss how to manage pain/symptoms especially as they relate to social activities and how to tolerate them.
- Load, load, load. At this point you are able to manage your pain and symptoms, you may feel like you can be done here, but this next step is key for managing this pain for the long term. The goal is to get you back to exercise, working out, sports, or any other physical activity you enjoy.
Chronic Recurrent Low Back Pain
When you are in a bout of low back pain, you will want to follow the steps that are outlined above. The last step is key with recurrent low back pain. Once you have successfully managed your bout of pain, you will feel like you return to life without making any long-term changes. However, typically with recurrent low back pain, it is a load management problem. This is why I would advise you to continue with loading. How? Consistent strength training in the gym. This will continue to build tolerance to loading your back and body, so you are more prepared for the potential next incidence. This does not mean you will never experience low back pain again. However, maybe the intensity and duration of the pain are less because of the tolerance you have built up.
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