Chronic Back Pain: Where Do I Start?

Written By: Hope Island Physiotherapist, Luke Reynolds. 

Chronic back pain is debilitating. It can leave you feeling frustrated, helpless, lonely and conflicted. With thousands of gimmicks and so called “quick fixes”, it can be hard to know who to actually trust. So where do you start?

Step one is to make a commitment to yourself that you can get better. With the help of your physiotherapist, you will together come up with a plan to improve your quality of life. It is okay to be sceptical, but trust that your physiotherapist has completed years of university level study to guide people through this exact situation.

Unfortunately, for long-term back pain, there is no quick fix. A massage or manipulation is not going cure you – as much as we wish it could. In the short term, evidence suggests that this can be an effective place to start for short term management of pain. It can provide increases in movement, decreases in pain levels and overall increase in function (Rubenstein et al. 2019). However, these effects are often short lived. This is not to say that it cannot be used to manage your pain and discomfort along the way; but unfortunately, it is not the sole solution.

In consultation with your physiotherapist, an initial program will be devised to address your movement fears, strength imbalances and apprehension to movement that causes you pain. Assessment of your movement, strength and overall goals will guide where we take your program. No person with back pain is exactly the same. This means a generic back pain program with stock standard exercises is not the answer. Your program will be tailor made with gentle movement and strength work to begin, and slowly progress over time to align with your goals.

Chronic back pain is multi-factorial. This means that there are numerous elements in your life (not just the physical) that can affect the pain that you are feeling. This includes aspects such as work status, relationships, mental health, cultural expectations, etc. So, what does this mean? If we just focus on the physical aspect of your body, we will not see all your issues resolve. This is where a team approach with your GP and Psychologist can aid in decreasing any stress and anxiety around your pain. Are you telling me I need to see a psychologist to fix my back pain? Absolutely not. It is not a necessity, but can be a very effective resource to help (depending on the person).

As explained by fellow physiotherapist Annabel in her Understanding Your Pain blog, pain does not equal further damage. Just because you are experiencing pain, does not mean you are further damaging tissue. The biggest piece of advice I give patients is to ask as many questions of your healthcare professional as possible.

  • Why am I experiencing pain?
  • Am I doing more damage?
  • How can I tell the difference between pain that is just being protective VS doing extra damage?

Over your journey, there will be highs and there may be small flare ups- but that is okay. It is all part of the process of your body understanding that it is okay to move. If you gain some additional short-term soreness around the area, this does not mean you have gone backwards. This is where asking questions of your health professional to help differentiate between muscle soreness pain and tissue damage can be extremely reassuring.

From the outset, 1-2 physiotherapy sessions for 2 weeks are not going to enough to see meaningful change. According to most trials, 12 weeks is the sweet spot for exercise-based management of low back pain. Does this mean I need to be in the clinic, paying money every single week? Absolutely not. In the short-term, face-to-face contact is crucial to devising a good starting point. It allows us to ensure you are performing the exercise correctly, adjust if necessary and provide reassurance. However, as time goes on and you become more comfortable in what you need to do, self-management can be performed. The biggest takeaway message from this is to commit to the process. There may be times where you feel as though progress is slow. However, trust that over time, you will see benefits if you stick to it.

Once this 12-week block is concluded, exercise unfortunately cannot stop. The human body is designed to move. With the world becoming a more and more sedentary place by the day, the importance of regular resistance and aerobic exercise is more important than ever. Over time, this movement will be something your body learns to crave, and ultimately something you enjoy.

In conclusion, back pain is hard to manage – but it can be done. There is no greater time to begin your back pain recovery journey than right now.


Book an appointment with Luke Reynolds HERE