Got chronic back pain? This is why you feel like you've tried everything, yet nothing has helped.

Buckle up. I wanna explain exactly why the most common treatments and solutions for back pain don't work long term (and what DOES work long term)

About a month ago, I had a physical therapy evaluation with a new client who was coming to us for chronic back pain.

She had been dealing with it for 5 YEARS at this point, and she felt like she had tried everything.

Different providers, PT, rest, ice, heat, massage, injections, and was even considering surgery.

She didn't know what to do. She had stopped doing any movement that was painful, so she felt like she was barely able to move at all. 

In our evaluation, she told me that she was really frustrated, because she thought she had been doing everything that she was supposed to do:

- she avoided any movement that targeted her back 

- she was doing "core stability" exercises

- she always lifted with her legs, never with her back 

- she had been adjusted many, many times

- she was always VERY aware of her posture 

- she constantly was stretching her hamstrings 

but yet... she was still dealing with pain.

This is a trap that most people fall into. As a physical therapist, I've seen it over and over.

She had been trying things for years, but she STILL didn't have complete freedom to move without worrying about her back. She couldn't do the things she wanted to without pain OR fear.

So I said: "You've tried a lot of different things. Why do you feel like none of those things are working for you?" 

and she said: "I don't feel like any of those things are solving my problem, they just feel like bandaids at this point." 

BOOM. 

This is such a common story we hear from new clients at made2move and I'm going to tell you exactly what causes this.

IDK if it's modern "healthcare," bad beliefs, bad advice, misinformation - whatever it is, it's keeping people in this frustrating pain cycle. 

There's a few basic things you need to understand before we dive In:

1. Remember that pain is a useful signal. It's a check engine light. It's an OUTPUT.

It's your body saying - "hey I think something could be wrong here. It might not be, but I'm kinda worried about it. Can you go check it out?"

The check engine light is on. We need to check the engine.

You know that friend in your life that's always worried about EVERYTHING? Yeah. That's your nervous system. She's nervous.

2. Avoiding things that are scary or uncomfortable does the opposite of what you want. It actually confirms to our brains that the thing - whatever we're avoiding - is actually dangerous, so now we become more sensitive and more fearful of it. 

Remember when our body was like, "hey something's wrong here" - now we're literally telling our body even more - HEY SOMETHING IS WRONG HERE.

Nervous system = even more nervous.

3. Imagine if you didn't walk or stand on your feet for 3 months. Your feet are going to get super weak, because you're avoiding doing the things that add load and stress to your feet. You're now weaker, more vulnerable, and probably more scared too. Picture this, but with your back. Always avoiding any movements that add stress to your back.

NOW there's even more of a reason for your nervous system to be nervous.

See where this going?

I wracked my brain with how to explain this and the way it makes the most sense to me is this cycle so I drew it up for ya: (shout out to canva)

I've been thinking about this a lot lately, and I think this ALLLL happens because the common treatments and solutions that we're often given - by healthcare providers, Dr. Google, our Aunt Becky who swears she knows everything about pain and injuries - aren't addressing the actual problems.

They're either...

1. only addressing the symptoms of the problem (turning off the check engine light)

2. making the problem worse by avoiding things 

A deadly combo, because now not only are we not solving the problems in the first place, we're actually making the problems worse and just digging ourselves into this deep hole. 

Trust me, I'm upset by this too. 

As a physical therapist and healthcare provider myself, this is one of the most frustrating things about healthcare and society's beliefs about the human body. It's way too symptom and avoidance focused. I realized this a few years ago and had to get the heck out of that system.

Only attacking the symptoms means we'll never fully solve the problem, and we'll just need to rely on temporary solutions forever... and so you end up at made2move 5 years later, sick of the cycle, having wasted all this time, money, and energy trying things that have made your life worse. UN FUN. Opposite of fun. (being at made2move is fun though, we'd like to think)

If you're stuck in this awful cycle and you're ready to get out, here's what I want you to do about it:

1. Look deeper. We need to figure out and solve the PROBLEM that caused the symptoms. If we just keep turning the light off without figuring out why it's coming on, it'll keep turning on.

SOMETIMES if you're super deep in this cycle, the problem itself might be the nervous system - you've been in this cycle for so long that it's gone haywire and you're experiencing pain with things that aren't dangerous at all (this is pretty common)

2. Also, instead of avoiding, we need to intentionally get better at the things we have discomfort/weakness/pain/fear with. Pain is a signal that your body is nervous about what you're doing. We gotta figure out why, we have to be the ones that interpret the smoke alarm, and then we have to get better at it. 

PRO TIP:

If you're stuck in this cycle - I'd start with figuring out all the things you have pain with, discomfort, fear, anxiety - basically all of the things you've been taught to avoid.

List them out.

Now, is there a level of doing those things (or similar things) that you ARE comfortable with? 

Modified range of motion, less weight, less reps are a few examples.

We have to teach our bodies that movement is safe and not dangerous by doing a combination of:

Gentle, non-threatening exercises (for back pain this may look like cat cows, seated jefferson curls, lumbar rotations, prone press ups)

AND

Some exercises/movements that we have a tolerable, temporary amount of discomfort with (I'm not saying I want you to push through pain. I'm just saying we should not avoid all discomfort.) 

ANDDDDD: 

Slowly adding weight and stress over time to make our backs more capable, our bodies less fearful, and ourselves more resilient and confident.

I see so many people that are in this sad situation and even if you're not, maybe you have a friend that is. Maybe this would help them get out of it and live life with movement freedom again.

• Dr. Hannah Breal