If you’re still dealing with lower back pain months or years after it started, you’ve probably been wondering why. Did you do something wrong? Is it because of your posture? Is it because your muscles are weak? Have you not rested enough or have you rested too much? Is it because of a bulging disc? Is there ongoing or further damage in your back?

And the question most people worry about is: will it get worse over time?

These questions and concerns make complete sense. It is in our human nature to look for answers and explanations. Especially when you know other people who recovered from their back pain or injury. It is then very normal to feel that something is still wrong, that you are still broken or that you haven’t been doing the right things.

An injury is supposed to heal. Rest is supposed to help. Treatment is supposed to fix something.

So when pain lingers, the most logical conclusion is that something has been missed or you have done something wrong.

The reason lower back pain persists is usually due to a variety of factors, not just one. These factors are often unique to the person, which is why a one size fits all approach doesn’t work.

In this blog, we’ll walk through some common reasons pain can persist. Some of these may be surprising.

1. Pain is a unique and personal experience

Pain is influenced by many factors. Some are helpful, others are not. Some reasons pain persists are still not fully understood. However, the factors that can increase the risk for pain to persist are unique to each person.

For further information read Chapter 5 (page 14) of our free e-book.

2. It can often not be seen on a scan

This surprises a lot of people, but pain cannot be seen on any scan.The extent of changes found on scans often correlates poorly with pain. Persistent pain is often not due to ongoing anatomical changes or damage. Findings on scans are often incidental. They were likely present before your

pain started, may still be there after pain resolves, and are a normal part of ageing. Like wrinkles on the inside of your skin.

For further information read Chapter 3 (page 9) of our free e-book.

Our current understanding is that persistent pain is more likely related to a sensitised system.It can be compared to a wildfire. It may start with a lightning strike, then spread and become difficult to control.

For further information read Chapter 2 (page 8) of our free e-book.

Note - this is not to say all findings on scans are irrelevant, it can still be part of the whole picture.

3. You may have put life on hold because of pain

It makes sense that when we have pain we stop doing the things that make the pain worse or that we think could make the pain worse. This can be really helpful in the short term. However, when life is put on hold long term, the things we avoid or do less of can start to make things worse and reduce quality of life. Some examples are:

• We stop being physically active. This can lead to deconditioning and further sensitisation of pain, and impact overall health.

• Avoiding social activities can affect important relationships and increase isolation, which can indirectly influence pain and quality of life.

  
  

For further information read Chapter 7 (page 21) of our free e-book.

You can download the ebook for free here

Living Well with a Bad Back

Note that this blog is about chronic lower back pain with no evidence of serious medical conditions (e.g., cancer, infection).

Written by

Samuel Bulten

Exercise Physiologist | Masters in Medicine (Pain Management)

Director, Adapt Movement

Disclaimer

This ebook and the emails that follow contain general educational information only and aren’t individual medical advice.