Low back pain is one of the most common reasons that Americans visit with their healthcare providers, as well as being one of the leading causes of disability in the US. see their doctors and it is a leading cause of disability in the US. It is also one of the most mysterious conditions that we seek help for.
Sometimes you know exactly why your back is hurting you. You slept funny. You twisted wrong. You picked something heavy up incorrectly. Whatever it was, your back was quick to let you know that it wasn’t happy about what you did.
Most of the time, however, it can be very difficult to pinpoint the exact cause of your lower back pain. The pain could be the result of years of bad posture or disk degeneration. Even diagnostic imaging is not always able to show us what the actual cause is or how we can fix it.
Lower back pain symptoms can vary a lot from person to person. Some people experience it as an acute, once-off occurrence, but for others, the journey can be much more challenging, with it becoming a chronic, debilitating condition. For many, low back episodes will occur randomly throughout their lifetime. In this article we look at some of the reasons for back pain flare ups, as well as 3 key causes of low back pain.
Causes Of Low Back Pain
Our backs support our bodies as we go about our daily activities, helping to support us and keep us moving. Most of the time we don’t even notice how hard our backs work to support us - until suddenly they don’t.
The most common reasons for low back pain are strains and sprains and they can result from a multitude of things. Acute injuries such as falls, sports injuries, or car accidents are some of the more obvious traumas that we can pin-point as causes of lower back pain, but strains and sprains can also develop slowly, over a long period of time without us noticing.
Repetitive movements at work, prolonged sitting, prolonged standing - these types of movements secretly strain our backs every day and if we aren’t doing things to help our backs stay strong and flexible these movements eventually take their toll.
Acute Low Back Pain
Fortunately, most cases of low back pain will resolve on their own since they are acute strains and sprains and are not typically serious injuries. A few weeks of stretching and strengthening and maintaining a moderate level of physical injury is generally all it takes to get your back feeling good again.
Unfortunately not all cases of low back pain will heal this way. Sometimes the pain becomes chronic and either lasts for 3 months or more, or your pain may go away but then recur again at different times.
Chronic Low Back Pain
Chronic low back pain is generally defined as pain that lasts for a period of 3 months or longer. It is different to acute low back pain in that it generally develops slowly, gradually becoming increasingly worse over time. While acute low back pain generally gets better with moderate exercise and sometimes over the counter pain relievers, chronic lower back pain can require a little more intervention.
If you have chronic low back pain you should also schedule a visit with your healthcare provider to rule out any more serious conditions. They will see if you have any red flags to indicate that something else might be the cause of your pain and suggest diagnostic imaging, if appropriate.
Back Pain Flare-Ups
When back pain becomes chronic, people often use the term “flare up” to describe the recurrent nature of their pain. A “flare up” is often defined as “a period when back pain is markedly more severe than is usual for the patient”. The time between flare ups can vary greatly ranging from days and weeks, to months and years.
Flare-ups are very common for chronic low back pain sufferers and are generally associated with higher levels of pain and increased disability. People often attribute flare-ups to certain activities, thinking of these actions as “triggers” for their back pain.
Research has shown that “Flare-ups were associated with greater levels of pain intensity, pain frequency, functional limitations, opioid medication use, number of physician visits, depression, somatization, and self-reported poor health. Even after adjusting for demographic factors, pain intensity, and pain frequency, subjects with flare-ups were more disabled than those without.”
Passive Coping Methods And Increased Low Back Pain
When it comes to why flare-ups happen, more research needs to be done specifically for low back pain, but data shows that the use of passive coping methods has a significant negative impact on flare-ups. These passive coping methods are risk factors for disabling low back pain and include the following:
Fear of Further Injury
Many people who suffer from low back pain are naturally afraid of doing anything that could make their injury worse. Sometimes we attribute a certain event or activity to our back pain and will do anything that could possibly “trigger” another attack, or that could make the pain worse.
Fear-avoidance beliefs are important determinants for disability in patients with non-specific low-back pain (LBP) and it is important for physical therapists and other healthcare professionals to measure the levels of fear-avoidance beliefs or pain catastrophizing to meet clients where they are at.
Research shows little evidence that exercise training helps reduce fear-avoidance so it is important to address these concerns with other types of treatments such as cognitive behavioral training and mindfulness techniques.
Avoiding exercise is connected with fear of further injury but it also takes into account that many people still believe that the best way to manage low back pain is to rest. Resting when you have low back pain can actually make your pain worse and create a cycle of rest-pain-rest.
The idea of resting a back injury is based on the advice that doctors used to give patients many years ago but current research shows that moderate regular activity is actually the best way to manage pain as it keeps your back mobile and prevents further stiffness from settling in and reducing mobility.
Resting and prolonged inactivity can actually make your back pain worse as it weakens the muscles and increases stiffness. When people rest to try and heal their back pain, they stop being active which leads to less circulation and increased stiffness which in turn leads to increased pain. Increased pain further reinforces their decision to rest and a pain-rest cycle is created. To help back pain heal faster it is now recommended that people continue to engage in moderate daily exercise similar to the activity levels that they had before their back pain started.
When it comes to low back pain, stress is a major contributing factor. Research has shown that increased stress leads to increased pain sensitivity which, in turn, leads to increased pain. New methods of thinking now include treatments such as cognitive behavioral therapy, meditation and mindfulness that can manage our perceptions and thoughts around pain, ultimately helping to decrease pain and pain sensitivity.
Our backs play a pivotal role in our every day functioning. From supporting movements such as twisting, bending, reaching, flexing. Over time, the vertebrae can start to wear leading to increased pain. Incorrect posture can also play a part in repeatedly straining the wrong ligaments leading to chronic overuse.
Typically people experience some combination of these causes leading to chronic lower back pain or back pain that feels like it comes and goes, but getting progressively worse over time. Fortunately, when we understand how things like fear, rest, and exercise avoidance affects our lower backs, we are able to use appropriate treatments such as exercise and behavioral health techniques to combat these problems and fight lower back pain.