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. 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 quite difficult to pinpoint the exact cause of your lower back pain. The pain could be the result of years of bad posture or it could be the result of a condition like degenerative disk disease. While typical injuries can be picked up on an x-ray or a CT scan, with low back pain 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 also vary a lot from person to person. Some people experience it as an acute, once-off occurrence, while others find the journey to be much more challenging, with it turning into a chronic, debilitating condition. For many individuals, low back episodes will continue to occur randomly throughout their lifetime. In this article we look at 3 reasons why your back pain comes and goes, as well as some of the underlying 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 can 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 can last 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 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.
Low 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.”
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:
1. 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. Stress and anxiety cause the muscles in our bodies to tense up, leading to pain and stiffness in areas like our lower backs. Research has also shown that increased stress leads to increased sensitivity to pain.
Chronic stress can also lead to an increase in inflammation in our bodies. Inflammation is part of the body’s natural defense mechanism and typically plays a role in healing. If we are constantly telling our body it needs to heal (when it doesn’t) then our systems become chronically activated, there is chronic inflammation, and our vulnerability to pain is increased.
New methods of thinking now include addressing the psychological component of pain and using techniques like cognitive behavioral therapy, meditation and mindfulness in order to change our thoughts and feelings about pain.
Our spines are vital to supporting the weight of our bodies and helping us perform every day movements such as bending, walking, and lifting things. Over time wear and tear can take place affecting how mobile our joints and ligaments are and wearing on the discs that cushion our vertebrae. When wear and tear happens we often experience pain which can become chronic over time. Sometimes this pain is consistent but often it comes and goes, causing what are known as "flare ups". These flare ups may be short lived in the beginning but can get progressively worse over time.
When it comes to managing lower back pain, when we understand how pain can lead us to adopt passive coping techniques, and when we understand that these techniques often do more harm than good, we can focus on more effective, scientifically-backed treatments. Continuing to stay active, and finding ways to help reduce and manage stress in our lives can make a significant difference to how intensely and how often we experience low back pain.