Chronic low back pain: How to get out of it?

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Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

Chronic low back pain, because it affects several spheres of life, is very disabling for those affected.

In this article, we cover several strategies aimed at treating chronic low back pain, whether from a physical, psychological or even social perspective.

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Chronic low back pain and social isolation

Before mentioning strategies to treat chronic low back pain, it is necessary to know its impact on the lives of those affected.

Back pain affects everyday life, and can lead to social isolation. Unfortunately, we often have to sacrifice certain activities at the risk of seeing our pain increase. You hesitate to go to a restaurant with your friends because prolonged sitting will be too uncomfortable. You cancel Friday bowling because you think your back is going to lock up. You tried to go to the weight room, but ended up canceling your membership because the exercises made your symptoms worse.

By dint of always canceling your outings, your loved ones contact you less and less. Either because they are tired of your continual refusals, or because they want to “protect” you and keep you out of trouble. They assume you'll have back pain, and decide not to invite you to the next social event. So you start to isolate yourself and withdraw into yourself. You feel denigrated, forgotten. You no longer leave the house, and no longer want to do anything.

Do you recognize yourself? If so, it's time to act so as not to fall into the vicious circle of social isolation because of your back pain! Low back pain is unfortunately strongly associated with depression, and we must at all costs find solutions to remedy this. Consider the following options to improve the situation:

 

5 Tips to Avoid Social Isolation:

 

1. Make sure your loved ones understand your situation:

Often your friends and family will try to “overprotect” you. They obviously mean well when they recommend that you rest as much as possible. Make them understand that you need to move to clear your mind and improve the condition of your back. If possible, do your own household chores, such as taking more breaks than normal. Also, tell your loved ones how important their moral support is to you. Back pain comes with a vulnerability that you may be trying to hide. The more you communicate, the more you will avoid misunderstandings that could lead to social isolation.

2. Seek to adapt your activities instead of giving them up:

For example, choose a restaurant with more comfortable chairs for your back. Or, instead of refusing to play tennis with your friends, be the referee at the next organized match. In short, know that it is always possible to find compromises that will allow you to participate in social activities. It is crucial to get a change of air and change your mind when you suffer from back pain. Your friends will appreciate the effort you are making, and will be grateful for your presence.

3. Do not neglect your social and family activities:

Let's be honest, it can be tempting to refuse an activity or household chore on the pretext that you have back pain. However, don't forget your responsibilities…even if it means visiting your mother-in-law on a weekend day! The disappearance of obligations is often the first phase of social isolation. Do not underestimate it, because it is often the preamble to the gradual loss of contact with your loved ones!

4. Prepare to receive criticism from time to time

This advice is a patient who offered me to add it. Unfortunately, not everyone is benevolent, and some may even consider a person with back pain as a burden. Obviously, this is an unfair and unfounded attitude, but it is a reality that should not be overlooked. And it is often the cause of social isolation that is the most painful to accept. Once again, it is essential to communicate one's opinion on the subject in order to limit the feeling of loneliness due to isolation. And above all, know that you are not responsible for your suffering.

5. Surround yourself with like-minded people:

At Lombafit Studio, the context allows people with back pain to help and motivate each other. Our clients feel accountable to each other when it comes to showing up for group exercise sessions. For example, engage in physical activity with someone who also complains of low back pain. This person will understand your situation and will be able to provide you with the necessary empathy and moral support. Also, share your experience on a forum. In addition to helping other back sufferers, writing down your thoughts will help you see things more clearly. 

Solutions to Chronic Low Back Pain

To fix objectives

Who says structure says objectives. More specifically, it will be necessary to set goals to visualize the light at the end of the tunnel, and to celebrate our successes (however small!). This step is essential and should not be taken lightly. In this section, we discuss the “SMART” method, and how to apply this tool in the treatment of your back pain.

My experience with my patients' goals

 

“Mr. Patient, what are your goals regarding your low back pain?”

I ask this question to ALL patients who consult me ​​for back pain. Guess the response I get 99% of the time?

“To have less pain, of course!”

I know it. If you have back pain, your greatest desire is to stop suffering. Obviously. This is also my greatest wish for all my patients. On the other hand, the vast majority of patients who consult already had occasional low back pain to which they were accustomed. The problem is when these pains affect our daily activities, and prevent us from doing the things we love. This is when we decide to take in charge as well as consult. For this reason, I always ask my patients to look beyond the pain when it comes to setting personal goals. Furthermore, as pain is subjective (ie unique to each person), it is difficult for me to assess objective progress in the context of my work as a physiotherapist/physiotherapist.

This is also the reason why I use the “SMART” method with my patients to clarify the objectives, and thereby the expectations.

“SMART” objectives, what are they exactly?

To better define an objective, we can use the acronym “SMART” which is very popular and often used in the field of management and human resources. SMART (or intelligent in English) is a mnemonic device to describe the objectives that we want to express in the clearest way, the easiest to understand, and for which the results are achievable. It is based on motivating and involving indicators that considerably increase the chances of success.

Acronym "SMART” in relation to your objectives can be defined as:

S: Your goal should be Sspecific, that is to say, it must be personalized to your needs. Think about the things you love and that make you happy. Your goal should also be simple, because complexity often slows down decision-making and action. Finally, make sure your goal is clear so it can be explained to everyone (including your doctor and therapist).

M:  Your goal should be Mmeasurable, that is to say, it must be possible to quantify or qualify it. How long, for how many times, in short, it is clearly necessary to be able to determine if your objective is achieved in the future. Why choose an indicator without it being possible to assess the results of the efforts made?

A: Your goal should be Aacceptable, that is, it must be large and ambitious enough to represent a challenge. You have the right to dream. This will ideally increase your motivation to achieve your goal.

R: Your goal should be Rrealistic, that is to say, we must also be realistic in our expectations, otherwise you may lose the desire to move forward. This realism is complementary and nuances the previous point, namely that your objective must represent a major challenge. It's all about balance...

T: Your goal should be Ttemporally defined, that is to say limited in time or with a deadline. Do not use vague terms such as “as soon as possible”, otherwise you will lose clarity.

How to apply the “SMART” method?

When I explain the concept of “SMART” goals to my patients, there is always a long moment of silence. Indeed, it is not easy to find such complete objectives, and this exercise necessarily requires a long reflection. If you're having trouble finding goals, just think of the activities you've had to restrict because of your back. Make one of these physical activity is a great starting point for setting a goal!

The other key point is to write your goals down on paper. Indeed, the fact of having objectives in writing makes it possible above all to clearly identify them. Also, this will allow you to be indebted to these objectives, and to better communicate them with those around you and the health professionals who follow you. It is exactly the same concept that can be applied with a daily logbook.

Examples of “SMART” objectives applied to back pain

 

Here are examples of “SMART” goals from the experience of my patients with back pain. Notice how comprehensive these goals are.

Indeed, it must be understood that an objective must not be vague, in which case it will be impossible to determine whether it has been achieved in the future.

 

“I plan, within 3 months, to take a daily 30-minute walk around the house with my partner to maintain our relationship, without the need to take painkillers afterwards.”

“I intend to return to my job as a secretary in 2 weeks, making sure to get up from my chair every 2 hours and perform the exercises prescribed by my physiotherapist, in order to avoid feeling tension lumbar.”

“I plan to take care of my son's young children while he goes to the movies with his wife, doing floor activities with my grandchildren for 3 hours without my back getting stuck. ”

“I intend to resume the golf in a month for the summer season, by completing a 9 hole without feeling radiated pain in the leg after the game.”

Your “SMART” goals

Your turn. I invite you to set 5 goals focused on managing your back pain. Take the time to reflect. Once the objectives have been completed, I invite you to keep them visible (for example on your wall, or near your computer screen). Feel free to share them with your friends and loved ones. Also, inform your doctor and/or therapist of these objectives so that he takes them into consideration in his treatment approach.

My “SMART” goals to overcome my back pain:

Remember, there are no wrong answers, and these goals are meant to help you. They will give clarity which will then guide you on the path to healing. This model can be used in all areas of your life, whether it's for a project at work, a weight loss program, etc.

active lifestyle

In this section, we cover 5 strategies for getting the most benefit from an active lifestyle to treat chronic low back pain.

 

1. Professional follow-up

 

If you have back pain, I'm sure you want to be able to move freely, and participate in many activities (sports or otherwise) without pain. For this, it goes without saying that a health professional is the more qualified to enable you to be active in safe and efficient manner. When we suffer from back, it is often necessary to make some adjustments (otherwise the inflammation would increase). The problem is that patients are often reluctant to explore different movements or activities. At the same time, I understand them well, because a wrong exercise performed may increase symptoms instead of reducing them reduce! This is also the reason why the most people opt for a rest following low back pain, which unfortunately turns out harmful in the long term.

 

With a qualified therapist, you can be sure that you are training in the right context, so you can get the most out of your exercise program. However, beware of “bad” therapists so as not to be hindered in your recovery.

 

 

2. Monitor progress!

 

The error of many back sufferers is not to follow the evolution of their symptoms over time. How can you expect improvement if you have a limited understanding of your condition? Beyond pain, it is also necessary to assess the strength of the hips and abs, the mobility of the spine, the flexibility of certain key muscles, etc.

Let me give you a more concrete example. At the house of Lombafit Studio, each client begins with an individual assessment where several basic data are taken. These measures are then reassessed regularly to monitor progress and ensure customer satisfaction. For example, we can see if a client has gained strength in their previously weak glutes, improved flexibility in their stiff hamstrings, or increased mobility in trunk flexion. Depending on the results, we can readjust certain elements such as the intensity of the exercises, their frequency, etc.

If you suffer from back pain and you are reading these lines, I strongly recommend that you follow the evolution of your condition over time. A simple way to monitor the symptoms is to keep a daily diary where you detail certain elements related to your low back pain (see this page to guide you on writing a logbook). A journal can also highlight the emotional aspect intrinsically linked to back problems, and unfortunately underestimated by many.

 

3. Be consistent!

The best way to see results is to stick with your exercise program. For this reason, it is essential to stay motivated. Be sure to find something that will be fun while giving you the desired benefits for improving your back condition. For example, using thegroup energy and/or a coach can help achieve our long-term goals. Several customers at Lombafit Studio report that the group effect alone pushes them to come to the sessions. For others, systematically allocating the first 5 minutes of the day to a mobility routine is a way of not deviating from this practice. Whatever the case, find a way not to stop your good habits along the way!

4. Vary the exercises!

 

You may already know that you need to incorporate several elements into your routine to have a healthy back. Thus, it is recommended to have a basic flexibility, a complete mobility and an optimal stability of the trunk to the execution of the activities of the daily life. To achieve these objectives, it is obviously necessary to resort to various exercises. If you spend your time doing the same movements, the body will quickly get used to it, and you will reach a therapeutic plateau. It is therefore essential to vary the activities imposed on the lumbar region to derive the most benefit.

5. Have fun!

 

If you hate doing your back exercises, it will be very difficult for you to maintain the consistency necessary to obtain favorable results. No matter the exercises, it is crucial to have fun! The main strategy employed by Lombafit Studio is to perform the exercises in a small group in order to stimulate motivation and camaraderie! If you ever train alone, try to do functional exercises where you will see the relevance in your daily activities and/or your other hobbies.

Hold a jlogbook

When you suffer from low back pain or chronic pain, discomfort and despair are feelings that affect us almost daily. We constantly adapt our daily life according to our symptoms, even if it means sacrificing certain social and sports

Unfortunately, it can become difficult to follow the evolution of chronic pain as they are present. As a physiotherapist, many of my patients tell me that they have difficulty qualifying their pain, or even identifying the activities that influence their symptoms.

It is for this reason that I suggest that they keep a diary for their chronic pain. Through this section, we will cover the benefits of keeping a daily diary to better understand your back pain, and of course increase its chances of recovery. 

What's a journal to do with back pain?

 

A diary is when you write down certain adventures and personal reflections on paper. In addition to the objective data, it is crucial to add one's impressions in order to identify the emotion associated with such an event.

Ideally, it's best to keep your diary updated regularly to get the most benefit from it. Several of my patients update it daily, while others prefer to fill it in once a week.

In the context of low back pain, a diary can cover several aspects related to pain and daily activities.

What are the benefits of keeping a diary when suffering from back pain?

The purpose of a logbook is to paint a global and personal portrait of his condition. For a health professional, it allows you to follow the evolution of your patient, in addition to evaluating the impact of low back pain on a daily basis. Specifically, here is a list of benefits of keeping a diary to better treat your low back pain:

1. Better understand their pain and symptom trends

It is not uncommon for patients to feel lost through the complex process of low back pain.

What increases his pain? What decreases it? Can we draw conclusions and/or key movements that are responsible for our pain?

When we write down certain elements related to our symptoms, we are able to better understand what explains our lower back pain.

2. Track the progress of your condition over time

Obviously, the main objective when suffering from the back is to get better. By noting the progression of his low back pain on paper, we can make sure that things are going well.

Also, we can rectify the situation as quickly as possible when we realize that the condition is stagnating, or -worse still- is getting worse.

 

3. Improve communication with your doctor or therapist

As mentioned, many of my patients have difficulty remembering their symptoms and their evolution over the past few weeks.

When a patient presents me with their diary, I am able to better understand the condition, and offer more appropriate and effective treatment.

4. Become aware of the emotional impact related to lower back pain

 

Back pain is strongly correlated with depression. After all, many areas of our lives are affected by low back pain.

The emotional impact related to his condition deserves to be explored, in particular because it indirectly contributes to the patient's symptoms. Also, expressing your emotions in writing can have a therapeutic benefit on the person.

5. Motivate to take the necessary steps to optimize recovery

The ultimate goal of the journal is to help you get better. By better understanding your pain and identifying the general progression, you are able to better guide the treatment plan.

What to do with your logbook?

 

A logbook is made primarily to help you live with your back pain. On the other hand, it can also be useful for your doctor or therapist to provide you with the support and advice adapted to your condition.

It may also benefit others who, like you, struggle with chronic lower back pain. Here is a series of actions to take with your logbook:

 

“A diary can also be useful for your doctor or therapist to provide you with support and advice adapted to your condition. »

  • Review your diary regularly to observe progress and better understand your back pain
  • Share the diary with your loved ones so that they better understand your reality.
  • Share your journal with your doctor and therapist to guide and optimize the treatment plan.
  • Publish your forum online (anonymously on our forum, for example) to share and share your experience with others.

What should a diary look like for her back pain?

 

There are several ways to keep a journal. Honestly, there's no best way to keep a journal, as long as it's relevant to you.

Ideally, it should include objective elements such as pain intensity, progression over time, pain-related activities, etc. It should also include a human and emotional component to make the journal more personal.

Finally, a diary should include short- and medium-term goals, as well as a concrete action plan to follow to overcome low back pain.

Here is an example of a journal that I often offer to my patients:

Have the right attitude

As physiotherapist, I have seen over the years that healing from chronic low back pain is possible. Certainly, several treatments exist, and it is even sometimes necessary to resolve to seepage or surgery. But in addition to these therapeutic modalities,  I found that those who saw their condition improve shared 5 specific characteristics.

These are not necessarily based on the severity of the involvement of the lumbar region. As surprising as it may seem, I have seen people with very large L4-L5 herniated discs return to the sport they practiced before the back problem. Conversely, some patients who a priori had “minimal” impairment on the MRI saw their condition deteriorate gradually.

In this section, I share 5 attitudes to adopt for those who suffer from chronic low back pain.

 

Attitude #1: Try to understand your back pain

I often repeat that an informed patient considerably increases his chances of recovery. As a therapist, I have always appreciated patients who ask me many questions. This desire to know more generally bears fruit insofar as the patient has a better understanding of his condition. This implies that he knows what is good for his back, what is bad, what to prioritize or avoid, etc.

Unfortunately, many patients with chronic low back pain tell me that they have seen their condition worsen after following advice found on the Internet. In the era of information overload, it is crucial to verify the reliability of the information found.

This is also the reason why Lombafit has made it its mission to popularize back pain by providing reliable, effective and proven advice. Our educational articles et our online guides  allow people with back pain to make the right decisions about their health.

 

Attitude #2: Seek help

Let me tell you about Sebastian. When this patient I treated a few months ago told me his story, I couldn't help but heave a sigh of discouragement.

Sébastien suffered from chronic low back pain for several years before consulting. Obviously, he thought like everyone else that his pain “would go away on its own with time!”. When he noticed that his condition was not improving – on the contrary, he was having more and more difficulty getting up in the morning! – he decided to act.

No, Sébastien has not chosen to consult a professional – not yet! — he opted instead for “natural and alternative” strategies. So he tried essential oils, clay application, cabbage leaves, and so on! Sure, these old-school tricks can sometimes provide some level of relief, but they're not the real solution to your back pain.

If you are like Sébastien and suffer from chronic lower back pain, let me tell you something. The longer you wait, the more difficult your condition will be to treat! Indeed, chronic pain is often "crystallized" at the level of the central nervous system, so much so that it requires more effort and stimulation in order to be reduced.

The other thing you should know is that the placebo effect provided by different treatment options should not be confused with solving your back problem. An expert will be able to guide you through the complex process of low back pain. An expert is someone who has seen your condition time and time again, who knows what you need to get better, and who knows the pitfalls to avoid. Why not enjoy it?!

Attitude #3: Be proactive

Never forget that you are the main actor in your recovery. Even if you are followed by a doctor or a therapist, you remain responsible for your body (and what you do with it!).

Do not rely 100% on the "magic" hands of your osteopath or massage therapist to relieve your back pain, and try to move as much as possible. Fear of movement, also called kinesiophobia, can also worsen your condition in the long term!

Incorporating therapeutic exercises into your routine will not only reduce your symptoms, but also prevent future recurrences. Several of my patients who saw an improvement in their symptoms followed an exercise program focused on back pain. (Do like them, and get your 21 day free program integrating progressive and safe exercises for your back.)

Some will say that they have already tried exercising without seeing any difference in their symptoms. Not so fast! Of course, everything poorly executed exercise –or the wrong dose– may not only provide no benefit, but may even make your pain worse!

On the other hand, theeffect of prolonged rest is even more harmful in the long run. It is for this reason that I often recommend to people who suffer from back pain to be followed by a health professional– at least for the first time – so that they can train in a safe and effective environment.

 

Attitude #4: Constancy

Here is a typical situation that I regularly encounter in the office:

Sophie woke up with a lumbago. As the condition does not improve, she ends up consulting. After a few sessions where massages are integrated, activities and advice, she feels much better. After 2 weeks, she gradually resumes her usual activities. Obviously, she swears to me that from now on she will do very pay attention to his posture, that she will lose her few extra pounds, and that she will join a gym. So I give him his leave and give him some advice and exercises to do to maintain what he has learned.

Guess who comes back to see me a few months later for the same condition? Yes yes, Sophie, because she woke up again with lumbago. And guess who forgot to exercise, lose those extra pounds, and pay attention to their posture?…

The #1 mistake people who suffer from chronic low back pain make is to stop taking care of their back as soon as it stops hurting. On the contrary, given the absence of inflammation and/or muscle spasms, this is the IDEAL time to maximize the strength of your stabilizing muscles, improve your mobility and flexibility, etc.

In the acute phase (following a lumbago for example), we must prioritize the control of symptoms, which often prevents us from working on the real cause of the problem.

The other mistake that I regularly see is the impatience of patients who hope to see results instantly! Remember, if your pain didn't appear overnight, it won't disappear overnight either!

It takes how long to heal, back pain? I often tell my patients that you sometimes have to wait 4 to 6 weeks before seeing concrete results, especially if you have chronic low back pain. So, if you ever think you have reached a therapeutic plateau, think twice, and remember that back pain is a condition that requires a lot of energy, motivation, and consistency.

Attitude #5: Adopt a positive attitude

Well, I'm not going to bore you with another mystical or esoteric theory. No need to talk about positive energy and vibration, or the law of attraction. But I promise you that theattitude you show in connection with your back problem there is a lot for your recovery.

Ask yourself the following questions: “Do I really believe in my chances of recovery? Do I see myself waking up one day without pain, and doing the activities I love, without being constantly restricted by my back?

If the answer is no, how do you expect achieve your goals?!

Patients who recover from the back are those who have always believed in their possibility of recovery. This belief manifests itself in a positive attitude, and leads to concrete actions aimed at treating their condition.

It's not just about dreaming, or hoping that the pain will miraculously dissipate. A positive attitude allows you to keep hope when the going gets tough. Back pain is pernicious, and believe me, there will be ups and downs!

A positive attitude means never losing hope in your ability to get better. It is to believe in oneself and in one's possibilities of healing. This attitude can develop, and sometimes requires the help of a health professional (doctor, therapist and sometimes psychologist).

Extra: Quit Smoking

This section is only for those who smoke. Obviously, I'm not here to lecture you (you already have several friends or family members for that!). But I want you to know that being a smoker can have an influence on back pain, and thus slow down your recovery. Let's take a look at some reasons why smoking can have a negative effect on your lower back condition:

Decreased calcium absorption

Smoking decreases bone density and decreases the absorption of calcium from the gut. This therefore increases the risk of long-term osteoporosis (the bones become more “porous”). This makes the column more fragile, and therefore at higher risk of fractures.

Increased back pain due to coughing

As smoking makes you cough, it can also increase intrathecal pressure, as well as pressure on the nerves in the intervertebral foramen (the space between the vertebrae). This also causes muscle spasms of the spinal muscles.

Deterioration of intervertebral discs

Smoking accelerates the degeneration of intervertebral discs compared to those who do not smoke. This can indirectly lead to potentially symptomatic herniated discs over time. It also increases the risk oflumbar instability, mainly due to the degeneration of the ligaments that support the spine. (Fogelholm et al, 2001)

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