Signs and Symptoms of Chronic Back Pain: What To Do When It Won't Go Away
You woke up excited to spend a beautiful, sunny summer day out on the water paddling around one of the Cascade lakes, but as soon as your feet hit the floor, you knew your back had other plans for you. Stiffness rolling over in bed, soreness sitting up and getting out of bed, tentative to bend forward, you knew with your back feeling this way your paddle was out of the question.
Back pain can have a big impact on your life and is one of the most common reasons active adults come to physical therapy for treatment.
It’s estimated that up to 70-85% of the population has experienced at least 1 episode of back pain in their lifetime and estimates suggest 20-30% will experience chronic back pain. Sharing this isn’t to scare you, but rather to acknowledge how common back pain is and to remind you that your pain and the impact it has on your active life deserves care and attention.
In this article, we’ll look at what chronic back pain is, common signs, when to see a doctor, and some treatment options so you can get back on the water sooner than later.
What Is chronic back pain
While most episodes of back pain resolve within a few months, there are cases in which pain persists for much longer.
When you experience pain for more than 3 months, we classify this as chronic pain. The reasons pain persists are multifactorial including increased sensitivity of your nervous system, changes in musculature and muscle coordination, and even changes in pain processing in the brain.
With back pain, imaging alone, like an x-ray or MRI, rarely tells the full story of your pain.
In some cases, you may have findings that sound scary and in other instances you may be told that your imaging looks “normal.”
It’s important to understand that an x-ray or MRI is just one metric. If you’re experiencing pain, it is real and you are far more than your imaging.
When to see a doctor about back pain
If you’re experiencing back pain and notice any of the following symptoms, it’s important to seek medical attention right away:
Sudden loss of bowel or bladder control
Numbness or tingling in the “saddle” region (groin, buttocks, inner thighs)
Sudden, severe weakness in your leg
Unexplained fever or night sweats
Unexplained weight loss
Pain following a fall or accident
Your doctor can direct you toward any testing or imaging needed to determine the next appropriate course of action based on your symptoms.
How chronic back pain differs from acute pain
Pain is an important communicator for your safety. It’s like an alarm going off that triggers your brain and nervous system to take protective action. For example, if you tweak your back bending over to pick up your paddleboard, the muscles in your back might spasm to prevent you from continuing to move in the direction that irritates your back. This is an important bracing strategy that subsides as your tissue heals and, in most cases, the pain alarm turns off within a few days to about 3 months.
As noted previously, pain that persists for more than 3 months is classified as chronic back pain. In these instances, pain is usually no longer a “tissue issue” but is more likely to be related to an overly sensitive nervous system, one in which the alarm has stayed on even though the threat is no longer present.
When our nervous system is overly sensitive, it takes less input, or less threat, to trigger the alarm to go off.
I often explain this to my patients using the analogy of a threat bucket.
Every morning your threat bucket starts out with a few (or maybe a lot) of stressors in it. Stressors can include a wide range of things like poor sleep, overtraining, dehydration (we do live in the high desert after all), work stress, finances, world events, and even pain itself. The more stressors you have filling up your bucket, the less room you have to handle your day-to-day activities. This can lead you to experiencing pain for seemingly no reason. In these cases, it takes us working together to uncover the lifestyle factors that need support in order to decrease the load on your nervous system and reduce your threat load.
If you’d like to learn more about the threat bucket and the relationship between stress and pain, check out this blog post - Does Stress Cause Pain in the Body? How Your Nervous System Links Stress to Pain
Many people with chronic back pain complain of dull, achy pain that isn’t always severe in nature, but is annoying and distracts them from being able to focus on work or be as engaged as they want to be during social connection.
Muscle tension, soreness, and tightness often lead to people not being able to participate in the physical activities they enjoy like walking, hiking, lifting, or paddling. As people decrease their activity level in response to pain, they often find their activity tolerance diminishes greatly and can impact their overall quality of life and well-being.
On occasion, chronic back pain can also be associated with pain that radiates down the legs toward the toes and some people will also experience numbness or tingling in their legs or feet.
How chronic back pain affects daily life
If you’ve been dealing with chronic pain for a while, you know how much it can impact your day-to-day life.
Many people describe chronic back pain like radio static; it’s always there in the background. As discussed previously, this can make concentrating at work and during social interactions much more challenging because at least part of your brain is focused on your pain.
Sleep can become a source of stress as you worry about finding a comfortable position for falling asleep and staying asleep. Many people also subconsciously worry if they’ll wake up in the middle of the night or in the morning with pain and this underlying worry can lead to restless sleep. You might even find yourself waking in the morning wondering why your back hurts.
Many people with chronic back pain once identified as a very active person and, over time, they find that identity no longer fits.
In an attempt to decrease their pain, they systematically eliminate activity to the point that they are very restricted in the number of activities they feel comfortable doing. I often use the analogy of a movement vocabulary. Over time, their movement vocabulary gets smaller and smaller and the goal in our work together is to gradually and intentionally expand their movement vocabulary, helping them reclaim their identity as an active person.
When to see a physical therapist for chronic back pain
If you’ve been dealing with chronic back pain for a while and find:
You’ve been modifying or avoiding activities you love
Feeling confused by your symptoms or your symptoms have been dismissed by healthcare providers
Rest or medications provide little to no relief
Pain is impacting your quality of life and overall well-being
That’s exactly where I come in. As a physical therapist who specializes in chronic back pain, I take a holistic approach that addresses not just your symptoms, but the full picture of your life. You don’t have to figure this out alone. Schedule a free consultation here.
Treatment options for chronic back pain
Unfortunately, I hear all too often from patients that they’ve been to healthcare providers for their chronic back pain and left feeling like their treatment was cookie cutter.
Treatment for chronic back pain really requires individualized and holistic care.
One patient came to me with a 10+ year history of back pain with only temporary relief from previous treatments. What we discovered over time was her history of surgery during a particularly stressful period of life was playing on repeat, keeping her threat bucket filled to the brim. Once we started to address the stressors, her life started opening up and she felt glimmers of hope for the first time in many years.
When I work with you for your chronic back pain, the first appointment is centered around understanding your:
Lifestyle including work and life stressors, sleep habits, nutrition, hydration, movement practices, and activities that bring you joy
History with your back pain and the impact it’s had on the way you move through your day and how that affects your overall well-being
Treatment history exploring what’s been helpful and what hasn’t made a meaningful difference
Because chronic back pain involves many different systems, the movement assessment during the first appointment is often more global. We look at patterns like a squat, hip hinge, walking pattern, general spinal mobility, balance, and breathing mechanics.
From there, treatment for your chronic back pain is centered around you and might include:
Activity pacing
Gradual and intentional exposure to aggravating activities
Nervous system support through mobility work and breathing exercises
Body scans to help build new neural pathways to the parts of your body that feel good or neutral
Most importantly, holistic physical therapy for chronic back pain isn’t something we rush. We move at the pace of your nervous system, building safety and confidence in the process.
Where to find physical therapy in Bend, OR for chronic back pain
Chronic back pain, while common, is not inevitable nor is it permanent.
If you’re in or near Bend, OR and navigating life with chronic back pain, you can reclaim your active lifestyle.
Your next paddle day on the Cascade lakes is waiting.
Get started by learning more about chronic pain physical therapy and holistic PT in Bend, OR, or by getting in touch with me.
Let’s figure this out together. Schedule a free consultation here.
Disclaimer: this post is intended for informational purposes only and is not medical advice. If you are experiencing pain, it is always in your best interest to consult with your medical doctor and/or your physical therapist.
