Understanding Longstanding Low Back Pain: Causes and Solutions

The Truth of Chronic Low Back Pain: It’s More Than Just a Physical Problem

Chronic low back pain affects millions of people worldwide, and for many, the persistent discomfort can feel like an unsolvable puzzle. You might have tried various treatments, from physical therapy to medication, but the pain lingers. The truth is, chronic low back pain is far more complex than just a mechanical issue with your spine or muscles. It involves a delicate interplay of emotional, psychological, and physical factors—some of which might surprise you.

In this blog, we'll explore the often-overlooked truths about chronic low back pain, including how emotional factors, beliefs, regional interdependence, and muscle imbalances all play a significant role. Understanding these elements can give you the knowledge needed to take control of your pain and pave the way to recovery.

1. The Emotional Connection: How Thoughts and Beliefs Affect Pain

One of the most misunderstood aspects of chronic low back pain is the role that your thoughts, emotions, and beliefs play in how you experience it. Experts like Lorimer Moseley and David Butler have extensively studied how our brain interprets pain. When it comes to chronic pain, our brain can amplify sensations based on emotional stress, fear, or negative beliefs about our bodies.

In other words, your pain may not just be a result of physical injury but also how you perceive that injury. For example, if you’ve had low back pain for months or years, you might start to believe that any movement could worsen your pain. This fear can lead to avoidance behaviors, causing more muscle stiffness and weakness, perpetuating the cycle of pain.

This concept is known as the DIMS & SIMS framework, which stands for “Danger In Me” and “Safety In Me.” The more we perceive things as dangerous to our body (like pain, stress, or fear), the more intense the pain becomes. On the other hand, cultivating SIMS—factors that make you feel safe, confident, and secure—can reduce your experience of pain.

The truth is, addressing the psychological aspect of pain is just as important as treating the physical causes. Cognitive-behavioral strategies and mindfulness can help reframe your thoughts and beliefs about pain, leading to a reduction in overall discomfort.

2. Regional Interdependence: Why the Problem May Not Be in Your Back

Another crucial factor in understanding chronic low back pain is the concept of regional interdependence. Simply put, this means that pain or dysfunction in one part of the body can affect other areas—even those far from the source of the pain.

For example, you might be experiencing low back pain, but the root cause could stem from an entirely different region, like your hips or even your feet. Over time, compensations develop throughout the body to protect the painful area, leading to imbalances that put strain on your spine. This is why it’s essential to assess not just your back but your entire body’s movement patterns to get a complete picture.

Greg Rose and Gray Cook, known for their work with the Functional Movement Screen (FMS) and Selective Functional Movement Assessment (SFMA), have shown how poor movement patterns in areas like the hips, knees, or shoulders can contribute to lower back pain. If your hips lack proper mobility or strength, for example, your low back may overcompensate, leading to discomfort over time.

When treating chronic low back pain, it’s important to think beyond the site of pain and consider the whole body. Addressing these imbalances can relieve strain on the spine and allow for more functional movement, ultimately reducing pain.

3. Muscle Imbalances and Insufficient Timing: The Silent Culprits

Muscle imbalances are one of the leading contributors to chronic low back pain. When certain muscles are weak or underactive, other muscles must compensate, which often leads to improper movement patterns and pain. This is particularly true for the muscles that support the spine and pelvis, such as the core, glutes, and hip flexors.

But muscle imbalances aren’t just about weakness or strength; timing and activation are equally important. If certain muscles aren’t firing when they should during a movement, this can lead to compensations that place undue stress on the spine. For instance, if your glutes aren’t activating properly when you walk or lift something, your low back may take on too much of the workload, leading to pain over time.

This lack of coordination between muscle groups is a common but often overlooked contributor to chronic pain. NeuroKinetic Therapy (NKT), for example, focuses on identifying these compensation patterns and reprogramming the body’s motor control to restore proper muscle activation.

By improving muscle timing and ensuring that all muscles are working together in a coordinated way, you can alleviate pressure on your low back and reduce pain.

4. The Importance of Movement and Strengthening

If you’ve been dealing with chronic low back pain, you may be hesitant to move, fearing that activity will worsen the problem. However, avoiding movement can actually make the pain worse in the long run. In fact, one of the best things you can do for your back is to keep moving—safely and strategically.

Strengthening key muscle groups, particularly the core and hips, can provide the support your spine needs to function correctly. Stuart McGill, a leading expert in spinal biomechanics, recommends specific exercises like the McGill curl-up, side plank, and bird dog to improve core stability and protect the spine. These exercises target the muscles responsible for stabilizing the spine, helping to reduce pain and prevent future episodes.

But it’s not just about strength; it’s about moving well. Poor movement patterns can contribute to chronic pain, so it’s essential to focus on quality, not just quantity, of movement. Techniques like Dynamic Neuromuscular Stabilisation (DNS) and Functional Movement Systems are designed to retrain your body to move efficiently, reducing strain on your back.

5. How to Move Forward with Chronic Low Back Pain

The truth about chronic low back pain is that it’s rarely just one thing. It’s a combination of physical and psychological factors, including muscle imbalances, poor movement patterns, and emotional stress. Understanding these interconnected elements can help you take a more holistic approach to managing your pain.

If you’ve been struggling with chronic low back pain, consider these key takeaways:

• Address emotional factors: Challenge negative beliefs and fears around pain.

• Assess your entire body: Look for dysfunctions in other areas that may be contributing to your back pain.

• Focus on movement: Move regularly and strengthen key areas like your core and hips, but prioritize quality of movement.

• Seek professional help: A specialist trained in movement and pain management can guide you through personalized strategies that target both the physical and emotional components of pain.

By taking a multi-faceted approach, you can reduce chronic low back pain and get back to living your life with more ease and less discomfort.