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Making Sense of Back Pain, Acute vs. Persistent

Updated: Jan 5

When someone contacts me about guidance with their back pain, this is usually the first thing that I like to find out. Is it acute or not?

First, I need to clarify what we are talking about. There is a difference between acute back pain and persistent back pain. Basically, any back pain that has been around for less than 12 weeks is considered acute. Anything longer than that is seen as persistent.

Why? Most studies have shown that tissues in the lower back will heal within 12 weeks with or without therapy and/or treatment. Surprised? Our bodies are not as fragile as you may believe. They are highly adaptable and when you live a fairly healthy lifestyle, you're body will do what it does best and adapt back to health. I'll write something soon that will talk about the best practices for working with acute back pain. Spoiler: keep moving and living your life.

Xray of back pain

Persistent back pain is a little more challenging. After 12 weeks your body has adapted to what you've asked of it in terms of healing. If you have rested (side note: Don't rest!) the full 12 weeks you're body doesn't feel the need to make anything stronger. So any damaged tissues will 'heal' but not likely become stable enough to resume previous activities and loads. Ideally from this point, all you need is the right rehab and you can get back to life. Sadly though, it is likely that there are a handful of other factors that need to be addressed to build your path back to wellness.

First, I know that no one wants to live with back pain. No one. So why isn't there a clear path out? Back pain is so prevalent and common! Now that is a can of worms. And to be honest it is such an individual path that I'll just list a few of the contributing factors and you can choose the ones that feel true for you. Seriously, grab a pen and circle the ones below that connect to you.

Stress, anxiety, overload at work, too much juggling at home, lack of strong social relationships, too much screen time, fatigue, poor diet, sleep deprivation, pushing through your day to get things done, needing things to be perfect in your household, paying too much attention to your posture, feeling you need to maintain a strong core to protect your back, believing your pain is age related, poor coping skills, fear of the pain itself, feeling helpless, and more...

If you recognized one or two (or three) of those factors in yourself, there is a solid chance that your nervous system is seeing more danger in your environment then is truly there. This sets you up for persistent back pain through the neuroplastic changes that have occurred in your body over the first 3 months.

The good news... As much as your nervous system to being more protective, we can calm it down and get you back to a baseline.

a couple out enjoying a walk

This likely sounds familiar. If you've read a few of my other posts, you've heard it before. Sometimes though, it takes a few observations to actually connect all the dots.

So, I want you to do a simple exercise right now. Close your eyes and take 5 breaths all while scanning your body for sensations. AND just notice those sensations without pushing them away or thinking the worst. Not thinking about an old injury, not thinking about getting rid of the pain, but just noticing the sensation with no judgement. Yep, it takes practice.

Now, there is more that I'd like you to learn. Start here though. Do it again. And again. Practice noticing the sensation without feeling the frustration, fear, 'what if'...

I'll catch you in the next post!

1. Hagen KB, Jamtvedt G, Hilde G, Winnem MF. The updated cochrane review of bed rest for low back pain and sciatica. Spine (Phila Pa 1976). 2005 Mar 1;30(5):542-6. doi: 10.1097/01.brs.0000154625.02586.95. PMID: 15738787.

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