Why your back pain may not be getting better and what does the research say?

Back pain is multifactorial, meaning it’s influenced by more than just physical structures. This is why both its causes - and its management can be often misunderstood in light of current evidence. To better understand your “back pain” - it can sometimes be helpful to first understand “pain”first and foremost. A lot of the time, people associate pain with structural changes, tissue damage, or pathology — and in some cases, this can be relevant. However, a growing body of evidence shows that there is often a poor or weak relationship between pain and structural findings.

Recent evidence highlights the relationship between psychological factors such as stress, anxiety, depression, catastrophising and fear avoidance when it comes to pain. Pain has also been linked to certain social factors such as lower socioeconomic status and physical factors such as low activity levels, altered load exposure, and reduced physical capacity It is also worth noting that these factors often interact rather than exist in isolation. Also worth noting is the relationship between structural changes and pain where it has been demonstrated that there is often not a clear correlation between pain and structural changes, damage etc where individuals with MRI’s reporting disc bulges and similar degenerative changes had no symptoms of such!

So the reason you are probably here is to see if there is something you can be doing to better manage your back pain. In this instance there is likely at least one thing you can be doing once you have been assessed by the appropriate health professional to rule out further investigations. What I would usually recommend to most people struggling with non specific lower back pain can be very lifestyle based at first. Education to start while improving things like your sleep, stress management (where possible) and gradual graded exposure to physical activity as pain allows. The next step will usually be to start building tolerance and resilience with graded strengthening with symptom guided progression to build confidence in your body. While there is an argument for passive treatments such as massage and dry needling - the evidence to suggest these are strong standalone treatments is quite low but can be somewhat effective for specific populations at very acute stages of the rehab process.

The goal of helping people with back pain for me as a physiotherapist will be to empower my patients/clients to embrace movement rather than avoid it where the research supports slowly and progressively returning to activity in a way that helps people to build confidence in their body and supporting them in their journey to better managing symptoms and help patients become more independent in the management of pain creating less reliance on physiotherapy which is what is likely to result in more favourable long term outcomes for each patient.

If you are on the fence about online coaching and want to know a little bit more about the process - just email me the word “ready” and I will be in touch! Please get in touch through the contact information below to check availability and avoid disappointment as spaces are limited! Please visit my new website www.coachedbycashel.com for more info!

Lastly, I would also like to clarify that I am not a registered dietician. All advice disclosed here is simply advisory based on my qualifications as a fitness professional and personal experience and knowledge gained working with individuals and helping them reach their goals. The advice given is not designed to diagnose, treat, cure, or prevent any health problem - nor is it intended to replace the advice of a physician. Always consult your physician or qualified health professional on any matters regarding your health. 

I hope someone out there found some of this information useful here, just some food for thought. For any questions in relation to this topic or training, nutrition, etc. or for coaching inquiries simply message me on my business page on instagram @coachedbycashel_ or by email - contact@coachedbycashel.com