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How Acute Low Back Pain Can Turn into Chronic Pain—and What You Can Do About It

Back pain is very common. Almost 90% of people will experience it at some point in their lives. With the right understanding and approach, most episodes will resolve. Acute back pain can be very distressing, suggesting something is terribly wrong. However, in most cases, it is considered non-specific, meaning no specific underlying cause can be identified. So why does some back pain become persistent? Let’s look at the factors that could potentially contribute to the ongoing experience of pain.

HOW BACK PAIN BECOMES CHRONIC

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Pain As an Experience

Pain is a complex, emergent experience. It is created by your brain based on input from your body and environment and influenced by your beliefs about your body and environment. Pain is your brain’s best estimation of threat to the body and its need for protection.

Every persistent pain has a beginning. Certain factors and characteristics of that experience can lead to viewing one’s body- particularly the spine- as damaged, unhealthy, and intolerant to load. These factors include:

-      Societal beliefs that back pain is caused by tissue injury due to overload

-      Pain behavior (worse with movement and load, relieved with rest) leading to avoiding movement and excessive rest

-      Treatments that promote unloading of the spine and inactivity

-      Diagnoses and scan reports that refer to the tissue injury as a primary reason for back pain

-      Interpretations of one’s back problem based on advice from family, friends, or internet resources

-      Psychological factors such as health related anxiety, pessimism about future outcome, or catastrophizing thoughts

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From Acute to Chronic: The Shift

Most people recover from acute low back pain relatively quickly. But for some, back pain becomes recurrent or persistent. As they try to make sense of their pain early on, in presence of various psychological, social, and clinical factors, they develop beliefs and understanding that their back is damaged, fragile, and unhealthy, and therefore needs protection. The back problem might be viewed as uncontrollable, irreversible, and unlikely to resolve.

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Initial Behaviors That Can Contribute to Chronic Pain

1)    When the back is moved and loaded, brain receives sensory information. If a person expects pain, the signals related to threat or harm to the tissue are prioritized over those related to movement or position.

2)    If a person believes that pain equals damage, they may catastrophize pain or discomfort during movement.

3)    Beliefs that it is not safe to move or load the back might lead to avoidance of some movements and adopting strategies that limit spinal motion. This in turn causes rigidity and reduced movement flexibility and variability.

These behaviors often result in spinal unloading and inactivity, both of which contribute to the persistence of pain.

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FactorsThat Sustain Low Back Pain

1)    Deconditioning of the back- changes in muscles and bone health

2)    Pain system hypersensitivity- the nervous system becomes more efficient at generating pain (the more pain you have, the better your body gets at producing it)

3)    Reduced proprioception- diminished awareness of the back’s position and movement

4)    Altered touch perception- less accurate sensing of the back, e.g. light touch might hurt or just feels weird

5)    Degraded control of the back- affecting perception, so that back feels foreign and disconnected

Why Thoughts and Perceptions Matter

How we think about our body in pain and how our body in pain feels plays a key role in whether pain becomes chronic.

When someone views their back as damaged and vulnerable, they may adopt behaviors that lead to deconditioning and deterioration. Anything that opposes this concept and supports a healthy body image is not considered. Over time, this creates a self-sustaining state.

Breaking that cycle begins with changing the narrative- from one of vulnerability and fear to one of resilience and capability.

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Symptoms You Should Not Ignore

While serious pathologies are rare, please consult a specialist for further evaluation if you have had recent trauma or are experiencing any of the following: loss of sensation in legs, groin, genital area or anal region, bowel or bladder issues, weakness in legs, have fever and unexplained weight loss, or history of cancer. Early evaluation can be critical, so please seek medical attention if any of these apply to you.

HOW TO TREAT YOUR CHRONIC BACK PAIN

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Multimodal treatments are now considered more effective than single-therapy approaches. One such approach is RESOLVE - a new treatment strategy that goes beyond temporary relief. Its goal is to restore your back to a strong, healthy state that supports everyday function. RESOLVE combines education about how pain works with gradual retraining of both the brain and body. It’s a promising, science-backed program- and I can tell you from personal experience, it transforms how you think about pain and approach recovery.

I have both professional and personal experience with RESOLVE. I’ve dealt with on-and-off back and leg pain for almost a decade, resulting from an injury I sustained while running just a few weeks post-surgery. I experienced episodes of intense pain followed by periods of complete recovery and full return to running and racing. Over the years, I’ve worked with multiple physical therapists and seen spine specialists. I’ve tried a variety of treatments, but the only thing that truly helped me return to my normal, active life was the complex and holistic approach I am about to share with you.

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A Powerful, Science-Backed Approach to Treatment of Chronic Back Pain

RESOLVE approach is rooted in the modern understanding of persistent back pain. It’s not about passive treatments, quick fixes, or magic bullets. Instead, it focuses on gradually retraining your entire body toward long term recovery. This is an empowering journey, where you are in the driver’s seat.

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The main goal of care is to improve back fitness by helping you:

1)    Understand that it is safe and helpful to move.

2)    Improve brain-body communication, so you start to move more smoothly and confidently.

3)    Load your back to promote tissue adaptations and experience safety with movement.

4)    Establish safety under load through long-term self-management strategies.

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First! Get a Professional Evaluation.

Anyone dealing with chronic back pain should be thoroughly evaluated by a physician(an orthopedist, physiatrist), physical therapist, or other qualified health professional. Ruling out serious conditions and getting personalized guidance is essential. Click here to schedule a back pain evaluation with me.

1)   UnderstandIt Is Safe and Helpful to Move

Within this strategy, you are offered a less threatening and more hopeful understanding of your condition. At its foundation is modern pain science education- helping you learn how pain works, how it’s influenced by various factors, and how your body is always capable of adapting to the demands placed on it.

Pain science education reinforces the idea that pain doesn’t necessarily mean tissue damage. Instead, it explains pain as a protective response influenced by mostly reversible biological, psychological, and social factors. Learning about pain through movement, activities, reflection, and questioning allows you to make informed decisions throughout your recovery and gradually change your pain experience overtime.

If you’d like to learn more about pain at your own pace, Explain Pain (Second Edition) is a great resource - written in clear, easy-to-follow language. Another interesting read is Pain and Perception: A closer look at why we hurt - a visually stunning and engaging book that uses illusions to explain how perception works and offers a fascinating perspective on pain. And for a practical guide that walks you through the treatment process covered in this post, check out Resolve Back Pain Handbook.

2)    Improve Brain-Body Communication So You Start to Move More Smoothly and Confidently

This strategy focuses on Graded Sensorimotor Retraining, including both touch retraining and movement retraining. Chronic back pain often disrupts body awareness and the brain’s ability to process sensory information from the back. This altered perception can lead to worsening of control of the spine and persistence of pain.

Touch retraining involves:

-      Touch localization: Identifying where on the skin you were touched.

-      Sensory discrimination: Distinguishing between different textures, pressures, and types of touch.

-      Graphesthesia: Recognizing numbers, letters, or symbols traced on the skin.

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A good starting point for movement precision training is motor imagery. This part doesn’t involve any physical movements but helps retrain safety neural pathways linked to activities that currently are painful.

Motor imagery involves:

-      Left/right judgments: Looking at photos of backs and determining if they’re turned to the right or left. People with back pain are usually slower at this and need to concentrate more.

-      Activity observation: Watching videos of others performing movements- either observing the whole task or focusing on how the back is moves

-      Imagined movements: Mentally rehearsing movements in a graded way, starting with movements that feel safe gradually progressing to more challenging ones.

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Pre-movement strategies are followed by movement of the physical body, with emphasis on goal-orientated tasks. In this stage, you’ll practice low intensity, precise and localized movements of the spine and hips. Mindful performance is key, with attention directed towards non-threatening aspects of the movement through visual, tactile and proprioceptive feedback.

These small, subtle movements gently load your spine in a safe way. The goal is to gradually build from mini movements to your desired activities, while staying in the “sweet zone”- doing just enough to make a positive change without risking a serious flare up.

Through graded movement retraining, you refine the way your back and brain communicate as you move. Over time, protective systems (including pain) reset, and the movements become smoother and more confident, helping you return to normal activity.

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3)   Load the back to promote tissue adaptations and experience safety with movement

The third critical part of recovery involves functional movement training and progressive loading. After establishing a foundation of mindful movement and developing a sense of safety through gradual activity, you are ready to begin rebuilding your fitness.

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This stage has two primary goals:

1) To put more load on your body to stimulate tissue adaptation and build tolerance.

2) Through skilled coaching, experience movement and loading that is pain free or causes less pain than anticipated.

Task selection, gradual exposure, and movement modification require collaboration between therapist and patient. The aim is to minimize pain provocation while still providing enough stimulus for positive change.

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There are two types of movement and loading:

1)    Movement and loading of the painful area-to restore previous capacity and reduce overprotection. It takes several weeks for the back muscle sensors to adjust to new load, so hang in there!

2)    Movement and loading of your entire body-more general physical activity of your preference and aligned with your goals.

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Training continues within the “sweet zone.” Mild provocation of symptoms is acceptable in order to improve tissue capacity and enhance tolerance.

To continue progressing, you need to nudge the challenge. This can be done by:

-      Increasing the intensity, frequency, or duration of your sessions.

-      Changing the context, such as training in less comfortable conditions (e.g., when tired, annoyed, or with music you don’t like) to gently challenge your body’s protective responses.

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Lastly, don’t forget you need to rest to progress! Make sure to build in recovery time and get sufficient sleep.

4)   Establish safety under load through long-term self-management strategies

The long-term goal in treating chronic nonspecific low back pain is resilience under movement and loading that you will be exposed to. Strength and fitness training promotes positive adaptations in the tissues of your back, which reduces fear and builds confidence with movement. This ultimately leads to shift in beliefs: that you are capable and that your back is strong, healthy, and able to handle even large loads.

What makes this approach stand out is that it prioritizes increasing movement confidence and change in beliefs rather than just optimizing tissue capacity.

The final goal of this program is to empower you with knowledge and skills to self-manage your condition and maintain physical health, even when future challenges arise.

This complex care program is a blueprint, and it is individualized based on your beliefs, misconceptions, behaviors, and goals. Ongoing assessment throughout each stage is needed to shape and refine your care.

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Chronic back pain can feel life-altering, but finding the right support can help you return to a normal and active life. If you live in the New York City area and would like guidance on how to alleviate your chronic back pain, feel free to contact me.