Back Pain Won’t Go Away? Effective Tips to Relieve Chronic Back Pain

Why Won't My Back Pain Go Away?

Chronic back pain is defined as pain that lasts for more than three months.

Unlike acute back pain, which typically results from a specific injury, chronic back pain can be more challenging to diagnose and treat.  This is especially true because it's often hard to localize chronic back pain to one specific structure on an MRI.

This pain often persists despite various treatments, leaving many people frustrated and searching for answers.

Hypermobility As A Cause Of Chronic Back Pain

Having been a physical therapist for 16+ years at the time of writing this, I've seen thousands of patients with back pain.

And by far, the most common cause of persistent back pain that I see is hypermobility in the spine.

Hypermobility means that there's too much movement between 2 or more vertebrae.

Now before you think, "That's not me... my back feels stiff", you should know that some common symptoms of hypermobility include:

• Stiffness when sitting, standing, or lying in one position too long
• Feeling the need to change positions often
• Episodes of your back "going out"
• Recurrent episodes of back pain that get subsequently worse over time
• Bending down and feeling like you need to climb your thighs with your hands to get back up to standing.
• Substantial relief from spinal manipulation, but the pain returns within days, weeks, or months.

If you experience any of these symptoms, it's very likely that you may have some degree of hypermobility in your back.

Muscular back pain due to hypermobility

Why there's hypermobility in the spine, the muscles around the spine have to tighten up to provide stability.

But if your muscles are constantly under tension, that muscle tension itself can become a source of pain.

And the frustrating thing is, since there's no structure "damage" to the muscles, muscle pain can't be seen on an MRI.

This can lead to misdiagnosing discs or other structures as the source of the pain and potentially lead to unnecessary and ineffective surgeries. 

Why Common Treatments for Back Pain Don't Work Long-Term

Before we get into tips to help chronic back pain, it first helps to understand why some of the common treatments you may have already tried haven't made your back pain go away, or at least not permanently.

Most of the treatments below DO work for some people for at least short periods of time. But often the pain comes back weeks, months, or years down the road.

Medications

Medications are often prescribed to manage back pain, but they provide only temporary relief.

Pain medications like acetaminophen (Tylenol) or stronger pain medicines such as opioids cover up the symptoms, but they don't do anything to fix the underlying cause.

Even anti-inflammatory drugs don't really fix the problem.

These may include NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as ibuprofen (Advil), naproxen (Aleve), or meloxicam (Mobic), or diclofenac (Voltaren).

Other types of anti-inflammatories include corticosteroids such as prednisone, methylprednisone, or cortisone injections.

Anti-inflammatories calm down inflammation, but they don't fix the thing that caused the inflammation in the first place.

Therefore, it's likely that the pain will come back once you stop taking the medication.

Additionally, pain medications can have side effects affecting the the liver, kidneys, gastro-intestinal system, and in the case of corticosteroids, bone and soft tissue strength and blood sugar.

For all of these reasons, medications are rarely ever a long-term fix for back pain.

Surgery

What about back surgery? Surgery is the ultimate long-term fix because you're repairing the injured tissue, right?

Well, not quite.

In younger people, discectomy surgeries can be helpful for back pain from an acute herniated disc.

But the discs are also the main stabilizers of the spine, and when you remove part of the disc, it can create hypermobility or instability that leads to recurrent problems years or decades down the road.

This can possibly lead to a lumbar fusion surgery to structurally fuse 2 or more vertebrae.

Fusions absolutely fix the hypermobility at the affected segment. They often fix leg symptoms that may be present due to the instability.

But back surgeries are meant to fix neurological problems caused by pinched nerves in the back. 

Back surgeries DO NOT always fix back pian. 

Additionally, lumbar fusions often create hypermobility in the segments above or below the fused vertebrae leading to fusing more levels in the future.

Furthermore, surgeries contain some inherent risk ranging from infection to death, and the odds of a successful surgical outcome decrease with each subsequent back surgery.

Stretching

Stretching can be beneficial for back pain, but it must be done correctly.

When muscles feel stiff, it often feels good to stretch them.  But it's hard to stretch muscles without also stretching the underlying hypermobile joints.

And you don't want your stretching to cause MORE hypermobility.

Stretching can, and often should, be a part of hypermobility treatment, but often it's more important to stretch the stiff muscles and joints around the painful area rather than stretching the painful area itself.

I'll describe some ways to do that later on in this post.

Core Strengthening

Core strengthening exercises are often recommended for back pain, but they may not be effective for everyone.

When you think of core "strengthening" it typically involves activating muscle to their maximum capacity to get them stronger.

But if over-active muscles are the source of the pain, core strengthening may not help, and may even make your pain worse.

However, learning to use your core muscles in proper amounts at the proper times, and in coordination with other muscles is important.

This is more precisely called motor control rather than strengthening.

Psychosocial Factors Related to Chronic Back Pain

Psychosocial factors, such as stress, anxiety, and depression, can significantly impact chronic back pain.

According to the International Association on the Study of Pain (IASP) pain is defined as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage."

Note that the sensory (physical) and emotional components cannot be separated, and therefore your thoughts, feelings, and belief can absolutely affect your pain experience.

However, it's rare that pain is 100% psychosomatic or "all in your head".

Unfortunately though, many people with chronic pain get labeled by family members, friends, or even healthcare providers:

• "You're making it up."
• "You're over-exaggerating."
• "You're doing it for attention."
• "You're just trying to get off work." (especially in worker's comp situations)
• "You're just getting older.  You'll have to learn to accept it."
• "It's all in your head."

When people with chronic pain hear statements like these over and over, they sometimes start to question themselves.

"Am I going crazy? Is it really all in my head?"

It's storied like those that inspired me to write this book:

Chronic Pain, You're Not Just Getting Older, You're Not Crazy, and It's Not All In Your Head

Buy Now

We'll get into some tips to help with chronic back pian in the section below. However, chronic pain is a complex topic, so if you'd like further tips for chronic back pain, knee pain, neck pain, headaches, and/or jaw pain, you can pick up a copy of my book by clicking the button above, or on Amazon.

Posture Tips for Chronic Back Pain

Maintaining proper posture is crucial for managing chronic back pain.

When your spine is stacked like a tower of blocks, the structure of the spine maintains it's own stability.

The spine normally has back and forth curves to it. You don't want your back to be either too flat or too arched.

If you use improper posture, your muscles have to work harder to stabilize your spine.  This can lead to chronic back pain.

Using the backrest of chairs when sitting (unlike what the people in the photo above are doing) can be helpful to allow your back muscles to rest.

Additionally, changing positions and postures frequently can be helpful.

Hence the common phrase in physical therapy: "Your best posture is your next posture."

Adjustable workstations such as the AnthroDesk can be quite helpful for this purpose if you spend a lot of time working at a computer.

Buy AnthroDesk on Amazon

 

More Tips On Proper Standing and Sitting Posture:

How To Stand Longer Without Pain In Your Back, Hips, Knees, or Feet

How To Relieve Lower Back Pain When Sitting: The Ultimate Guide

Effective Stretching Techniques for Chronic Back Pain

Incorporating effective stretching techniques into your routine can help relieve back pain that won't go away.

As previously mentioned though, it's often more important to stretch the areas above and below the hypermobile area rather than stretching the hypermobile segment itself.

Here are some stretches to consider:

Lower Back and Hip Stretch

This stretch can stretch either the lower back and/or hip muscles.

If you rock back like the child's pose, this helps stretch stiff lower back muscles.

This is a good stretch for pain relief for people who have a lot of arch in their lower back and get pain when standing or walking for long periods of time.

Many people with chronic back pain also have stiffness in either their hip joints or hip muscles.

A slight modification of this stretch targets the hips while keeping the lower back in a neutral position.

Hip Flexor Stretch 1

Tight hip flexors can contribute to lower back pain. One way to stretch your hip flexors while lying down is to lie with one leg off the side of the bed.

Make sure to keep your other knee pulled to your chest and lower back flat on the bed.

SI Joint Correction

Mobilizing the sacroiliac (SI) joint can help alleviate pain associated with this joint.

The SI joints are particularly likely to become hypermobile in women who are pregnant, or who have had several children.

When the SI joints become hypermobile, they can have a tendency to "lock up".

To get them unlocked, you can use the same stretch position shown above.

However, use your hands to pull the knee to your chest while applying pressure against your hands with your thigh.

Hold 5-10 seconds, and repeat 3-5 times.

Try doing this with the painful side first and see if you feel better.  If it doesn't help, try doing it on the other side.

Lie on your back with your knees bent, place your feet flat on the floor, and gently rock your knees side to side to mobilize the SI joint.

Hip Flexor Stretch 2

Some people have difficulty with the lying hip flexor stretch above.  Here's standing version of the hip flexor stretch.

Stand with one foot forward and the other back.

Roll your pelvis underneath of you to flatten the curve in your lower back.

Bend your front knee, and push your hips forward to stretch the hip flexor of your back leg.

Hold for 1 minute, and then switch sides.

Here are a few other versions of hip flexor stretches for back pain.

Upper Back Mobility Exercise

Improving upper back mobility can help improve posture and reduce lower back pain.

If you're too rounded in the upper back, it's likely that you may compensate by arching your lower back excessively.

This in turn can lead to lower back pain when standing.

To help improve your upper back mobility while stabilizing your lower back, stand with your lower back flat against a wall.

Your feet will likely be 1-2 feet away from the wall.  If your upper back and shoulders don't touch the wall, that's ok.  It's probably a good indication that you may benefit from doing this stretch.

Raise your arms up like a goal post and then hold the stretch position for 1 minute.

If you can't hold it that long, you can also break it up into 2 sets of 30 seconds, 3 sets of 20 seconds, or 6 sets of 10 seconds.

As a side benefit, this is also a good chest stretch for people who have shoulder pain due impingement.

Diaphragmatic Breathing

Practicing diaphragmatic breathing can help relieve stress, relax your muscles, and reduce pain.

This technique involves deep breathing using the diaphragm rather than shallow chest breathing.

To practice, lie on your back with one hand on your chest and the other on your abdomen.

Push your belly out to inhale.  This makes your diaphragm move down so that air con enter your lungs.

"Cenveo - Drawing Diaphragm, rib cage and lungs during inhalation - English labels" by Cenveo, license: CC BY

To exhale, allow your abdomen to fall.  This makes your diaphragm relax and forces air out of your lungs.

"Cenveo - Drawing Diaphragm, rib cage and lungs during expiration - English labels" by Cenveo, license: CC BY

Breathing in this manner intentionally for as little as 5-10 minutes per day can help relieve pain and stress.

Psoas Release

The iliopsoas muscle can play a significant role in chronic lower back pain.

In particular, the psoas portion attaches to the lumbar vertebrae and can create compression on the spine and discs.

Additionally, when the iliopsoas is stiff, it can contribute to excessive extension in the lower back.

To release the psoas, lie on your back with your knees bent.

Gently press your fingers into your abdomen between the inner rim of your pelvis and the belly button.

When you find a sore or tender area, hold a gentle pressure there for 1-3 minutes.

Alternatively, you can use a Psoas Release Tool.

Save 50% on the Pso-Rite Psoas Release Tool using discount code "M4LPT"

How to use the Psoas Release Tool

You can lie on your belly with the Psoas Release Tool placed between your pelvic bones as shown below.

Using the too in this manner allows for the deepest muscle release, but it can also be quite painful.

An alternative is to lie on your back with knees bent and press the tool into your abdomen.

This is often more comfortable method and may be more suitable for people with chronic back pain.

Quadratus Lumborum Breathing Technique

The quadratus lumborum (QL) is another muscle that can contribute to chronic back pain.

This muscle runs along the side of the lumbar spine from the 12th rib to the pelvis.

As such, you can use breathing to help relax and stretch the quadratus lumborum.

To do this sit in a chair and raise the arm on the side of the stiff QL up in the air. Put the opposite elbow on your knee.

Reach your arm up in the air and slightly over your head while breathing in.

Then hold the arm up high in the air as you breathe out.

Breathe in and reach your arm up a little higher and more over your head.

Then breathe out and hold the position.

Repeat this for 5-10 deep breaths.

Motor Control Exercises

Motor control exercises can help improve stability of the spine and reduce pain.

However, this is quite a bit different than "core strengthening" per se.

These exercises focus on retraining the muscles to support and protect the spine while moving your arms and legs.

They involve specifically controlled and coordinated muscle contractions rather than purely focusing on strengthening.

Check out these posts to learn motor control and core stability exercises for back pain:

7 Ab Exercises For Back Pain

10 Standing Core Stability Exercises For Seniors

The 7 Best Core Strengthening Exercises For Lower Back Pain

Conclusion

Chronic back pain can be challenging to manage. Although the tips in this post can be helpful for chronic back pain, it's a good idea to consult with a healthcare professional who specializes in treating chronic pain conditions.

If you have persistent back pain that won't go away and live in the St. Louis area, we'd be happy to help you at More 4 Life.

Just tap the button below to request an appointment with one of our specialists.

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